Smoking Among Pregnant Women in Outpatient Treatment for Opioid Dependence: A Qualitative Inquiry

Abstract

Introduction: Smoking during pregnancy is a major public health issue, contributing to adverse health outcomes. The vast majority of women with substance use disorders smoke during the perinatal period. Medication Assisted Treatment (MAT) is the standard of care for women using opioids during pregnancy. The majority of women engaged in MAT (88%-95%) report smoking. The purposes of this study were to describe: (1) facilitators and barriers to engaging in tobacco treatment among pregnant, opioid dependent women receiving MAT; and (2) strategies to tailor tobacco treatment interventions with this population. Methods: Two semi-structured focus groups lasting approximately 45 minutes each were conducted with 22 women engaged in MAT. Focus groups were recorded, transcribed and analyzed in MAXQDA using content analysis. Results: Participants reported: (1) desire to quit smoking for themselves and their children; (2) aversion to smoking; (3) a turning point in their lives from being pregnant and entering MAT; (4) nicotine dependence; (5) smoking as a way to cope with stress; (6) coping with dual dependencies; (7) past experiences with stopping smoking due to smoking restrictions; (8) perceived lack of success with nicotine replacement therapy or other tobacco treatment medications; and (9) the need for intensive environmental support for quit attempts. Conclusions: Participants were motivated to quit smoking, but faced multiple complex barriers. Integrating tobacco treatment into the psychosocial services offered in conjunction with MAT would allow a healthcare provider to offer tailored tobacco treatment in a supportive environment. Implications: Results of this qualitative study include facilitators and barriers to engaging in tobacco treatment among pregnant, opioid dependent women receiving MAT, as well as strategies to tailor tobacco treatment interventions for this population. In-depth knowledge of the complex barriers facing this patient population can be used to inform tailored tobacco treatment services that can be integrated into clinics providing MAT.

Tailoring a NICU-Based Tobacco Treatment Program for Mothers Who Are Dependent on Opioids

“…To appropriately tailor a tobacco treatment intervention for vulnerable women, it is necessary to first understand the link between smoking and stress in their lives and then integrate stress reduction and tobacco treatment interventions into prenatal and postpartum care. This supports the results of previous studies that indicated that vulnerable women were interested in smoking cessation but recognized a need for intense support (e.g., a buddy; Fallin et al, 2016; Stewart et al, 2011) and assistance to navigate the many barriers to cessation services (e.g., child care; Stewart et al, 2011). …”

“…This is supported by a body of research indicating that disadvantaged women (Flemming, Graham, Heirs, Fox, & Sowden, 2013; Flemming, McCaughan, Angus, & Graham, 2015; Howard et al, 2013; Stewart et al, 2011), including women dependent on opioids (Fallin, Miller, & Ashford, 2016) report smoking to relieve stress. In addition, results of our study complemented previous research findings that some women dependent on opioids feel overwhelmed at quitting smoking while receiving treatment for their substance use disorder (Fallin et al, 2016). To appropriately tailor a tobacco treatment intervention for vulnerable women, it is necessary to first understand the link between smoking and stress in their lives and then integrate stress reduction and tobacco treatment interventions into prenatal and postpartum care.…”

Smoking cessation for substance misusers: A systematic review of qualitative studies on participant and provider beliefs and perceptions

“…The screening process identified 21 studies reported in 22 papers (see Figure 1 for PRISMA flow diagram (33)). Most were carried out in the USA (n=16) (34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50), with two in Australia (51,52) and one in each of Switzerland, Taiwan and UK (53)(54)(55). 11 studies included only service users (34, 35, 37, 40, 44-46, 50, 51, 54, 55), five only treatment providers (41,42,47,48,52), and five both (36,38,39,43,49,53).…”

An Exploration of Young Australian Women's Smoking Cessation Goals across the Trajectory of Pregnancy and Post Birth

“…Other research has suggested the relationship between trauma, pregnancy and smoking is complex. Trauma frequently occurs in conjunction with psychosocial issues [16][17][18]32,39,40]. A womancentred approach to quitting smoking is essential for trauma informed care, as it recognises smoking as a response to an individual's challenges [18].…”

“…One woman described a scenario where her 'new boyfriend comes over most days and smokes…not interested in quitting. Share a pack of 40 [cigarettes] a day' (P73) U . Another identified her increased smoking was related to her partner's continued smoking and 'stress with partner' (P31) U .…”