A content analysis of self-reported barriers and facilitators to preventing postpartum smoking relapse among a sample of current and former smokers in an underserved population

The Understanding of Maternal Smoking among Women who were Smoking or had Quit Smoking during Pregnancy

Background

Maternal tobacco smoking during pregnancy is associated with adverse health effects for the woman, fetus, and child, including such serious effects as preterm birth, low birth weight, stillbirth, and neonatal and sudden infant death. Smoking cessation during pregnancy reduces health risks.

Purpose

In order to support pregnant women to quit smoking, it is essential to know determinants of quitting smoking in pregnancy. The purpose of this research was to examine women's understanding of maternal smoking, in terms of their beliefs, in relation to quitting smoking during pregnancy.

Methods

The study was a cross-sectional survey with anonymous questionnaires. The sample consisted of 161 pregnant and postnatal women who were continuing or had continued to smoke during pregnancy or had quit smoking during pregnancy. Logistic regression was used to determine the impact of women's understanding of maternal smoking on quitting smoking in pregnancy.

Results

A large majority of the women had low to moderate understanding of maternal smoking. Those with higher levels of understanding were more likely to quit smoking during pregnancy than were those with a low level of understanding. Not having children prior to the current pregnancy or childbirth also increased the likelihood of quitting smoking during pregnancy while being without a partner combined with having a longer duration of smoking decreased the likelihood of quitting smoking during pregnancy.

Conclusion

As a modifiable factor, pregnant women's understanding of maternal smoking can be readily targeted with informational interventions in an effort to help them quit smoking.

Challenges Experienced by Women Who Smoke During Pregnancy or Postnatally

Maternal smoking during pregnancy and maternal smoking postnatally are important public health concerns worldwide. Smoking adversely affects the woman's general health and is causally related to pregnancy complications and serious health outcomes for the child, such as stillbirth, preterm delivery, low birth weight, and sudden infant death. The purpose of this research was to examine maternal smoking through a quantitative descriptive survey of 164 women, 120 who were pregnant and 44 who were postnatal. Women experienced barriers to quitting smoking, including dealing with stress, being exposed to smokers, not being ready to quit, not knowing how to quit, not looking for or not being able to find information about smoking or quitting smoking, and lacking adequate social and healthcare provider support. On the other hand, women revealed characteristics that suggest they might have had improved potential for quitting smoking, including having negative feelings about smoking, having cut down on smoking, smoking at a low level, having made quit attempts, thinking it would not be hard to quit smoking, being in the preparation stage of behavioral change, and thinking their healthcare providers (HCPs) would help them if they decided to quit. Taken together, those findings suggest that HCPs could offer important assistance to help women achieve smoking cessation. However, more research needs to be conducted to clarify the role and effectiveness of various HCPs in smoking cessation interventions and to identify measures to strengthen their provision of such interventions.

Postpartum Tobacco Use and Perceived Stress among Alaska Native Women: MAW Phase 4 Study

Prior research explored reasons for tobacco use among pregnant Alaska Native (AN) women but did not address the postpartum period. This study followed up with AN women one to three years postpartum who had participated in a prenatal smoking cessation intervention study (Motivate Alaska Women (MAW) Phase 3) and had consented to be re-contacted for future studies. Of 47 eligible women, 32 (68%) participated. A semi-structured phone interview was conducted a mean of 2.0 years after delivery (range 1.6-2.8). Measures assessed self-reported tobacco use status in the 12 months after delivery, at 12 months postpartum, and at the time of the interview; reasons for maintaining abstinence, continued use, or relapse; and included the Perceived Stress Scale (PSS) and Negative Affect (NA) scale. Content analysis was used to generate themes from open-ended response items. Tobacco use was reported by 23 women (72%) at delivery, 30 (94%) within the 12 months after delivery, 27 (84%) at 12 months postpartum, and 29 (91%) at the time of the interview. Among nine women not using tobacco at delivery, seven (78%) relapsed during the 12 months after delivery. Of the 29 current tobacco users, 28 (97%) smoked cigarettes. Twenty-seven participants (84%) reported stress and 15 (52%) indicated addiction as reasons for continuing, starting, or resuming tobacco use. Types of stressors were related to parenting and traumatic experiences. Among current tobacco users, mean NA score (18.7) was significantly higher (p = 0.01) than the normative mean (14.8), but no differences were detected for PSS score. In this sample of AN women, postpartum tobacco use was highly prevalent, and stress was a primary reason that women endorsed for using tobacco. These preliminary results have several practice and research implications for exploring ways to support non-tobacco use among postpartum AN women.

