Understanding Inequalities of Maternal Smoking—Bridging the Gap with Adapted Intervention Strategies

Abstract

Women who are generally part of socially disadvantaged and economically marginalized groups are especially susceptible to smoking during pregnancy but smoking rates are underreported in both research and interventions. While there is evidence to support the short-term efficacy of nicotine replacement therapy (NRT) use in pregnancy, long-term abstinence rates are modest. Current health strategies and interventions designed to diminish smoking in pregnancy have adopted a simplified approach to maternal smoking—one that suggests that they have a similar degree of choice to non-pregnant smokers regarding the avoidance of risk factors, and overlooks individual predictors of non-adherence. As a result, interventions have been ineffective among this high-risk group. For this reason, this paper addresses the multiple and interacting determinants that must be considered when developing and implementing effective strategies that lead to successful smoking cessation: socioeconomic status (SES), nicotine dependence, social support, culture, mental health, and health services. Based on our review of the literature, we conclude that tailoring cessation programs for pregnant smokers may ultimately optimize NRT efficacy and reduce the prevalence of maternal smoking.

Pregnancy-specific telephone support helps reduce maternal smoking

“…These findings are consistent among other developed countries2 and accentuate that the struggle pregnant smokers may have to quit and remain quit 4. Interventions that promote cessation during pregnancy that overlook the determinants of smoking behaviour result in low rates of smoking abstinence and high relapse after childbirth 2. The complex reasons that contribute to maternal smoking require well-designed population-specific strategies and tailored interventions to attain long-term cessation.…”

“…In Canada, lower education, lower household income and lack of social support were among the population-level determinants associated with continued smoking during pregnancy and relapse after childbirth 5. These findings are consistent among other developed countries2 and accentuate that the struggle pregnant smokers may have to quit and remain quit 4. Interventions that promote cessation during pregnancy that overlook the determinants of smoking behaviour result in low rates of smoking abstinence and high relapse after childbirth 2.…”

“…In high-income countries, the prevalence of maternal smoking has declined, but it remains high among women who are more socially disadvantaged 1 2. According to the authors of this study, limitations of nicotine replacement therapy and other tobacco dependence medications during pregnancy increase the importance of behavioural interventions to combat tobacco use.…”

Consequences and Possible Predictors of Health-damaging Behaviors and Mental Health Problems in Pregnancy – A Review

“…Social integration and the availability of emotional support, and of informal and practical help were important resources for successfully managing stressful events and had a correspondingly positive impact on the physical and mental health [88]. Social support also played an important role in helping pregnant women stop smoking [89]. Pregnant women who continued to smoke were more likely to experience conflicts with their partner [54,59] and were less likely to feel they were supported by their partner or by close relatives or friends or were less satisfied with the perceived support they received from their partner [37].…”

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

“…For example, Graham (1993, p. 80) identified "trajectories of disadvantage" that shape women's vulnerability to smoking during pregnancy, including growing up in poverty, low socioeconomic status, and being a young and/or single mother. More recently, Boucher and Konkle (2016) identified six key factors that affected smoking during pregnancy: socioeconomic status, nicotine dependence, social support, culture, mental health, and health services. Hence, intersectionality may be a useful framework through which to contextualize disparities in tobacco use during pregnancy and to recognize the complex needs of pregnant women who are trying to reduce or quit tobacco use.…”