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Special Issue "Smoking Cessation in Pregnancy and Postpartum"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (30 September 2020).

Special Issue Editors

Dr. Sue Cooper
E-Mail Website
Guest Editor
Principal Research Fellow, Faculty of Medicine & Health Sciences, Room 1408 Tower Building, University Park, Nottingham, NG7 2RD, UK
Interests: Smoking cessation in pregnancy and postpartum; including e-cigarettes; clinical trials; applied health research; health services research; intervention development
Dr. Katarzyna Campbell
E-Mail Website
Guest Editor
Research Fellow, Faculty of Medicine & Health Sciences, Room 1407 Tower Building, University Park, Nottingham, NG7 2RD, UK
Interests: Smoking cessation in pregnancy and postpartum; smoking cessation interventions; behaviour change; health service research; online research; qualitative research; systematic reviews
Dr. Sophie Orton
E-Mail Website
Guest Editor
Senior Research Fellow, Faculty of Medicine & Health Sciences, Room 1407 Tower Building, University Park, Nottingham, NG7 2RD, UK
Interests: smoking cessation in pregnancy and postpartum; secondhand smoke exposure in the home; breastfeeding; postpartum return to smoking; behaviour change; intervention development; health service research; qualitative research

Special Issue Information

Dear Colleagues,

This Special Issue will focus on smoking cessation in pregnancy and postpartum.

Smoking tobacco in pregnancy is known to have adverse health effects on women and infants. Worldwide, 8% of women are current tobacco smokers; however, global trends in tobacco smoking suggest this will increase to 20% by 2025. Although some women quit during pregnancy, many women continue to smoke tobacco throughout. Average rates of tobacco smoking in pregnancy range between <1% and 18.3% from country to country but can be much higher in certain communities, particularly those affected by greater economic deprivation. Of those women who do successfully quit smoking in pregnancy, up to 75% will return to smoking within the first 12 months postpartum, increasing their own and their children’s risk of smoking-related ill health. More effective interventions to support smoking cessation in pregnancy and postpartum and to prevent return to smoking need to be developed, evaluated, and implemented. Examples might include novel behavioral, tailored or targeted approaches, use of e-health, m-health or other technologies, consideration of better or alternative ways of using nicotine as a cessation aid (for example, increasing adherence to nicotine replacement therapy or use of electronic cigarettes), and improved training for health professionals. Harm reduction approaches could also be considered.

We invite those of you working in this area to submit articles on these and other themes relating to smoking cessation and preventing return to smoking in pregnancy and postpartum.

Dr. Sue Cooper
Dr. Katarzyna Campbell
Dr. Sophie Orton
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2300 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • smoking cessation
  • pregnancy
  • postpartum
  • return to smoking/relapse
  • e-cigarettes
  • nicotine replacement therapy
  • intervention development
  • minority groups
  • inequalities
  • harm reduction
  • smoking cessation interventions
  • secondhand smoke exposure
  • smoking in the home

Published Papers (8 papers)

