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Clark MM, Cooper S, Naughton F, Ussher M, Emery J, McDaid L, Thomson R, Phillips L, Bauld L, Aveyard P, Torgerson D, Berlin I, Lewis S, Parrott S, Hewitt C, Welch C, Parkinson G, Dickinson A, Sutton S, Brimicombe J, Bowker K, McEwen A, Vedhara K, Coleman T. Smoking, nicotine and pregnancy 2 (SNAP2) trial: protocol for a randomised controlled trial of an intervention to improve adherence to nicotine replacement therapy during pregnancy. BMJ Open 2024; 14:e087175. [PMID: 38806422 PMCID: PMC11138292 DOI: 10.1136/bmjopen-2024-087175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/24/2024] [Indexed: 05/30/2024] Open
Abstract
INTRODUCTION Smoking during pregnancy is harmful to unborn babies, infants and women. Nicotine replacement therapy (NRT) is offered as the usual stop-smoking support in the UK. However, this is often used in insufficient doses, intermittently or for too short a time to be effective. This randomised controlled trial (RCT) explores whether a bespoke intervention, delivered in pregnancy, improves adherence to NRT and is effective and cost-effective for promoting smoking cessation. METHODS AND ANALYSIS A two-arm parallel-group RCT was conducted for pregnant women aged ≥16 years and who smoke ≥1 daily cigarette (pre-pregnancy smoked ≥5) and who agree to use NRT in an attempt to quit. Recruitment is from antenatal care settings and via social media adverts. Participants are randomised using blocked randomisation with varying block sizes, stratified by gestational age (<14 or ≥14 weeks) to receive: (1) usual care (UC) for stop smoking support or (2) UC plus an intervention to increase adherence to NRT, called 'Baby, Me and NRT' (BMN), comprising adherence counselling, automated tailored text messages, a leaflet and website. The primary outcome is biochemically validated smoking abstinence at or around childbirth, measured from 36 weeks gestation. Secondary outcomes include NRT adherence, other smoking measures and birth outcomes. Questionnaires collect follow-up data augmented by medical record information. We anticipate quit rates of 10% and 16% in the control and intervention groups, respectively (risk ratio=1.6). By recruiting 1320 participants, the trial should have 90% power (alpha=5%) to detect this intervention effect. An economic analysis will use the Economics of Smoking in Pregnancy model to determine cost-effectiveness. ETHICS AND DISSEMINATION Ethics approval was granted by Bloomsbury National Health Service's Research Ethics Committee (21/LO/0123). Written informed consent will be obtained from all participants. Findings will be disseminated to the public, funders, relevant practice/policy representatives, researchers and participants. TRIAL REGISTRATION NUMBER ISRCTN16830506. PROTOCOL VERSION 5.0, 10 Oct 2023.
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Affiliation(s)
- Miranda M Clark
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Sue Cooper
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Felix Naughton
- Addiction Research Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Michael Ussher
- Population Health Research Institute, St George's University of London, London, UK
- Institute of Social Marketing and Health, University of Stirling, Stirling, UK
| | - Joanne Emery
- Addiction Research Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Lisa McDaid
- Addiction Research Group, School of Health Sciences, University of East Anglia, Norwich, UK
| | - Ross Thomson
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Lucy Phillips
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Linda Bauld
- Usher Institute and Behavioural Research UK, The University of Edinburgh, Edinburgh, UK
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David Torgerson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Ivan Berlin
- Department of Medical Pharmacology, Pitié Salpêtrière Hospital-Sorbonne Université, Paris, France
| | - Sarah Lewis
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Steve Parrott
- Department of Health Sciences, University of York, York, UK
| | - Catherine Hewitt
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Charlie Welch
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Gill Parkinson
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Anne Dickinson
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Stephen Sutton
- Behavioural Science Group, University of Cambridge, Cambridge, UK
| | - James Brimicombe
- Cambridge Research Methods Hub, University of Cambridge, Cambridge, UK
| | - Katharine Bowker
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
| | - Andrew McEwen
- National Centre for Smoking Cessation and Training (NCSCT), Dorchester, UK
- Department of Behavioural Science and Health, University College London, London, UK
| | | | - Tim Coleman
- Centre for Academic Primary Care, School of Medicine, University of Nottingham, Nottingham, UK
