Prenatal and Postpartum Women and Tobacco

Lesson One: Pregnant women are motivated - quitting is still difficult

1. Although it is difficult to obtain exact numbers, it appears that smoking prevalence rates during pregnancy have declined from the 1960s to the 1990s

A pre-TDRS review of the literature on smoking in pregnancy (P3) noted that no national data documenting smoking trends during pregnancy were available for Canada. The review used provincial data as well as data from the U.S. and Europe to examine smoking prevalence trends among pregnant women. The resulting picture mirrors that of smoking prevalence trends in general - fewer women are smoking during their pregnancies in the 1990s than in the 1960s.

2. Women may have greater intentions of quitting during pregnancy than at other times in their lives

During pregnancy, women who smoke may find themselves questioning their smoking behaviour and trying to change it. In qualitative work conducted by several of the community-based TDRS projects, pregnant women indicated that they wanted to quit smoking and they were willing to participate in the development and testing of resources and programs (B6, K2, S16, T12). Studies cited in a pre-TDRS literature review (P3) found that pregnant women are more likely to quit smoking and smoke fewer cigarettes on average than women smokers who are not pregnant. The literature review also noted that the intention to quit is something that women seem to act on early: most pregnant smokers who attempt to quit do so during the first trimester of the pregnancy.

3. According to TDRS survey data, the majority of current female smokers continued to smoke during their most recent pregnancy

The Survey of Smoking in Canada (SOSIC) (S8) collected information on a sample of roughly 15,800 Canadians over the age of 15. The information was collected in four cycles that were three months apart. The survey measured levels and changes in cigarette smoking behaviour over the course of one year. It was also one of the first national surveys on smoking that collected specific information related to tobacco use during pregnancy.

In its first cycle, the survey found that smoking prevalence for women of reproductive age (15- to 44-year-olds) was almost 34%. Smoking prevalence rates among 15- to 19-year-olds were 29% compared to 38% among 20- to 24-year-olds and 34% for 25- to 44-year-olds.

Of all women aged 20 to 44 years (smokers and non-smokers) who had been pregnant in the previous five years, 19% reported that they had smoked "regularly" during their most recent pregnancy. However, 58% of the women who currently smoke reported that they had smoked during their most recent pregnancy (S8, Cycle 4).

Whether they actually quit smoking or not, pregnancy is a time when many women seriously think about their smoking behaviour. A qualitative study of 43 women found that many of them described their pregnancies as a time when they thought of their smoking differently (R7). This openness to thinking about the role that smoking plays in their lives makes the prenatal period an important opportunity for tobacco reduction intervention.

4. Certain groups of women find it harder to quit than others

TDRS work identified several differences between women who quit smoking during pregnancy and women who continue to smoke. Smoking during pregnancy is most common among women who are 20 years of age or younger and is more prevalent among women who started smoking at a younger age (P3). Pregnant women who feel confident about their ability to quit and have a high perception of risk appear to progress toward quitting and staying quit, even without any intervention (R7).

The relatively high rate of smoking prevalence among pregnant women begs the question: Why do women smoke during pregnancy? The social context of women's lives is an important factor in their continuing to smoke during pregnancy. The women who continue to smoke during pregnancy tend to be the women who are surrounded by family members and friends who smoke. A literature review of smoking and high-risk women found that continued smoking in pregnancy is associated with having a smoking partner and being exposed to environmental tobacco smoke, among other factors (S4). In a study of pregnant and postpartum smokers, over 50% of the 226 respondents reported that at least half of their close friends and family members smoked (R7).

5. Providing cessation support may reduce the percentage of women who smoke during pregnancy

There is relatively little data available to indicate what methods (e.g. nicotine replacement therapy, group programs, selfhelp materials) women who smoke use to quit smoking during their pregnancies. About 13% to 21% of pregnant women quit smoking spontaneously - without a service provider's intervention - when they are planning to become pregnant or as soon as they find out that they are pregnant (P3, T2e). An additional 2% to 22% of pregnant smokers may quit spontaneously later in their pregnancy (P3, T2e). In total, a low of 15% to a high of 43% of pregnant smokers may quit spontaneously. It is possible that these quit rates could be increased if pregnant smokers have access to a range of cessation interventions and options specifically designed for pregnant women.

Counselling Aboriginal Women During Pregnancy

The Northern Family Health Society in Prince George, B.C. wanted to have an impact on the use of tobacco by pregnant Aboriginal women. Through TDRS funding, the Society developed The Smoke Free Journey Counselling Guide (S16) which provides lay counsellors with information and skill development opportunities so that they can discuss tobacco reduction options with Aboriginal women during pregnancy. The guide incorporates solution- focused counselling approaches and teachings from the Medicine Wheel and Sacred Tree to make pre-existing tobacco reduction resources more useful for Aboriginal women. A set of three culturally relevant posters were also developed to raise awareness among pregnant women and their families.

Northern Family Health Society
1010-B 4th Avenue
Prince George, BC V2L 3J1
Phone: 250-561-2689

Cessation Support for Young Pregnant Women

The service providers in the Young Single Parents Support Network in Ottawa had noticed that many of the young women using their services were smokers. When they tried to find a smoking cessation program for the group, nothing existed that combined the concerns of youth with the concerns of pregnancy and single parenthood. With TDRS funding, the Network developed a new, bilingual program Kick Butt for Two (K2). Kick Butt for Two is a facilitated support group program that is delivered in eight sessions. While it encourages participants to quit smoking, it also identifies reducing the amount smoked and making other personal lifestyle changes as program goals. The program design is flexible so that participants can select the topics they want to discuss rather than follow a prescribed program. A key lesson from Kick Butt for Two is that young pregnant women and young single parents need an opportunity to talk about all the stresses in their lives - the stresses that they smoke to cope with - and that talking is an important part of moving toward reducing or quitting smoking.

Young Single Parents Support Network
659 Church Street Ottawa,
ON K1K 3K1
Phone: 613-749-4584
Fax: 613-749-7018