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Research

Article
The Effects of Different Smoking Patterns in Pregnancy on Perinatal Outcomes in the Southampton Women’s Survey
Int. J. Environ. Res. Public Health 2020, 17(21), 7991; https://doi.org/10.3390/ijerph17217991 - 30 Oct 2020
Viewed by 757
Abstract
Maternal smoking during pregnancy has established associations with poor perinatal outcomes. Among continuing pregnant smokers, harm-reduction strategies have been suggested, including temporary cessation of smoking during pregnancy, also known as partial quitting. Support for this strategy, however, remains limited. Six hundred and ninety-seven [...] Read more.
Maternal smoking during pregnancy has established associations with poor perinatal outcomes. Among continuing pregnant smokers, harm-reduction strategies have been suggested, including temporary cessation of smoking during pregnancy, also known as partial quitting. Support for this strategy, however, remains limited. Six hundred and ninety-seven women in the Southampton Women’s Survey who smoked at their last menstrual period were categorised into sustained quitters, partial quitters (quit in either the first or third trimester but not both) or sustained smokers (continued to smoke throughout pregnancy). In regression models, compared with infants born to sustained smokers, infants born to sustained quitters and partial quitters were heavier at birth by β = 0.64 standard deviations (SD) (WHO z-score) (95% CI: 0.47–0.80) and 0.48 SD (WHO z-score) (95% CI: 0.24–0.72) respectively, adjusted for confounders, with similar patterns seen for other anthropometric measures (head circumference and crown–heel length). Sustained quitters had longer gestations by β = 3.5 days (95% CI: 1.8–5.2) compared with sustained smokers, but no difference was seen for partial quitters. While sustained quitting remains the most desired outcome for pregnant smokers, partial quitting should be explored as a strategy to reduce some of the harmful effects of smoking on offspring in those who cannot achieve sustained quitting. Full article
(This article belongs to the Special Issue Smoking Cessation in Pregnancy and Postpartum)
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Article
Experts’ Views on Behaviour Change Techniques for Smoking Cessation in Pregnancy: A Qualitative Study
Int. J. Environ. Res. Public Health 2020, 17(21), 7729; https://doi.org/10.3390/ijerph17217729 - 22 Oct 2020
Viewed by 947
Abstract
Smoking during pregnancy is a global health problem which has devastating health implications. Behavioural support is an important part of smoking cessation support for pregnant women. Research has identified barriers and facilitators (B&Fs) and effective behaviour change techniques (BCTs) to aid women’s quit [...] Read more.
Smoking during pregnancy is a global health problem which has devastating health implications. Behavioural support is an important part of smoking cessation support for pregnant women. Research has identified barriers and facilitators (B&Fs) and effective behaviour change techniques (BCTs) to aid women’s quit attempts. However, the extent to which and how these BCTs are used in practice is unclear. The research aimed to establish experts’ views on how behavioural support can be optimised and techniques operationalised in clinical practice, by identifying ways to address known B&Fs for smoking cessation in pregnancy. A focus group discussion took place with six experts, which highlighted how BCTs can be used in practice to support women in their quit attempts. A thematic analysis was conducted to elicit overarching themes. Five themes were found: involving the family, empowering women, using incentives to boost motivation, using practical techniques to help women with their quit attempts and managing expectations about nicotine replacement therapy. Empowering women to make their own decisions and encouraging small positive changes in smoking habits, using visual aids (e.g., growth charts) to inform women of the harms of smoking to the baby and treating families holistically were deemed important. Full article
(This article belongs to the Special Issue Smoking Cessation in Pregnancy and Postpartum)
Article
Addressing and Overcoming Barriers to E-Cigarette Use for Smoking Cessation in Pregnancy: A Qualitative Study
Int. J. Environ. Res. Public Health 2020, 17(13), 4823; https://doi.org/10.3390/ijerph17134823 - 04 Jul 2020
Cited by 5 | Viewed by 1306
Abstract
E-cigarettes may have a role in supporting pregnant women who would otherwise smoke to stop smoking. The study aimed to understand pregnant women’s vaping experiences, in particular how vaping to stop smoking is facilitated and how barriers to this are overcome. We conducted [...] Read more.
