Pregnancy and the struggle to quit smoking

The negative effects of smoking during pregnancy are well documented. Health care providers typically advise pregnant women who smoke usually to quit for their health as well as for the health of their fetus. Most women are familiar with the need to stop smoking while pregnant. Hospitals offer various smoking cessation services. However, the literatures reveals a low uptake of smoking cessation services among pregnant women. The purpose of this paper is to explore the smoking cessation experience and feelings amongst women during pregnancy and assess smoking cessation intervention in antenatal care. Findings may provide health care providers a better understanding of this issue and help women overcome related challenges.     

WIC providers' perspectives on offering smoking cessation interventions

PURPOSE: To examine the perspectives of WIC clinic providers on offering smoking cessation interventions for pregnant women. STUDY DESIGN AND METHODS: Four focus groups consisting of WIC nurses, dietitians, and social workers (N = 25) were conducted at WIC clinics in eastern Iowa. Researchers developed discussion guidelines to determine how WIC providers currently approached pregnant women who smoke cigarettes and what they considered barriers to providing effective smoking cessation interventions. Code mapping was used to analyze focus group discussions. RESULTS: Factors influencing the ability of WIC staff to provide a smoking cessation intervention for pregnant women included available time, clinic priorities, staff approaches to clients, and staff training. In addition, providers expressed concerns about educational materials for clients as well as additional client issues that prevented smoking cessation. The absence of mechanisms to track clinic outcomes related to smoking cessation was also noted. CLINICAL IMPLICATIONS: WIC providers have time limitations that may necessitate minimal or low-intensity interventions for smoking cessation, but did not know that such approaches are actually effective. WIC providers require more education about the entire issue of smoking cessation in order to become more proactive in their attempts to help pregnant women quit. Training that enhances self-efficacy and understanding of the impact of smoking on mothers, infants, and children should be initiated to motivate staff to intervene. Another strategy to motivate WIC staff in this regard could be tracking clinic outcomes in helping women to quit smoking or prevent relapse.     

Partner influences on smoking cessation: A longitudinal study of couple relationships

Introduction: Despite declines in population tobacco use, smoking remains unacceptably high. Smoking cessation may be particularly difficult in couple relationships when partners continue to smoke, and when relationship satisfaction is low. This study examined the longitudinal influence of partner tobacco use and relationship satisfaction on the likelihood of smoking cessation. Methods: Data were obtained from 238 tobacco-using couples aged between 18 and 45 over three assessments from a nationally representative sample of Australian households. Results: There was high concordance between partner smoking six years after the initial assessment, with a little more than three-quarters (76.1%) of non-smokers residing with partners who had also ceased smoking. Step-wise logistic regression models indicated that females were more likely to cease smoking if their partners had previously quit. Males were more likely to quit smoking when they perceived their relationship as highly satisfying and their partner had stopped smoking. Female partners were also more likely to quit smoking when they were highly satisfied with their relationships. Conclusions: Both partner’s smoking status and relationship satisfaction are important considerations in smoking-related cessation. For entrenched smokers in couple relationships, involvement of partners in interventions may be useful.     

Abuse and smoking cessation in clinical practice

Aims and objectives. This discursive paper explores issues of abuse during smoking cessation counselling. Background. During a training session for a smoking cessation intervention pilot study, nurses expressed concerns about issues of abuse that had previously surfaced during cessation counselling in their practice. Abused women are more likely to smoke. As guidelines recommend integrating cessation interventions into practice, issues of abuse are likely to surface. Methods. A literature review and synthesis of abuse and smoking cessation was undertaken to arrive at recommendations for practice. Results. There are a few suggestions about how to manage abuse within cessation counselling, but none have been studied: (1) integrate stress‐management strategies, (2) assess for abuse, (3) provide separate interventions for partners to create a safe environment, and (4) develop interventions that consider the relationship couples have with tobacco. However, coping strategies alone do not address abuse, screening without treatment is not helpful, and partner interventions assume both partners are open to quitting/counselling. In contrast, as with all clinical practice, abuse and cessation would be considered separate but intertwined problems, and following best practice guidelines for abuse would provide the guidance on how to proceed. After care has been taken to address abuse, it is the patient’s decision whether to continue with cessation counselling. Conclusion. Guidelines addresses both care planning and the ethical/legal issues associated with the disclosure of abuse and provide a practical tool for addressing abuse that obviates the need to tailor cessation interventions to abuse. Relevance to clinical practice. This paper clarifies a relationship between smoking and abuse and the subsequent implications for smoking cessation interventions and highlights the importance of addressing abuse and smoking cessation separately, even though they are interrelated problems. It provides nurses with appropriate initial responses when abuse is disclosed during an unexpected encounter such as during a smoking cessation intervention.     