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Tatton C, Lloyd J. Understanding for whom, under what conditions and how smoking cessation services for pregnant women in the United Kingdom work-a rapid realist review. BMC Public Health 2023; 23:2488. [PMID: 38087281 PMCID: PMC10717267 DOI: 10.1186/s12889-023-17378-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Maternal smoking in pregnancy is associated with several adverse maternal and infant health outcomes including increased risk of miscarriage, stillbirth, low birth weight, preterm birth, and asthma. Progress to reduce rates of smoking at time of delivery in England have been slow and over the last decade, less than half of pregnant women who accessed services went onto report having quit. This realist review was undertaken to improve the understanding of how smoking cessation services in pregnancy work and to understand the heterogeneity of outcomes observed. METHODS The initial programme theory was developed using the National Centre for Smoking Cession and Training Standard Treatment Programme for Pregnant Women and the National Institute for Health and Care Excellence guidance on treating tobacco dependency. A search strategy and inclusion criteria were developed. Four databases were searched to identify published papers and four websites were hand searched to identify any unpublished literature that could contribute to theory building. Realist logic was applied to the analysis of papers to identify the contexts in which the intended behaviour change mechanism(s) were triggered, or not, and towards what outcomes to develop context mechanism outcome configurations. RESULTS The review included 33 papers. The analysis produced 19 context mechanism outcome configurations structured under five closely interconnected domains (i) articulating harm, (ii) promoting support, (iii) managing cravings, (iv) maintaining commitment and (v) building self-efficacy. This review identifies two key processes involved in how services achieve their effects: how material resources are implemented and relationships. Of the two key processes identified, more existing literature was available evidencing how material resources are implemented. However, the review provides some evidence that non-judgemental and supportive relationships with healthcare workers where regular contact is provided can play an important role in interrupting the social cues and social practice of smoking, even where those around women continue to smoke. CONCLUSIONS This review clarifies the range of interconnected and bi-directional relationships between services and the personal and social factors in women's lives. It underscores the importance of aligning efforts across the models five domains to strengthen services' ability to achieve smoking cessation.
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Affiliation(s)
- Claire Tatton
- Faculty of Health and Life Sciences, Department of Health and Community Sciences, University of Exeter, Exeter, UK.
| | - Jenny Lloyd
- Faculty of Health and Life Sciences, Department of Health and Community Sciences, University of Exeter, Exeter, UK
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McDaid L, Emery J, Thomson R, Coleman T, Cooper S, Dickinson A, Kinahan-Goodwin D, Phillips L, Naughton F. Development of "Baby, Me, & NRT": A Behavioral Intervention to Improve the Effectiveness of Nicotine Replacement Therapy in Pregnancy. Nicotine Tob Res 2023; 25:1770-1780. [PMID: 37349134 PMCID: PMC10475605 DOI: 10.1093/ntr/ntad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND The effectiveness of Nicotine Replacement Therapy (NRT) for smoking cessation in pregnancy is limited by inconsistent and incorrect use. This paper describes the development process for "Baby, Me, & NRT", a novel pregnancy-specific intervention aimed at enhancing adherence to NRT. METHODS An integrated approach to intervention development was used, combining evidence, theory, stakeholders' feedback, and tailoring principles. The process involved six iterative steps: (1) synthesizing relevant published evidence and guidance, (2) collecting primary qualitative data on barriers and facilitators to NRT adherence along with potential intervention design features, (3) identifying relevant behavioral theories and mapping the evidence against these, (4) prioritizing behavioral determinants identified in steps 1 and 2, generating intervention objectives, and identifying behavior change techniques which target the prioritized determinants, (5) consulting with stakeholders on intervention components, key content and tailoring features, and (6) producing a prototype intervention along with implementation guidance. RESULTS The prototype intervention comprises of a multi-component, 1-month cessation programme, which includes six enhanced behavioral support sessions delivered by a trained advisor, tailored text messages, a website, and an illustrated booklet. It promotes the uptake of high-dose and combination NRT, emphasizes the importance of adherence, addresses motivation to use NRT, proactively helps problem solve NRT use issues, and provides guidance on preventing and managing smoking lapses. CONCLUSION The development process generated an evidence- and theory-guided intervention, designed with stakeholder input, aimed at improving NRT effectiveness for smoking cessation in pregnancy. The prototype intervention has since been optimized and is being evaluated in a randomized controlled trial.
