Tailored Intervention for Smoking Reduction and Cessation for Young and Socially Disadvantaged Women During Pregnancy

Abstract

Rates of smoking during pregnancy remain high in Canada, and cessation rates are low among women who are younger than 24 years and who are socially disadvantaged, that is, have few social and economic resources because of poverty, violence, or mental health issues. On the basis of findings from literature reviews and consultation with policy makers, we developed and operationalized four approaches that can be used by health care providers to tailor interventions for tobacco use in pregnancy. These four approaches are woman centered, trauma informed, harm reducing, and equitable. Public health initiatives that address smoking in young and socially disadvantaged women could be more sharply focused by shifting to such tailored approaches that are grounded in social justice aims, span pre-and postpregnancy periods, and can be used to address women's social contexts and concerns.

“They Were Willing to Work with Me and Not Pressure Me”: A Qualitative Investigation into the Features of Value of a Smoking Cessation in Pregnancy Program for Aboriginal and Torres Strait Islander Women

“…Placing Aboriginal and Torres Strait Islander women at the center of the ESF program in this way further contrasts standard cessation support that has narrowly favored fetal health to the exclusion of the contexts impacting women's health and wellbeing-a focus that risks further stigmatizing women and inducing shame for stress-response behaviors [2,3,39]. The ESF program avoided such harm by being women-centered-focused on progressing the health and wellbeing of pregnant women while recognizing the intrinsic relationship between a woman and her unborn baby's health [2].…”

“…The ESF program avoided such harm by being women-centered-focused on progressing the health and wellbeing of pregnant women while recognizing the intrinsic relationship between a woman and her unborn baby's health [2]. This was made possible through holistic wraparound care that was highly flexible, tailored, and non-stigmatizing, and through including significant others to foster supportive and smoke-free environments to support pregnant women's smoking behavioral change [2,20,39]. Ultimately, this comprehensive approach to addressing participants' complex stressors was considered essential for creating a more realistic foundation from which tobacco smoking reduction or cessation could be considered.…”

“…The program's flexible and tailored approach to smoking cessation support required a reconfiguration of what success looks like in this space-viewing it through a contextual and harm-reduction lens [3,39], rather than a narrow focus where only cessation is valued [1]. Thus, the significance of improvements in ESF participants' daily circumstances and general health and wellbeing were recognized.…”

“…Specific to tobacco use, this involved celebrating the success of each change in smoking behavior made, as appropriate to individual circumstances and capacity, including changes in passive smoking exposure, along with reductions or cessation of tobacco use. Supporting ESF participants to be the directors of their smoking cessation journey in a safe environment further exemplified a trauma-informed approach to cessation support by avoiding directive and confrontational approaches to behavioral change goal setting, which can be experienced as unsafe and authoritative, particularly for women who have experienced discrimination and trauma [39].…”

Nurse home visiting and prenatal substance use in a socioeconomically disadvantaged population in British Columbia: analysis of prenatal secondary outcomes in an ongoing randomized controlled trial

“…4 NFP therefore shows promise, building on other harm reduction efforts. [38][39][40] For prenatal alcohol use, we found relatively low baseline rates (5.7%) and no evidence of benefit from NFP by 34-36 weeks' gestation. Similarly, previous US NFP trials have not shown significant reductions in prenatal alcohol use.…”