Smoking in pregnancy: who makes quit attempts whilst pregnant and what types of cessation support do they prefer?

Background Smoking in pregnancy is strongly associated with adverse pregnancy and birth outcomes. In England, 26% of women smoke at some point during pregnancy, and 12% smoke throughout. Reducing smoking during pregnancy is therefore an NHS priority. Despite this, little is known about women who make a quit attempt during pregnancy. This study examined sociodemographic and psychological characteristics associated with making a quit attempt during pregnancy, and explored preferences for cessation support. Methods Cross-sectional, baseline data collected as part of the Pregnancy Lifestyle Survey cohort was analysed. Self-reported current or recent ex-smokers (smoked within 3 months of pregnancy) completed a questionnaire between 8-26 weeks gestation. Logistic regression analysis was used to examine characteristics associated with making a quit attempt. Descriptive statistics were used to investigate interest in accessing different forms of cessation support. Results Of the 850 participants, 57% were self-reported current smokers. Cigarettes smoked per day, smoking beliefs, previous pregnancy and a planned pregnancy were found to be significantly associated with whether women made a quit attempt whilst pregnant. Primiparous women were more than twice as likely (OR 2.20: 95% CI 1.33-3.66) to have made a quit attempt than multiparous women, and those who smoked ≥11 cigarettes per day were 72% less likely to have made a quit attempt than those who smoked ≤5 cigarettes per day (OR 0.28: 95% CI 0.16-0.48). Over 70% of women who had made a quit attempt were interested in accessing health professional led support and self-help materials. Conclusions Understanding the characteristics of women who make a quit attempt whilst pregnant and their cessation support preferences could inform future smoking cessation service design, and improve uptake of support services by allowing healthcare providers to target the women most likely to make a quit attempt, and provide support tailored specifically to meet their needs

Smoking in the home after childbirth: prevalence, determinants and the relationship to smoking in pregnancy

Childhood secondhand smoke (SHS) exposure causes substantial ill health and mortality, and poses a significant economic and social burden. This thesis aimed to explore the prevalence and determinants of smoking in the home after childbirth, and to understand the experience and attitudes of mothers who stop smoking during pregnancy but relapse soon after delivery. In study one, the factors associated with child SHS exposure in the home were systematically reviewed. Parental smoking, low socioeconomic status and being less educated were all frequently and consistently independently associated with children’s SHS exposure in the home. Children whose parents held more negative attitudes towards SHS were less likely to be exposed. In study two, cohort data were analysed to estimate maternal self-reported prevalence of SHS exposure among young infants (≤3 months) of women who smoked just before or during pregnancy, and identify its associated factors. In 471 households, the prevalence of smoking in the home was 16.3% (95% CI 13.2-19.8%), and after multiple imputation controlling for non-response 18.2% (95% CI 14.0-22.5%). Mothers’ smoking ≥11 cigarettes per day were 8.2 times (95% CI 3.4-19.6) more likely to report smoking in the home. Significant associations were also observed for younger age, being of non-White ethnicity, increased deprivation and less negative attitudes towards SHS. In study three, semi-structured interviews with women who quit smoking during pregnancy, but relapsed ≤3 months postpartum were conducted. Central to mothers’ accounts of their smoking behaviours during pregnancy and postpartum was their desire to be a ‘responsible mother’. Mothers described using strategies to protect their infant from SHS exposure, and held strong negative attitudes towards other smoking parents. After relapsing, mothers repositioned themselves as ‘social/occasional’ smokers rather than ‘regular’ smokers. Taken together, these findings can be used to inform the development of future, targeted interventions to prevent or reduce infant and child SHS exposure

Smoking in the home after childbirth: prevalence, determinants and the relationship to smoking in pregnancy

Childhood secondhand smoke (SHS) exposure causes substantial ill health and mortality, and poses a significant economic and social burden. This thesis aimed to explore the prevalence and determinants of smoking in the home after childbirth, and to understand the experience and attitudes of mothers who stop smoking during pregnancy but relapse soon after delivery. In study one, the factors associated with child SHS exposure in the home were systematically reviewed. Parental smoking, low socioeconomic status and being less educated were all frequently and consistently independently associated with children’s SHS exposure in the home. Children whose parents held more negative attitudes towards SHS were less likely to be exposed. In study two, cohort data were analysed to estimate maternal self-reported prevalence of SHS exposure among young infants (≤3 months) of women who smoked just before or during pregnancy, and identify its associated factors. In 471 households, the prevalence of smoking in the home was 16.3% (95% CI 13.2-19.8%), and after multiple imputation controlling for non-response 18.2% (95% CI 14.0-22.5%). Mothers’ smoking ≥11 cigarettes per day were 8.2 times (95% CI 3.4-19.6) more likely to report smoking in the home. Significant associations were also observed for younger age, being of non-White ethnicity, increased deprivation and less negative attitudes towards SHS. In study three, semi-structured interviews with women who quit smoking during pregnancy, but relapsed ≤3 months postpartum were conducted. Central to mothers’ accounts of their smoking behaviours during pregnancy and postpartum was their desire to be a ‘responsible mother’. Mothers described using strategies to protect their infant from SHS exposure, and held strong negative attitudes towards other smoking parents. After relapsing, mothers repositioned themselves as ‘social/occasional’ smokers rather than ‘regular’ smokers. Taken together, these findings can be used to inform the development of future, targeted interventions to prevent or reduce infant and child SHS exposure