Direct and Indirect Effects of Psychological Distress on Stress-Induced Smoking

OBJECTIVE

Numerous studies have modeled the effects of stress in the laboratory, demonstrating that smokers who are exposed to experimental stressors exhibit significant increases in acute psychological distress. Whether these stress reactions are predictive of stress-induced smoking during an actual quit attempt, however, has not been examined. Furthermore, the possibility that such effects are particularly strong among smokers with higher ambient levels of distress has not been addressed.

METHOD

Nicotine-dependent smokers (N = 60; 40 women, 20 men) completed the Brief Symptoms Index (BSI) and then participated in a laboratory stress task 1 week before a quit attempt. Acute psychological distress was measured immediately before and after exposure to stressful and neutral stimuli. After they quit, participants completed a smoking diary for 14 days in which they recorded the degree to which their smoking was precipitated by emotional stress.

RESULTS

Consistent with our hypotheses, BSI scores predicted both exaggerated laboratory stress responses (p < .005) and smoking that was attributable to stress during the 14-day postquit period (p < .01). Laboratory stress reactions were predictive of stress-induced smoking (p < .01), and acute psychological stress reactions mediated the effects of BSI on stress-induced smoking.

CONCLUSIONS

Acute psychological stress reactivity is a potential mechanism underlying the effect of stress-induced smoking during a quit attempt.

Review of the Relationships Among Psychosocial Stress, Secondhand Smoke, and Perinatal Smoking

OBJECTIVE

To summarize and evaluate the recently published literature in which the relationships among psychosocial stress, smoking, and exposure to secondhand smoke during the perinatal period are examined, and to describe the characteristics and demographics of the samples.

DATA SOURCES

Electronic databases MEDLINE, Academic Search Complete, CINAHL, Psychology and Behavioral Sciences Collection, and PsychINFO. In addition, hand searches of reference lists supplemented the electronic search.

STUDY SELECTION

English language, peer-reviewed studies published between 2010 and 2015 on the relationships of self-reported or perceived stress, smoking, and secondhand smoke exposure during pregnancy and postpartum were included. Twenty-four studies met the inclusion criteria.

DATA EXTRACTION

Data that specified the relationships among smoking, stress, and secondhand smoke exposure during pregnancy and postpartum were extracted from the studies. A table matrix, available as supplemental material, to summarize the literature and sample characteristics and demographics was created.

DATA SYNTHESIS

Evidence from the included studies supported an association between psychosocial stress specific to pregnancy or from other sources and smoking or smoking relapse during pregnancy or in the postpartum period. In the studies in which it was included, exposure to secondhand smoke was cited as a barrier to abstinence.

CONCLUSION

It is probable that women who persistently smoke in pregnancy experience elevated stress. Further research with longitudinal designs and inclusion of secondhand smoke as a variable are needed.

Stuck in the catch 22: attitudes towards smoking cessation among populations vulnerable to social disadvantage

AIM

To explore how smoking and smoking cessation is perceived within the context of disadvantage, across a broad cross-section of defined populations vulnerable to social disadvantage.

DESIGN

Qualitative focus groups with participants recruited through community service organizations (CSO).

SETTING

Metropolitan and regional settings in Queensland, Australia. Focus groups were held at the respective CSO facilities.

