Pregnant Smokers’ Experiences and Opinions of Techniques Aimed to Address Barriers and Facilitators to Smoking Cessation: A Qualitative Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Recruitment
2.2. Semi-Structured Interviews
2.3. Interview Guide
2.4. Analysis
3. Results
3.1. Analysis on the Barriers and Facilitators
3.2. Techniques that Could Help Overcome Barriers or Enhance Facilitators towards Cessation
3.2.1. Accessing Professional Help
“I think it’s important to have somebody, like from a service, you know, so they can talk you through it and say it is normal … because I was worried, you know, I was still having cravings like up til now and she says ‘no that’s normal, sometimes it takes people a couple of weeks, sometimes it takes people a couple of months, everybody’s different’, but to answer those questions and just to have somebody, you know, keeping check, you know, and see how you’re doing, it helps.”Participant 2.
“…[W]hen I walk in her room we have a good laugh and a good giggle and we have a good chat, she isn’t one of these that just gets straight down to business and lets you blow in the meter and sends you on your way and just asks you questions and questions and questions, she makes sure that you’re alright in yourself.”Participant 4.
“I did admit it to my adviser, I had a fag, I had one … I had that fall back and we talked through it and we got through it.”Participant 4.
“Well I get an advisor so, you know, if I’m having a bad day and I need to phone her, I could … I can just phone her up at the club.”Participant 2.
“I weren’t due to see her til the following Tuesday and over the weekend I felt really low … you know because I’d been doing it [not smoking] for that long and it made me feel really, really down and I just had to have a smoke … if I’d have seen her sooner I think that might have helped.”Participant 11.
“… she told me about the placenta as well, the placenta of a smoker, she showed us some pictures … and I was shocked … a normal healthy placenta and then somebody who smokes, it looks like it’s dead, you know, so that made a big impact, I think that would help anyone pregnant that wanted to stop smoking seeing those pictures, definitely.”Participant 2.
“[Interviewer: what sort of support so you think will be helpful] I honestly don’t know … I don’t know what sort of things are out there.”Participant 6.
“I didn’t smoke enough when I got pregnant to need that help necessarily.”Participant 1.
“I think once I’ve had her I’m going to get, like help.”Participant 12.
3.2.2. Nicotine Replacement Therapy
“They [hospital-based stop smoking practitioners] just came out and offered nicotine replacement.”Participant 7.
“I could have stopped [smoking] using patches, gum, the spray, the lozenges, the sticks, most of the aids that are available she’s [stop smoking practitioner] been able to offer.”Participant 4.
“I had the Nicorette patch and I had the inhalator. Because you’re supposed to choose two products … That was good. I stopped three full days as well as in the morning, which was the worst one, you know what I mean, or after eating.”Participant 11.
“I chose the chewing gum [Interviewer: did that help?] Yeah, it has.”Participant 4.
“I had the gum which made me have heartburn and the patches which made me itch.”Participant 5.
“… [B]ecause she [stop smoking practitioner] was saying there’s chewing gums and whatever available. But for me, it’s not necessarily about replacing the nicotine. Obviously that would affect it … but for me, it was the habit of the hand to the mouth. So I needed that substitute of fag, if that makes sense?”Participant 8.
“E-cigarettes are meant to be a substitute [but] it’s not exactly the same. I know with the cigarette you get a complete release from stress when you smoke one, whereas with the E-cig, I think it’s more like the placebo effect … I still don’t get the same satisfaction that I would do from a cigarette.”Participant 10.
“I have thought about that [trying an e-cigarette] but I don’t know if they’re worse with all the studies … I just know in the past, on the news they say they can be more harmful when pregnant.”Participant 11.
3.2.3. Distraction from Smoking
“Like first thing in the morning, I used to wake up and have a fag straightaway in bed. That was difficult at first … I overcome that by, you know, like instead of smoking, doing the kids’ sandwiches…”Participant 2.