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Affiliation(s)
- Lisa McDaid
- School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK
| | - Joanne Emery
- School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK
| | - Ross Thomson
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK
| | - Anne Dickinson
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK
| | | | - Lucy Phillips
- Division of Primary Care, University of Nottingham, Nottingham NG7 2RD, UK
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK
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Almehmadi S, Almehmadi M, Alhajaji F, Alharbi F, Alqorashi S, Alqahtani M, Alhindi YZ. Awareness and Perception Toward Nicotine Replacement Therapy Among Medical Students at Umm Al-Qura University. Cureus 2023; 15:e44343. [PMID: 37779753 PMCID: PMC10539035 DOI: 10.7759/cureus.44343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Background Tobacco smoking is a leading cause of premature mortality worldwide, with most deaths attributed to smoking-related diseases. Quitting smoking can have significant health benefits and increase one's lifespan. Nicotine, the addictive component of tobacco, can lead to cravings and withdrawal symptoms. Nicotine replacement therapy (NRT) can be an effective aid in easing these symptoms. This study aimed to estimate the awareness, acceptance, knowledge, and perception of NRT among medical students at Umm Al-Qura University in Makkah City. Methodology A cross-sectional survey method using Google Forms was utilized to distribute a questionnaire among medical students. The data were analyzed data using RStudio with statistical significance set at p-values <0.05. Results Of the 310 students included in this study, the majority were males (56.5%) and were aged between 21 and 24 years. Overall, 31.9% of the participants were in their fourth year of study. Regression analysis showed that being in the fifth or sixth academic year significantly predicted awareness of NRT. Conclusions Senior-year medical students had more knowledge and awareness about NRT than their junior colleagues. Future recommendations are vital for medical students to increase their knowledge, awareness, and practice regarding NRT.
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Affiliation(s)
| | | | | | - Fahad Alharbi
- Medicine and Surgery, Umm Al-Qura University, Makkah, SAU
| | | | | | - Yosra Z Alhindi
- Pharmacology and Toxicology, Umm Al-Qura University, Faculty of Medicine, Makkah, SAU
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Knowledge, Attitudes, and Beliefs about Relapse Prevention Research Involving Bupropion among Current and Former Pregnant Individuals Who Smoke. J Smok Cessat 2022; 2022:1925071. [PMID: 36618776 PMCID: PMC9788884 DOI: 10.1155/2022/1925071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/29/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction While many individuals quit smoking during pregnancy, most relapse within one year postpartum. Research into methods to decrease smoking relapse postpartum has been hampered by difficulties with recruitment. Method We conducted individual interviews with pregnant women (N = 22) who were interested in quitting smoking while pregnant about their attitudes regarding smoking and quitting during pregnancy, clinical trial participation, and smoking cessation medication use. Results Participants were aware of the risks of smoking while pregnant. Many wanted to quit smoking before delivery. Few used empirically supported treatments to quit. While research was viewed positively, interest in taking on new commitments postpartum and taking a medication to prevent relapse was low. Medication concerns were evident among most participants, especially among those planning to breastfeed. Further, several women noted medication was unnecessary, as they did not believe they would relapse postpartum. Financial incentives, childcare, and fewer and/or remote visits were identified as facilitators to participating in research. However, these factors did not outweigh women's concerns about medication use and time commitments. Conclusions Women are aware that quitting smoking during pregnancy and remaining smoke-free postpartum are important. However, beliefs that personal relapse risk is low and that medications are dangerous reduced enthusiasm for taking medication for postpartum relapse prevention. Future medication trials should educate women about the high likelihood of relapse, prepare to answer detailed questions about risks of cessation medications, and connect with participants' clinicians. For new mothers, studies conducted remotely with few scheduled appointments would reduce barriers to participation.
