Pregnant women’s use of e‐cigarettes in the UK: a cross‐sectional survey

Bowker, Katharine; Lewis, Sarah; Phillips, Lucy; Orton, Sophie; Ussher, Michael; Naughton, Felix; Bauld, Linda; Coleman, Tim; Sinclair, Lesley; McRobbie, Hayden; Khan, Arooj; Cooper, Susan

doi:10.1111/1471-0528.16553

Cited by 24 publications

(34 citation statements)

References 48 publications

(104 reference statements)

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“…It is possible that some of the decline in prescribing of NRT is related to increased use of electronic cigarettes; the number of e-cigarette users in the general population in Great Britain increased from 0.7 million in 2012 to 2.9 million in 2017. 14 However, in the UK, use of e-cigarettes by pregnant women is not particularly widespread; a 2017 survey found that only 5% of pregnant women reported any vaping during pregnancy and only around 1% reported exclusive vaping (ie, they had stopped smoking). 14 It seems unlikely, therefore, that vaping behavior would have had a substantial impact on pregnant women’s propensity to use NRT and hence, on primary care prescribing.…”

Section: Discussionmentioning

confidence: 99%

“… 14 However, in the UK, use of e-cigarettes by pregnant women is not particularly widespread; a 2017 survey found that only 5% of pregnant women reported any vaping during pregnancy and only around 1% reported exclusive vaping (ie, they had stopped smoking). 14 It seems unlikely, therefore, that vaping behavior would have had a substantial impact on pregnant women’s propensity to use NRT and hence, on primary care prescribing. Nevertheless, research investigating any relationships between smoking, e-cigarette, and NRT use by pregnant women, including impacts of longitudinal changes in prevalence of use and potential trade-offs between e-cigarette use and primary care NRT prescribing, would be informative.…”

Section: Discussionmentioning

confidence: 99%

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Trends in Prescribing of Nicotine Replacement Therapy to Pregnant Women in Primary Care in England

Szatkowski

Vaz

Fiaschi

et al. 2021

Nicotine &Amp; Tobacco Research

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Introduction Smoking during pregnancy remains common and the English National Health Service (NHS) has recently been directed to prioritise providing cessation support for pregnant women. We investigated the impact on prescribing of stop smoking treatments to pregnant women of the 2013 transfer of public health budgets from the NHS to administrative authorities responsible for local social care and other non-health services (local authorities). Methods We used data from the Clinical Practice Research Datalink and Hospital Episode Statistics to determine annual proportions (2005-2017) of women who smoked during pregnancy and who were prescribed, at least once before childbirth, a) any NRT and b) long- and short-acting NRT together (dual NRT). Segmented regression was used to quantify the impact of the 2013 transfer of smoking cessation budgets to local authorities, assessing changes in the level and the trend of the proportions post-2013 compared to pre-2013. Results We identified 84,539 pregnancies in which women were recorded as smoking; any NRT was prescribed in 7.9% (n=6,704) and dual NRT in 1.7% (n=1,466). Prescribing of any NRT was declining prior to 2013 at an absolute decrease of -0.25% per year, but the rate of decline significantly increased from 2013 onwards to -1.37% per year. Prescribing of dual NRT was increasing prior to 2013 but also decreased post-2013. Conclusions These findings suggest that transferring responsibility for English Smoking Cessation Services from the NHS to local authorities adversely affected provision of cessation support in pregnancy. Consequently, some women may have been denied access to effective cessation treatments. Implications Women who smoke during pregnancy may be being denied potentially effective means to help them quit, contrary to NICE guidance, at what can be a teachable moment with substantial immediate and longer-term health benefits for woman and their unborn child, and economic benefits for the NHS. When the organisations responsible for offering smoking cessation support are changed, health systems should consider potential adverse effects on the delivery of support and deploy strategies for mitigating these.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Trends in Prescribing of Nicotine Replacement Therapy to Pregnant Women in Primary Care in England

Szatkowski

Vaz

Fiaschi

et al. 2021

Nicotine &Amp; Tobacco Research

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“…The prevalence of vaping estimated in this study was lower than that from a survey of women who were attending hospital antenatal care appointments at 8 to 24 weeks into their pregnancy, which was conducted in England and Scotland between June and November 2017 [ 37 ]. Like our study, the antenatal survey found that most of the women who vaped also smoked, however they reported a higher prevalence of current vaping than we observed: 4.8% (95%CI 4.1 to 5.6), of which 1.3% (95%CI 1.0 to 1.8) were exclusive vapers and 3.5% (95%CI 2.9 to 4.2) were dual cigarette smokers and vapers.…”

