Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto M5T 3M7, Canada.
BMC Public Health. 2013 May 14;13:472. doi: 10.1186/1471-2458-13-472.
Smoking in pregnancy exemplifies the relationship between tobacco use and health inequalities. While difficulty reaching and engaging this population in cessation support is often highlighted in the literature, there is limited research that explores the factors that shape the provision and use of support by this subpopulation. Using Ontario, Canada, as a case study, this study examines how the use of cessation support by women is encouraged or discouraged by cessation policy, programming and practice; how geographical and sociocultural factors influence provision and uptake of support; and how barriers and challenges can be addressed through a comprehensive approach.
Semi-structured, in-depth interviews with key informants (31) and pregnant or postpartum women (29) were conducted to examine the cessation needs of this subpopulation, barriers to the provision and uptake of cessation support and directions for policy, service provision and programming.
Key barriers included: the absence of a provincial cessation strategy and funding, capacity and engagement/accessibility issues. Geographical features presented additional challenges to provision/uptake, as did the absence of resources tailored to Aboriginal women and adolescents. Key informants recommended a comprehensive cessation strategy to facilitate coordination of cessation resources provincially and locally and elucidated the need for capacity building within tobacco control and within reproductive, child and maternal health. Participants also highlighted the need to further develop tobacco control policies and target the social determinants of health through poverty reduction, housing and education support. The provision of incentives, transportation, childcare and meals/snacks; adoption of woman-centred, harm-reduction and stigma reduction approaches; and promotion of programs through a variety of local venues were recommended by participants to address engagement and accessibility issues.
The current cessation system in Ontario is not equipped to adequately reduce smoking among pregnant and postpartum women. A comprehensive, multi-sector strategy designed to provide tailored and sustainable support through different system entry points is needed. A cultural shift in practice is also necessary to eliminate mixed messaging, strengthen practice and encourage open channels of communication about smoking between women and their providers. The study highlights the need to address smoking among women in a more holistic manner and for capacity building strategies that focus on strengthening providers' competency and confidence in practice. Future research should explore: capacity building strategies, especially among rural and remote communities; the smoking and cessation experiences of different subpopulations of pregnant and postpartum women; the effectiveness of tailored strategies; and interventions that address smoking among partners and other family members.
孕妇吸烟是烟草使用与健康不平等之间关系的典型例子。尽管文献中经常强调难以接触到并使这一人群参与戒烟支持，但很少有研究探讨影响这一亚人群使用支持的因素。以加拿大安大略省为案例研究，本研究考察了戒烟政策、规划和实践如何鼓励或阻碍妇女使用戒烟支持；地理和社会文化因素如何影响支持的提供和采用；以及如何通过综合方法解决障碍和挑战。
对主要知情人（31 人）和孕妇或产后妇女（29 人）进行了半结构式深入访谈，以研究这一亚人群的戒烟需求、提供和采用戒烟支持的障碍以及政策、服务提供和规划的方向。
主要障碍包括：缺乏省级戒烟战略和资金、能力和参与/可及性问题。地理特征对提供/采用造成了额外的挑战，缺乏针对土著妇女和青少年的资源也是如此。主要知情人建议制定一项全面的戒烟战略，以促进省内和当地戒烟资源的协调，并强调需要在烟草控制和生殖、儿童和孕产妇健康领域进行能力建设。参与者还强调需要进一步制定烟草控制政策，通过减少贫困、住房和教育支持来解决健康的社会决定因素。参与者建议提供激励措施、交通、儿童保育和餐食/小吃；采用以妇女为中心、减少伤害和减少污名化的方法；并通过各种当地场所推广方案，以解决参与和可及性问题。
安大略省目前的戒烟系统不足以有效减少孕妇和产后妇女的吸烟。需要制定一项全面的多部门战略，通过不同的系统切入点提供量身定制和可持续的支持。还需要在实践中进行文化转变，以消除混合信息、加强实践并鼓励妇女及其提供者就吸烟问题进行开放沟通。该研究强调需要更全面地处理妇女吸烟问题，并制定重点关注加强提供者实践能力和信心的能力建设战略。未来的研究应探讨：能力建设战略，特别是在农村和偏远社区；不同孕妇和产后妇女亚人群的吸烟和戒烟经验；定制策略的有效性；以及解决伴侣和其他家庭成员吸烟问题的干预措施。