The relationship between reported daily nicotine dose from NRT and daily cigarette consumption in pregnant women who smoke in an observational cohort study

Introduction: For nonpregnant people unable to quit smoking, the NHS recommends nicotine replacement therapy (NRT) for smoking reduction. This is not recommended during pregnancy due to concerns about higher nicotine intake than smoking alone. We investigated the relationship between daily nicotine dose from NRT and cigarette consumption reported by pregnant women receiving smoking cessation support. Methods: We conducted secondary analysis of data from currently smoking pregnant women, recruited from antenatal clinics (Nottingham University Hospitals, UK) or online between June 2019–September 2020. Participants set a quit date, received a prototype NRT adherence intervention, and reported cigarettes per day (CPD) and daily NRT dose (mg) via smartphone app for 28 days. Results: 388 women were screened, 32 (8%) were eligible and joined the study. 24 (75%) submitted 510 app reports in total. 17 (71%) reported smoking and using NRT concurrently on at least one day, with concurrent use reported on 109 (21%) of app reports. The relationship between daily NRT dose and CPD followed an exponential decay curve of approximately 7%. In multilevel repeated measures modelling using 4 linear splines (knots 17, 40, and 85 mg/NRT), significant fixed effects of daily NRT dose on CPD were observed for splines 1, 3, and 4. The strongest association was spline 1 (0–17 mg/NRT), where each 10 mg NRT increase was associated with a 0.6 CPD reduction (24% on average). Conclusions: Among women in a cessation study, many smoked and used NRT concurrently; within these women, daily nicotine dose and heaviness of smoking were inversely related. Implications: Findings have implications for the design of future interventions intended to reduce harm associated with smoking in pregnancy. They suggest using NRT alongside smoking in pregnancy could help some women reduce the number of cigarettes they smoke per day

Development of a complex intervention for the maintenance of postpartum smoking abstinence: Process for defining evidence based intervention

Relapse to tobacco smoking for pregnant women that quit is a major public health problem. Evidence based approaches to intervention are urgently required. This study aimed to develop an intervention to be integrated into existing healthcare. A mixed methods approach included a theory driven systematic review identifying promising behaviour change techniques for targeting smoking relapse prevention, and qualitative focus groups and interviews with women, (ex-smokers who had remained quit and those who had relapsed), their partners, and healthcare professionals (N=74). A final stage recruited ten women to refine and initially test a prototype intervention. Our qualitative analysis suggests a lack but need for relapse prevention support. This should be initiated by a trusted ‘credible source’. For many women this would be a midwife or a health visitor. Support needs to be tailored to individual needs, including positive praise/reward, novel digital and electronic support, and partner or social support. Advice and support to use e cigarettes or nicotine replacement therapy for relapse prevention was important for some women, but others remained cautious. The resulting prototype complex intervention includes face to face support reiterated throughout the postpartum period, tailored digital and self-help support, and novel elements such as gifts and NRT

Re-Configuring Identity Postpartum and Sustained Abstinence or Relapse to Tobacco Smoking

Relapse to smoking postpartum is a common and important public health problem. Difficulty in adjusting to a non-smoking identity is a key factor prompting relapse. However, postpartum relapse prevention interventions rarely focus upon offering support for identity change. We conducted an exploratory inductive analysis of a dataset from the Prevention of Return to Smoking Postpartum (PReS) study to understand identity constructs and experiences of pre- and postpartum women (smokers and ex-smokers), partners and health professionals. Data were obtained from 77 unique participants via focus groups, interviews, email or online questionnaires, and were analyzed by two researchers independently, using NVivo 12. Four main themes emerged reflecting identity transition from the pre- to the postpartum period: (i) Pregnancy and the categorization of smoking status; (ii) the disruption of motherhood and loss of self; (iii) adapting to a maternal non-smoking identity; and (iv) factors influencing sustained abstinence versus relapse to smoking. Postpartum relapse prevention interventions need to consider support for women, and the whole family unit, in adjusting to a new identity as a non-smoking mother. Smoking status should be revisited throughout pregnancy and into the postpartum period to aid the long-term integration of smoke-free behavior

