Summary of Better and Promising Practices
Better Practice Approaches
The report Expecting to Quit: A Best Practices Review of Smoking Cessation Interventions for Pregnant and Postpartum Girls and Women, 2nd edition examines interventions designed to reduce or eliminate smoking during pregnancy. Based on this review, interventions can be divided into best practices, better practices, and those showing promise.
Based on these effective interventions and our review of the broader literatures on women’s health, women-centred care and other substance use literature, we recommend several approaches or perspectives that should form the basis of intervening with pregnant and postpartum women and girls who smoke. These approaches could be applied immediately to the field of tobacco cessation with pregnant smokers or with women postpartum and integrated into future intervention development and research. These seven approaches are:
- Women-Centred Care
- Reducing Stigma
- Relapse Prevention
- Harm Reduction
- Partner/Social Support
- Social Issues Integration
Recommendations - Practice, Research, and Structural Changes
In addition to these approaches, our review resulted in 27 recommendations for changing practice and research to reduce or eliminate smoking during pregnancy.
- Ensure public health messages are framed in a sensitive, nonjudgmental way that is relevant to the social and economic circumstances of women’s daily lives.
- Encourage harm reduction among pregnant smokers by recommending a decrease in the number of cigarettes they smoke, brief periods of cessation at any point in pregnancy and around delivery, and health-promoting behaviours such as exercising and addressing partner smoking.
- Recognize that motivation to quit is a dynamic factor that changes throughout any period of cessation and incorporate increased support for women throughout the postpartum period.
- Integrate tailored treatment of nicotine addiction for pregnant smokers into substance-use-treatment programs in recognition of women’s identification of nicotine as a problem drug.
- Encourage women to use behavioural methods before pharmacotherapy in order to avoid potential teratogenic side effects that can result from the use of drugs such as bupropion and nicotine replacement therapies (NRTs).
- Offer nicotine-replacement therapies to women who are unable to quit smoking during pregnancy after twelve weeks gestation to reduce damage caused by inhaled smoke to both the woman and the fetus.
- Encourage women to continue breastfeeding even if they smoke or are using NRTs to aid their cessation.
- Increase surveillance and tracking of tobacco-use patterns, including spontaneous quitting, in clinical settings.
- Use individualized information on smoking patterns to construct highly tailored cessation strategies.
- Assess smokers for concurrent mental health issues/other diagnoses, since many smokers experience multiple forms of substance use and/or other mental health issues.
- Emphasize cessation and the importance of the woman’s own health, rather than primarily the health of her fetus, to foster motivation to remain smoke free pre- and postpartum.
- Create specific interventions for the postpartum period that address motivational and stress-related issues for postpartum women.
- Create specific interventions for women who quit spontaneously during pregnancy and postpartum.
- Screen all women and girls of childbearing age for tobacco use.
- Develop more comprehensive measures of harm reduction and lowered consumption to better illuminate the relationship between dosage and fetal health outcomes.
- Develop more comprehensive measures of outcomes that extend beyond quit and relapse rates to include attitudinal, and behavioural changes, reduction, and other context-specific issues.
- Develop and test more interventions that are specifically targeted to young pregnant smokers.
- Conduct research exploring the genetic factors associated with nicotine metabolism with the aim of developing better-tailored approaches to cessation.
- Develop and implement intensive postpartum-specific relapse-prevention interventions for women who have quit smoking during their pregnancies.
- Conduct research examining the safety and utility of bupropion during pregnancy.
- Develop and test more interventions for disadvantaged populations of pregnant and postpartum women using monetary incentives to encourage and maintain cessation.
- Develop and test smoking-cessation interventions for the partners of pregnant and postpartum smokers.
- Design and test interventions tailored for women and girls who continue to smoke during their pregnancies, and for those who stop smoking but relapse before delivery.
- Examine the efficacy of particular program materials and intervention components to elucidate precisely which aspects influence cessation.
- Examine comprehensive tobacco-control strategies with respect to their specific impact on pregnant women, particularly denormalization initiatives.
- Allocate more resources to address the social and structural factors that influence women’s smoking in order to reduce the burden that tobacco-related disease places on disadvantaged women and their fetuses and infants.
- Increase awareness and influence public attitudes about tobacco use among disadvantaged groups so that smoking is seen not a “lifestyle choice” but as a reflection of social and economic circumstances. Such an attitude change would reduce stigma associated with smoking during and after pregnancy.
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