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Thomson R, Cooper S, Waldron J, Mamuzo E, McDaid L, Emery J, Phillips L, Naughton F, Coleman T. Smoking Cessation Support for Pregnant Women Provided by English Stop Smoking Services and National Health Service Trusts: A Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031634. [PMID: 35162656 PMCID: PMC8835166 DOI: 10.3390/ijerph19031634] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/27/2022] [Accepted: 01/28/2022] [Indexed: 02/05/2023]
Abstract
Reducing smoking rates in pregnancy continues to be a public health priority. Given a recent UK government policy change resulting in The National Health Service (NHS) making a significant new contribution to cessation support in pregnancy in England, in addition to that of Local Authorities (LA), an up-to-date assessment of national support offered to pregnant women is needed. LA Stop Smoking Service (SSS) managers and representatives from maternity services in NHS Trusts were invited to participate in an online survey in autumn 2020. Topics included service configuration, staffing, practitioner consultations and treatments offered. The survey response rate was 66% (99/151) of LAs and 68% (95/140) of Trusts. Most LAs provided smoking support for pregnant smokers (78%), whereas under half (43%) of NHS Trusts did. Combination nicotine replacement therapy, i.e., a combination of a patch and short-acting product, was offered by LAs (92%) and Trusts (95%) and most commonly for 12 weeks duration, at 53% and 50%, respectively. Similar national online training was undertaken by those supporting women, with the majority undertaking the specialist pregnancy-specific module: LAs 60% and Trusts 79%. However, clinicians were reported to deliver specialist stop smoking support in over 50% of Trusts, whereas this was reported in only 16% of LAs. In England, both LA and NHS Trusts are currently delivering similar stop smoking support to pregnant women. Having nationally recognised treatment programmes and training allows for the delivery of consistent, evidence-based smoking cessation to pregnant women in different healthcare settings.
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Affiliation(s)
- Ross Thomson
- Centre for Academic Primary Care, School of Medicine, University Park, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (L.P.); (T.C.)
- Correspondence:
| | - Sue Cooper
- Centre for Academic Primary Care, School of Medicine, University Park, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (L.P.); (T.C.)
| | - John Waldron
- Action on Smoking and Health, Unit 2.9, The Foundry, 17 Oval Way, London SE11 5RR, UK; (J.W.); (E.M.)
| | - Efe Mamuzo
- Action on Smoking and Health, Unit 2.9, The Foundry, 17 Oval Way, London SE11 5RR, UK; (J.W.); (E.M.)
| | - Lisa McDaid
- School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (L.M.); (J.E.); (F.N.)
| | - Joanne Emery
- School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (L.M.); (J.E.); (F.N.)
| | - Lucy Phillips
- Centre for Academic Primary Care, School of Medicine, University Park, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (L.P.); (T.C.)
| | - Felix Naughton
- School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (L.M.); (J.E.); (F.N.)
| | - Tim Coleman
- Centre for Academic Primary Care, School of Medicine, University Park, University of Nottingham, Nottingham NG7 2RD, UK; (S.C.); (L.P.); (T.C.)
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Kumar R, Stevenson L, Jobling J, Bar-Zeev Y, Eftekhari P, Gould GS. Health providers' and pregnant women's perspectives about smoking cessation support: a COM-B analysis of a global systematic review of qualitative studies. BMC Pregnancy Childbirth 2021; 21:550. [PMID: 34384387 PMCID: PMC8359058 DOI: 10.1186/s12884-021-03773-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 04/05/2021] [Indexed: 12/15/2022] Open
Abstract
Background Smoking cessation in pregnancy has unique challenges. Health providers (HP) may need support to successfully implement smoking cessation care (SCC) for pregnant women (PW). We aimed to synthesize qualitative data about views of HPs and PW on SCC during pregnancy using COM-B (Capability, Opportunity, Motivation, Behaviour) framework. Methods A systematic search of online databases (MEDLINE, EMBASE, PsycINFO and CINAHL) using PRISMA guidelines. PW’s and HPs’ quotes, as well as the authors’ analysis, were extracted and double-coded (30%) using the COM-B framework. Results Thirty-two studies included research from 5 continents: twelve on HPs’ perspectives, 16 on PW’s perspectives, four papers included both. HPs’ capability and motivation were affected by role confusion and a lack of training, time, and resources to provide interventions. HPs acknowledged that advice should be delivered while taking women’s psychological state (capability) and stressors into consideration. Pregnant women’s physical capabilities to quit (e.g., increased metabolism of nicotine and dependence) was seldom addressed due to uncertainty about nicotine replacement therapy (NRT) use in pregnancy. Improving women’s motivation to quit depended on explaining the risks of smoking versus the safety of quit methods. Women considered advice from HPs during antenatal visits as effective, if accompanied by resources, peer support, feedback, and encouragement. Conclusions HPs found it challenging to provide effective SCC due to lack of training, time, and role confusion. The inability to address psychological stress in women and inadequate use of pharmacotherapy were additional barriers. These findings could aid in designing training programs that address HPs’ and PW’s attitudes and supportive campaigns for pregnant smokers. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03773-x.
