Perceptions of Smoking Cessation Barriers During Pregnancy

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Introduction: Smoking during pregnancy can lead to many negative health outcomesfor the mother and child. More than 30% of pregnant women in rural Appalachia smoke, which is three times the national average. Prenatal appointments present a unique opportunity for health care professionals to address smoking in this population. However, many cessation efforts during pregnancy address only the physical health impact of smoking rather than the personal circumstances surrounding cigarette use. Therefore, the current project investigated self-reported barriers to pregnancy smoking cessationand whether these differed by smoking cessation status at delivery. Methods: Study participants (N=459) were women from the state-funded Tennessee Intervention for Pregnant Smokers (TIPS) program who were self-reported smokers at the beginning of their pregnancy. Women receiving prenatal care in Northeast Tennessee were recruited for participation. The majority of participants were Caucasian, low income, and received state-assisted medical insurance coverage. Participants completed multiple questionnaires, including an assessment of background characteristics and smoking behaviors/beliefs. Of interest to the current investigation was the following open-ended question, asked at entry into prenatal care: “What do you see as the biggest barriers to your quitting smoking (i.e. what would be most likely to keep you from being able to quit)?” Common themes of responses were developed and coded using an iterative process by three independent reviewers, resulting in ten themes. Finally, medical charts were reviewedfor self-reported smoking status at delivery, and participants were subsequently coded as either continued smokers (N=347) or successful quitters (N=112). Results: The majority of women, regardless of delivery smoking status, responded that stress was their primary barrier to smoking cessation, followed by second-hand smoke. Significant differences were found between continuing smokers and those who were able to quit, with quitters less likely to report stress, Χ2 (1, 459) = 7.32, p = .007, or emotional/mental health Χ2 (1, 459) = 12.90, p < .001), as barriers. Continued smokers also listed significantly more barriers per person than quitters t(238.2) = -2.81, p = .005, while quitters were more likely to report that they had no barriers to smoking cessation. Conclusions and Implications: This study suggests that smoking cessation interventions during pregnancy should specifically address stress management and emotional/mental health, as well as second hand smoke, and underlines the importance of addressing mental health issues early in pregnancy. In sum, understanding women’s perceptions of why they believe they cannot quit smoking during pregnancy may help in the development of more effective smoking cessation interventions.


Johnson City, TN

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