Smoking and vaping patterns during pregnancy and the postpartum:a longitudinal UK cohort survey

Abstract:Introduction:There is limited information about longitudinal patterns of vaping during pregnancy and the postpartum. We describe the prevalence, frequency, and reasons for vaping throughout pregnancy and postpartum. We also describe temporal patterns in pregnant women’s vaping.Methods:A longitudinal cohort study across England and Scotland, with questionnaires in early pregnancy (8-24 weeks gestation), late pregnancy (34-38 weeks) and 3 months postpartum. A total of 750 women, aged 16 years or over, who were either current smokers, vapers or had smoked in the 3 months before pregnancy, were recruited between June and November 2017.<br/

A survey of engagement and competence levels in interventions and activities in a community mental health workforce in England.

National Health Service (NHS) mental health workforce configuration is at the heart of successful delivery, and providers are advised to produce professional development strategies. Recent policy changes in England have sharpened the focus on competency based role development. We determined levels of intervention activities, engagement and competence and their influencing factors in a community-setting mental health workforce. Using a modified questionnaire based on the Yorkshire Care Pathways Model we investigated 153 mental health staff working in Coventry and Warwickshire NHS Trust. A median score of competence was computed across 10 cluster activities. Low engagement and competence levels were examined in a logistic regression model. In 220 activities, Monitoring risk was the highest rate of engagement (97.6%) and Group psychological therapy/Art/Drama therapy was the lowest engagement (3.6%). The median competence level based on all activities was 3.95 (proficient). There were significant differences in the competence level among professional groups; non-qualified support group (3.00 for competent), Counsellor/Psychologist/Therapist (3.38), Occupational therapists (3.76), Nurses (4.01), Medical staff (4.05), Social workers (4.25) and Psychologists (4.62 for proficient/expert). These levels varied with activity clusters; the lowest level was for Counsellor/Psychologist/Therapist in the accommodation activity (1.44 novice/advance beginner) and the highest for Occupational therapists in personal activity (4.94 expert). In a multivariate analysis, low competence was significantly related to non-qualified community support professions, late time of obtaining first qualification, more frequencies of clinical training, and training of cognitive behavioural therapy. The associations were similar in the analysis for 10 activity clusters respectively. There was a reasonable competence level in the community-setting mental health workforce, but competence varied with professional groups and cluster activities. New staff and other non-qualified support professions need to receive efficient training, and the training content is more important than frequency to increase level of competence

Interest in and Use of Smoking Cessation Support Across Pregnancy and Postpartum.

BACKGROUND: Limited research exists on interest in and use of smoking cessation support in pregnancy and postpartum. METHODS: A longitudinal cohort of pregnant smokers and recent ex-smokers were recruited in Nottinghamshire, United Kingdom (N = 850). Data were collected at 8-26 weeks gestation, 34-36 weeks gestation, and 3 months postpartum and used as three cross-sectional surveys. Interest and use of cessation support and belief and behavior measures were collected at all waves. Key data were adjusted for nonresponse and analyzed descriptively, and multiple regression was used to identify associations. RESULTS: In early and late pregnancy, 44% (95% CI 40% to 48%) and 43% (95% CI 37% to 49%) of smokers, respectively, were interested in cessation support with 33% (95% CI 27% to 39%) interested postpartum. In early pregnancy, 43% of smokers reported discussing cessation with a midwife and, in late pregnancy, 27% did so. Over one-third (38%) did not report discussing quitting with a health professional during pregnancy. Twenty-seven percent of smokers reported using any National Health Service (NHS) cessation support and 12% accessed NHS Stop Smoking Services during pregnancy. Lower quitting confidence (self-efficacy), higher confidence in stopping with support, higher quitting motivation, and higher age were associated with higher interest in support (ps ≤ .001). A recent quit attempt and greater interest in support was associated with speaking to a health professional about quitting and use of NHS cessation support (ps ≤ .001). CONCLUSIONS: When asked in early or late pregnancy, about half of pregnant smokers were interested in cessation support, though most did not engage. Cessation support should be offered throughout pregnancy and after delivery. IMPLICATIONS: There is relatively high interest in cessation support in early and late pregnancy and postpartum among smokers; however, a much smaller proportion of pregnant or postpartum women access any cessation support, highlighting a gap between interest and engagement. Reflecting women's interest, offers of cessation support should be provided throughout pregnancy and after delivery. Increasing motivation to quit and confidence in quitting with assistance may enhance interest in support, and promoting the discussion of stopping smoking between women and health practitioners may contribute to higher support engagement rates