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

Sue Cooper,Felix Naughton,Anne Dickinson,Sarah Lewis,Rachel Whitemore,Tim Coleman,Lesley Sinclair,Michael Ussher,Sophie Orton,Katharine Bowker,Katarzyna A Campbell,Andy Mcewen,Naomi Coleman-Haynes,Linda Bauld

doi:10.3390/ijerph16010110

Abstract

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.

Highlights

Smoking when pregnant impacts on the health of mothers and unborn babies and on children after birth and as they grow [1,2,3,4]
Both sets of data were analysed separately in sequence, with the survey analysed first followed by the interviews, and the two approaches were mixed at the interpretation level
We identified the commissioning leads with public health duties at 152 English local authorities and from these obtained contact details for the managers of 106 Smoking Services (SSS)

Summary

Introduction

Smoking when pregnant impacts on the health of mothers and unborn babies and on children after birth and as they grow [1,2,3,4]. Women are motivated to quit smoking during pregnancy. Around half of those who smoke report quitting with most doing so just before or on discovering they are pregnant [6,7]; many find it difficult and try multiple times without success [8,9], and rates of decline in smoking at time of delivery appear to have stalled more recently [5]. Most women who quit during pregnancy re-start smoking within 6 months of birth [10,11,12]; this has negative impacts on their health and increases their children’s risk of being exposed to second-hand smoke. Pregnancy and the postpartum period, are crucially important times for helping women to quit as stopping for good improves both women’s and children’s health

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Discussion

Conclusion