“I was thinking about … getting a gym membership as obviously exercise releases the stress … if you wake up and you put smoking at the back of your head, and, especially because going to the gym is to do with being healthy … it makes me not want to smoke.”Participant 10.
“…[H]e [partner] supports me because he’ll hide his tobacco and fags so I can’t find them if I wanted one anyway.”Participant 4.
“I think any sort of illness or like hospitalisation where I was away from it [smoking]…makes you realise that you’ve gone a period of time without it so you realise you’re not dependent upon it.”Participant 3.
3.2.4. Social Interactions in Relation to Smoking and Cessation Attempts
“It’s getting him [partner] to not smoke around me … sometimes I’ll go upstairs because he’s having a cigarette.”Participant 6.
“… [M]y Mum and my sister, they smoke a hell of a lot, so there’s always going to be someone like sparking up … so I just have to stay away from them, you know what I mean, for a bit.”Participant 11.
“Yeah, he [partner] was helpful, he was very like cheering me on and ‘you’re doing really well’ and everything, yeah that helped.”Participant 11. (partner was still smoking)
“… [It] was more my Mum and my Grandma, because they used to smoke and they both made a pact together to quit, and they went onto e-cigarettes, and they kind of supported me and helped me to do the transition the way they did.”Participant 10.
“They [midwives] just keep telling me to stop … it winds me up a little and makes me worse [with smoking].”Participant 7.
“I’ve got certain family members that are ‘well it’s about time you stopped smoking’ … ‘well I’ve been telling you for years you should stop’ … Whereas it’s not the help that you need. That’s not help. That puts more pressure on you to say ‘well you’re not supporting me, you want me to stop smoking but you’re telling me that I should have done it years ago, not praising me for actually being say seven days without a cigarette.”Participant 4.
“Or maybe I’d join a group with other people going through the same thing, to hear what they’re doing to cope … and they might be doing things that are helping them that I haven’t tried yet, so that would be good to explore other options.”Participant 10.
“I have had help from the non-smoking group at the hospital, the midwife put me through to them, so they’ve helped me with the patches and I go to pregnancy club once a week … we do discuss the no smoking thing but we like make friendship bracelets or do pregnancy exercises …”Participant 2.
4. Discussion
4.1. Strengths and Weaknesses
4.2. Discussion of Findings
4.3. Further Work
5. Conclusions
Author Contributions
Funding
Acknowledgments
Data Availability
Conflicts of Interest
References
- Cnattingius, S. The epidemiology of smoking during pregnancy: Smoking prevalence, maternal characteristics, and pregnancy outcomes. Nicotine Tob. Res. 2004, 6, S125–S140. [Google Scholar] [CrossRef]
- World Health Organization. Who Recommendations for The Prevention and Management of Tobacco Use and Second-Hand Smoke Exposure in Pregnancy; World Health Organization: Geneva, Switzerland, 2013. [Google Scholar]
- Knopik, V.S.; Marceau, K.; Bidwell, L.C.; Palmer, R.H.C.; Smith, T.F.; Todorov, A.; Evans, A.S.; Heath, A.C. Smoking during pregnancy and adhd risk: A genetically informed, multiple-rater approach. Am. J. Med. Genet. B Neuropsychiatr. Genet. 2016, 171, 971–981. [Google Scholar] [CrossRef] [PubMed]
