Isolation, Marginalisation and Disempowerment – Understanding How Interactions with Health Providers Can Influence Smoking Cessation in Pregnancy

2021 ◽  
Author(s):  
Cherise Fletcher ◽  
Elizabeth Hoon ◽  
Angela Gialamas ◽  
Gustaaf Dekker ◽  
John Lynch ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Focus Groups ◽  
South Australia ◽  
Antenatal Clinic ◽  
Health Providers ◽  
Smoking During Pregnancy ◽  
Healthcare Barriers ◽  
Adverse Health Outcomes ◽  
Smoking In Pregnancy ◽  
In Pregnancy

Abstract BackgroundMaternal smoking during pregnancy can lead to serious adverse health outcomes for both women and their infants. While smoking in pregnancy has declined over time, it remains consistently higher in women with lower socioeconomic circumstances. Furthermore, fewer women in this group will successfully quit during pregnancy. AimThis study explores the barriers to smoking cessation experienced by socially disadvantaged pregnant women and investigates how interactions with health providers can influence their smoking cessation journey.Methodsomen (either pregnant or birthed in the previous 10 years, who smoked or quit smoking in pregnancy) were recruited from a metropolitan public hospital antenatal clinic in South Australia and community organisations in surrounding suburbs. Seventeen women participated in qualitative semi-structured small focus groups or interviews. The focus groups and interviews were recorded, transcribed and thematically analysed. FindingsFour interconnected themes were identified: 1) smoking embedded in women’s challenging lives and pregnancies, 2) cyclic isolation and marginalisation, 3) feeling disempowered, and 4) autonomy and self-determination. Themes 3 and 4 are characterised as being two sides of a single coin in that they coexist simultaneously and are inseparable. A key finding is a strong unanimous desire for smoking cessation in pregnancy but women felt they did not have the necessary support from health providers or confidence and self-efficacy to be successful.ConclusionWomen would like improvements to antenatal care that increase health practitioners’ understanding of the social and contextual healthcare barriers faced by women who smoke in pregnancy. They seek assistance from health providers to make informed choices about smoking cessation and would like women-centred care. Women feel that with greater support, consistency and encouragement from health providers they could be more successful at antenatal smoking cessation.

Collective and negotiated design for a clinical trial addressing smoking cessation supports for Aboriginal and Torres Strait Islander mothers in NSW, SA and Qld – developing a pilot study

2017 ◽  
Vol 23 (6) ◽  
pp. 497 ◽  
Author(s):  
Michelle Bovill ◽  
Yael Bar-Zeev ◽  
Maree Gruppetta ◽  
Peter O'Mara ◽  
Brett Cowling ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Aboriginal People ◽  
Research Approach ◽  
Developmental Phase ◽  
Health Providers ◽  
Aboriginal Community ◽  
Smoking During Pregnancy ◽  
Aboriginal Women ◽  
The People ◽  
In Pregnancy

Tobacco smoking leads to one in five deaths of Aboriginal Australians and accounts for 17% of the reversible health gap. One in two Aboriginal women are reported to smoke during pregnancy, with no effective strategies currently available for health practitioners to utilise for supporting Aboriginal women. Aboriginal community participation in primary health research is crucial to implementing ethical research, with a clear benefit to the people and communities involved. However, currently there is little evidence on how Aboriginal programs and interventions are being developed in partnership with Aboriginal people and communities. ‘Indigenous Counselling and Nicotine (ICAN) QUIT in Pregnancy’ aims to address the prevalence of smoking during pregnancy by enhancing health providers’ training in offering evidence-based smoking cessation care to Aboriginal mothers during pregnancy. This paper outlines the participatory research approach adopted for the developmental phase of the ‘ICAN QUIT in Pregnancy’ project developed in partnership with two Aboriginal Community-Controlled Health Services in NSW, and negotiation processes undertaken to implement a pilot intervention across NSW, SA and Qld.

scholarly journals Trends in maternal use of snus and smoking tobacco in pregnancy. A register study in Southern Norway

2019 ◽  
Author(s):  
Ellen Rygh ◽  
Frode Gallefoss ◽  
Liv Grøtvedt
Keyword(s):  
Tobacco Use ◽  
First Trimester ◽  
Third Trimester ◽  
Smoking During Pregnancy ◽  
Adverse Health Outcomes ◽  
Time Period ◽  
Moist Snuff ◽  
Southern Norway ◽  
High Level ◽  
In Pregnancy