PARTICIPANTS

Fifty-six participants across nine focus groups, including people living with mental illness, people experiencing or at risk of homelessness (adult and youth populations), people living with HIV, people living in a low-income area and Indigenous Australians.

MEASUREMENTS

Thematic, in-depth analysis of focus group discussions. Participant demographic information and smoking history was recorded.

FINDINGS

Smoking behaviour, smoking identity and feelings about smoking were reflective of individual circumstances and social and environmental context. Participants felt 'trapped' in smoking because they felt unable to control the stressful life circumstances that triggered and sustained their smoking. Smoking cessation was viewed as an individual's responsibility, which was at odds with participants' statements about the broader factors outside of their own control that were responsible for their smoking.

CONCLUSION

Highly disadvantaged smokers' views on smoking involve contradictions between feeling that smoking cessation involves personal responsibility, while at the same time feeling trapped by stressful life circumstances. Tobacco control programmes aiming to reduce smoking among disadvantaged groups are unlikely to be successful unless the complex interplay of social factors is carefully considered.

Cognitive-behavioral intervention to promote smoking cessation for pregnant and postpartum inner city women

This study evaluated a theory-guided cognitive-behavioral counseling (CBC) intervention for smoking cessation during pregnancy and postpartum. It also explored the mediating role of cognitive-affective variables on the impact of CBC. Underserved inner city pregnant women (N = 277) were randomized to the CBC or a best practice (BP) condition, each of which consisted of two prenatal and two postpartum sessions. Assessments were obtained at baseline, late pregnancy, and 1- and 5-months postpartum. An intent-to-treat analysis found no differences between the two groups in 7-day point-prevalence abstinence. However, a respondents-only analysis revealed a significantly higher cessation rate in the CBC (37.3 %) versus the BP (19.0 %) condition at 5-months postpartum follow-up. This effect was mediated by higher quitting self-efficacy and lower cons of quitting. CBC, based on the Cognitive-Social Health Information Processing model, has the potential to increase postpartum smoking abstinence by assessing and addressing cognitive-affective barriers among women who adhere to the intervention.

The roles of resilience and childhood trauma history: main and moderating effects on postpartum maternal mental health and functioning

OBJECTIVE

Recently postpartum women participated to investigate main and moderating influences of resilience and childhood history of maltreatment on posttraumatic stress disorder (PTSD), major depressive disorder (MDD), parental sense of mastery, and family functioning.

METHOD

At 4-months postpartum, 214 mothers (145 with a history of childhood abuse or neglect) completed interviews assessing mental health symptoms, positive functioning, resilience and trauma history. Multiple and moderated linear regression with the Connor-Davidson Resilience Scale (CD-RISC) and Childhood Trauma Questionnaires (CTQ) were conducted to assess for main and moderating effects.

RESULTS

Resilience, childhood trauma severity, and their interaction predicted postpartum PTSD and MDD. In mothers without childhood maltreatment, PTSD was absent irrespective of CD-RISC scores. However, for those with the highest quartile of CTQ severity, 8% of those with highest resilience in contrast with 58% of those with lowest CD-RISC scores met PTSD diagnostic criteria. Similar, in those with highest resilience, no mothers met criteria for postpartum MDD, irrespective of childhood trauma, while for those with lowest quartile of resilience, 25% with lowest CTQ severity and 68% of those with highest CTQ severity were depressed. The CD-RISC, but not the CTQ, was predictive of postpartum sense of competence. The CD-RISC and the CTQ were predictive of postpartum family functioning, though no moderating influence of resilience on childhood trauma was found.

CONCLUSIONS

Resilience is associated with reduced psychopathology and improved wellbeing in all mothers. It further serves as a buffer against psychiatric symptoms following childhood trauma. Such findings may assist in identification of those at greatest risk of adverse functioning postpartum, utilization of resilience-enhancing intervention may benefit perinatal wellness, and reduce intergenerational transmission of risk.