- Bao, W.; Michels, K.B.; Tobias, D.K.; Li, S.; Chavarro, J.E.; Gaskins, A.J.; Vaag, A.A.; Hu, F.B.; Zhang, C. Parental smoking during pregnancy and the risk of gestational diabetes in the daughter. Int. J. Epidemiol. 2016, 45, 160–169. [Google Scholar] [CrossRef] [PubMed]
- Chu, P.; Wang, H.; Han, S.; Jin, Y.; Lu, J.; Han, W.; Shi, J.; Guo, Y.; Ni, X. Maternal smoking during pregnancy and risk of childhood neuroblastoma: Systematic review and meta-analysis. J. Cancer Res. 2016, 12, 999–1005. [Google Scholar]
- Jauniaux, E.; Burton, G.J. Morphological and biological effects of maternal exposure to tobacco smoke on the feto-placental unit. Early Hum. Dev. 2007, 83, 699–706. [Google Scholar] [CrossRef]
- Leonardi-Bee, J.; Jere, M.L.; Britton, J. Exposure to parental and sibling smoking and the risk of smoking uptake in childhood and adolescence: A systematic review and meta-analysis. Thorax 2011, 66, 847–855. [Google Scholar] [CrossRef] [PubMed]
- Lange, S.; Probst, C.; Rehm, J.; Popova, S. National, regional, and global prevalence of smoking during pregnancy in the general population: A systematic review and meta-analysis. Lancet Global Health 2018, 6, e769–e776. [Google Scholar] [CrossRef]
- Department of Health England. Towards a Smokefree Generation—A Tobacco Control Plan for England. Department of Health: London, UK, 2017. [Google Scholar]
- Solomon, L.J.; Quinn, V.P. Spontaneous quitting: Self-initiated smoking cessation in early pregnancy. Nicotine Tob. Res. 2004, 6, S203–S216. [Google Scholar] [CrossRef] [PubMed]
- Bauld, L.; Graham, H.; Sinclair, L.; Flemming, K.; Naughton, F.; Ford, A.; McKell, J.; McCaughan, D.; Hopewell, S.; Angus, K. Barriers to and facilitators of smoking cessation in pregnancy and following childbirth: Literature review and qualitative study. Health Technol. Assess. 2017, 21. [Google Scholar] [CrossRef]
- Flemming, K.; McCaughan, D.; Angus, K.; Graham, H. Qualitative systematic review: Barriers and facilitators to smoking cessation experienced by women in pregnancy and following childbirth. J. Adv. Nurs. 2015, 71, 1210–1226. [Google Scholar] [CrossRef] [PubMed]
- Campbell, K.A.; Fergie, L.; Coleman-Haynes, T.; Cooper, S.; Lorencatto, F.; Ussher, M.; Dyas, J.; Coleman, T. Improving behavioral support for smoking cessation in pregnancy: What are the barriers to stopping and which behavior change techniques can influence these? Application of theoretical domains framework. Int. J. Environ. Res. Public. Health 2018, 15, 359. [Google Scholar] [CrossRef] [PubMed]
- Lorencatto, F.; West, R.; Michie, S. Specifying evidence-based behavior change techniques to aid smoking cessation in pregnancy. Nicotine Tob. Res. 2012, 14, 1019–1026. [Google Scholar] [CrossRef] [PubMed]
- Chamberlain, C.; O’Mara-Eves, A.; Porter, J.; Coleman, T.; Perlen, S.M.; Thomas, J.; McKenzie, J.E. Psychosocial interventions for supporting women to stop smoking in pregnancy. Cochrane Database Syst. Rev. 2017. [Google Scholar] [CrossRef] [PubMed]
- Riaz, M.; Lewis, S.; Naughton, F.; Ussher, M. Predictors of smoking cessation during pregnancy: A systematic review and meta-analysis. Addiction 2018, 113, 610–622. [Google Scholar] [CrossRef] [PubMed]
- Tong, A.; Sainsbury, P.; Craig, J. Consolidated criteria for reporting qualitative research (coreq): A 32-item checklist for interviews and focus groups. Int. J. Qual. Health Care 2007, 19, 349–357. [Google Scholar] [CrossRef] [PubMed]
- Ziebland, S.; McPherson, A. Making sense of qualitative data analysis: An introduction with illustrations from dipex (personal experiences of health and illness). Med. Educ. 2006, 40, 405–414. [Google Scholar] [CrossRef] [PubMed]