Abstract Background The use of tobacco products including Swedish snus (moist snuff) in pregnancy may cause adverse health outcomes. While smoking prevalence has decreased among fertile women in Norway, snus use has increased during the last years. We investigated whether these trends were reflected also during pregnancy in a population of women in Southern Norway. Methods Data on smoking tobacco and snus use at three time points before and during pregnancy for 20 844 women were retrieved from the electronic birth record for the years 2012-2017. The results for the three-year period 2015-2017 were compared with a previously studied period 2012-2014. Prevalence and quit rates of tobacco use within groups of age, parity and education were reported. Within the same groups adjusted quit rates were analyzed using logistic regression. Mean birthweight and Apgar score of offspring were calculated for tobacco-users and non-users. Results There was an increase of snus use before pregnancy from the period 2012-2014 to the period 2015-2017 from 5.1% (CI; 4.6 to 5.5) to 8.4% (CI; 7.8 to 8.9). Despite this, the use of snus during pregnancy did not increase from the first to the second period, but stabilized at 2.8% (CI; 2.5 to 3.2) in first trimester and 2.0% (CI; 1.7 to 2.2) in third trimester. Cigarette smoking decreased significantly both before and during pregnancy. Snus use and smoking during pregnancy were associated with a reduction in average birthweight, but no significant effects on Apgar scores. Odds ratios for quitting both snus and smoking tobacco during pregnancy were higher for women aged 25-34 years, for the primiparas and for those with a high level of education. Pregnant women were more likely to have quit tobacco use in the last time period compared to the first. Conclusions While smoking during pregnancy was decreasing, the use of snus remained constant, levelling off to around 3% in first trimester and 2% in third trimester. Approximately 25% of those that used snus, and 40% that smoked before pregnancy, continued use to the third trimester. This calls for a continuous watch on the use of snus and other nicotine products during pregnancy.

scholarly journals Trends in maternal use of snus and smoking tobacco in pregnancy. A register study in southern Norway

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Ellen Rygh ◽  
Frode Gallefoss ◽  
Liv Grøtvedt
Keyword(s):  
Tobacco Use ◽  
First Trimester ◽  
Third Trimester ◽  
Smoking During Pregnancy ◽  
Adverse Health Outcomes ◽  
Time Period ◽  
Moist Snuff ◽  
Southern Norway ◽  
High Level ◽  
In Pregnancy

Abstract Background The use of tobacco products including Swedish snus (moist snuff) in pregnancy may cause adverse health outcomes. While smoking prevalence has decreased among fertile women in Norway, snus use has increased during the last years. We investigated whether these trends were reflected also during pregnancy in a population of women in Southern Norway. Methods Data on smoking tobacco and snus use at three time points before and during pregnancy for 20,844 women were retrieved from the electronic birth record for the years 2012–2017. The results for the three-year period 2015–2017 were compared with a previously studied period 2012–2014. Prevalence and quit rates of tobacco use within groups of age, parity and education were reported. Within the same groups adjusted quit rates were analyzed using logistic regression. Mean birthweight and Apgar score of offspring were calculated for tobacco-users and non-users. Results There was an increase of snus use before pregnancy from the period 2012–2014 to the period 2015–2017 from 5.1% (CI; 4.6 to 5.5) to 8.4% (CI; 7.8 to 8.9). Despite this, the use of snus during pregnancy did not increase from the first to the second period, but stabilized at 2.8% (CI; 2.5 to 3.2) in first trimester and 2.0% (CI; 1.7 to 2.2) in third trimester. Cigarette smoking decreased significantly both before and during pregnancy. Snus use and smoking during pregnancy were associated with a reduction in average birthweight, but no significant effects on Apgar scores. Odds ratios for quitting both snus and smoking tobacco during pregnancy were higher for women aged 25–34 years, for the primiparas and for those with a high level of education. Pregnant women were more likely to have quit tobacco use in the last time period compared to the first. Conclusions While smoking during pregnancy was decreasing, the use of snus remained constant, levelling off to around 3% in first trimester and 2% in third trimester. Approximately 25% of those that used snus, and 40% that smoked before pregnancy, continued use to the third trimester. This calls for a continuous watch on the use of snus and other nicotine products during pregnancy.

