Predictors of smoking cessation during pregnancy among the women of Yamato and Ayase municipalities in Japan

Predictors of smoking cessation during pregnancy: a systematic review and meta-analysis

AIM

To identify factors found in the research literature to be associated with smoking cessation in pregnancy.

METHODS

Electronic searches of the bibliographic databases of PubMed, EMBASE, PsycINFO, Elsevier, Scopus and ISI Web of Science were conducted to April 2017. All studies reporting factors associated with smoking cessation or continuing smoking during pregnancy were included and reviewed systematically, irrespective of study design. The Newcastle-Ottawa Quality Assessment Scale was used to assess the study quality. The DerSimonian & Laird random-effects model was used to conduct meta-analyses, and where effect estimates were reported for factors included in at least three studies.

RESULTS

Fifty-four studies, including 505 584 women globally who smoked before pregnancy, 15 clinical trials and 40 observational studies, were included in the review and 36 (65.5%) were considered to be of high quality. This review identified 11 socio-demographic, seven socially related, 19 smoking behaviour-related, five pregnancy-related, six health-related and six psychological factors that were associated significantly with smoking cessation during pregnancy. The most frequently observed significant factors associated with cessation were: higher level of education, pooled odds ratio (OR), 95% confidence interval (CI) = 2.16 (1.80-2.84), higher socio-economic status: 1.97 (1.20-3.24), overseas maternal birth: 2.00 (1.40-2.84), Medicaid coverage or private insurance: 1.54 (1.29-1.85), living with partner or married: 1.49 (1.38-1.61), partner/other members of the household do not smoke: 0.42 (0.35-0.50), lower heaviness of smoking index score: 0.45 (0.27-0.77, lower baseline cotinine level: 0.78 (0.64-0.94), low exposure to second-hand smoking: 0.45 (0.20-1.02), not consuming alcohol before and/or during pregnancy: 2.03 (1.47-2.80), primiparity: 1.85 (1.68-2.05), planned breastfeeding:1.99 (1.94-2.05), perceived adequate pre-natal care: 1.74 (1.38-2.19), no depression: 2.65 (1.62-4.30) and low stress during pregnancy: 0.58 (0.44-0.77).

CONCLUSION

A wide range of socio-demographics, relationship, social, smoking-related, pregnancy-related, health and psychological factors have been found to predict smoking cessation in pregnancy.

Smoking cessation during pregnancy: the influence of partners, family and friends on quitters and non-quitters

This research compared pregnant quitters' and non-quitters' accounts of how partners, family and friends influenced their smoking cessation attempts. Qualitative secondary data analysis was carried out on a purposive sample of motivational interview transcripts undertaken by research midwives with pregnant women as part of SmokeChange, a smoking cessation intervention. Interviews with all quitters in the intervention group (n = 12) were analysed comparatively with interviews from a matched sample of non-quitters (n = 12).The discourses of both revealed similarity in how their partners, family and friends influenced their cessation efforts: salient others were simultaneously perceived by both groups of women as providing drivers and barriers to quit attempts; close associates who smoked were often perceived to be as supportive as those who did not. However, women who quit smoking during pregnancy talked more about receiving active praise/encouragement than those who did not. While close associates play an important role in women's attempts to stop smoking during pregnancy, the support they provide varies; further research is needed to develop a better understanding of how key relationships help or hinder cessation during pregnancy.

Denial of smoking-related risk among pregnant smokers

OBJECTIVE

To examine pregnant women's denial of risk, tobacco dependence and their partner's smoking status on smoking behavior during pregnancy.

DESIGN

Cross-sectional design with convenience sampling.

SETTING

Data collection was carried out in hospitals and antenatal clinics in Budapest and 12 other Hungarian cities.

POPULATION OR SAMPLE

A total of 406 adult pregnant women (mean age: 28.2 years; SD = 5.6) with a mean gestational age of 23.3 weeks ranging from 4 to 40 (SD = 8.9).

METHODS

Pregnant women were enrolled in the study by midwives and home-care attendants.

MAIN OUTCOME MEASURES

Smoking status was assessed by self-report questions. Further measures included the Fagerstrom Test of Nicotine Dependence to assess nicotine dependence, and the Wisconsin Inventory of Smoking Dependence Motives to assess the motivational background of smoking. Risk perception was assessed by Haslam and Draper's (2000) 12-item risk perception questionnaire.

RESULTS

Prevalence of occasional and daily smokers was 21.7 and 29.3%, respectively. Some 59.7% of the pregnant women have a partner who smokes. Daily smokers had a higher level of risk denial than occasional or non-smokers (Welch F = 91.607; p < 0.001). Current smokers also had a higher denial than temporary quitters (t = -3.153; p = 0.003). Denial of risk correlated significantly with nicotine dependence (r = 0.30) and the main motivational factors (r = 0.34-0.48). A multinomial logistic regression model of denial of risk concurrently predicted women's smoking status (p = 0.001), even when controlling for age, education, partner's smoking status and parity.

CONCLUSIONS

A higher level of risk denial seems to be one of the major determinants of women's smoking status during pregnancy.

Smoking cessation during pregnancy: a systematic literature review

ISSUES

Second-hand smoke presents a health risk for a large group of entirely helpless nonsmokers: unborn children. Reliable data on women continuing to smoke during pregnancy are essential for effective preventive and interventional programs. The aim of this review is therefore to identify this risk group compared with spontaneous quitters of smoking.

APPROACH

This systematic literature review is based solely on empirical original papers derived from samples of pregnant women smoking at the beginning of pregnancy. In accordance with the QUOROM Statement all population or clinic-based samples were included. Collectives from intervention studies were not included. All studies were from developed nations and published between January 1997 and March 2008.

