How do we help more women quit smoking in pregnancy?

Chief Investigator: Associate Professor Lisa Smithers

Funding Amount: $74,904

Recipient: University of Adelaide

Overview:

Of all the exposures during pregnancy, effects of smoking are amongst the most damaging to the infant. Smoking increases stillbirth, perinatal health and harms continue into childhood.

In Adelaide’s north, South Australia’s most concentrated area of disadvantage, approximately 25% of pregnant women smoke and only one fifth quit during pregnancy. The health system response of referral’s to Quit counselling clearly doesn’t work for most pregnant women who smoke. This project involves better understanding pregnant women’s perspectives on smoking and which smoking cessation strategies might work for them. This work will enhance antenatal care and our ability to help women quit.


Research Outcomes:

Researchers: Lisa Smithers, John Lynch, Gustaff Dekker, Elizabeth Hoon, Josephine Telfer

Research Completed: 2022

Research Findings: Smoking is known to be harmful to the health of women and their unborn babies. Smoking while pregnant is more common among women living in disadvantaged circumstances. In current antenatal care, many women who smoke when pregnant are offered a referral for smoking cessation counselling. Yet the majority of pregnant women who smoke do not quit. In this project we convened a community panel of women to give advice on researching antenatal care for women who smoke and their preferred smoking cessation options. We then interviewed 17 women who smoked or quit while pregnant. Women described how smoking was embedded in their lives and the lives of the people around them. Women reported feelings of isolation and marginalisation, which led to disempowerment, both in relation to their interactions with health care professionals, as well as sourcing credible, up-to-date information about smoking cessation in pregnancy. Despite such feelings, women unanimously expressed a desire to quit smoking and advice to help them make informed choices about cessation. Challenges in the provision of smoking cessation care have been demonstrated to impede women’s smoking cessation. Therefore, in parallel to our work with the panel and with women, we conducted focus groups and in-depth interviews with health professionals to gather perceptions on their ability to provide smoking cessation care. This work involved 53 midwives, 8 obstetricians, 8 general practitioners and 3 smoking cessation counsellors. While we are in the process of analysing data from obstetricians, GPs and counsellors, the perspectives from midwives revealed a range of barriers to delivering smoking cessation care. These included organisational, interpersonal and individual barriers. Midwives’ suggestions on how to facilitate better smoking cessation care could improve clinical practice for the management of smoking in pregnancy, particularly among socioeconomically disadvantaged women.

Key Outcomes:

Smoking is known to be harmful to the health of women and their unborn babies. In current antenatal care, many women who smoke when pregnant are offered a referral for smoking cessation counselling. Smoking while pregnant is more common among women living in disadvantaged circumstances and fewer such women successfully quit while pregnant.

We convened a community panel of women to give advice on antenatal care of women who smoke and their preferred smoking cessation options. The community panel assisted in determining the research plan, specifically around the research design, including when and how to approach women to discuss smoking. We conducted focus groups and in-depth interviews with women who smoked while pregnant to explore barriers to smoking cessation and investigate how interactions with health professionals influenced their smoking cessation journey. As challenges in the provision of smoking cessation care have been demonstrated to impede women’s smoking cessation, we also conducted focus groups and in-depth interviews with a range of health professionals, to seek perceptions of their ability to provide smoking cessation care. All health professionals were currently practicing in antenatal care and in socially disadvantaged areas. A semi-structured interview schedule was used, and all interviews were recorded, transcribed and thematically analysed.

In following the recommendations of the community panel, we interviewed 17 women who smoked or quit while pregnant about their experience of antenatal care. Women described that smoking was an embedded in their lives and the lives of the people around them. The isolation and marginalisation that they reported led them to feeling disempowered, both in relation to their interactions with health care professionals, as well as in sourcing credible and up-to-date information about smoking in pregnancy. Despite feelings of disempowerment, isolation and marginalisation, women unanimously expressed a desire to quit smoking and advice to help them make informed choices about smoking cessation. Our work with health professionals involved 53 midwives, 8 obstetricians, 8 general practitioners and 3 smoking cessation counsellors. We are in the process of analysing data from obstetricians, GPs and counsellors. Our analysis of midwives’ perceptions included barriers to the delivery of smoking cessation care, which included organisational, interpersonal and individual factors. Midwives’ suggestions on how to facilitate better smoking cessation care may include improvements to education, training and resources available to support them in providing smoking cessation care to women. Such suggestions could improve clinical management of smoking in pregnancy among socioeconomically disadvantaged communities, potentially leading to greater success in helping more pregnant women to quit smoking.

Research Papers:

The following two papers have been submitted for publication and are currently undergoing peer review. CRF funding has been acknowledged in both publications.

Fletcher C, Hoon E, Gialamas A, Dekker G, Lynch J, Smithers LG. Isolation, marginalisation and disempowerment: Understanding how interactions with health providers can influence smoking cessation in pregnancy. Kalamkarian A, Hoon E, Chittleborough C, Dekker G, Lynch J, Smithers LG. Smoking cessation care during pregnancy: a qualitative exploration of midwives’ tenuous role.

Related Publications:

Future Outcomes:

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