Fallin Amanda, Miller Alana, Ashford Kristin
College of Nursing, University of Kentucky, Lexington, KY
College of Nursing, University of Kentucky, Lexington, KY.
Nicotine Tob Res. 2016 Aug;18(8):1727-32. doi: 10.1093/ntr/ntw023. Epub 2016 Jan 27.
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.
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.
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.
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.
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.
孕期吸烟是一个重大的公共卫生问题，会导致不良健康后果。绝大多数患有物质使用障碍的女性在围产期吸烟。药物辅助治疗（MAT）是孕期使用阿片类药物的女性的标准治疗方法。参与MAT的大多数女性（88%-95%）报告有吸烟行为。本研究的目的是描述：（1）接受MAT的孕期阿片类药物依赖女性参与烟草治疗的促进因素和障碍；（2）针对该人群调整烟草治疗干预措施的策略。
对22名参与MAT的女性进行了两个时长约45分钟的半结构化焦点小组访谈。焦点小组访谈进行了录音、转录，并在MAXQDA中使用内容分析法进行分析。
参与者报告了以下内容：（1）为自己和孩子戒烟的愿望；（2）对吸烟的厌恶；（3）怀孕并开始接受MAT后生活中的转折点；（4）尼古丁依赖；（5）吸烟作为应对压力的方式；（6）应对双重依赖；（7）过去因吸烟限制而戒烟的经历；（8）认为尼古丁替代疗法或其他烟草治疗药物效果不佳；（9）戒烟尝试需要密集的环境支持。
参与者有戒烟的动机，但面临多重复杂障碍。将烟草治疗纳入与MAT相结合提供的心理社会服务中，将使医疗保健提供者能够在支持性环境中提供量身定制的烟草治疗。
这项定性研究的结果包括接受MAT的孕期阿片类药物依赖女性参与烟草治疗的促进因素和障碍，以及针对该人群调整烟草治疗干预措施的策略。深入了解该患者群体面临的复杂障碍，可用于为可纳入提供MAT的诊所的量身定制的烟草治疗服务提供信息。