Social attitudes towards smoking in pregnancy in East Surrey: A qualitative study of smokers,former smokers and non-smokers

A qualitative study was undertaken to explore social attitudes towards smoking by pregnant women, mothers of preschool children and their partners based in Merstham and Horley, East Surrey. All respondents felt that smoking in pregnancy was associated with considerable social stigma and negative social attitudes. Non-smokers were particularly negative in their views on smoking in pregnancy feeling that it was socially unacceptable. Women who smoked during pregnancy reported various negative social experiences such as receiving criticism from health professionals and community associates. They reported feeling under pressure to quit to achieve social acceptability as much as for health improvements. Some pregnant smokers denied smoking to health professionals, partners and colleagues and used private smoking places out of public view to reduce the chances of detection. Women who smoked or had a partner who smoked were more accepting of smoking in pregnancy than non-smokers and former smokers. Moreover, residents from the more socio-economically deprived area of Merstham were more tolerant of smoking in pregnancy and parenthood, compared to Horley-based respondents, regardless of their personal smoking status. They gave examples of local women they knew who had smoked in pregnancy without apparent complication. While all respondents were aware of health risks associated with smoking, smokers did not feel the risks were personally relevant to them and were exaggerated in an anti-smoking society. Health professionals need to be aware that pregnant women may not disclose smoking activity due to perceived social stigma and may require more intensive smoking cessation support services in socio-economically deprived areas.     

Barriers to smoking cessation in pregnancy: a qualitative study

The magnitude of smoking as a public health concern in Britain is reflected in the recent government investment to develop smoking cessation services. Smoking in pregnancy is a priority. This article presents the findings of a small qualitative research study exploring barriers to pregnant women stopping smoking. The research was conducted in deprived areas of South Yorkshire, with levels of smoking-related ill health higher than the national average. The study participants revealed a belief system resulting in a self-fulfilling prophecy of relapse or failure to quit. The role and meaning of smoking for women with a high caring burden and socio-economic problems resonate strongly with earlier studies. Other barriers were the influence of family and friends, how women interpreted facts relating to smoking risks and the nature of smoking cessation service delivery. Community nursing staff have a potential in the delivery of smoking cessation interventions. Effective training should be a priority.     

Nurses' perspectives of smoking initiation, addiction, and cessation

BACKGROUND: It is estimated that 18% of registered nurses smoke. Although nurses can make an important contribution to national cessation efforts, continuing smoking among nurses has been cited as one of the barriers against higher nursing involvement. OBJECTIVES: To develop a national program to assist nurses in smoking cessation through an in-depth understanding of issues related to nurses' attitudes toward smoking and quitting, and to explore nurses' preferences for smoking cessation interventions. METHODS: Eight focus groups were conducted in four states with nurses who were current or former smokers. Content analysis was used to identify major themes. RESULTS: Four themes were identified: initiation of smoking and addiction, myths and misconceptions about quitting, overcoming addictions, and strategies for enhancing successful cessation. Nurses described addiction and cessation efforts similar to those of the general population. However, nurses experienced guilt related to their smoking, and perceived a lack of understanding by nonsmoking colleagues and managers about their need of support for smoking cessation. Nurses who had successfully quit smoking were motivated by health concerns, pregnancy, and their children. Nurses suggested many interventions that would be supportive of their quit attempts, such as worksite services and Internet-based support groups. CONCLUSIONS: Nurses expressed the need for smoking cessation interventions similar to that of the general population, and for additional support that recognizes two concerns: confidentiality about their smoking in terms of the general public, and support along with counseling with regard to their feelings of shame and guilt in relation to their public image as nurses.     

Developing guidelines for smoking cessation interventions for pregnant adolescents.

More than 400,000 deaths a year in the United States are attributed to active and passive tobacco smoke exposure. Healthy People 2000 objectives target a reduction in the tobacco use of high-risk populations such as youth and pregnant women. This article describes guidelines for health professionals to address smoking cessation when working with pregnant adolescents and teen mothers who smoke.     

