Division of Primary Care, University of Nottingham, Tower Building, University Park, Nottingham NG7 2RD, UK.
School of Health Sciences, University of East Anglia, Norwich NR4 7UL, UK.
Int J Environ Res Public Health. 2019 Nov 29;16(23):4791. doi: 10.3390/ijerph16234791.
Many countries, including the UK, recommend nicotine replacement therapy (NRT) for smoking cessation during pregnancy. However, adherence to NRT is generally low, smoking lapse or relapse is common and using NRT to reduce the harm from the number of cigarettes smoked is only advocated in non-pregnant smokers. Two focus groups were conducted with 13 professionals involved in antenatal stop smoking services (SSS). The data were analysed thematically. Two themes were extracted that describe health professionals' attitudes towards using NRT either during lapses or to reduce smoking in women who cannot quit (harm reduction). These are presented around a social-ecological framework describing three hierarchical levels of influence within smoking cessation support: (1) Organizational: providing NRT during lapses could be expensive for SSS though harm reduction could result in services helping a wider range of clients. (2) Interpersonal: participants felt using NRT for harm reduction was not compatible with cessation-orientated messages practitioners conveyed to clients. (3) Individual: practitioners' advice regarding using NRT during smoking lapses varied; many were generally uncomfortable about concurrent smoking and NRT use and had strong reservations about recommending NRT when smoking during all but the briefest lapses. Further evidence is required to guide policy and practice.
包括英国在内的许多国家都建议在怀孕期间通过尼古丁替代疗法（NRT）来戒烟。然而，NRT 的依从性通常较低，吸烟复发或复吸很常见，并且仅在非孕妇吸烟者中提倡使用 NRT 来减少吸烟量带来的危害。我们对参与产前戒烟服务（SSS）的 13 名专业人员进行了两次焦点小组讨论。对数据进行了主题分析。得出了两个主题，描述了卫生专业人员对在复发期间使用 NRT 或减少不能戒烟的女性的吸烟量（危害降低）的态度。这些主题围绕着描述戒烟支持中三个层次影响的社会生态框架提出：（1）组织：虽然减少危害可能会导致服务帮助更多的客户，但在 SSS 中提供 NRT 可能会很昂贵。（2）人际间：参与者认为，使用 NRT 来减少危害与从业者向客户传达的以戒烟为导向的信息不一致。（3）个体：从业者在吸烟复发期间使用 NRT 的建议各不相同；许多人对同时吸烟和使用 NRT 感到非常不舒服，并且对在除了最短的复发期间之外的所有吸烟期间推荐 NRT 持强烈保留意见。需要进一步的证据来指导政策和实践。