Section: Discussionmentioning

confidence: 75%

Electronic cigarette use (vaping) and patterns of tobacco cigarette smoking in pregnancy–evidence from a population-based maternity survey in England

et al. 2021

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Objectives Exposure to tobacco products during pregnancy presents a potential harm to both mother and baby. This study sought to estimate the prevalence of vaping during pregnancy and to explore the factors and outcomes associated with vaping in pregnancy. Setting England. Participants Women who gave birth between 15th and 28th October 2017. Methods A cross-sectional population-based postal survey of maternal and infant health, the National Maternity Survey (NMS) 2018. The prevalence of vaping and patterns of cigarette smoking were estimated, and regression analysis was used to explore associations between maternal characteristics and vaping, and between vaping and birth outcomes. Outcome measures Unweighted and weighted prevalence of vaping with 95% confidence intervals, and unadjusted and adjusted relative risks or difference in means for the association of participant characteristics and secondary outcomes with vaping. Secondary outcome measures were: preterm birth, gestational age at birth, birthweight, and initiation and duration of breastfeeding. Results A total of 4,509 women responded to the survey. The prevalence of vaping in pregnancy was 2.8% (95%CI 2.4% to 3.4%). This varied according to the pattern of cigarette smoking in pregnancy: 0.3% in never-smokers; 3.3% in ex-smokers; 7.7% in pregnancy-inspired quitters; 9.5% in temporary quitters; and 17.7% in persistent smokers. Younger women, unmarried women, women with fewer years of formal education, women living with a smoker, and persistent smokers were more likely to vape, although after adjusting for pattern of cigarette smoking and maternal characteristics, persistent smoking was the only risk factor. We did not find any association between vaping and preterm birth, birthweight, or breastfeeding. Conclusions The prevalence of vaping during pregnancy in the NMS 2018 was low overall but much higher in smokers. Smoking was the factor most strongly associated with vaping. Co-occurrence of vaping with persistent smoking has the potential to increase the harms of tobacco exposure in pregnant women and their infants.

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“…Use of electronic cigarettes (EC/vaping) is a potential smoking cessation intervention in pregnancy; there is some evidence for effectiveness in non-pregnant smokers [ 10 , 11 ], and they are increasingly used in pregnancy [ 12 , 13 ], including for cessation [ 14 , 15 ]. In the UK around 5% of pregnant women report vaping [ 16 ]. Pregnant women and health professionals (HPs) consider vaping safer than smoking [ 17 , 18 , 19 , 20 ], yet also have concerns about safety [ 14 , 17 , 21 ].…”

Section: Introductionmentioning

confidence: 99%

A Qualitative Study of Factors Influencing Adherence among Pregnant Women Taking Part in a Trial of E-Cigarettes for Smoking Cessation

Ford

Uny

Lowes

et al. 2021

IJERPH

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Use of e-cigarettes (vaping) has potential to help pregnant women stop smoking. This study explored factors influencing adherence among participants in the vaping arm of the first trial of vaping for smoking cessation in pregnancy. We conducted semi-structured telephone interviews (n = 28) with women at three-months postpartum. Interviews were analysed using thematic analysis, informed by the Theoretical-Domains Framework, Necessity-Concerns Framework and Perceptions and Practicalities Approach. Interviewees generally reported high levels of vaping. We found that: (1) intervention adherence was driven by four necessity beliefs—stopping smoking for the baby, and vaping for harm reduction, smoking cessation or as a last resort; (2) necessity beliefs outweighed vaping concerns, such as dependence and safety; (3) adherence was linked to four practicalities themes, acting as barriers and facilitators to vaping—device and e-liquid perceptions, resources and support, whether vaping became habitual, and social and environmental factors; and (4) intentional non-adherence was rare; unintentional non-adherence was due to device failures, forgetting to vape, and personal circumstances and stress. Pregnant smokers provided with e-cigarettes, and with generally high levels of vaping, had positive beliefs about the necessity of vaping for smoking cessation which outweighed concerns about vaping. Non-adherence was mainly due to unintentional factors.

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Pregnant women’s use of e‐cigarettes in the UK: a cross‐sectional survey

Cited by 24 publications

References 48 publications

Trends in Prescribing of Nicotine Replacement Therapy to Pregnant Women in Primary Care in England

Trends in Prescribing of Nicotine Replacement Therapy to Pregnant Women in Primary Care in England

Electronic cigarette use (vaping) and patterns of tobacco cigarette smoking in pregnancy–evidence from a population-based maternity survey in England

A Qualitative Study of Factors Influencing Adherence among Pregnant Women Taking Part in a Trial of E-Cigarettes for Smoking Cessation

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