scholarly journals Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: literature review and qualitative study

2017 ◽  
Vol 21 (36) ◽  
pp. 1-158 ◽  
Author(s):  
Linda Bauld ◽  
Hilary Graham ◽  
Lesley Sinclair ◽  
Kate Flemming ◽  
Felix Naughton ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Pregnant Women ◽  
Smoking Behaviour ◽  
Smoking In Pregnancy ◽  
Social Ecological ◽  
Stop Smoking ◽  
Effective Interventions ◽  
The Social ◽  
In Pregnancy

Background Although many women stop smoking in pregnancy, others continue, causing harm to maternal and child health. Smoking behaviour is influenced by many factors, including the role of women’s significant others (SOs) and support from health-care professionals (HPs). Objectives To enhance understanding of the barriers to, and facilitators of, smoking cessation and the feasibility and acceptability of interventions to reach and support pregnant women to stop smoking. Design Four parts: (1) a description of interventions in the UK for smoking cessation in pregnancy; (2) three systematic reviews (syntheses) of qualitative research of women’s, SOs’ and HPs’ views of smoking in pregnancy using meta-ethnography (interpretative approach for combining findings); (3) semistructured interviews with pregnant women, SOs and HPs, guided by the social–ecological framework (conceptualises behaviour as an outcome of individuals’ interactions with environment); and (4) identification of new/improved interventions for future testing. Setting Studies in reviews conducted in high-income countries. Qualitative research was conducted from October 2013 to December 2014 in two mixed urban/rural study sites: area A (Scotland) and area B (England). Participants Thirty-eight studies (1100 pregnant women) in 42 papers, nine studies (150 partners) in 14 papers and eight studies described in nine papers (190 HPs) included in reviews. Forty-one interviews with pregnant women, 32 interviews with pregnant women’s SOs and 28 individual/group interviews with 48 HPs were conducted. Main outcome measures The perceived barriers to, and facilitators of, smoking cessation in pregnancy and the identification of potential new/modified interventions. Results Syntheses identified smoking-related perceptions and experiences for pregnant women and SOs that were fluid and context dependent with the capacity to help or hinder smoking cessation. Themes were analysed in accordance with the social–ecological framework levels. From the analysis of the interviews, the themes that were central to cessation in pregnancy at an individual level, and that reflected the findings from the reviews, were perception of risk to baby, self-efficacy, influence of close relationships and smoking as a way of coping with stress. Overall, pregnant smokers were faced with more barriers than facilitators. At an interpersonal level, partners’ emotional and practical support, willingness to change smoking behaviour and role of smoking within relationships were important. Across the review and interviews of HPs, education to enhance knowledge and confidence in delivering information about smoking in pregnancy and the centrality of the client relationship, protection of which could be a factor in downplaying risks, were important. HPs acknowledged that they could best assist by providing support and understanding, and access to effective interventions, including an opt-out referral pathway to Stop Smoking Services, routine carbon monoxide screening, behavioural support and access to pharmacotherapy. Additional themes at community, organisational and societal levels were also identified. Limitations Limitations include a design grounded in qualitative studies, difficulties recruiting SOs, and local service configurations and recruitment processes that potentially skewed the sample. Conclusions Perceptions and experiences of barriers to and facilitators of smoking cessation in pregnancy are fluid and context dependent. Effective interventions for smoking cessation in pregnancy should take account of the interplay between the individual, interpersonal and environmental aspects of women’s lives. Future work Research focus: removing barriers to support, improving HPs’ capacity to offer accurate advice, and exploration of weight concerns and relapse prevention. Interventions focus: financial incentives, self-help and social network interventions. Study registration This study is registered as PROSPERO CRD42013004170. Funding The National Institute for Health Research Health Technology Assessment programme.

scholarly journals A Qualitative Study of Factors Influencing Adherence among Pregnant Women Taking Part in a Trial of E-Cigarettes for Smoking Cessation

2021 ◽  
Vol 18 (2) ◽  
pp. 430
Author(s):  
Allison Ford ◽  
Isabelle Uny ◽  
Judith Lowes ◽  
Felix Naughton ◽  
Sue Cooper ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Pregnant Women ◽  
Thematic Analysis ◽  
Theoretical Domains Framework ◽  
Telephone Interviews ◽  
Factors Influencing ◽  
Stop Smoking ◽  
Pregnant Smokers ◽  
Intervention Adherence ◽  
In Pregnancy

