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A cultural shift in practice is also necessary to eliminate mixed messaging, strengthen practice and encourage open channels of communication about smoking between women and their providers.

The study highlights the need to address smoking among women in a more holistic manner and for capacity building strategies that focus on strengthening providers’ competency and confidence in practice.

Participants also highlighted the need to further develop tobacco control policies and target the social determinants of health through poverty reduction, housing and education support.

The provision of incentives, transportation, childcare and meals/snacks; adoption of woman-centred, harm-reduction and stigma reduction approaches; and promotion of programs through a variety of local venues were recommended by participants to address engagement and accessibility issues.

Specific determinants include: low education, low income and low occupational status, young age, Aboriginal status, lone parenthood, smoking in social networks, and mental health, addiction and violence issues [].