- Title
- Piloting an antenatal tobacco smoking intervention that incorporates financial incentives in women with other substance use problems during pregnancy
- Creator
- Jackson, Melissa
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2023
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Tobacco smoking during pregnancy is the leading, preventable cause of poor birth outcomes and maternal health complications. While prenatal smoking prevalence rates have reduced substantially in western countries over the past twenty years, rates in some disadvantaged subgroups remains high. In women who use tobacco and other psychoactive substances during pregnancy, up to 95% will report smoking. Considerable resources are devoted to helping stop their use of other substances, but most will continue to smoke tobacco throughout their pregnancy and beyond. Along with social disadvantage, women with substance use concerns are more likely to be highly nicotine dependent and experience concurrent mental health problems, trauma, intimate partner violence and child protection issues. These contribute significantly to an already complex set of behavioural and physiological mechanisms that underlie and maintain smoking behaviours during pregnancy. Another contributing factor is a lack of effective tobacco treatments targeted to the needs of this group. A range of tobacco treatment strategies with an evidence base in general maternal populations does exist. These include behavioural counselling, contingency management and nicotine replacement therapy, yet their efficacy and acceptability as treatment for women with substance use concerns is less well understood. To address this evidence gap, this thesis aimed to: - Systematically review the literature for tobacco treatments previously trialled in groups of pregnant women who smoke tobacco and use other substances concurrently. - Examine tobacco smoking behaviours, motivators and barriers to tobacco treatment and the acceptability of individually delivered tobacco interventions with women who smoke, and clinicians involved in public antenatal facilities that support maternal substance use. - Assess the feasibility and acceptability of a comprehensive tobacco treatment designed for women who smoke and attend public antenatal facilities that support maternal substance use. - Describe the treatment challenges encountered by women with substance use concerns who have participated in the tobacco treatment described above. These aims have been addressed in a series of studies that includes: a systematic review describing the results of six interventions that address tobacco smoking in maternal substance use populations; a mixed-methods study informed by surveys of 28 antenatal clinicians and qualitative interviews with 13 women who smoke and attend antenatal services that support substance use; a single-arm pilot evaluation of a tobacco intervention utilising contingency management, nicotine replacement therapy and behavioural counselling with 48 participants; a qualitative evaluation of the tobacco treatment’s acceptability with participants and antenatal clinicians; and a case-study describing the challenges experienced by one woman who took part in the tobacco treatment and stopped smoking. The work of this thesis contributes to existing research in this field in several ways. Firstly, it highlights the current lack of tobacco treatment and need for rigorously tested and evidence-based interventions that will be effective for pregnant women with a range of substance use concerns. Secondly, it provides an understanding of smoking behaviours and of the acceptability of various smoking cessation strategies for this group, and uses this as a framework for a comprehensive, consumer informed tobacco treatment. Thirdly, it provides robust evidence for the feasibility of intensive behavioural and pharmacological combined treatments to improve smoking outcomes in pregnant women who use other substances. Lastly, it provides a formal evaluation of the treatment from a consumer perspective with detailed insight emphasizing the complexities of treating tobacco smoking in pregnant women with complex behavioural and social challenges. Overall, this thesis highlights a need for governments and/or healthcare services to prioritise the elevated prevalence of tobacco smoking in high-risk maternal populations and provides support for strategies that may positively impact the serious but preventable harm tobacco has on these women and the life-course of their children. Future research considerations include the need to rigorously evaluate tobacco treatments offering combined behavioural and pharmacological support strategies in a larger sample, including an evaluation of the costs and cost-savings associated with such treatments. The identification of innovative and sustainable ways to deliver these strategies using the latest technologies is also vital for the provision of ongoing best practice tobacco treatment for this and other high-priority groups of women.
- Subject
- smoking cessation; tobacco treatment; harm reduction; health services; social disadvantage; nicotine dependence; substance use; pregnancy; antenatal care; intervention; contingency management; nicotine replacement therapy; behavioural Counselling
- Identifier
- http://hdl.handle.net/1959.13/1470431
- Identifier
- uon:48467
- Rights
- This thesis is currently under embargo and will be available from 15.02.2024. Copyright 2023 Melissa Jackson
- Language
- eng
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