KEY FINDINGS

A total of 19 studies were identified. The rate of quitters was between 4.0% and 69.7% for population-based studies, and 26.5% and 47.0% for clinic-based studies. A smoking partner, a large number of children, a high rate of tobacco consumption, as well as deficiencies in prenatal care were predictors of smoking during pregnancy.

IMPLICATIONS

This study identifies risk factors and correlates and indicates common obstacles for women to quit smoking during pregnancy.

CONCLUSION

The risk groups that can be defined based on our results are a key target population for preventive measures.

Smoking trends before, during, and after pregnancy among women and their spouses

BACKGROUND

Pregnancy and childbirth can act as strong factors motivating parents to spontaneously quit smoking. The aim of the present survey was to establish smoking cessation guidelines for this group. The objectives were to clarify the smoking status of parents before, during and after pregnancy, as well as the factors associated with continuous smoking during pregnancy and post-partum smoking relapse among women who had stopped smoking during pregnancy.

METHODS

A cross-sectional survey with self-administered questionnaires was conducted for the parents of the 908 infants who participated in the official medical and dental examination for 18-month-old infants in Itabashi ward, Tokyo, Japan.

RESULTS

The prevalence of smoking among women before, during pregnancy, and at post-partum 18 months at 95% confidence intervals was 29.3% (23.3-35.3%), 9.8% (3.0-16.6%), and 23.1 (16.8%-29.4%), and among their spouses it was 64.3% (60.0-68.6%), 58.1% (53.4-62.7%), and 58.2% (53.5-62.8%), respectively. The positive factors associated with smoking among pregnant women were marriage to a smoker, less education, under stress, and part-time employment rather than unemployment. The positive factors associated with smoking relapse after childbirth among women were breast-feeding <6 months and age under 30 years.

CONCLUSION

Compared with Western countries, the rate of smoking cessation during pregnancy was relatively high in Japan. It is necessary that smoking cessation intervention and support for men be initiated at the early stages of their spouses' pregnancies. These observations could influence the targeting and design of maternal smoking intervention.

Smoking among pregnant women in Cantabria (Spain): trend and determinants of smoking cessation

Background

Cantabria (Spain) has one of the highest prevalence of smoking among women of the European Union. The objectives are to assess the trend of smoking during pregnancy in a five-year period and the determinants of smoking cessation during pregnancy in Cantabria.

Methods

A 1/6 random sample of all women delivering at the reference hospital of the region for the period 1998–2002 was drawn, 1559 women. Information was obtained from personal interview, clinical chart, and prenatal care records. In the analysis relative risks and 95% confidence intervals were estimated. Multivariable analysis was carried out using stepwise logistic regression.

Results

Smoking prior to pregnancy decreased from 53.6% in 1998 to 39.4% in 2002. A decrease in smoking cessation among women smoking at the beginning of pregnancy was observed, from 37.3% in 1998 to 20.6% in 2002. The mean number of cigarettes/day (cig/d) before pregnancy remained constant, around 16 cig/d, whereas a slight trend to increase over time was seen, from 7.7 to 8.9 cig/d. In univariate analysis two variables favoured significantly smoking cessation, although they were not included in the stepwise logistic regression analysis, a higher education level and to be married. The logistic regression model included five significant predictors (also significant in univariate analysis): intensity of smoking, number of previous pregnancies, partner's smoking status, calendar year of study period (these four variables favoured smoking continuation), and adequate prenatal care (which increased smoking cessation).

Conclusion

The frequency of smoking among pregnant women is very high in Cantabria. As smoking cessation rate has decreased over time, a change in prenatal care programme on smoking counseling is needed. Several determinants of smoking cessation, such as smoking before pregnancy and partner's smoking, should be also addressed by community programmes.

Which women stop smoking during pregnancy and the effect on breastfeeding duration

BACKGROUND

Cigarette smoking during pregnancy increases the risk of adverse pregnancy outcomes and women who quit smoking at this time are able to reduce the risk of low birth weight, preterm labour, spontaneous abortion and perinatal death. This study investigates the socio-demographic characteristics of pregnant women who stop smoking during pregnancy and the association between stopping smoking and breastfeeding duration.

METHODS

A 12 month longitudinal study was conducted in two public maternity hospitals in Perth, Australia between mid-September 2002 and mid-July 2003. While in hospital, participating mothers completed a self-administered baseline questionnaire. Follow up telephone interviews were conducted at 4, 10, 16, 22, 32, 40 and 52 weeks.

RESULTS

A total of 587 (55%) mothers participated in the study. Two hundred and twenty six (39%) mothers reported smoking prior to pregnancy and 77 (34%) of these stopped smoking during pregnancy. Women who were pregnant for the first time were twice as likely (OR = 2.05; 95% CI 1.047 - 4.03; p < 0.05) to quit smoking as multiparous women. Women who smoked more than 10 cigarettes per day were significantly less likely to quit smoking during pregnancy (OR = 0.36; 95% CI 0.18 - 0.69; p < 0.05). Women who consumed alcohol before pregnancy were three times more likely to quit smoking (OR = 2.58; 95% CI 1.00 - 6.66; p < 0.05). Quitting smoking during pregnancy was significantly associated with breastfeeding for longer than six months (OR = 3.70; 95% CI 1.55 - 8.83; p < 0.05).

CONCLUSION

Pregnancy is a time when many women are motivated to quit smoking and providing targeted smoking cessation interventions at this time, which take into account factors predictive of quitting smoking, are more likely to be successful.