Use of e-cigarettes (vaping) has potential to help pregnant women stop smoking. This study explored factors influencing adherence among participants in the vaping arm of the first trial of vaping for smoking cessation in pregnancy. We conducted semi-structured telephone interviews (n = 28) with women at three-months postpartum. Interviews were analysed using thematic analysis, informed by the Theoretical-Domains Framework, Necessity-Concerns Framework and Perceptions and Practicalities Approach. Interviewees generally reported high levels of vaping. We found that: (1) intervention adherence was driven by four necessity beliefs—stopping smoking for the baby, and vaping for harm reduction, smoking cessation or as a last resort; (2) necessity beliefs outweighed vaping concerns, such as dependence and safety; (3) adherence was linked to four practicalities themes, acting as barriers and facilitators to vaping—device and e-liquid perceptions, resources and support, whether vaping became habitual, and social and environmental factors; and (4) intentional non-adherence was rare; unintentional non-adherence was due to device failures, forgetting to vape, and personal circumstances and stress. Pregnant smokers provided with e-cigarettes, and with generally high levels of vaping, had positive beliefs about the necessity of vaping for smoking cessation which outweighed concerns about vaping. Non-adherence was mainly due to unintentional factors.

scholarly journals Attitudes to E-Cigarettes and Cessation Support for Pregnant Women from English Stop Smoking Services: A Mixed Methods Study

2019 ◽  
Vol 16 (1) ◽  
pp. 110 ◽  
Author(s):  
Sue Cooper ◽  
Sophie Orton ◽  
Katarzyna A. Campbell ◽  
Michael Ussher ◽  
Naomi Coleman-Haynes ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Public Health Problem ◽  
Mixed Methods Study ◽  
Cigarette Use ◽  
Smoking In Pregnancy ◽  
Stop Smoking ◽  
Quitting Smoking ◽  
Stop Smoking Services ◽  
The Uk ◽  
In Pregnancy

Smoking in pregnancy remains a public health problem. In the UK e-cigarettes are the most popular aid to quitting smoking outside of pregnancy, but we don’t know the extent of e-cigarette use in pregnancy or how English Stop Smoking Services (SSS) respond to pregnant women who vape. In 2015 we surveyed SSS managers about cessation support for pregnant women and responses to clients who vaped. Subsequently we interviewed a sub-sample of managers to seek explanations for the SSS’ position on e-cigarettes; interviews were thematically analysed. Survey response rate was 67.8% (72/106); overall managers reported 2.2% (range 1.4–4.3%) of pregnant clients were using e-cigarettes. Most SSS reported supporting pregnant women who already vaped, but would not recommend e-cigarette use; for women that were still smoking and not using e-cigarettes, 8.3% of SSS were likely/very likely to advise using e-cigarettes, with 56.9% of SSS unlikely/very unlikely to advise using them. Fifteen respondents were interviewed; interviewees were generally positive about the potential of e-cigarettes for cessation in pregnancy although concerns about perceived lack of evidence for safety were expressed and most wanted research on this. Clear guidance on e-cigarette use informed by pregnancy specific research will assist SSS to provide consistent evidence-based support.

scholarly journals An Exploration of Pregnant Women Smokers Knowledge of Accessing ‘Stop Smoking’ Services in Wales

2020 ◽  
Vol 5 (9) ◽  
pp. 499-504
Author(s):  
Marian Olamide Owoniyi ◽  
Dr. Olutoyin Elizabeth Okeya
Keyword(s):  
Public Health ◽  
Pregnant Women ◽  
Health Professionals ◽  
Service Improvement ◽  
Women Smokers ◽  
Smoking In Pregnancy ◽  
Public Health Professionals ◽  
Stop Smoking ◽  
Stop Smoking Services ◽  
In Pregnancy

The problem of smoking in pregnancy has remained a challenge to both public health professionals and Welsh Government with the low uptake of stop smoking services by pregnant women. Despite the evidence base for stop smoking, services have neither been implemented consistently nor robustly across Wales. Hence the need to develop a service improvement project like ‘Models for Access to Maternal Stop Smoking Support’ (MAMSS) to provide new ways of supporting pregnant women who smoke, alongside the current national Stop Smoking Services. The study explored the experiences and views of pregnant women smokers accessing stop smoking services in Wales. The need for suitable training was reported amongst public health professionals involved in providing stop smoking service for pregnant women. Most women wanted to reduce and not stop smoking; also available opportunities were important in determining the ability to access and deliver services, with the use of carbon monoxide (CO) monitors positively influencing the receptiveness of the pregnant women. Midwives were however reluctant to create an image of enforcing stop smoking and a holistic approach was advocated by some staff members to encourage health education and promotion. Overall, a specialist service such as that provided by the MAMSS project was viewed as appropriate. Public health professionals understood their roles and the advantages of the CO monitors in encouraging quitting/stop smoking in pregnancy. Specialist midwives made positive impacts on the pregnant smoker’s receptiveness to stop smoking support. Both staff and pregnant women acknowledged that accessibility and flexibility of service were key determinants of service delivery and service uptake, whilst incorporating an approach that is supportive rather than enforcing. This electronic document is a “live” template and already defines the components of your paper [title, text, heads, etc.] in its style sheet

