The key relationships in the lives of pregnant women who smoke are often with other smokers - partners, family and friends. Trying to quit makes them doubly different from their peers - they are pregnant and they are trying to stop smoking. Time and again, TDRS projects found that being surrounded by partners, extended families and friends who smoked had a powerful impact on pregnant and postpartum women in terms of the extent to which they were able to reduce or quit smoking and the likelihood of relapse (E10, P3, P8, R7, S4, T2).
For many women, being alone in trying to change their smoking behaviour while surrounded by other smokers who are not making any changes negatively affects their ability to succeed. An important lesson learned from the TDRS is that effective interventions in the prenatal and postpartum period need to reach all smokers in an individual household, not just the pregnant or postpartum woman (E10, P8, R7).
The Survey of Smoking in Canada found that 32% of all Canadian women had smoked or were exposed to their partners' smoke during their most recent pregnancy and 74% of women who currently smoke either smoked or were exposed to partners' smoke during their most recent pregnancy (S8). Through focus group research, several TDRS projects discovered that, while most women were aware of the potential negative health effects on the fetus from maternal smoking, many women were less aware of the impact of environmental tobacco smoke (ETS) on the fetus, infants and young children (B6, S18, T11). Smokers and individuals from households with smokers consistently demonstrate a lower awareness of the health effects of exposure to ETS (A3, E1). This suggests a need to develop approaches that reach all adults and smokers living in individual households.
TDRS work found that the majority of adults favour placing some restrictions on the places where smokers may smoke when it is for the benefit of children's health (A3, E1, E2, E11). This suggests that ETSrelated educational efforts directed toward all adult smokers and focusing on the impact on children have the potential to be effective.
Many prenatal smoking interventions include information on ETS and ways in which pregnant women can make their homes smoke free (K2, S13, U1). Although women tend to be the primary initiators of smoke free policies in their homes (R7), care must be taken not to add to their pressures or guilt by adopting strategies that seem to make women solely responsible for creating smoke free homes. Programs that focus on the whole family may reduce the guilt women feel when they are singled out to quit because they are pregnant, emphasize the shared responsibility of all smokers in a household, and provide an opportunity for children to be involved.
Through TDRS funding, many communities and organizations developed new programs and resources that take a family- or couple-centred approach to ETS education and awareness building. The types of programs developed include:
The Community Health Program, St. Johns Region and the Newfoundland and Labrador Lung Association shared a concern about the extent to which new babies were exposed to environmental tobacco smoke. They decided to work together to help prenatal and postpartum women create smoke free environments for their babies. The result is Baby's Coming, Baby's Home (B6), a 10- minute video and support materials.
The project also provided training for resource people who work with prenatal and postpartum women. After receiving the training, resource people use the video in a one-to-one or group setting. The video itself, which is accompanied by a discussion guide for the resource person, tells one woman's story about her first pregnancy and her efforts to make her home smoke free during her second pregnancy. Support materials include household visual cues such as a door knob hanger and decals. Both the video and the training provided for resource people are appropriate to work with women living on low incomes or with low literacy skills.
When the Saskatchewan Institute on Prevention of Handicaps approached the Gabriel Springs Health District about piloting a community environmental tobacco smoke (ETS) awareness campaign, they knew that they had to find several ways to get their message across and involve the community in developing the campaign. The result was the Smoke Free Spaces for the Little Reasons campaign (E11). By field testing all materials, including the slogan, logo, posters and pamphlets, the campaign organizers were able to raise community awareness about ETS before actually launching the campaign!
To encourage community residents to commit to not smoking around children and pregnant women, a contract and prize draw contest was developed. Smokers who signed the contract agreeing not to smoke around children and pregnant women were entered into a draw for several prizes donated through community businesses - a $500 shopping spree for the under 18 entrants and a family weekend at the Fantasyland Hotel in the West Edmonton Mall for the adult entrants.
Other resources developed for a provincial campaign included a poster and brochure for pregnant women "You can already see his feet, his hands...but can you see the effects of smoking?", a poster and brochure for the general public "She needs to breathe more than you need to smoke" and an information booklet Tobacco Smoke: The Risk to Unborn Babies, Pregnant Women and Children.