E-cigarettes may have a role in supporting pregnant women who would otherwise smoke to stop smoking. The study aimed to understand pregnant women’s vaping experiences, in particular how vaping to stop smoking is facilitated and how barriers to this are overcome. We conducted semi structured telephone interviews (n = 15) with pregnant or postpartum women who vaped during pregnancy, either exclusively (n = 10) or dual-used (n = 5) (smoked and vaped). Thematic analysis was used to analyse the interviews. Two themes emerged. First, ‘facilitating beliefs’: inherent beliefs that helped women overcome barriers to vaping. These included understanding the relative safety of vaping and economic gains compared with smoking and pregnancy being a motivator to stop smoking. Second, ‘becoming a confident vaper’: accumulating sufficient skill and confidence to comfortably vape. This included experimentation with e-cigarettes to ensure nicotine dependence and sensory needs were met. Seeking social support and employing strategies to address social stigma were also important. Positive beliefs about vaping and becoming proficient at vaping were viewed as ways to overcome barriers to vaping. The theoretical domain framework informed intervention recommendations to assist pregnant smokers who have tried but cannot stop smoking to switch to vaping. Full article
(This article belongs to the Special Issue Smoking Cessation in Pregnancy and Postpartum)
Article
Obstetricians’ and Gynecologists’ Communication Practices around Smoking Cessation in Pregnancy, Secondhand Smoke and Sudden Infant Death Syndrome (SIDS): A Survey
Int. J. Environ. Res. Public Health 2020, 17(8), 2908; https://doi.org/10.3390/ijerph17082908 - 23 Apr 2020
Cited by 1 | Viewed by 1357
Abstract
Secondhand smoke (SHS) is a potential direct cause of Sudden Infant Death Syndrome (SIDS) among infants. Disparities in SHS exposure and SIDS deaths may be due to inconsistent communication among practitioners about SHS/SIDS risks. In order to assess current SHS/SIDS risks and communication [...] Read more.
Secondhand smoke (SHS) is a potential direct cause of Sudden Infant Death Syndrome (SIDS) among infants. Disparities in SHS exposure and SIDS deaths may be due to inconsistent communication among practitioners about SHS/SIDS risks. In order to assess current SHS/SIDS risks and communication practices and to identify areas of improvement, we conducted a survey of 316 obstetricians and gynecologists (ob/gyns) about the length of time spent having discussions, supplemental materials used, risks covered, cessation, and frequency of discussions. Most (55.3%) reported spending 1–4 min discussing risks/cessation. Nearly a third reported not using any supplemental materials; few used apps (4.4%) or videos (1.9%). Assisting patients with steps toward cessation was infrequent. Few ob/gyns had discussions with patients immediately postpartum. Only 51.9% strongly agreed that they felt sufficiently informed about SHS/SIDS risks to educate their patients. The communication by ob/gyns of SHS/SIDS risk varies greatly and presents opportunities for improvement. Each additional minute spent having discussions and the use of supplemental materials, such as apps, may improve communication effectiveness. The discussion of smoking behaviors immediately postpartum may help to prevent smoker relapse. An increased awareness of statewide cessation resources by ob/gyns is needed to assist patients with cessation. The development of standardized risk messaging may reduce the variation in communication practices among ob/gyns. Full article
(This article belongs to the Special Issue Smoking Cessation in Pregnancy and Postpartum)
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Article
Smoking Prevalence and Secondhand Smoke Exposure during Pregnancy and Postpartum—Establishing Risks to Health and Human Rights before Developing a Tailored Programme for Smoking Cessation
Int. J. Environ. Res. Public Health 2020, 17(6), 1838; https://doi.org/10.3390/ijerph17061838 - 12 Mar 2020
Viewed by 1595
Abstract
Both smoking during pregnancy and secondhand smoke exposure are associated with reduced health outcomes. However, limited consistent evidence exists of risks of secondhand smoke exposure in pregnancy. Currently, inadequate smoking cessation services exist in Irish maternity hospitals. To identify the number of pregnant [...] Read more.
Both smoking during pregnancy and secondhand smoke exposure are associated with reduced health outcomes. However, limited consistent evidence exists of risks of secondhand smoke exposure in pregnancy. Currently, inadequate smoking cessation services exist in Irish maternity hospitals. To identify the number of pregnant women smoking during pregnancy and to identify their exposure to secondhand smoke, we conducted a cross-sectional observational pilot study in one regional maternity hospital in Ireland in July/August 2018. Respondents were (1) women attending antenatal clinics and (2) postpartum women before discharge. Variables measured included smoking status of pregnant women and partner status, demographic variables, secondhand smoke exposure, and support for hospital smoke-free policy and development of smoking cessation services. The overall response rate was 42.2% in this study. The response rate was 56.5% (111/196) from postnatal wards and 37.3% (215/577) from antenatal clinics. Over 40% of respondents reported they had smoked during their lifetime. The majority of women (70%) reported quitting smoking before their pregnancy. Few women were active smokers. Almost 40% reported exposure to tobacco smoke in the previous week (38.5%); 16.9% reported living with a smoker, a critical factor in increased risk (Odds Ratio (OR) 3.89, 95% CI = 1.86–8.15, p < 0.001). Approximately 10% of postnatal mothers reported that their newborn would travel home with a smoker. Support for a no-smoking hospital policy was very high as was support for the development of cessation services. No documentation of secondhand smoke exposure for pregnant women or newborns is sought or recorded routinely in the hospital. A systems approach to develop smoking cessation programmes in maternity care should include screening and documenting of secondhand smoke exposure risks for women during pregnancy, and for their newborns at discharge, to improve health outcomes and protect human rights. Full article
