title: Understanding Pregnant Smokers' Adherence to Nicotine Replacement Therapy During a Quit Attempt: A Qualitative Study.
abstract: BACKGROUND
  Pregnant smokers may be offered nicotine replacement therapy (NRT) alongside behavioral support to assist with a quit attempt. Yet trials of NRT have found adherence to be low among pregnant women, and this has made it difficult to determine the efficacy of NRT. The aim of this study is to understand the experience of pregnant women who use NRT but discontinue this early or do not use the medication as recommended.
  
  
  METHODS
  Semi-structured telephone interviews were conducted with 14 pregnant smokers who had recently been prescribed NRT, but self-reported poor NRT adherence or discontinuing treatment prematurely. Data were transcribed and analyzed using inductive thematic analysis
  
  
  RESULTS
  There were four main themes identified; expectations of NRT, experience of using NRT, safety concerns and experience of using e-cigarettes. Some women intentionally used NRT to substitute a proportion of their cigarette intake and smoked alongside. Most women smoked while using NRT. Women who underutilized NRT did so as they experienced side effects, or were concerned that using NRT instead of smoking could actually increase their nicotine exposure and potential for increased nicotine dependence or fetal harm. Most women spoke about the use of e-cigarettes as a smoking cessation method but only a few had actually experienced using them during pregnancy.
  
  
  CONCLUSIONS
  Many women underused NRT but simultaneously smoked. Challenging negative perceptions about NRT and educating women further about the risks of smoking may encourage them to use NRT products as recommended.
  
  
  CONCLUSIONS
  These findings add to the research surrounding the efficacy of NRT during pregnancy by providing insight into how pregnant women use NRT during a quit attempt and how this may influence adherence. It may assist health professionals to support pregnant smokers by increasing their understanding about the differing ways in which women use NRT and help them address concerns women may have about the safety of NRT.
authors.affiliation: Division of Primary Care, University of Nottingham, Nottingham, United Kingdom; Katharine.bowker@nottingham.ac.uk.
authors.forename: Katharine
authors.initials: K
authors.lastname: Bowker
authors.affiliation: Division of Primary Care, University of Nottingham, Nottingham, United Kingdom;
authors.forename: Katarzyna A
authors.initials: KA
authors.lastname: Campbell
authors.affiliation: Division of Primary Care, University of Nottingham, Nottingham, United Kingdom;
authors.forename: Tim
authors.initials: T
authors.lastname: Coleman
authors.affiliation: Division of Epidemiology and Public Health, Nottingham City Hospital, Nottingham, United Kingdom;
authors.forename: Sarah
authors.initials: S
authors.lastname: Lewis
authors.affiliation: Behavioural Science Group, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom.
authors.forename: Felix
authors.initials: F
authors.lastname: Naughton
authors.affiliation: Division of Primary Care, University of Nottingham, Nottingham, United Kingdom;
authors.forename: Sue
authors.initials: S
authors.lastname: Cooper
mesh_terms: D005260:Female; D006801:Humans; D055118:Medication Adherence / Q000523:psychology; D009538:Nicotine / Q000627:therapeutic use*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000523:psychology; D016540:Smoking Cessation / Q000523:psychology*; D061485:Tobacco Use Cessation Devices; D014029:Tobacco Use Disorder / Q000188:drug therapy / Q000523:psychology; D016903:Drug Monitoring
chemical_list: D009538:Nicotine