Abstract P385: Pregnancy Care Must Do More to Meet Women's Social Needs: A Systematic Review of Interventions Addressing the Social Determinants of Health

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Ana Reyes ◽  
Rabih Dahdouh ◽  
Precious Akanyirige ◽  
Araceli Estrada ◽  
Maria R Young ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Social Needs ◽  
Determinants Of Health ◽  
Cochrane Library ◽  
Risk Screening ◽  
Pregnancy Care ◽  
The Social ◽  
In Pregnancy

Introduction: Consistent evidence has shown that the social determinants of health (SDoH) play an important role in shaping overall health. As health systems become more focused on improving the health of populations, there is an urgent need for interventions that address upstream factors such as the social determinants of health. Such interventions have not been widely studied and even less work exists in the realm of maternal health. But as maternal and infant mortality remain critical issues, there is great opportunity for the study and development of interventions to address social needs in pregnancy care. Hypothesis: We assessed the hypothesis that most existing interventions addressing the social needs of pregnant women would focus only on identifying social risks, while fewer would connect patients with resources in the community. We expected that most studies would not provide evaluations of effectiveness. Methods: We conducted a database search of MEDLINE, Embase, Cochrane Library, CINAHL, Scopus, and Web of Science to capture literature published between January 1970 and April 2019. A team of reviewers screened titles and abstracts for interventions that were issued in a clinical setting and addressed at least one SDoH as defined by the World Health Organization. Results: Preliminary results revealed 25 studies. All consisted of some form of risk screening and four included a referral process. Interventions addressing intimate partner violence were most numerous followed by psychosocial factors and cigarette smoking. Financial needs were assessed in one study. Eight studies included an evaluation process. Staff carrying out the interventions were primarily research staff, nurse practitioners or nurse midwives. Conclusions: In conclusion, more must be done to connect pregnant women with social resources. As unmet social needs put women at higher risk for poor outcomes in pregnancy, action should be taken to more seamlessly integrate social needs interventions into clinical workflows. Focus should expand beyond traditional social risk screening to capture a wider range of needs including financial stability, housing, and transportation. These are particularly important during pregnancy because adequate prenatal care requires women to be more engaged with the health care system than they would to maintain baseline health.

scholarly journals Evaluating and Planning Green Infrastructure: A Strategic Perspective for Sustainability and Resilience

2019 ◽  
Vol 11 (10) ◽  
pp. 2726 ◽  
Author(s):  
Angioletta Voghera ◽  
Benedetta Giudice
Keyword(s):  
Case Studies ◽  
Green Infrastructure ◽  
Evaluation Process ◽  
Ecological Indicators ◽  
Social Ecological ◽  
The Social ◽  
The One ◽  
Strategic Perspective ◽  
Social Components

In the light of the current changing global scenarios, green infrastructure is obtaining increasing relevance in planning policies, especially due to its ecological, environmental and social components which contribute to pursuing sustainable and resilient planning and designing of cities and territories. The issue of green infrastructure is framed within the conceptual contexts of sustainability and resilience, which are described through the analysis of their common aspects and differences with a particular focus on planning elements. In particular, the paper uses two distinct case studies of green infrastructure as representative: the green infrastructure of the Region Languedoc-Roussillon in France and the one of the Province of Turin in Italy. The analysis of two case studies focuses on the evaluation process carried on about the social-ecological system and describes the methodologies and the social-ecological indicators used to define the green infrastructure network. We related these indicators to their possible contribution to the measurement of sustainability and resilience. The analysis of this relationship led us to outline some conclusive considerations on the complex role of the design of green infrastructure with reference to sustainability and resilience.

scholarly journals Exposure to Tobacco, Environmental Tobacco Smoke and Nicotine in Pregnancy: A Pragmatic Overview of Reviews of Maternal and Child Outcomes, Effectiveness of Interventions and Barriers and Facilitators to Quitting

