Abstract
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.
Highlights
Relapse to tobacco smoking among women who quit smoking for or during pregnancy is common.Up to 76% of spontaneous quitters return to smoking postpartum [1]
We aimed to conduct an exploratory inductive analysis of a qualitative dataset taken from a wider study [15], to understand identity constructs, and the experiences of adjusting simultaneously to a new maternal and non-smoking identity, in order to explore how this might influence the likelihood of maintaining smoking abstinence postpartum
We report a qualitative analysis of data from the Prevention of Return to Smoking Postpartum (PReS) study, an early phase study to develop an intervention to maintain smoking abstinence postpartum
Summary
Up to 76% of spontaneous quitters return to smoking postpartum [1]. Relapse to smoking is a critical public health problem, as there are significant personal and wider societal health costs of a return to smoking [2,3,4]. Babies exposed to second-hand smoke are more likely to suffer from poor infant health outcomes [2]. There are important psychosocial implications, as children of families where smoking behavior is the norm are more likely to become smokers themselves in later life, perpetuating a cycle of health inequality [5]. As a smoker or non-smoker, mothering identity, social identity and relationships are strongly connected to postpartum smoking relapse [6,7,8,9,10].
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