Attitude towards cessation among French pregnant smokers: Explaining the poor uptake of specialised support
Received 14 November 2008; received in revised form 22 June 2009; accepted 25 July 2009. published online 17 August 2009.
Abstract
Objectives
This study investigated pregnant smokers’ profile and attitude towards cessation to explain who stops smoking during pregnancy and who is unsuccessful.
Study design
682 pregnant smokers aged less than 50 had visited cessation services between 2004 and 2006. Pregnant smokers’ profile was described using: socio-demographic details, psychological and medical history, characteristics of tobacco consumption and details of cessation interventions. At the end of the first visit, cessation specialists could record a brief report of the visit with additional information on the smoker. Abstinence was verified during follow-up visits with expired carbon monoxide measures, with a threshold of 5ppm. Associations between pregnant smokers’ profile and subsequent cessation interventions outcomes were tested using descriptive statistics. Predictors of cessation were determined with multivariate logistic regression. Reports of the visits were analysed by open coding to determine main themes.
Results
80.5% of women were heavy smokers at baseline whatever the intervention outcome (10 cigarettes or more per day by the first visit). 16.3% (N=111) of women stopped smoking during their pregnancy. 59.8% (N=408) were registered during a first visit but never returned to a cessation service. The reports revealed that these women showed little motivation for complete cessation, despite being offered an intervention plan. They were more interested in maintaining a reduced tobacco consumption for stress relief. Women who lived or worked with smokers feared that they would not be able to maintain abstinence.
Conclusions
Despite being offered professional help, many pregnant heavy smokers do not feel ready to stop smoking. Their attitude towards cessation illustrates ambivalence. There is thus a need for coordinated efforts between antenatal care providers and smoking treatment specialists in order to enhance pregnant smokers’ motivation to quit.
aFaculté de médecine Paris VI, Université Pierre et Marie Curie, 15 rue de l’Ecole de Médecine, 75006 Paris, France
bUnité de recherche 4069, Fondation MGEN: Epidémiologie, évaluation et politique de santé, Faculté de Médecine René Descartes, Université Paris V, 3 square Max Hymans, 75015 Paris, France
cCentre de Tabacologie, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France
Corresponding author at: Laboratoire de Santé Publique et Informatique Médicale (SPIM), Université Paris V – Descartes, 15 rue de l’Ecole de Médecine, 75006 Paris, France. Tel.: +33 1 42 34 69 83; fax: +33 1 53 10 92 01.
ABSTRACT