2020 ◽  
Vol 17 (6) ◽  
pp. 2034 ◽  
Author(s):  
Gillian S. Gould ◽  
Alys Havard ◽  
Ling Li Lim ◽  
Ratika Kumar ◽  
Keyword(s):  
Smoking Cessation ◽  
Health Outcomes ◽  
Pregnant Women ◽  
Replacement Therapy ◽  
Nicotine Replacement Therapy ◽  
Systematic Reviews ◽  
Nicotine Replacement ◽  
Increased Risk ◽  
Pertinent Data ◽  
In Pregnancy

The aim of this review of reviews was to collate the latest evidence from systematic reviews about the maternal and child health outcomes of being exposed to tobacco and nicotine during pregnancy; the effectiveness of interventions designed to reduce these exposures, and barriers to and facilitators of smoking cessation during pregnancy. Two databases were searched to obtain systematic reviews published from 2010 to 2019. Pertinent data from 76 articles were summarized using a narrative synthesis (PROSPERO reference: CRD42018085896). Exposure to smoke or tobacco in other forms during pregnancy is associated with an increased risk of obstetric complications and adverse health outcomes for children exposed in-utero. Counselling interventions are modestly effective, while incentive-based interventions appear to substantially increase smoking cessation. Nicotine replacement therapy is effective during pregnancy but the evidence is not conclusive. Predictors and barriers to smoking cessation in pregnancy are also discussed. Smoking during pregnancy poses substantial risk to mother’s and child’s health. Psychosocial interventions and nicotine replacement therapy (NRT) appear to be effective in helping pregnant women quit smoking. Barriers to smoking cessation must be identified and steps taken to eradicate them in order to reduce smoking among pregnant women. More research is needed on smoking cessation medications and e-cigarettes.

scholarly journals Stop smoking practitioner consensus on barriers and facilitators to smoking cessation in pregnancy and how to address these: A modified Delphi survey

2019 ◽  
Vol 9 ◽  
pp. 100164
Author(s):  
Libby Fergie ◽  
Katarzyna A. Campbell ◽  
Tom Coleman-Haynes ◽  
Michael Ussher ◽  
Sue Cooper ◽  
...  
Keyword(s):  
Smoking Cessation ◽  
Delphi Survey ◽  
Barriers And Facilitators ◽  
Modified Delphi ◽  
Stop Smoking ◽  
In 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.

scholarly journals Smoking cessation advice after cervical screening: a qualitative interview study of acceptability in Dutch primary care

2018 ◽  
Vol 69 (678) ◽  
pp. e15-e23
Author(s):  
Marthe BL Mansour ◽  
Mathilde R Crone ◽  
Henk C van Weert ◽  
Niels H Chavannes ◽  
Kristel M van Asselt
Keyword(s):  
Smoking Cessation ◽  
Cervical Screening ◽  
Qualitative Interview ◽  
Smoking Behaviour ◽  
Interview Study ◽  
Interactive Approach ◽  
Smear Test ◽  
Stop Smoking ◽  
Qualitative Interview Study ◽  
Practice Assistant

BackgroundCervical cancer screening in general practice could be a routine and opportune moment to advise females who smoke to stop smoking.AimThe aims of this study were to investigate the attitudes of females who smoke to receiving advice about stopping smoking after cervical screening and to identify factors associated with the acceptability of this advice.Design and settingThis qualitative interview study was conducted with Dutch females who smoked, had undergone cervical screening, and were aged 30 to 60 years. Interviews were performed between December 2016 and September 2017.MethodIn this study 15 participants were interviewed and transcripts were analysed using thematic analysis.ResultsFemales who smoke were ambivalent (positive or sceptical) about being advised to stop smoking after they had undergone cervical screening. An explanation of why smoking behaviour is addressed by the practice assistant performing the smear, and making females feel at ease during the smear test, were found to be factors that might influence acceptability of such advice. Although a personal and non-judgemental approach to discussing smoking was considered essential, participants expressed different preferences regarding the form and content of cessation support. This was reflected by the variations in knowledge about smoking cessation support, previous experiences of cessation attempts, and received cessation advice or support.ConclusionStudy participants had mixed opinions about being given advice about smoking cessation after their cervical smear test and differed in their preferences for the type of support for smoking cessation. An interactive approach might improve how well a smoking cessation intervention is received by females who smoke and cater to their individual needs and preferences.

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