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Affiliation(s)
- Ratika Kumar
- School of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, New South Wales, 2308, Australia
| | - Leah Stevenson
- School of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, New South Wales, 2308, Australia
| | - Judith Jobling
- School of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, New South Wales, 2308, Australia
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine Hebrew University - Hadassah Medical Center, PO Box 12272, Jerusalem, 91120, Israel
| | - Parivash Eftekhari
- School of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, New South Wales, 2308, Australia
| | - Gillian S Gould
- School of Medicine and Public Health, The University of Newcastle, University Dr, Callaghan, New South Wales, 2308, Australia.
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McDaid L, Thomson R, Emery J, Coleman T, Cooper S, Phillips L, Naughton F. Agreement and Disparities between Women and Stop-Smoking Specialists about How to Promote Adherence to Nicotine Replacement Therapy in Pregnancy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094673. [PMID: 33924763 PMCID: PMC8125676 DOI: 10.3390/ijerph18094673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/23/2021] [Accepted: 04/25/2021] [Indexed: 11/16/2022]
Abstract
Evidence for the effectiveness of nicotine replacement therapy (NRT) for smoking-cessation in pregnancy is weak. This has been attributed to insufficient dosing and low adherence. This study investigated the acceptability of key messages and delivery modes for a behavioral intervention to increase NRT adherence in pregnancy. Semi-structured telephone interviews were carried out with pregnant or postpartum women aged ≥16 from across England, who had been offered NRT during pregnancy as part of a quit attempt and who struggled to quit (n = 10), and a focus group with stop-smoking specialists from across England (n = 6). The two data sources were coded separately using a thematic approach and then integrated to compare perspectives. Women and specialists agreed on message tone and delivery modes. However, views diverged on the most influential sources for certain messages and whether some information should be given proactively or reactively. There was also disagreement over which messages were novel and which were routinely delivered. This study demonstrates the value of capturing and integrating different perspectives and informational requirements when developing behavior-change interventions. The findings provide useful insights for designing a pregnancy-specific NRT adherence intervention that is acceptable to both those who will deliver and receive it.
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Affiliation(s)
- Lisa McDaid
- Behavioral and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (J.E.); (F.N.)
- Correspondence:
| | - Ross Thomson
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; (R.T.); (T.C.); (S.C.); (L.P.)
| | - Joanne Emery
- Behavioral and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (J.E.); (F.N.)
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; (R.T.); (T.C.); (S.C.); (L.P.)
| | - Sue Cooper
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; (R.T.); (T.C.); (S.C.); (L.P.)
| | - Lucy Phillips
- Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK; (R.T.); (T.C.); (S.C.); (L.P.)
| | - Felix Naughton
- Behavioral and Implementation Science Group, School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK; (J.E.); (F.N.)
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Campbell K, Coleman-Haynes T, Bowker K, Cooper SE, Connelly S, Coleman T. Factors influencing the uptake and use of nicotine replacement therapy and e-cigarettes in pregnant women who smoke: a qualitative evidence synthesis. Cochrane Database Syst Rev 2020; 5:CD013629. [PMID: 32441810 PMCID: PMC7387757 DOI: 10.1002/14651858.cd013629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Nicotine replacement therapy (NRT) delivers nicotine without the toxic chemicals present in tobacco smoke. It is an effective smoking cessation aid in non-pregnant smokers, but there is less evidence of effectiveness in pregnancy. Systematic review evidence suggests that pregnant women do not adhere to NRT as prescribed, which might undermine effectiveness. Electronic cigarettes (e-cigarettes) have grown in popularity, but effectiveness and safety in pregnancy are not yet established. The determinants of uptake and use of NRT and e-cigarettes in pregnancy are unknown. OBJECTIVES To explore factors affecting uptake and use of NRT and e-cigarettes in pregnancy. SEARCH METHODS We searched MEDLINE(R), CINAHL and PsycINFO on 1 February 2019. We manually searched OpenGrey database and screened references of included studies and relevant reviews. We also conducted forward citation searches of included studies. SELECTION CRITERIA We selected studies that used qualitative methods of data collection and analysis, included women who had smoked in pregnancy, and elicited participants' views about using NRT/e-cigarettes for smoking cessation or harm reduction (i.e. to smoke fewer cigarettes) during pregnancy. DATA COLLECTION AND ANALYSIS We identified determinants of uptake and use of NRT/e-cigarettes in pregnancy using a thematic synthesis approach. Two review authors assessed the quality of included studies with the Wallace tool. Two review authors used the CERQual approach to assess confidence in review findings. The contexts of