"I Was a Full Time Proper Smoker": A Qualitative Exploration of Smoking in the Home after Childbirth among Women Who Relapse Postpartum

Trajectories of Return to Cigarette Smoking Up to 1 Year Postpartum Among People Who Quit Smoking During Pregnancy

INTRODUCTION

Previous work has identified predictors of relapse to smoking postpartum among parenting people who quit during pregnancy, but less is known about the time course of postpartum relapse. The study goals were to document patterns and correlates of smoking resumption among people who quit smoking during pregnancy and were motivated to remain abstinent.

AIMS AND METHODS

We conducted a secondary analysis among participants in a randomized controlled trial of postpartum-specific smoking relapse prevention interventions who self-reported no smoking since the quit date to delivery (n = 280). Participants provided expired air samples of carbon monoxide, and completed self-report measures of mood, perceived stress, and demographic and pregnancy-related information. Timeline follow-back interviews were conducted at the end of pregnancy and 12-, 24-, and 52-weeks postpartum.

RESULTS

The largest group (49.7% of participants) belonged to a trajectory reflecting abstinence across 1 year postpartum. Another 13% remained abstinent 5-6 months after delivery. However, one in five started to smoke consistently within 100 days after delivery, and 16% relapsed in a pattern that can be described as inconsistent smoking. Participants with more prior quit attempts and those who smoked more cigarettes prior to their quit attempt were more likely to relapse within 100 days of delivery.

CONCLUSIONS

The first 3 months postpartum represent a critical window for relapse prevention, given that most individuals who relapsed did so in the first 100 days or so after delivery. Assessing prior smoking history can help identify pregnant people who will need additional support in the early postpartum period.

IMPLICATIONS

Relapse to smoking during the year after childbirth is common, but the time course of relapse after delivery is poorly understood. This study provides evidence for 4 distinct trajectories of relapse, and highlights variables linked to early relapse that may improve efforts to target and time intervention efforts. Specifically, assessing age at initiation, quantity of tobacco use prior to quit attempt, and number of previous quit attempts will identify pregnant people at greatest risk of early relapse. These findings also suggest that additional support early in the postpartum period is crucial for most people in the postpartum who will relapse.

Perceptions of Safety Around Use of Cannabis and Nicotine/Tobacco in Pregnancy

The perceived safety of cannabis and nicotine/tobacco use contribute to use of these substances in pregnancy. We assessed time trends in self-reported perception of safety of use of cannabis and nicotine/tobacco among US women of reproductive age. We also reviewed qualitative literature to elucidate factors contributing to the perceived safety of use of cannabis and nicotine/tobacco. US women increasingly perceive cannabis use as posing no health risks; whereas cigarette smoking is perceived as posing substantial health risks. Qualitative studies suggest that personal experiences, sociocultural norms, and environmental factors contribute to the perceived safety of cannabis and nicotine/tobacco use in pregnancy.

[Management of Resumption Risk in Postpartum for Women who Quit Smoking During Pregnancy - CNGOF-SFT Expert Report and Guidelines for Smoking Management During Pregnancy]

According to the 2016 National Perinatal Survey, 30.0 % of women smoked before pregnancy, 45.8 % quit smoking in the 1st or 2nd trimester. Many do this only for pregnancy and the risk of postpartum relapse is high (up to 82 % at 1 year). The main factors associated with postpartum abstinence are breastfeeding, not having a smoker at home, and having no symptoms of postpartum depression. No drug treatment can be recommended to prevent the smoking postpartum relapse. Only global counseling can prevent this risk.

The opinions regarding smoking behaviors in the postpartum period of the women who quit smoking during pregnancy: A qualitative study

PURPOSE

Research is designed to know the opinions of women who quit smoking during pregnancy on changing smoking behaviors during the postpartum period.

DESIGN AND METHODS

Forty-seven women who quit smoking during pregnancy were included in the sample of study. Data were collected using in-depth face-to-face interview method with semistructured interview forms.

FINDINGS

Most of the reasons of women about their restarting were either individual such as the need to cope with stressful events in the family, or baby-related such as termination of breastfeeding.

PRACTICE IMPLICATIONS

Determining causes of relapse will guide nurses to develop effective intervention to reduce smoking rates in women.

An Interpretative Phenomenological Analysis of Discontinued Use of the E-Cigarette

Introduction: Many UK smokers use e-cigarettes as a quitting aid; however, a substantial number discontinue use of the e-cigarette and revert to smoking. Understanding why this may happen is important both for individuals and for stop smoking services.

Aims: To explore young adult smokers’ experiences of use and discontinued use of the e-cigarette.

Methods: Semi-structured interviews were conducted with six participants who tried e-cigarettes for at least seven days and returned to smoking. Data was transcribed and analysed using interpretative phenomenological analysis.