- Braun, V.; Clarke, V. Using thematic analysis in psychology. Qual. Res. Psychol. 2006, 3, 77–101. [Google Scholar] [CrossRef] [Green Version]
- Hennink, M.M.; Kaiser, B.N.; Marconi, V.C. Code saturation versus meaning saturation:How many interviews are enough? Qual. Health Res. 2017, 27, 591–608. [Google Scholar] [CrossRef]
- Leavitt, L.; Abroms, L.; Johnson, P.; Schindler-Ruwisch, J.; Bushar, J.; Singh, I.; Cleary, S.D.; McInvale, W.; Turner, M. Recruiting pregnant smokers from text4baby for a randomized controlled trial of quit4baby. Transl. Behav. Med. 2017, 7, 157–165. [Google Scholar] [CrossRef]
- Shipton, D.; Tappin, D.M.; Vadiveloo, T.; Crossley, J.A.; Aitken, D.A.; Chalmers, J. Reliability of self reported smoking status by pregnant women for estimating smoking prevalence: A retrospective, cross sectional study. BMJ 2009, 339, b4347. [Google Scholar] [CrossRef]
- Novick, G. Is there a bias against telephone interviews in qualitative research? Res. Nurs. Health 2008, 31, 391–398. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- NHS Digital. Statistics on Women’s Smoking Status at Time of Delivery, England—Quarter 4, 2017–2018. Available online: https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-women-s-smoking-status-at-time-of-delivery-england/statistics-on-womens-smoking-status-at-time-of-delivery-england---quarter-4-october-2017-to-december-2017 (accessed on 2 August 2019).
- Smith, T.; Noble, M.; Noble, S.; Wright, G.; McLennan, D.; Plunkett, E. The English Indices of Deprivation 2015. Department for Communities and Local Government: London, UK, 2015. [Google Scholar]
- Hinton, L.; Kurinczuk, J.J.; Ziebland, S. Reassured or fobbed off? Perspectives on infertility consultations in primary care: A qualitative study. Br. J. Gen. Pract. 2012, 62, e438–e445. [Google Scholar] [CrossRef] [PubMed]
- Semwal, M.; Taylor, G.; Car, J. Personalised information for improving the uptake of smoking cessation programs. Ann. Transl. Med. 2017, 5, 260. [Google Scholar] [CrossRef] [PubMed]
- Naughton, F.; Hopewell, S.; Sinclair, L.; McCaughan, D.; McKell, J.; Bauld, L. Barriers and facilitators to smoking cessation in pregnancy and in the post-partum period: The health care professionals’ perspective. Br. J. Health Psychol. 2018, 23, 741–757. [Google Scholar] [CrossRef] [PubMed]
- Lemola, S.; Grob, A. Smoking cessation during pregnancy and relapse after childbirth: The impact of the grandmother’s smoking status. Matern. Child Health J. 2008, 12, 525–533. [Google Scholar] [CrossRef] [PubMed]
- Ingall, G.; Cropley, M. Exploring the barriers of quitting smoking during pregnancy: A systematic review of qualitative studies. Women Birth 2010, 23, 45–52. [Google Scholar] [CrossRef] [Green Version]
- Murray, C.L.; Small, S.P.; Burrage, L. The lived experience of smoking in pregnancy. Open J. Nurs. 2014, 4, 762–773. [Google Scholar] [CrossRef]
- Koshy, P.; Mackenzie, M.; Tappin, D.; Bauld, L. Smoking cessation during pregnancy: The influence of partners, family and friends on quitters and non-quitters. Health Soc. Care Community 2010, 18, 500–510. [Google Scholar] [CrossRef]
- Robles, Z.; Garey, L.; Hogan, J.; Bakhshaie, J.; Schmidt, N.B.; Zvolensky, M.J. Examining an underlying mechanism between perceived stress and smoking cessation-related outcomes. Addict. Behav. 2016, 58, 149–154. [Google Scholar] [CrossRef] [Green Version]
- NHS Digital. Statistics on NHS Stop Smoking Services in England April 2017 to December 2017. Available online: https://digital.nhs.uk/data-and-information/publications/statistical/statistics-on-nhs-stop-smoking-services-in-england (accessed on 2 August 2019).