Characteristics of smoking in low-income pregnant Latina and white women

Smoking during pregnancy is hazardous as it poses numerous risks to both the mother and the unborn child. Formerly, interventions that were successful for White smokers were thought to be equally appropriate for all smokers. It is now acknowledged that there is a need to tailor interventions for distinct ethnic and cultural groups. This study was designed to identify variables that are associated with smoking status in a low-income sample of pregnant Latina and White women. Results indicate that Latinas had lower levels of addiction to cigarettes and were less likely to have partners who smoked than White women. Identifying differences in the characteristics of ethnically diverse pregnant smokers will assist in the development of interventions that are tailored for women who attend prenatal clinics.     

Smoking cessation intervention with pregnant women and new parents (part 2): A focus group study of health visitors and midwives working in the UK

A qualitative, focus group study was undertaken in the United Kingdom with NHS-employed health visitors and midwives to examine their attitudes towards smoking in pregnancy and their perception of their professional role in smoking cessation/relapse prevention work with women in their care. The health visitors and midwives felt there were several social and personal reasons why women smoke in pregnancy. Most felt a professional responsibility to intervene with smokers, even though they also felt their intervention was ineffective unless patients were ‘ready’ to quit and a multidisciplinary team was in place to support their patients according to their individual needs. Midwives and health visitors are willing to promote smoking cessation with their patients, but feel there are personal and organisational barriers to providing an effective service. Respondents held mixed views on the effectiveness of interventions for smoking cessation highlighting the need for evidence-based training.     

Smoking habits before, during and after pregnancy among Swedish women and their partners in suburban Stockholm.

Smoking habits of pregnant women and their partners at three health centres in Stockholm, Sweden, were monitored by a postal questionnaire. Of 582 women enlisted at the antenatal clinics, 433 (74%) were included. 253 (58%) women and 230 (53%) partners responded. 30% of the women were smokers at the start of pregnancy, compared with 27% of the men. During pregnancy 18% continued to smoke, and after the birth of the child 21% were smokers. The male partners stopped or decreased smoking less often. Fewer women aged 25 or more were smokers. The number of heavy smokers decreased considerably during and after pregnancy. The women were more prone to stop smoking if the partner was a non-smoker. 87% made some restriction in their smoking habits after the baby was born.     

HISPANIC WOMEN AND AIDS: GENDERED RISK FACTORS AND CLINICAL IMPLICATIONS

Persons with serious mental illness (SMI) are faced with substantial challenges to their health. This population is two to three times more likely to smoke cigarettes than persons who do not suffer from mental illness. In particular, young adults are at high risk for vulnerability to both SMI and cigarette smoking. Although there are proven methods for smoking cessation, both pharmacologic and non-pharmacologic interventions show limited usefulness for SMI who smoke. Alternative health care options as well as support groups and physical exercise are discussed as methods that may be useful in smoking cessation. Finally, integration of smoking cessation programming into existing mental health treatment services may offer the greatest opportunity for client success.     

Serious mental illness and smoking cessation

Persons with serious mental illness (SMI) are faced with substantial challenges to their health. This population is two to three times more likely to smoke cigarettes than persons who do not suffer from mental illness. In particular, young adults are at high risk for vulnerability to both SMI and cigarette smoking. Although there are proven methods for smoking cessation, both pharmacologic and non-pharmacologic interventions show limited usefulness for SMI who smoke. Alternative health care options as well as support groups and physical exercise are discussed as methods that may be useful in smoking cessation. Finally, integration of smoking cessation programming into existing mental health treatment services may offer the greatest opportunity for client success.     

Smoking cessation for older people: neither too little nor too late

Community nurses are uniquely placed to facilitate smoking cessation with older people. Older people who smoke in the home expose not only themselves to the many health risks associated with tobacco use but also partners, children and grandchildren through second-hand smoke. Yet research has found that community nurses have several concerns about raising the issue of smoking in the home with older people including taking away one of their few pleasures; fear that the damage is done; damaging the professional relationship and a lack of knowledge about smoking cessation advice and services. In this article the authors acknowledge and challenge these concerns to encourage community nurses to embed smoking cessation in their daily practice with older people.     

