Smoking Cessation During Pregnancy: Thoughts Expressed During Motivational Interviewing

Special Article – Tobacco and Smoking Cessation

J Fam Med. 2016; 3(9): 1087.

Smoking Cessation During Pregnancy: Thoughts Expressed During Motivational Interviewing

Risica PM1,2, Parker DR2,3,4*, Hardy N1 and Salkeld J1

1Institute for Community Health Promotion, Brown University School of Public Health, Providence, USA

2Department of Epidemiology, Brown University School of Public Health, Providence, USA

3Brown University Center for Primary Care and Prevention, Memorial Hospital of Rhode, Island, Pawtucket, USA

4Warren Alpert Medical School, Brown University, Department of Family Medicine, Providence, USA

*Corresponding author: Donna R. Parker, Brown Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, 111 Brewster Street, Pawtwucket, RI 02860, USA

Received: September 16, 2016; Accepted: October 13, 2016; Published: October 17, 2016


Background: While underserved pregnant women smoke for many of the same reasons as smokers in general, there are other factors contributing to higher smoking prevalence. Health interventions require an understanding of the problem if they are to be appropriately targeted and effective.

Aims: To assess barriers, facilitators and motivators of participants from the New England SCRIPT smoking cessation study who were trying to or recently quit smoking during pregnancy.

Methods: Pregnant participants recruited from prenatal clinics were randomized into one of three groups comparing the effectiveness of smoking cessation interventions differing in complexity and cost. Responses from motivational interviewing calls of 227 women were coded and tallied as a percent of respondents. Smokers were queried about perceptions of health risks, pros and cons, and benefits of quitting. Recent quitters were asked why they quit; benefits since quitting; difficulties/urges anticipated; and plans for not smoking.

Results: Health concerns of mothers and infants were cited as a benefit to quitting. Barriers to quitting included stress reduction, weight issues, and social acceptance. Unique facilitators and/or benefits included self-talk, prayer, selfwill and weight gain.

Discussion: Some of these findings mirrored previous research. However, participants who quit smoking during pregnancy did not mention weight concerns as a barrier to maintenance, and reported new and useful facilitators.

Conclusions: Data collected during this MI counseling study supports and expands other qualitative literature of smoking cessation processes among pregnant women, and may help inform the development of new interventions to appropriately support this population.

Keywords: Pregnant women; Smoking; Cessation; Motivation interviewing


NE: New England; Q & W: Quit and Win; MI: Motivation Interviewing


Smoking during pregnancy poses a significant health risk to both women and their unborn infants [1-3]. Moreover, smoking cessation reduces the deleterious effects to the fetus, the infant, and, may benefit a woman’s long-term health [4]. Pregnancy, therefore, provides an ideal opportunity to promote smoking cessation for women and their family, given that many women are motivated to protect the health of their fetus and/or have developed an aversion to smoking [5-8]. Yet despite significant progress in developing effective smoking cessation interventions, not all women are motivated to quit smoking during and after pregnancy [9-12]. In the U.S., the prevalence among pregnant women has been reported to be 10.7% although smoking rates remain disproportionately high among underserved pregnant women [13]. The highest prenatal smoking prevalence has been reported to be among those who are aged 20–24 years, (17.6%), American Indian/Alaskan Native (26.0%), <12 years of education (17.4%), and have Medicaid coverage during pregnancy, [13] which may represent a disadvantaged subgroup of pregnant smokers who are less likely to quit smoking during pregnancy [14].

To develop targeted interventions to achieve sustained smoking cessation during and after pregnancy, a comprehensive understanding of the scope of the problems they face is needed. Although qualitative studies have been conducted exploring potential barriers, many of the studies have been small, have been based on purposive samples, or examined select barriers [15,16]. Recently, Fleming et al. conducted a qualitative systematic review synthesizing findings from 38 studies that examined barriers and facilitators to smoking cessation experienced by women during and after pregnancy [17]. They highlighted the preponderance of barriers over facilitators for disadvantaged pregnant smokers to help assist with development of policy and practice [17]. Qualitative studies have increased our understanding of barriers to quitting faced by underserved pregnant women. However, additional research is needed to further expand our understanding of this complex, challenging and changing issues. To better understand barriers preventing this subgroup of pregnant smokers to quit smoking, we were interested in examining the thoughts and concerns expressed about smoking and cessation as part of information collected during motivational interviewing (MI) counseling during the randomized clinical trial, the New England Smoking Cessation/Reduction in Pregnancy Trial (NE SCRIPT). The objectives of this study were to: 1) identify barriers, facilitators, and motivators of pregnant women who were still smoking during pregnancy and 2) identify barriers, facilitators, and motivators of pregnant women who quit smoking before of during pregnancy based on information obtained during MI counseling sessions.


The MI counseling sessions were part of the randomized clinical trial, the New England Smoking Cessation/ Reduction in Pregnancy Trial (N.E. SCRIPT) with the primary aim of comparing the effectiveness of three smoking cessation interventions. A total of 8,526 pregnant women attending prenatal clinics were screened for smoking status at their first or second visit from 22 urban prenatal care clinics in Rhode Island, Connecticut, and Massachusetts. Patients were invited by clinic staff to participate even if they had no intention to quit smoking. Of those screened, 1,858 smokers (21.8%) were identified, 1,341 (72.2%) smokers initially agreed to participate, 517 smokers refused and 276 could not be contacted. To be eligible, a pregnant woman had to have had at least one puff of a cigarette within the past 7 days Sixty-three adolescents were also excluded from these analyses as we focused on adults. Furthermore, the adolescents represented a very small group for this study and may have very different views on smoking cessation compared to their adult counterparts. The final group consisted of 1002 pregnant smokers (54%) (Figure 1).