Abstract
BackgroundLimited research exists on interest in and use of smoking cessation support in pregnancy and postpartum.MethodsA 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.ResultsIn 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).ConclusionsWhen 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.ImplicationsThere 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.
Highlights
Reducing smoking rates in pregnancy remains a global public health priority.[1]
In the UK at least, currently policy relating to the offer of cessation support is weighted towards early pregnancy, even if strictly following National Institute for Health and Care Excellence (NICE) guidance.[5]. This is reflected by our findings, where we found far fewer smokers reporting a discussion with a health professional about stopping smoking in mid to late pregnancy compared with early pregnancy
To promote interest in cessation support, which was predictive of accessing support, our findings suggest that increasing motivation to stop smoking, ensuring health professionals discuss stopping smoking and enhancing women’s confidence that their chances of stopping smoking are higher if they receive professional support are important targets for interventions
Summary
Reducing smoking rates in pregnancy remains a global public health priority.[1]. While smoking in pregnancy rates have continued to reduce over the last decade,[2] rates remain relatively high in many European and American nations. Guidance from the UK National Institute for Health and Care Excellence (NICE) recommends that all pregnant women are carbon monoxide (CO) breath tested, with all those identified as smokers provided with risk information and referred to local National Health Service (NHS) Stop Smoking Services (SSS) for specialist behavioural support and Nicotine Replacement Therapy (NRT) where appropriate.[5] This ‘opt-out’ referral pathway can increase both access rates to the English SSS, from 11% to 18% in one site,[6] and abstinence rates.[6,7] Use of other smoking cessation support among pregnant smokers is largely unknown. Cessation support should be offered throughout pregnancy and after delivery
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