Reducing tobacco use among women of childbearing age: Contributions of tobacco regulatory science and tobacco control

Tobacco endgame and priority populations: a scoping review

AIM

To summarise the research literature on the impacts or perceptions of policies to end tobacco use at a population level (ie, tobacco endgame policies) among people from eight priority population groups (experiencing mental illness, substance use disorders, HIV, homelessness, unemployment or low incomes, who identify as lesbian, gay, bisexual, transgender, queer or intersex (LGBTQI+) or who have experienced incarceration).

METHODS

Guided by JBI Scoping Review Methodology, we searched six databases for original research examining the impacts or perceptions of 12 tobacco endgame policies among eight priority populations published since 2000. We report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.

RESULTS

Of the 18 included studies, one described perceptions of five endgame policies among people on low incomes in Aotearoa (New Zealand), and 17 focused on the effectiveness or impacts of a very low nicotine content (VLNC) cigarette standard among people experiencing mental illness (n=14), substance use disorders (n=8), low incomes (n=6), unemployment (n=1) or who identify as LGBTQI+ (n=1) in the USA. These studies provide evidence that VLNC cigarettes can reduce tobacco smoking, cigarette cravings, nicotine withdrawal and nicotine dependence among these populations.

CONCLUSIONS

Most of the tobacco endgame literature related to these priority populations focuses on VLNC cigarettes. Identified research gaps include the effectiveness of endgame policies for reducing smoking, impacts (both expected and unexpected) and policy perceptions among these priority populations.

The association between preconception cannabis use and depression and anxiety during pregnancy

OBJECTIVE

Cannabis use among individuals of reproductive age has increased with cannabis legalization and heightened stress during the COVID-19 pandemic. Our study provides data on preconception cannabis use and cannabis use disorder (CUD) during the pandemic and models the association between preconception cannabis use and depression and anxiety during pregnancy.

METHODS

Data on substance use and depression and anxiety symptoms were collected from questionnaires and the Structured Clinical Interview for DSM-5 (SCID-5) from pregnant individuals in Oregon in 2019-2022. Linear regression was used to model the association between the frequency of preconception cannabis use and scores on the Center for Epidemiological Studies of Depression-Revised (CESD-R) and Beck Anxiety Inventory (BAI).

RESULTS

The prevalence of preconception cannabis use was 27.8% among 227 study participants. CUD was diagnosed in 19% of cannabis users, or 5.3% of the overall sample. Daily cannabis use, compared to rare/never use, was associated with increases in CESD-R (β = 6.22, p 0.029) and BAI (β = 4.71, p 0.045) scores.

CONCLUSIONS

Cannabis use and CUD are common among individuals of reproductive age. Given the association between preconception cannabis use and depression and anxiety during pregnancy, more attention is needed on screening and counseling of cannabis use among people of reproductive age.

Trends in Use of Conventional Cigarettes, E-cigarettes, and Marijuana in Pregnancy and Impact of Health Policy

The substance use policy context continues to evolve. As tobacco control policies have become more restrictive, marijuana legalization has increased access to marijuana. Data suggest that prenatal conventional cigarette use is declining, while e-cigarette and marijuana use are increasing among persons preconception, prenatally, and postpartum. Policy evaluations have found that increasing cigarette taxes reduces prenatal smoking and improves birth outcomes; however, there have been few studies of e-cigarette policies or marijuana legalization on prenatal use or birth outcomes. It is important for clinicians to screen for prenatal substance use, as recommended by American College of Obstetricians and Gynecologists (ACOG), and understand how policies influence use among their patients.

Closing the gaps in tobacco endgame evidence: a scoping review

OBJECTIVE

Tobacco endgame policies aim to rapidly and permanently reduce smoking to minimal levels. We reviewed evidence syntheses for: (1) endgame policies, (2) evidence gaps, and (3) future research priorities.

DATA SOURCES

Guided by JBI scoping review methodology, we searched five databases (PubMed, CINAHL, Scopus, Embase and Web of Science) for evidence syntheses published in English since 1990 on 12 policies, and Google for publications from key national and international organisations. Reference lists of included publications were hand searched.