studies from this review and the relevant Cochrane effectiveness review were not similar enough to fully integrate findings; however, we created a matrix to juxtapose findings from this review with the descriptions of behavioural support from trials in the effectiveness review. MAIN RESULTS We included 21 studies: 15 focused on NRT, 3 on e-cigarettes, and 3 on both. Studies took place in five high-income countries. Most studies contributed few relevant data; substantially fewer data were available on determinants of e-cigarettes. Many studies focused predominantly on issues relating to smoking cessation, and determinants of NRT/e-cigarette use was often presented as one of the themes. We identified six descriptive themes and 18 findings within those themes; from these we developed three overarching analytical themes representing key determinants of uptake and adherence to NRT and/or e-cigarettes in pregnancy. The analytical themes show that women's desire to protect their unborn babies from harm is one of the main reasons they use these products. Furthermore, women consider advice from health professionals when deciding whether to use NRT or e-cigarettes; when health professionals tell women that NRT or e-cigarettes are safer than smoking and that it is okay for them to use these in pregnancy, women report feeling more confident about using them. Conversely, women who are told that NRT or e-cigarettes are as dangerous or more dangerous than smoking and that they should not use them during pregnancy feel less confident about using them. Women's past experiences with NRT can also affect their willingness to use NRT in pregnancy; women who feel that NRT had worked for them (or someone they know) in the past were more confident about using it again. However, women who had negative experiences were more reluctant to use NRT. No trials on e-cigarette use in pregnancy were included in the Cochrane effectiveness review, so we considered only NRT findings when integrating results from this review and the effectiveness review. No qualitative studies were conducted alongside trials, making full integration of the findings challenging. Women enrolled in trials would have agreed to being allocated to NRT or control group and would have received standardised information on NRT at the start of the trial. Overall, the findings of this synthesis are less relevant to women's decisions about starting NRT in trials and more likely to help explain trial participants' adherence to NRT after starting it. We considered most findings to be of moderate certainty; we assessed findings on NRT use as being of higher certainty than those on e-cigarette use. This was mainly due to the limited data from fewer studies (only in the UK and USA) that contributed to e-cigarette findings. Overall, we judged studies to be of acceptable quality with only minor methodological issues. AUTHORS' CONCLUSIONS Consistent messages from health professionals, based on high-quality evidence and clearly explaining the safety of NRT and e-cigarettes compared to smoking in pregnancy, could help women use NRT and e-cigarettes more consistently/as recommended. This may improve their attitudes towards NRT or e-cigarettes, increase their willingness to use these in their attempt to quit, and subsequently encourage them to stay smoke-free.
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Affiliation(s)
| | | | - Katharine Bowker
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Sue E Cooper
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Sarah Connelly
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Tim Coleman
- Division of Primary Care, University of Nottingham, Nottingham, UK
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Practitioners' Views on Nicotine Replacement Therapy in Pregnancy during Lapse and for Harm Reduction: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234791. [PMID: 31795347 PMCID: PMC6926779 DOI: 10.3390/ijerph16234791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/22/2019] [Accepted: 11/23/2019] [Indexed: 11/17/2022]
Abstract
Many countries, including the UK, recommend nicotine replacement therapy (NRT) for smoking cessation during pregnancy. However, adherence to NRT is generally low, smoking lapse or relapse is common and using NRT to reduce the harm from the number of cigarettes smoked is only advocated in non-pregnant smokers. Two focus groups were conducted with 13 professionals involved in antenatal stop smoking services (SSS). The data were analysed thematically. Two themes were extracted that describe health professionals' attitudes towards using NRT either during lapses or to reduce smoking in women who cannot quit (harm reduction). These are presented around a social-ecological framework describing three hierarchical levels of influence within smoking cessation support: (1) Organizational: providing NRT during lapses could be expensive for SSS though harm reduction could result in services helping a wider range of clients. (2) Interpersonal: participants felt using NRT for harm reduction was not compatible with cessation-orientated messages practitioners conveyed to clients. (3) Individual: practitioners' advice regarding using NRT during smoking lapses varied; many were generally uncomfortable about concurrent smoking and NRT use and had strong reservations about recommending NRT when smoking during all but the briefest lapses. Further evidence is required to guide policy and practice.
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