title: Exploring the adequacy of smoking cessation support for pregnant and postpartum women.
abstract: BACKGROUND
  Smoking in pregnancy exemplifies the relationship between tobacco use and health inequalities. While difficulty reaching and engaging this population in cessation support is often highlighted in the literature, there is limited research that explores the factors that shape the provision and use of support by this subpopulation. Using Ontario, Canada, as a case study, this study examines how the use of cessation support by women is encouraged or discouraged by cessation policy, programming and practice; how geographical and sociocultural factors influence provision and uptake of support; and how barriers and challenges can be addressed through a comprehensive approach.
  
  
  METHODS
  Semi-structured, in-depth interviews with key informants (31) and pregnant or postpartum women (29) were conducted to examine the cessation needs of this subpopulation, barriers to the provision and uptake of cessation support and directions for policy, service provision and programming.
  
  
  RESULTS
  Key barriers included: the absence of a provincial cessation strategy and funding, capacity and engagement/accessibility issues. Geographical features presented additional challenges to provision/uptake, as did the absence of resources tailored to Aboriginal women and adolescents. Key informants recommended a comprehensive cessation strategy to facilitate coordination of cessation resources provincially and locally and elucidated the need for capacity building within tobacco control and within reproductive, child and maternal health. Participants also highlighted the need to further develop tobacco control policies and target the social determinants of health through poverty reduction, housing and education support. The provision of incentives, transportation, childcare and meals/snacks; adoption of woman-centred, harm-reduction and stigma reduction approaches; and promotion of programs through a variety of local venues were recommended by participants to address engagement and accessibility issues.
  
  
  CONCLUSIONS
  The current cessation system in Ontario is not equipped to adequately reduce smoking among pregnant and postpartum women. A comprehensive, multi-sector strategy designed to provide tailored and sustainable support through different system entry points is needed. A cultural shift in practice is also necessary to eliminate mixed messaging, strengthen practice and encourage open channels of communication about smoking between women and their providers. The study highlights the need to address smoking among women in a more holistic manner and for capacity building strategies that focus on strengthening providers' competency and confidence in practice. Future research should explore: capacity building strategies, especially among rural and remote communities; the smoking and cessation experiences of different subpopulations of pregnant and postpartum women; the effectiveness of tailored strategies; and interventions that address smoking among partners and other family members.
authors.affiliation: Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto M5T 3M7, Canada.
authors.forename: Tracey
authors.initials: T
authors.lastname: Borland
authors.forename: Alexey
authors.initials: A
authors.lastname: Babayan
authors.forename: Saeeda
authors.initials: S
authors.lastname: Irfan
authors.forename: Robert
authors.initials: R
authors.lastname: Schwartz
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D009864:Ontario; D049590:Postpartum Period; D011247:Pregnancy; D037841:Pregnant People / Q000208:ethnology / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods*; D012944:Social Support; D016387:Women's Health; D055815:Young Adult