(This article belongs to the Special Issue Smoking Cessation in Pregnancy and Postpartum)
Article
Practitioners’ Views on Nicotine Replacement Therapy in Pregnancy during Lapse and for Harm Reduction: A Qualitative Study
Int. J. Environ. Res. Public Health 2019, 16(23), 4791; https://doi.org/10.3390/ijerph16234791 - 29 Nov 2019
Cited by 3 | Viewed by 1273
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Smoking Cessation in Pregnancy and Postpartum)
Article
Re-Configuring Identity Postpartum and Sustained Abstinence or Relapse to Tobacco Smoking
Int. J. Environ. Res. Public Health 2019, 16(17), 3139; https://doi.org/10.3390/ijerph16173139 - 28 Aug 2019
Cited by 1 | Viewed by 1452
Abstract
Relapse to smoking postpartum is a common and important public health problem. Difficulty in adjusting to a non-smoking identity is a key factor prompting relapse. However, postpartum relapse prevention interventions rarely focus upon offering support for identity change. We conducted an exploratory inductive [...] Read more.
Relapse to smoking postpartum is a common and important public health problem. Difficulty in adjusting to a non-smoking identity is a key factor prompting relapse. However, postpartum relapse prevention interventions rarely focus upon offering support for identity change. We conducted an exploratory inductive analysis of a dataset from the Prevention of Return to Smoking Postpartum (PReS) study to understand identity constructs and experiences of pre- and postpartum women (smokers and ex-smokers), partners and health professionals. Data were obtained from 77 unique participants via focus groups, interviews, email or online questionnaires, and were analyzed by two researchers independently, using NVivo 12. Four main themes emerged reflecting identity transition from the pre- to the postpartum period: (i) Pregnancy and the categorization of smoking status; (ii) the disruption of motherhood and loss of self; (iii) adapting to a maternal non-smoking identity; and (iv) factors influencing sustained abstinence versus relapse to smoking. Postpartum relapse prevention interventions need to consider support for women, and the whole family unit, in adjusting to a new identity as a non-smoking mother. Smoking status should be revisited throughout pregnancy and into the postpartum period to aid the long-term integration of smoke-free behavior. Full article
(This article belongs to the Special Issue Smoking Cessation in Pregnancy and Postpartum)
Article
Pregnant Smokers’ Experiences and Opinions of Techniques Aimed to Address Barriers and Facilitators to Smoking Cessation: A Qualitative Study
Int. J. Environ. Res. Public Health 2019, 16(15), 2772; https://doi.org/10.3390/ijerph16152772 - 02 Aug 2019
Cited by 5 | Viewed by 2398
Abstract
Pregnant women experience certain barriers and facilitators (B&Fs) when trying to quit smoking. This study aimed to elicit women’s views on techniques that could help overcome or enhance these. Semi-structured interviews were conducted with 12 pregnant women who had experience of smoking during [...] Read more.
Pregnant women experience certain barriers and facilitators (B&Fs) when trying to quit smoking. This study aimed to elicit women’s views on techniques that could help overcome or enhance these. Semi-structured interviews were conducted with 12 pregnant women who had experience of smoking during pregnancy. Participants were prompted to discuss experiences of B&Fs and give suggestions of techniques that could address these appropriately. A thematic analysis was conducted using the one sheet of paper method. Four themes relating to suggested techniques were identified: accessing professional help, nicotine replacement therapy (NRT), distraction, and social interactions. Experiences of accessing professional help were generally positive, especially if there was a good rapport with, and easy access to a practitioner. Most women were aware of NRT, those who had used it reported both negative and positive experiences. Praise and encouragement from others towards cessation attempts appeared motivating; peer support groups were deemed useful. Women reported experiencing B&Fs which fell under four themes: influence of others, internal motivation, cues to smoke, and health. Overall, accessing professional support generated positive changes in smoking habits. Establishing ways of how to encourage more women to seek help and raising awareness of different types of support available would seem beneficial. Full article
(This article belongs to the Special Issue Smoking Cessation in Pregnancy and Postpartum)
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