A tailored video intervention to reduce smoking and environmental tobacco exposure during and after pregnancy: Rationale,design and methods of Baby's Breath

Low-cost interventions to decrease environmental tobacco smoke (ETS) exposure of pregnant women and their newborns are needed to lower health risks of exposed fetuses and infants. Baby's Breath is a tailored video intervention developed and tested in a randomized controlled trial. The study aimed to test the efficacy of tailored video versus usual care approaches to reduce the ETS exposure of fetuses of low-income women during and after pregnancy; and to assess this intervention separately among non-smoking and smoking women. Participating women, recruited early in pregnancy, who spoke English, were at least 18 years old, smoke exposed (current smokers, quit smoking on their own, or were exposed to smoke of others), pregnant with only one baby, and had access to a telephone and video player, were randomized to experimental or control conditions. Intervention participants received newsletters containing content aimed at smoking cessation and avoidance (5 during and 3 after pregnancy), in addition to videos (3 during and 2 after pregnancy) individually tailored on behavioral theory-based survey questions. Comparison participants received newsletters and videos on healthy pregnancy topics. Outcomes included salivary cotinine of both mother and baby (32 weeks gestation and 6 months postpartum) as well as self-reported ETS exposure and avoidance behaviors. This study may demonstrate the efficacy of a low-cost intervention to decrease ETS exposure, and will fill an important gap in describing the utility of this innovative intervention technology, as well as demonstration of potential benefits to this type of intervention.     

Why tobacco is a women's health issue

Tobacco use is the leading cause of preventable death amongwomen but is under-recognized as a critical women's health issue.This article provides an overview of the current data about womenand tobacco use, tobacco industry tactics that have resulted in theincreased smoking among women, and gender differences inhealth effects of tobacco use and exposure to secondhand smoke,and in cessation interventions. Resources for clinicians are pro-vided that specifically focus on women and tobacco.     

Smoking Cessation Basics: An Essential Component of Radiation Therapy Clinical Practice

Tobacco addiction is among the top preventable health risks to combat cancer. Smoking is responsible for almost 30% of cancer deaths in Canada; it increases the risk of developing cancers of the lung, mouth, throat, larynx, cervix, pancreas, esophagus, colon, rectum, kidney, and bladder and in acute myeloid leukemia. Nonsmokers exposed to second-hand smoke are also at higher risk of developing lung cancer and other respiratory diseases. More than 300 nonsmokers die from lung cancer each year due to second-hand smoke. Smoking cessation programs can improve overall health and quality of life for cancer survivors. Most cancer patients would like to quit smoking, but they find it difficult. Advice and support from health care professionals can increase success. A cancer diagnosis may be the impetus required for patients to make that positive change in their lives. Studies have shown that continued smoking while receiving radiation therapy limits treatment efficacy. Additionally, smoking interferes with chemotherapy and can negatively affect wound healing. Smoking cessation is an evidence-based program; patients who quit smoking are less likely to experience recurrence of disease or additional primary cancers. Even brief interventions may be what the patient needs to assess the benefits of quitting. Many cancer health care professionals do not feel prepared to discuss smoking cessation with their patients. A large number of cancer patients survive more than 5 years past their diagnosis, making smoking cessation an even more important focus in long-term disease management and improving the length and quality of life for these patients. The aim of this directed reading is to assist radiation therapists to support their patients who smoke and integrate smoking cessation into clinical practice.     

Smoking cessation interventions for pregnant women to prevent low birth weight: what does the evidence show?

PURPOSE: To review the epidemiology of smoking cessation and low birth weight (LBW), the use of meta-analysis and cost-benefit analysis in analyzing this problem, and the financial considerations of institutionalizing smoking cessation interventions. Recommendations for clinicians caring for smoking pregnant women and suggestions for implementing the recommended strategies for smoking cessation programs are included. DATA SOURCES: Comprehensive review of smoking and low birth weight (LBW) outcomes, cost-effectiveness, and tobacco use and dependence literature; clinical practice guidelines, and a widely cited meta-analysis on smoking cessation. CONCLUSIONS: Research has shown that smoking is a significant factor in LBW outcomes and that cessation is especially critical for pregnant women. IMPLICATIONS FOR PRACTICE: Careful evaluation of the intervention research is required before designing local interventions to ensure the most effective measures are utilized.     

Smoking cessation strategy use among pregnant ex-smokers

There is strong evidence for the beneficial health effects associated with smoking cessation during pregnancy. Although many pregnant women spontaneously quit smoking during pregnancy, postpartum relapse is high. Evidence suggests that pregnant women do not use smoking cessation strategies as identified by the 40-item Processes of Change Scale as frequently as others who quit smoking. The purpose of this study is to identify factors associated with pregnant exsmokers' use of experiential and behavioral smoking cessation strategies. A cross-sectional survey design is used for the study. From a sample of 201 primarily low-income pregnant women recruited to participate in a larger study, 58 were biologically confirmed ex-smokers. Multiple regression analysis reveals that motivation to quit smoking is the only significant factor explaining the use of experiential and behavioral smoking cessation strategies, accounting for 44% of the variance in experiential processes and 31% of the variance in behavioral processes.