scholarly journals Knowledge and Education as Barriers and Facilitators to Nicotine Replacement Therapy Use for Smoking Cessation in Pregnancy: A Qualitative Study with Health Care Professionals

2019 ◽  
Vol 16 (10) ◽  
pp. 1814 ◽  
Author(s):  
Ross Thomson ◽  
Lisa McDaid ◽  
Joanne Emery ◽  
Felix Naughton ◽  
Sue Cooper ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Health Care Professionals ◽  
Educational Interventions ◽  
Barriers And Facilitators ◽  
Nicotine Replacement ◽  
Smoking During Pregnancy ◽  
Stop Smoking ◽  
In Pregnancy

Smoking during pregnancy is a leading cause of negative pregnancy and perinatal outcomes. While UK guidelines recommend nicotine replacement therapy (NRT) for smoking cessation during pregnancy, adherence to NRT is generally low and may partially explain why NRT appears less effective in pregnancy compared to non-pregnant smokers. This study aimed to identify and describe factors associated with NRT adherence from a health professional’s perspective. Two focus groups and one expert group were conducted with 26 professionals involved in antenatal stop smoking services and the data were analysed thematically using a template methodology. From our analyses, we extracted two main themes: (i) ‘Barriers to NRT use in pregnancy’ explores the issues of how misinformation and unrealistic expectations could discourage NRT use, while (ii) ‘Facilitators to NRT use in pregnancy’ describes the different information, and modes of delivery, that stop smoking professionals believe will encourage correct and sustained NRT use. Understanding the barriers and facilitators to improve NRT adherence may aid the development of educational interventions to encourage NRT use and improve outcomes for pregnant women wanting to stop smoking.

Social influences for smoking in pregnancy in south western Sydney antenatal clinic attendees

2007 ◽  
Vol 47 (3) ◽  
pp. 207-212 ◽  
Author(s):  
Mohammed MOHSIN ◽  
Roberto FORERO ◽  
Angela BERTHELSEN ◽  
Adrian BAUMAN ◽  
Bin JALALUDIN ◽  
...  
Keyword(s):  
Social Influences ◽  
Antenatal Clinic ◽  
Smoking In Pregnancy ◽  
In Pregnancy

scholarly journals Health providers’ and pregnant women’s perspectives about smoking cessation support: a COM-B analysis of a global systematic review of qualitative studies

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ratika Kumar ◽  
Leah Stevenson ◽  
Judith Jobling ◽  
Yael Bar-Zeev ◽  
Parivash Eftekhari ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Psychological State ◽  
Health Providers ◽  
Training Time ◽  
Online Databases ◽  
Pregnant Smokers ◽  
Need Support ◽  
Motivation To Quit ◽  
Role Confusion ◽  
In Pregnancy

Abstract Background Smoking cessation in pregnancy has unique challenges. Health providers (HP) may need support to successfully implement smoking cessation care (SCC) for pregnant women (PW). We aimed to synthesize qualitative data about views of HPs and PW on SCC during pregnancy using COM-B (Capability, Opportunity, Motivation, Behaviour) framework. Methods A systematic search of online databases (MEDLINE, EMBASE, PsycINFO and CINAHL) using PRISMA guidelines. PW’s and HPs’ quotes, as well as the authors’ analysis, were extracted and double-coded (30%) using the COM-B framework. Results Thirty-two studies included research from 5 continents: twelve on HPs’ perspectives, 16 on PW’s perspectives, four papers included both. HPs’ capability and motivation were affected by role confusion and a lack of training, time, and resources to provide interventions. HPs acknowledged that advice should be delivered while taking women’s psychological state (capability) and stressors into consideration. Pregnant women’s physical capabilities to quit (e.g., increased metabolism of nicotine and dependence) was seldom addressed due to uncertainty about nicotine replacement therapy (NRT) use in pregnancy. Improving women’s motivation to quit depended on explaining the risks of smoking versus the safety of quit methods. Women considered advice from HPs during antenatal visits as effective, if accompanied by resources, peer support, feedback, and encouragement. Conclusions HPs found it challenging to provide effective SCC due to lack of training, time, and role confusion. The inability to address psychological stress in women and inadequate use of pharmacotherapy were additional barriers. These findings could aid in designing training programs that address HPs’ and PW’s attitudes and supportive campaigns for pregnant smokers.

