Facilitators and Barriers to Cigarette Smoking While Pregnant for Women With Substance Use Disorders

Abstract

This study adds to the literature by identifying childbirth as an opportunity to address smoking for women with SUD. Furthermore, it supports the interconnectedness of triggers for smoking with those of other addictive substances, and the perceptual barrier tobacco is often not viewed as a drug by women with SUD. Findings demonstrate a need for increased health literacy and enhanced external supports around smoking cessation for this population.

Systematic Review of Clinician-Reported Barriers to Provision of Smoking Cessation Interventions in Hospital Inpatient Settings

“…Personal discomfort on the part of clinicians when broaching the subject of tobacco cessation interventions has been previously identified (Pipe et al, 2009). One study identified the barrier of smoking being seen as 'a coping mechanism for patients' by healthcare workers, which has been similarly described in previous literature (Acquavita, Talks, & Fiser, 2017). Prior research has demonstrated that providing training to physicians and other healthcare workers substantially boosts their efficacy, which then translates into improved cessation intervention delivery (Carson et al, 2012).…”

The Incentives to Quit tobacco in Pregnancy (IQuiP) protocol: piloting a financial incentive-based smoking treatment for women attending substance use in pregnancy antenatal services

“…Up to half of all pregnant women who smoke will quit spontaneously prior to their initial antenatal visit 20. Unfortunately, pregnant women with other substance use problems are more likely to persist with tobacco smoking21 22 despite strong aspirations to stop 23 24. Their success is typically hampered by a combination of biological, psychosocial or systemic barriers 10…”

“…Psychosocial factors that have been shown to impede cessation in this priority population include: a strong psychological dependence to nicotine, the struggle to stop or reduce multiple substances, a perceived lack of vulnerability to the damaging effects of maternal tobacco smoking and a belief that tobacco is legal and therefore not harmful 10 23 24. Moreover, a lack of support from partners, having partners or other household members who smoke tobacco and high levels of smoking acceptability within close social networks are common and have a detrimental impact on tobacco smoking cessation efforts 10 23 24 35 36…”

“…Evidence suggests that antenatal healthcare providers perceive pregnant women with substance use problems as not wanting to stop smoking 37. When asked, however, many do report a desire to quit but lack the resources and support required to do so 23 24. Treatment providers may also prioritise alcohol and other drug cessation over tobacco38–41 as concurrent cessation is considered overwhelming and thought to compromise substance treatment 39.…”

Commentary on Guillaumier et al. (2020): Is harm reduction a suitable outcome for historically hard‐to‐treat smokers?

“…The reality is that smokers enrolled in AOD treatment smoke at disproportionately high rates [2] and while many endorse interest in quitting [3], access to smoking cessation treatment is low and few achieve cessation from tobacco during their treatment episode [4,5]. Further, smoking can be perceived as helpful among those navigating sobriety [6] or less harmful compared to the substance that led them to treatment [7]. These longstanding barriers among the AOD treatment population seem almost intractable.…”