- Pledger, A.B. Exploring the experiences of pregnant women using an nhs stop smoking service: A qualitative study. Perspect Public Health 2015, 135, 138–144. [Google Scholar] [CrossRef]
- Miyazaki, Y.; Hayashi, K.; Imazeki, S. Smoking cessation in pregnancy: Psychosocial interventions and patient-focused perspectives. Int. J. Women’s Health 2015, 7, 415–427. [Google Scholar] [CrossRef] [PubMed]
- Bradizza, C.M.; Stasiewicz, P.R.; Zhuo, Y.; Ruszczyk, M.; Maisto, S.A.; Lucke, J.F.; Brandon, T.H.; Eiden, R.D.; Slosman, K.S.; Giarratano, P. Smoking cessation for pregnant smokers: Development and pilot test of an emotion regulation treatment supplement to standard smoking cessation for negative affect smokers. Nicotine Tob. Res. 2017, 19, 578–584. [Google Scholar] [CrossRef] [PubMed]
- West, R.; Brown, J.; Shahab, L.; Pokhrel, S.; Owen, L. How Much Improvement in Mental Health Can Be Expected When People Stop Smoking? FINDINGS from a National Survey. Available online: https://bura.brunel.ac.uk/bitstream/2438/10995/1/FullText.pdf. (accessed on 2 August 2019).
- De Wilde, K.S.; Trommelmans, L.C.; Laevens, H.H.; Maes, L.R.; Temmerman, M.; Boudrez, H.L. Smoking patterns, depression, and sociodemographic variables among flemish women during pregnancy and the postpartum period. Nurs. Res. 2013, 62, 394–404. [Google Scholar] [CrossRef] [PubMed]
- Shahab, L.; Sarkar, B.K.; West, R. The acute effects of yogic breathing exercises on craving and withdrawal symptoms in abstaining smokers. Psychopharmacol. (Berl.) 2013, 225, 875–882. [Google Scholar] [CrossRef] [PubMed]
- McClernon, F.J.; Westman, E.C.; Rose, J.E. The effects of controlled deep breathing on smoking withdrawal symptoms in dependent smokers. Addict. Behav. 2004, 29, 765–772. [Google Scholar] [CrossRef] [PubMed]
- Ussher, M.; Taylor, A.; Faulkner, G. Exercise interventions for smoking cessation. Cochrane Database Syst. Rev. 2012, 1. [Google Scholar] [CrossRef]
- Ussher, M.; Etter, J.-F.; West, R. Perceived barriers to and benefits of attending a stop smoking course during pregnancy. Patient Educ. Couns. 2006, 61, 467–472. [Google Scholar] [CrossRef] [PubMed]
- Herbec, A.; Beard, E.; Brown, J.; Gardner, B.; Tombor, I.; West, R. The needs and preferences of pregnant smokers regarding tailored internet-based smoking cessation interventions: A qualitative interview study. BMC Public Health 2014, 14, 1070. [Google Scholar] [CrossRef] [PubMed]
- Stead, L.F.; Carroll, A.J.; Lancaster, T. Group behaviour therapy programmes for smoking cessation. Cochrane Database Syst. Rev. 2017. [Google Scholar] [CrossRef]
- Stewart, M.J.; Kushner, K.E.; Greaves, L.; Letourneau, N.; Spitzer, D.; Boscoe, M. Impacts of a support intervention for low-income women who smoke. Soc. Sci. Med. 2010, 71, 1901–1909. [Google Scholar] [CrossRef]
- Ussher, M.; West, R.; Hibbs, N. A survey of pregnant smokers’ interest in different types of smoking cessation support. Patient Educ. Couns. 2004, 54, 67–72. [Google Scholar] [CrossRef]
- Malchodi, C.S.; Oncken, C.; Dornelas, E.A.; Caramanica, L.; Gregonis, E.; Curry, S.L. The effects of peer counseling on smoking cessation and reduction. Obstet. Gynecol. 2003, 101, 504–510. [Google Scholar] [PubMed]
Participant Identifier (ID) | Age | Smoking Status |
---|---|---|