scholarly journals Ancestral smoking and developmental outcomes: A review of publications from a population birth cohort

2021 ◽  
Author(s):  
Jean Golding ◽  
Marcus Pembrey ◽  
Yasmin Iles-Caven ◽  
Sarah Watkins ◽  
Matthew Suderman ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Smoking During Pregnancy ◽  
Beneficial Effects ◽  
Smoking In Pregnancy ◽  
Parents And Children ◽  
Paternal Grandmother ◽  
Sex Specificity ◽  
Using Data ◽  
Offspring Health ◽  
In Pregnancy

Abstract The adverse effects on the child of maternal smoking in pregnancy is well-recognised, but little research has been carried out on the possible non-genetic effects of ancestral smoking prior to the pregnancy including parental initiation of cigarette smoking in their own childhoods or a grandmother smoking during pregnancy. Here we summarise the studies that have been published mainly using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). We demonstrate evidence that ancestral smoking prior to or during pregnancy can often be beneficial for offspring health and both ancestor- and sex-specific. More specifically, we report evidence of (i) adverse effects of the father starting to smoke pre-puberty on his son’s development; (ii) beneficial effects on the grandson if his maternal grandmother had smoked in pregnancy; and (iii) mainly adverse effects on the granddaughter when the paternal grandmother had smoked in pregnancy. The ancestor- and sex-specificity of these results is consistent with earlier studies reporting associations of health and mortality with ancestral food supply in their parents’ and grandparents’ pre-pubertal childhoods.

scholarly journals Experts’ Views on Behaviour Change Techniques for Smoking Cessation in Pregnancy: A Qualitative Study

2020 ◽  
Vol 17 (21) ◽  
pp. 7729
Author(s):  
Fizzah B. Abidi ◽  
Libby Laing ◽  
Sue Cooper ◽  
Tim Coleman ◽  
Katarzyna A. Campbell
Keyword(s):  
Smoking Cessation ◽  
Behaviour Change ◽  
Group Discussion ◽  
Behaviour Change Techniques ◽  
Visual Aids ◽  
Smoking During Pregnancy ◽  
Behavioural Support ◽  
Quit Attempts ◽  
The Family ◽  
In Pregnancy

Smoking during pregnancy is a global health problem which has devastating health implications. Behavioural support is an important part of smoking cessation support for pregnant women. Research has identified barriers and facilitators (B&Fs) and effective behaviour change techniques (BCTs) to aid women’s quit attempts. However, the extent to which and how these BCTs are used in practice is unclear. The research aimed to establish experts’ views on how behavioural support can be optimised and techniques operationalised in clinical practice, by identifying ways to address known B&Fs for smoking cessation in pregnancy. A focus group discussion took place with six experts, which highlighted how BCTs can be used in practice to support women in their quit attempts. A thematic analysis was conducted to elicit overarching themes. Five themes were found: involving the family, empowering women, using incentives to boost motivation, using practical techniques to help women with their quit attempts and managing expectations about nicotine replacement therapy. Empowering women to make their own decisions and encouraging small positive changes in smoking habits, using visual aids (e.g., growth charts) to inform women of the harms of smoking to the baby and treating families holistically were deemed important.

scholarly journals Improving smoking cessation care in pregnancy at Aboriginal Medical Services: ‘ICAN QUIT in Pregnancy’ step-wedge cluster randomised study

BMJ Open ◽  
2019 ◽  
Vol 9 (6) ◽  
pp. e025293
Author(s):  
Yael Bar-Zeev ◽  
Michelle Bovill ◽  
Billie Bonevski ◽  
Maree Gruppetta ◽  
Christopher Oldmeadow ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Likert Scale ◽  
Composite Score ◽  
Medical Services ◽  
Controlled Study ◽  
Health Providers ◽  
Attitudes And Practices ◽  
Composite Scores ◽  
The Impact ◽  
In Pregnancy

