Pieces of the Puzzle

 
Rationale: The Missing Pieces

Smoking in pregnancy and postpartum remain serious public health problems. Approximately 20%–30% of pregnant women use tobacco^1,2. In Canada, as few as 15.8% of pregnant women who smoke make a quit attempt and only half of these are smoke-free when their child is born³. Estimated relapse rates are reported at 25% within one month postpartum, 50% within four months postpartum, and 70%-90% by one year postpartum^4,5,6. Canadian federal surveys report that 29% of men continue to smoke during their child rearing years⁷, 15% of households have at least one person who smokes inside the home every day, and almost 10% of children under the age of 12 (about 379,000 children) are regularly exposed to second-hand smoke at home.

Health burdens of smoking include increased risk of cardiovascular disease and cancer, decreased fertility and sperm quality, and pregnancy outcomes such as ectopic pregnancy and placenta previa. Serious health consequences for fetuses and infants include early pregnancy loss⁸, low birth weight and associated risks, middle ear infections, respiratory infections such as bronchitis and pneumonia, and sudden infant death syndrome^9,10.

Social factors (e.g., having a partner who smokes, lack of social support) are strong predictors of return to tobacco; for example, a partner’s smoking negatively influences women’s tobacco reduction and cessation during pregnancy and postpartum^{11,12,13,14,15}. Despite our knowledge of smoking and its health consequences, there is a dearth of both scientific information and interventions that account for family dynamics influencing tobacco use in pregnancy and postpartum, particularly for expectant and new fathers.

History: The Project Begins

FACET (Families Controlling and Eliminating Tobacco) is a program of research focused on finding ways to support tobacco reduction for women and their partners who smoke during pregnancy and postpartum. Our primary goal is to reduce tobacco use in young families.

For many families, pregnancy and the postpartum period present opportunities to rethink health behaviours such as smoking. Understanding interactions within family units surrounding tobacco use and reduction will strengthen programs and interventions for tobacco reduction.

In the first phase of the project (FACET 1: 2002-2004), we interviewed couples about the dynamics surrounding tobacco in their household that affect the woman’s success in tobacco reduction during pregnancy and postpartum.

In the second phase (FACET 2: 2005-2007), we examined the mechanisms by which partners’ smoking influenced women’s return to smoking in postpartum. We also described fathers’ resistance to quitting, their responses to tobacco control messages targeting men, and the influence of masculinities on smoking and tobacco reduction experiences.

Our findings indicated a need for tobacco reduction interventions that take into consideration household dynamics, and that provide guidance for women and their partners on how to create a supportive environment for tobacco reduction within family units. The “ Couples and Smoking ” booklet was developed in partnership with Act Now BC to address these needs. Findings also highlighted a real gap in support for men’s tobacco reduction during their partners’ pregnancy/ postpartum.

A number of accepted qualitative methodologies were selected to generate detailed, contextually grounded descriptions and theoretical explanations of smoking in young families; a variety of methodological and theoretical frameworks have informed these processes (please refer to the published articles for more information).

In-depth, open-ended interviews, photo elicitation, and group consultation sessions have been our primary methods of data collection. We have used grounded theory methods to guide the analysis of interview transcripts and to inform our interview questions in an iterative process; narrative and discourse analyses have also been conducted on interview transcripts to contribute to rich or ‘thick’ ethnographic descriptions of the contexts of smoking behaviours.

Participant-produced photographs have provided a data set that privileges fathers’ perspectives on smoking and fatherhood; we have also elicited fathers’ readings of mass media anti-smoking campaigns targeted at men.

Current Activities: The Story Continues... 

In the current Knowledge to Action phase of the project, we are developing and pilot-testing novel implementation strategies for the “ Couples and Smoking ” booklet and its key messages. We are also developing and piloting tobacco reduction interventions for new dads.

Group consultation sessions with moms, dads, health care professionals and community service providers are designed and facilitated by a Knowledge Broker to ensure innovative ways of engaging participants and exchanging knowledge. This phase also involves a formal evaluation of the knowledge translation/exchange process.

¹Coleman, G., & Joyce, T. (2003). Trends in smoking before, during, and after pregnancy in ten states. American Journal of Preventive Medicine, 24, 29–35.
²Infant Feeding Survey—Department of Health. (2004). Cigarette smoking by women during pregnancy: By social class, 1985-2000: Social Trends 32. National Statistics Online. Retrieved from: http://www.statistics.gov.uk/STATBASE/Product.asp?vlnk=8677&More=Y.
³Connor, S.K., & McIntyre, L. (1999). The socio-demographic predictors of smoking cessation among pregnant women in Canada. Canadian Journal of Public Health, 90, 352–355.
⁴Fingerhut LA, Kleinman JC, Kendrick JS. Smoking before, during, and after pregnancy. American Journal of Public Health 1990; 80(5):541-544.
⁵Mullen PD, Quinn VP, Ershoff DH. Maintenance of nonsmoking postpartum by women who stopped smoking during pregnancy. American Journal of Public Health 1990; 80(8):992-994.
⁶Secker-Walker RH, Solomon LJ, Flynn BS, Skelly JM, Lepage SS, Goodwin GD et al. Smoking relapse prevention counseling during prenatal and early postnatal care [published erratum appears in Am J Prev Med 1996 Mar-Apr;12(2):71-2]. American Journal of Preventive Medicine 1995; 11(2):86-93.
⁷Callard, C., & Lavigne, C. (2005). A World No Tobacco Day Message from Canada’s Health Professionals. Physicians for a smoke-free Canada: The Canadian Dental Association. Available from: http://www.cda-adc.ca/en/cda/news_events/media/news_releases/2005/pdfs/wntd2005.pdf.
⁸Venners, S. A., Wang, X., Chen, C., Wang, L., Chen, D., Guang, W., et al. (2004). Paternal smoking and pregnancy loss: A prospective study using a biomarker of pregnancy. American Journal of Epidemiology, 159, 993–1001.
⁹British Medical Association. (2004). Smoking and reproductive life: The impact of smoking on sexual, reproductive and child health. London; Edinburgh: British Medical Association, Board of Science and Education and Tobacco Control Resource Centre.
¹⁰Martinez, F. D., Wright, A., Taussig, L., & Group Health Medical Associates. (1994). The effect of paternal smoking on the birthweight of newborns whose mothers did not smoke. American Journal of Public Health, 84, 1489–1491.
¹¹Fingerhut, L. A., Kleinman, J. C., & Kendrick, J. S. (1990). Smoking before, during, and after pregnancy. American Journal of Public Health, 80, 541–544.
¹²Johnson, J. L., Ratner, P. A., Bottorff, J. L., Hall, W., & Dahinten, S. (2000). Preventing smoking relapse in postpartum women. Nursing Research, 49, 44–52.
¹³Klesges, R. C., Johnson, K. C., Ward, K. D., & Barnard, M. (2001). Smoking cessation in pregnant women. Obstetrics and Gynecological Clinics of North America, 28, 269–282.
¹⁴Mullen, P. D., Richardson, M. A., & Quinn, V. P. (1997). Postpartum return to smoking: Who is at risk and when? American Journal of Health Promotion, 11, 323–330.
¹⁵Ratner, P. A., Johnson, J. L., Bottorff, J. L., Dahinten, S., & Hall, W. (2000). Twelve-month follow-up of a smoking relapse prevention intervention for postpartum women. Addictive Behaviors, 25, 81–92.

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