A content analysis of self-reported barriers and facilitators to preventing postpartum smoking relapse among a sample of current and former smokers in an underserved population

Abstract

To characterize the barriers and facilitators thatprevent postpartum relapse and maintain smoking abstinence among a socioeconomically underserved population, recruited through Philadelphia-area women, infants, and children clinics, in-person interviews were conducted with 30 women who had quit smoking for one or more pregnancies in the past 3 years to retrospectively describe their attempts to remain abstinent during the postpartum period. Responses were analysed using the constructs from the Cognitive-Social Health Information Processing model, which identifies the cognitive, affective and behavioral factors involved in goal-oriented self-regulatory actions, in the context of a vulnerable population of women. Motherhood demands were a significant source of relapse stress. Stresses associated with partner and family relationships also contributed to relapse. The presence of other smokers in the environment was mentioned by many women in our sample as affecting their ability to remain smoke-free postpartum. Participants reported four main strategies that helped them to successfully cope with postpartum cravings and relapses, including being informed of smoking risks, maintaining goal-oriented thoughts, focusing on their concerns about the baby's health and receiving positive social support from families and friends. Results provide guidance for the design of smoking relapse interventions that may address the unique stressors reported by underserved postpartum women.

Stuck in the catch 22: attitudes towards smoking cessation among populations vulnerable to social disadvantage

“…Living in a disadvantaged community increases the likelihood of smoking due to an 'area effect' caused by highly stressful environments, limited resources and options for recreation, normalisation of smoking, increased availability of tobacco and isolation from the wider community (8)(9)(10). At an individual level, issues of nicotine addiction, competing priorities, life stress, negative attitudes towards cessation and limited access to or engagement with quit support services also influence smoking prevalence (4,(11)(12)(13)(14) Previous research has described the barriers to smoking cessation experienced by individuals living in disadvantaged areas (8,11,(15)(16)(17) and clients of community service organisations (18)(19)(20). Among the broader sphere of groups at risk of social and economic disadvantage, specific sub-populations report unique barriers to quitting (4).…”

Cognitive-behavioral intervention to promote smoking cessation for pregnant and postpartum inner city women

“…This transition represents a unique window of opportunity for postpartum cessation since the barriers to smoking cessation have been shown to change after delivery. Decreased motivation and low social pressure to maintain abstinence, stress associated with caring for a newborn, insufficient support and resources for coping with new challenges as they arise, and postpartum depression become paramount (Curry et al, 2001; Park et al, 2009; Wen et al, 2014a, b), particularly among those who live in disadvantaged urban areas (Harmer & Memon, 2013). …”

An Exploration of Young Australian Women's Smoking Cessation Goals across the Trajectory of Pregnancy and Post Birth

“…Post birth women who sustained their smoking cessation held this belief for their newborn, whilst those who relapsed had lost the incentive of being pregnant. Others report similar findings, as the motivation to cease smoking in pregnancy relies upon a woman's desire to protect her unborn baby [22,37]. This motivation detracts from woman focused approaches which have greater success in sustained smoking cessation post birth [25].…”

“…Indeed, a recent thematic synthesis of 16 studies, including 1031 women, found those who relapse post birth, talk about no longer needing to protect their baby from nicotine [24]. Clinicians have been criticised for interventions which rely on this motivation, especially as a repercussion of this foetus-centric approach is reflected in the finding that post birth, women who relapse are rarely aware of the negative effects of second hand smoke [22,25].…”

“…Although evidence suggests these sub-groups are the least likely to quit, a higher proportion of women stop smoking in pregnancy than at any other time in their lives [18,21]. This positive change in smoking behaviour is often short-lived, with many women relapsing post birth [22][23][24].…”