ObjectivesThis study aimed to examine the impact of the ‘ICAN QUIT in Pregnancy’ intervention on individual health providers (HPs) smoking cessation care (SCC) knowledge, attitudes and practices in general, and specifically regarding nicotine replacement therapy (NRT) prescription.DesignStep-wedge clustered randomised controlled study. HPs answered a preintervention and 1–6 months postintervention survey.SettingSix Aboriginal Medical Services (AMSs) in three states of Australia.ParticipantsAll HPs were invited to participate. Of 93 eligible, 50 consented (54%), 45 completed the presurvey (90%) and 20 the post (40%).InterventionIncluded three 1-hour webinar sessions, educational resource package and free oral NRT.OutcomesHPs knowledge was measured using two composite scores—one from all 24 true/false statements, and one from 12 NRT-specific statements. Self-assessment of 22 attitudes to providing SCC were measured using a five-point Likert scale (Strongly disagree to Strongly agree). Two composite mean scores were calculated—one for 15 general SCC attitudes, and one for 7 NRT-specific attitudes. Self-reported provision of SCC components was measured on a five-point Likert scale (Never to Always). Feasibility outcomes, and data collected on the service and patient level are reported elsewhere.ResultsMean knowledge composite scores improved from pre to post (78% vs 84% correct, difference 5.95, 95% CI 1.57 to 10.32). Mean NRT-specific knowledge composite score also improved (68% vs 79% correct, difference 9.9, 95% CI 3.66 to 16.14). Mean attitude composite score improved (3.65 (SD 0.4) to 3.87 (SD 0.4), difference 0.23, 95% CI 0.05 to 0.41). Mean NRT-specific attitudes composite score also improved (3.37 (SD 0.6) to 3.64 (SD 0.7), difference 0.36, 95% CI 0.13 to 0.6). Self-reported practices were unchanged, including prescribing NRT.ConclusionsA multicomponent culturally sensitive intervention in AMSs was feasible, and might improve HPs provision of SCC to pregnant Aboriginal women. Changes in NRT prescription rates may require additional intensive measures.Trial registration numberACTRN 12616001603404; Results.

scholarly journals The association of maternal-fetal attachment with smoking and smoking cessation during pregnancy in The FinnBrain Birth Cohort Study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Heidi Jussila ◽  
Juho Pelto ◽  
Riikka Korja ◽  
Eeva Ekholm ◽  
Marjukka Pajulo ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Cohort Study ◽  
Early Pregnancy ◽  
Smoking Behavior ◽  
Birth Cohort Study ◽  
Prenatal Smoking ◽  
Smoking In Pregnancy ◽  
Maternal Fetal Attachment ◽  
Fetal Attachment ◽  
In Pregnancy

Abstract Background Smoking in pregnancy constitutes a preventable risk factor for fetal/child development and maternal-fetal attachment (MFA) seems to contain a momentum that can break the chain of adverse outcomes by promoting maternal prenatal health practices. This study aimed to explore the association of MFA with smoking at any time during pregnancy and smoking cessation in early pregnancy, and the modifying role of MFA on the expected effects of education and prenatal psychological distress (PPD) on prenatal smoking behavior. Methods The pregnant women (n = 3766) participated in the The FinnBrain Birth Cohort Study in Finland between December 2011 and April 2015. The binary outcomes, smoking at any time during pregnancy and smoking cessation in early pregnancy, were obtained from self-reports at gestational weeks (gwks) 14 and 34 and The Finnish Medical Birth Register. MFA was assessed with the Maternal-Fetal Attachment Scale (MFAS) at gwks 24 and 34. Logistic regression analyses were used to determine the association between MFA and maternal prenatal smoking behavior. Findings The prevalence of smoking was 16.5%, and 58.1% of the smokers quit smoking during pregnancy. The independent associations of total MFA scores with prenatal smoking behavior were not established (aOR = 1.00-1.02, multiplicity adjusted p > 0.05). A higher score in the altruistic subscale of MFA, Giving of self, associated with a higher probability of smoking cessation (24 gwks: aOR = 1.13, 95% CI [1.04, 1.24], p = 0.007, multiplicity adjusted p = 0.062; 34 gwks: aOR = 1.17, 95% CI [1.07, 1.29], p < 0.001, multiplicity adjusted p = 0.008). The modifying effect of MFA on the observed associations between PPD and smoking in pregnancy and between maternal education and smoking in pregnancy / smoking cessation in early pregnancy was not demonstrated. Conclusions The altruistic dimension of maternal-fetal attachment associates with an increased probability of smoking cessation during pregnancy and therefore strengthening altruistic maternal-fetal attachment may constitute a promising novel approach for interventions aiming at promoting smoking cessation during pregnancy.

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