Participant 1 | 19 | Had quit |
Participant 2 | 36 | Had quit |
Participant 3 | 27 | Had quit |
Participant 4 | 40 | Had quit |
Participant 5 | 20 | Still smoking but had cut down |
Participant 6 | 27 | Still smoking but had cut down |
Participant 7 | 33 | Still smoking but had cut down (managed to quit briefly) |
Participant 8 | 29 | Still smoking but had cut down (managed to quit briefly) |
Participant 9 | 20 | Still smoking but had cut down |
Participant 10 | 22 | Switched to solely using e-cigarettes |
Participant 11 | 32 | Still smoking but had cut down (managed to quit briefly) |
Participant 12 | 27 | Still smoking but had cut down |
Influence of Others | |
---|---|
B: | Participant 9: “Well quite a few of my family smoke, so, I mean I’d say that tempts me to smoke when they’re around and stuff” |
F: | Participant 1: ““I started to feel funny after having like a fag … so I turned to my partner when I had enough of it and I was like ‘just don’t let me have one even if I beg for it’ and he didn’t so here I am” |
Internal motivation | |
B: | Participant 6: “… the second I found out [about being pregnant] I did want to quit, but I just couldn’t do it this time … I just couldn’t stop” |
F: | Participant 10: “the only reason why I quit was because I was pregnant, so I mean, if I hadn’t fallen pregnant, I’d probably still be smoking cigarettes now” |
Cues to smoke | |
B: | Participant 1: “I wasn’t pleased [about smoking] but I was like in a really stressful place” |
F: | Participant 4: “But now sitting on a bus I’d get up and move seats just to move away from a smoker because I can’t stand the smell” |
Health | |
F: | Participant 4: “… because it’ll [staying quit] also help my health because I’ve got asthma and osteoarthritis as well, so it’s like if I stop smoking it helps with my health because it helps with my lungs and my asthma, but then it also helps if I’ve got more energy …” (Existing health conditions) |
F: | Participant 3: “It was just that I kept being sick so I didn’t have the inclination to want to smoke just in case it made me worse” (Pregnancy related health issues) |
F: | Participant 5: “If it put my children in danger … Like if my daughter stopped growing while she was inside me” (Babies’ health) |
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Fergie, L.; Coleman, T.; Ussher, M.; Cooper, S.; Campbell, K.A. Pregnant Smokers’ Experiences and Opinions of Techniques Aimed to Address Barriers and Facilitators to Smoking Cessation: A Qualitative Study. Int. J. Environ. Res. Public Health 2019, 16, 2772. https://doi.org/10.3390/ijerph16152772
Fergie L, Coleman T, Ussher M, Cooper S, Campbell KA. Pregnant Smokers’ Experiences and Opinions of Techniques Aimed to Address Barriers and Facilitators to Smoking Cessation: A Qualitative Study. International Journal of Environmental Research and Public Health. 2019; 16(15):2772. https://doi.org/10.3390/ijerph16152772
Chicago/Turabian StyleFergie, Libby, Tim Coleman, Michael Ussher, Sue Cooper, and Katarzyna A Campbell. 2019. "Pregnant Smokers’ Experiences and Opinions of Techniques Aimed to Address Barriers and Facilitators to Smoking Cessation: A Qualitative Study" International Journal of Environmental Research and Public Health 16, no. 15: 2772. https://doi.org/10.3390/ijerph16152772