Smoking cessation and health promotion around pregnancy
Abstract: A smoking cessation program targeting pregnant women and their partners was monitored during 17 years and subjected to several substudies. All women in Blekinge, who gave birth in the months of September during the period 1984 to 2000, were asked to fill out a questionnaire, anonymously, about their smoking habits before and during pregnancy. During these years a long-term educational programme concerning health factors and pregnancy was in process. All personnel the woman met during pregnancy, labour and the infant period had continuously been offered specific education in smoking cessation. The proportion of women smoking that stopped smoking during pregnancy increased from 20% in 1984 to 74% in 2000. Of the women, 84% reported having been informed about smoking cessation and 93% of them felt the information to be of good quality. Twenty-four women were interviewed 2-3 years after delivery with regard to their smoking habits during and after pregnancy. Women who still smoked at their first visit to the antenatal clinic often had an established smoking pattern. They had vague knowledge about the risks of smoking during pregnancy. All women stated that the midwife played an important role in their motivation to stop smoking but many women, however, lacked the support from other staff. In Kronoberg, 403 women, smoking at the time of conception, were asked about their smoking habits during their pregnancies. At the time of registration at the antenatal clinic, the proportion of smoking women had fallen from 403 (100%) to 308 (76%), and at the postpartum check-up, the proportion had fallen further to 225 (56%). Heavy smokers and women with smoking partners continued smoking to a greater extent, as did multiparae and women in unqualified jobs. Serum samples from 496 pregnant women were tested for cotinine. In stated non-smokers, 13 had cotinine levels suggesting substantial exposure to environmental smoke and 25 women who reported to be non-smokers had cotinine levels consistent with active smoking. Another 19 women reported to be light smokers but had values above the median of those of heavy smokers. Thus, 439 of the women (89%) had cotinine levels corresponding with their histories. Members from five groups of health care professionals, altogether 14 persons, involved in a long-term anti-smoking program in maternal and child health care were interviewed about their experiences. The interaction between the professional and the smoker was regarded as the most powerful and important factor to support smoking cessation. Continuous staff training, collaboration between different personnel groups, and program monitoring were other important factors. Pregnancy offers multiple windows of opportunity for smoking cessation intervention. The course of pregnancy and the reality of the postpartum period generate the moving goal for cessation efforts. The target of creating smoke free pregnancies, however, cannot be attained with a single, simple intervention.
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