Results: Findings suggested participants held conflicting attitudes about using e-cigarettes, which undermined attempts to quit smoking, and led to the discontinuation of the e-cigarette. These conflicts centred on participants’ discomfort with the e-cigarette or vaping identity, lack of abstinence self-efficacy and navigation of barriers to e-cigarette use. The complex interplay of these factors may have led to an underestimation of the individual effort required to continue vaping and reinforced participants’ perception of the e-cigarette as an inferior product to the cigarette.

Conclusions: Future research should focus on the role of identity, self-efficacy, control and smokers’ expectations of e-cigarettes on smoking cessation as these may be important factors to consider for a more tailored service for e-cigarette users.

Smoking during pregnancy, stigma and secrets: Visual methods exploration in the UK

BACKGROUND

Moral judgements are commonly directed towards mothers through reference to health behaviour in pregnancy, and working-class mothers are particularly subject to this moral gaze.

AIM

To gain an in-depth understanding of the health issues affecting 10 low income pregnant women from deprived areas of south Wales, UK.

METHODS

Participants completed visual activities (timelines, collaging or thought bubbles and dyad sandboxing) prior to each interview. Participants' visual representations were used in place of a topic guide, to direct the interview. Guided by feminist principles, 28 interviews were completed with 10 women. Data were analysed thematically.

FINDINGS

Smoking was discussed at length during interviews, and this paper focuses on this issue alone. Five of the participants had smoked during pregnancy. Negative reactions were directed towards pregnant women who smoked in public, resulting in maternal smoking being undertaken in private. Participants also reported awkward relationships with midwives and other health professionals, including receipt of public health advice in a judgemental tone.

DISCUSSION

Smoking during pregnancy is a particularly demonised and stigmatised activity. This stigma is not always related to the level of risk to the foetus, and instead can be seen as a moral judgement about women. We urgently need to move from individualised neo-liberal discourses about the failure of individual smokers, to a more socio-ecological view which avoids victim blaming.

CONCLUSION

Stigma from friends, family, strangers and health professionals may lead to hidden smoking. This is a barrier to women obtaining evidence based stop smoking support.

Smoking and Smoking Cessation During Pregnancy. An Analysis of a Hospital Based Cohort of Women in Romania

Perinatal smoking is associated with a wide range of negative reproductive and pregnancy outcomes. The aim of the current study was to examine the prevalence and characteristics of women who report smoking prenatally and quit during pregnancy in a large sample of Romanian women. Understanding which women are more likely to quit will contribute to public health knowledge that will help more women stop smoking prior to or during pregnancy and prevent relapse postpartum. This cross-sectional analysis was conducted based on cross-sectional data collected between May 2012 and April 2015 as part of a cohort study of pregnancy implemented in six clinical settings in central Romania (N = 2370). Approximately 28 % of the sample reported smoking in the 6 months prior to learning they were pregnant. Half of the women who reported smoking 6 months before learning of their pregnancy, also reported that they stopped smoking by the time of the interview. Overall, tobacco consumption decreased from a sample mode of 10 cigarettes/day (range: 1-30) before pregnancy, to a sample mode of 5 cigarettes/day (range: 1-25) at the time of the interview. Women who quit had a higher socioeconomic position, were more likely to live in urban areas, partnered, primigravid, nulliparous, and reported lower anxiety and more social support. The combination of a socioeconomic gradient, less anxiety, and more social support suggests that efforts should be increased to target lower income, less educated, multigravid, and multiparous women and to develop programs that heighten social support and alleviate anxiety.

Effects of cigarette smoke exposure during suckling on food intake, fat mass, hormones, and biochemical profile of young and adult female rats

PURPOSE

Children from smoking mothers have a higher risk of developing obesity and associated comorbidities later in life. Different experimental models have been used to assess the mechanisms involved with this increased risk. Using a rat model of neonatal nicotine exposure via implantation of osmotic minipumps in lactating dams, we have previously shown marked sexual dimorphisms regarding metabolic and endocrine outcomes in the adult progeny. Considering that more than four thousand substances are found in tobacco smoke besides nicotine, we then studied a rat model of neonatal tobacco smoke exposure: adult male offspring had hyperphagia, obesity, hyperglycemia, hypertriglyceridemia, secondary hyperthyroidism and lower adrenal hormones. Since litters were culled to include only males and since sexual dimorphisms had already been identified in the nicotine exposure model, here we also evaluated the effects of tobacco smoke exposure during lactation on females.

METHODS

Wistar rat dams and their pups were separated into two groups of 8 litters each: SMOKE (4 cigarettes per day, from postnatal day 3 to 21) and CONTROL (filtered air). Offspring of both sexes were euthanized at PN21 and PN180.

RESULTS

Changes in male offspring corroborated previous data. At weaning, females showed lower body mass gain and serum triglycerides, but no alterations in visceral fat and hormones. At adulthood, females had higher body mass, hyperphagia, central obesity, hyperleptinemia, hypercholesterolemia, hypercorticosteronemia, but no change in serum TSH and T3, and adrenal catecholamine CONCLUSIONS: Sexual dimorphisms were observed in several parameters, thus indicating that metabolic and hormonal changes due to smoke exposure during development are sex-dependent.