STUDY SELECTION

Two reviewers independently screened titles and abstracts. Inclusion criteria were broad to capture policy impacts (including unintended), feasibility, public and stakeholder acceptability and other aspects of policy implementation.

DATA EXTRACTION

We report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.

DATA SYNTHESIS

Eight policies have progressed to evidence synthesis stage (49 publications): mandatory very low nicotine content (VLNC) standard (n=26); product standards to substantially reduce consumer appeal or remove the most toxic products from the market (n=1); moving consumers to reduced risk products (n=8); tobacco-free generation (n=4); ending sales (n=2); sinking lid (n=2); tax increases (n=7); and restrictions on tobacco retailers (n=10). Based on published evidence syntheses, the evidence base was most developed for a VLNC standard, with a wide range of evidence synthesised.

CONCLUSIONS

VLNC cigarettes have attracted the most attention, in terms of synthesised evidence. Additional focus on policies that reduce the availability of tobacco is warranted given these measures are being implemented in some jurisdictions.

Smoking Patterns and Anxiety Factors Among Women Expressing Perinatal Depression

Background: Relationships among perinatal depression occurring a number of weeks before and after childbirth and smoking have been identified. Depression may lead to the inability to abstain from smoking during pregnancy.

Objectives: This study aims to determine factors affecting smoking during pregnancy revealing potential relationships between depression and smoking patterns during and after pregnancy.

Methods: A total of 206 mothers participated in the study. Data were collected through self-reporting as respondents were asked to answer questionnaires during the 12th week of pregnancy, during the 30th week of pregnancy, after childbirth, and during the period after pregnancy. Relationships between smoking behavior, sociodemographic variables, and feelings of perinatal depression were examined using chi-square test and binary logistic regression analysis. A follow-up investigation has been conducted after 2 years revealing the percentage of women returning to their smoking habits.

Results: Smokers before (B = 0.568; p = 0.026) and during pregnancy (B = 1.238; p = 0.009) were more likely to express depression before childbirth. Average daily cigarette consumption before (B = 1.110; p = 0.001) and during pregnancy (B = 1.167; p = 0.002) was associated with depression during pregnancy. Women who smoked during pregnancy reported significantly more depressive symptoms after pregnancy (B = 1.757; p = 0.005) compared with nonsmokers and smokers who abstained during pregnancy. Average daily cigarette consumption during pregnancy (B = 1.402; p = 0.002) affects the expression of depression after pregnancy. Women who smoked before pregnancy (B = 0.568; p = 0.025) and their average daily cigarette consumption before pregnancy (B = 1.465; p = 0.025) were highly associated with the inability to abstain from smoking during pregnancy. However, the knowledge of risks of maternal smoking during pregnancy (B = −1.110; p = 0.001) and medical consult on abstaining (B = −1.238; p = 0.009) reinforced the maternal attempt to quit smoking. The follow-up investigation revealed an elevated amount of women returning to previous smoking patterns.

Discussion: Perinatal depression is associated with smoking patterns during pregnancy. Assessment of depression and smoking is needed throughout perinatal period to support the health of women.

Electronic Nicotine Delivery Systems (ENDS) Use and Pregnancy II: Perinatal Outcomes Following ENDS Use During Pregnancy

Purpose of Review

This review examines the risk of adverse perinatal outcomes following electronic nicotine delivery system (ENDS) use during pregnancy, and considers whether there are sufficient data to support ENDS as a harm reduction approach during pregnancy.

Recent Findings

Seven papers assessed perinatal outcomes following ENDS use during pregnancy. There was evidence that ENDS use was associated with increased risk for some adverse perinatal outcomes (e.g., small for gestational age). However, the repeated use of data sets, insufficient data (e.g., timing of ENDS use, type of ENDS products used), and limited samples size, contributed to mixed findings on the degree to which ENDS use (alone or in combination with combustible cigarettes (CC)) impacts the risk of adverse perinatal outcomes relative to CC smoking alone.

Summary

The current data are still insufficient to support ENDS as a harm reduction approach, though findings do warrant concern and more detailed investigation of ENDS use during pregnancy. Future research directions, as well as implications for clinical recommendations and tobacco regulatory science are discussed.