title: A qualitative analysis of messages to promote smoking cessation among pregnant women.
abstract: OBJECTIVE
  Although aware that smoking while pregnant presents serious risks to their unborn children, some women continue to smoke and rationalise their dissonance rather than quit. We explored metaphors women used to frame smoking and quitting, then developed cessation messages that drew on these metaphors and examined the perceived effectiveness of these.
  
  
  METHODS
  We used a two-phase qualitative study. Phase one involved 13 in-depth interviews with women who were smoking (or who had smoked) while pregnant. Phase two comprised 22 in-depth interviews with a new sample drawn from the same population.
  
  
  METHODS
  Data were analysed using thematic analysis, which promoted theme identification independently of the research protocol.
  
  
  RESULTS
  Participants often described smoking as a choice, a frame that explicitly asserted control over their behaviour. This stance allowed them to counter-argue messages to quit, and distanced them from the risks they created and faced. Messages tested in phase 2 used strong affective appeals as well as themes that stimulated cognitive reflection. Without exception, the messages depicting unwell or distressed children elicited strong emotional responses, were more powerful cessation stimuli, and elicited fewer counter-arguments.
  
  
  CONCLUSIONS
  Cessation messages that evoke strong affective responses capitalise on the dissonance many women feel when smoking while pregnant and stimulate stronger consideration of quitting. Given the importance of promoting cessation among pregnant women, future campaigns could make greater use of emotional appeals and place less emphasis on informational approaches, which often prompt vigorous counter-arguments.
authors.affiliation: Department of Marketing, University of Otago, New Zealand.
authors.forename: Janet
authors.initials: J
authors.lastname: Hoek
authors.affiliation: Whakauae Research for a Māori Health and Development, Whanganui, New Zealand.
authors.forename: Heather
authors.initials: H
authors.lastname: Gifford
authors.affiliation: Department of Marketing, University of Otago, New Zealand.
authors.forename: Ninya
authors.initials: N
authors.lastname: Maubach
authors.affiliation: Health Promotion Agency, Wellington, New Zealand.
authors.forename: Rhiannon
authors.initials: R
authors.lastname: Newcombe
mesh_terms: D000293:Adolescent; D000328:Adult; D002755:Choice Behavior; D005260:Female; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D019365:Metaphor; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods* / Q000523:psychology; D055815:Young Adult
keywords: PUBLIC HEALTH; QUALITATIVE RESEARCH