Couple dynamics and maternal smoking cessation during pregnancy: A qualitative examination of nulliparous women and their partners

Background: Maternal smoking during pregnancy is associated with an array of adverse health outcomes, for women and their children (Gluckman, Hanson, Cooper, and Thornburg, 2008; Green et al, 2005; Hammoud et al, 2005; Kramer, 1987; Salihu and Wilson, 2007; US Department of Health and Human Services, 2004;). Despite these risks, the literature demonstrates that tobacco smoking during pregnancy if fairly common, and the effectiveness of smoking cessation interventions for pregnant women is poor, with around 6% of women accessing such interventions successfully stopping smoking during pregnancy (Lumley, Chamberlain, Dowswell, Oliver, Oakley, and Watson, 2009). The interventions offered to pregnant smokers are most commonly provided on an individual basis, to expectant mothers and not to their partners, usually involving the use of nicotine replacement therapies, motivational interviewing, and strategies for modifying cognitive and behavioural patterns. Aim: Framed by an understanding of tobacco dependence as a multidimensional behavioural phenomenon, and informed by theories of social support, this study aimed to explore pregnant women’s experiences of smoking cessation within the contexts of their intimate relationships in order to develop an improved understanding of the manner in which interpersonal dynamics and patterns affect the women’s smoking cessation attempts, ultimately aiding the development of effective interventions, programs, and policies. Method: Semi-structured interviews were conducted with five expectant mothers and their partners. Grounded Theory Methods (Charmaz, 20012), including Constant Comparative analytic methods (Boeije, 2002), were used for data synthesis and the generation of an explanatory theoretical model. Results: Couple dynamics were pertinent to the meaning attributed to smoking by the expectant couple. The meaning of smoking in individual and social contexts was also relevant, as were contextual factors and beliefs about risk. These factors, in turn, emerged to be relevant to the manner with which couples navigated the important changes associated with smoking cessation, ultimately affecting the potential success of the pregnant smoker’s cessation attempt. Conclusions: Smoking cessation interventions for pregnant women may benefit from the involvement of a woman’s intimate partner in the smoking cessation intervention process. Other implications for clinical practice are discussed, alongside directions for further research.