title: Smoking Among Pregnant Women in Outpatient Treatment for Opioid Dependence: A Qualitative Inquiry.
abstract: Smoking during pregnancy is a major public health issue, contributing to adverse health outcomes. The vast majority of women with substance use disorders smoke during the perinatal period. Medication Assisted Treatment (MAT) is the standard of care for women using opioids during pregnancy. The majority of women engaged in MAT (88%-95%) report smoking. The purposes of this study were to describe: (1) facilitators and barriers to engaging in tobacco treatment among pregnant, opioid dependent women receiving MAT; and (2) strategies to tailor tobacco treatment interventions with this population.
  
  
  
  Two semi-structured focus groups lasting approximately 45 minutes each were conducted with 22 women engaged in MAT. Focus groups were recorded, transcribed and analyzed in MAXQDA using content analysis.
  
  
  
  Participants reported: (1) desire to quit smoking for themselves and their children; (2) aversion to smoking; (3) a turning point in their lives from being pregnant and entering MAT; (4) nicotine dependence; (5) smoking as a way to cope with stress; (6) coping with dual dependencies; (7) past experiences with stopping smoking due to smoking restrictions; (8) perceived lack of success with nicotine replacement therapy or other tobacco treatment medications; and (9) the need for intensive environmental support for quit attempts.
  
  
  
  Participants were motivated to quit smoking, but faced multiple complex barriers. Integrating tobacco treatment into the psychosocial services offered in conjunction with MAT would allow a healthcare provider to offer tailored tobacco treatment in a supportive environment.
  
  
  
  Results of this qualitative study include facilitators and barriers to engaging in tobacco treatment among pregnant, opioid dependent women receiving MAT, as well as strategies to tailor tobacco treatment interventions for this population. In-depth knowledge of the complex barriers facing this patient population can be used to inform tailored tobacco treatment services that can be integrated into clinics providing MAT.
authors.affiliation: College of Nursing, University of Kentucky, Lexington, KY Amanda.fallin@uky.edu.
authors.forename: Amanda
authors.initials: A
authors.lastname: Fallin
authors.affiliation: College of Nursing, University of Kentucky, Lexington, KY.
authors.forename: Alana
authors.initials: A
authors.lastname: Miller
authors.affiliation: College of Nursing, University of Kentucky, Lexington, KY.
authors.forename: Kristin
authors.initials: K
authors.lastname: Ashford
mesh_terms: D000328:Adult; D005260:Female; D017144:Focus Groups; D006801:Humans; D009293:Opioid-Related Disorders / Q000150:complications* / Q000517:prevention & control; D010045:Outpatients; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control / Q000523:psychology*; D037841:Pregnant People; D011295:Prenatal Care; D012907:Smoking / Q000523:psychology*; D016540:Smoking Cessation / Q000379:methods; D000074606:Smoking Prevention; D055815:Young Adult
references.citation: Drug Alcohol Depend. 2004 Sep 6;75(3):253-60
references.pmid: 15283946
references.citation: J Obstet Gynecol Neonatal Nurs. 2012 Mar;41(2):180-190
references.pmid: 22375882
references.citation: J Consult Clin Psychol. 2004 Dec;72(6):1144-56
references.pmid: 15612860
references.citation: J Consult Clin Psychol. 2004 Aug;72(4):712-22
references.pmid: 15301656
references.citation: AIDS Educ Prev. 2012 Apr;24(2):132-47
references.pmid: 22468974
references.citation: J Atten Disord. 2017 Oct;21(12):975-985
references.pmid: 25416463
references.citation: J Urban Health. 2012 Feb;89(1):117-28
references.pmid: 21989498
references.citation: Nurse Educ Today. 2004 Feb;24(2):105-12
references.pmid: 14769454
references.citation: Exp Clin Psychopharmacol. 2010 Feb;18(1):37-50
references.pmid: 20158293
references.citation: Drug Alcohol Depend. 2010 Aug 1;110(3):177-82
references.pmid: 20378281
references.citation: JAMA. 1996 Apr 10;275(14):1097-103
references.pmid: 8601929
references.citation: Hum Reprod Update. 2011 Sep-Oct;17(5):589-604
references.pmid: 21747128
references.citation: N Engl J Med. 2011 Jul 21;365(3):196-8
references.pmid: 21774707
references.citation: Nicotine Tob Res. 2013 Jul;15(7):1297-304
references.pmid: 23288871
references.citation: J Adv Nurs. 2013 May;69(5):1023-36
references.pmid: 23278126
references.citation: Ann Epidemiol. 2013 Oct;23(10):652-61
references.pmid: 23969303
references.citation: J Clin Psychiatry. 2006 Feb;67(2):247-57
references.pmid: 16566620
references.citation: J Subst Abuse Treat. 2014 Feb;46(2):194-201
references.pmid: 23988192
references.citation: Health Promot Pract. 2011 Jan;12(1):126-34
references.pmid: 20720096
references.citation: Psychiatr Clin North Am. 2010 Jun;33(2):339-55
references.pmid: 20385341
references.citation: MMWR Surveill Summ. 2013 Nov 8;62(6):1-19
references.pmid: 24196750
references.citation: Leg Med (Tokyo). 2013 May;15(3):115-21
references.pmid: 23219585
references.citation: Lancet. 2011 Jan 8;377(9760):139-46
references.pmid: 21112082
references.citation: J Subst Abuse Treat. 2015 May;52:40-7
references.pmid: 25592332
references.citation: J Correct Health Care. 2009 Jul;15(3):190-6
references.pmid: 19477804
references.citation: Addiction. 2012 Jun;107(6):1168-73
references.pmid: 22188214
references.citation: Am J Public Health. 2001 Feb;91(2):296-9
references.pmid: 11211643
references.citation: Int J Nurs Stud. 2013 Jun;50(6):797-806
references.pmid: 23107006
references.citation: JAMA Intern Med. 2013 May 13;173(9):789-94
references.pmid: 23567902
references.citation: Nicotine Tob Res. 2015 Aug;17(8):955-9
references.pmid: 26180219
references.citation: N Engl J Med. 2015 May 28;372(22):2118-26
references.pmid: 25913111