title: Facilitators and Barriers to Cigarette Smoking While Pregnant for Women With Substance Use Disorders.
abstract: BACKGROUND
  Cigarette smoking among pregnant women diagnosed with substance use disorders (SUD) is four times higher than smoking among pregnant women without SUD. However, much of the literature on pregnancy and smoking has centered on the latter group. This study used the Health Belief Model as a framework to explore smoking cessation in pregnant women with SUD.
  
  
  METHODS
  Four 60-minute focus groups were conducted with a semistructured moderator guide. Participants (N = 21) were women who smoked during pregnancy, gave birth within the past year, and were residing at a women's SUD treatment center. A directed content analysis approach was utilized for examining focus group data.
  
  
  RESULTS
  Similar to women without SUD, barriers to smoking cessation were smoking behaviors of partners and using cigarettes to cope with stress; reasons to stop included the child's health. Participants reported that having children gave them a sense of purpose and their guilt about smoking became stronger once the child was born. Smoking also provided them with a sense of freedom. Women's triggers for smoking were interconnected with those of other addictive substances. Women identified behaviors that helped and hindered them.
  
  
  CONCLUSIONS
  Lack of internalization of the negative effects of smoking was a barrier to stopping, indicating a need for health literacy. Furthermore, women struggled with the perception of tobacco as a drug as compared with other addictive substances. Exploring facilitators and barriers to smoking cessation among pregnant women with SUD is critical to the health and well-being of this vulnerable population.
  
  
  CONCLUSIONS
  This study adds to the literature by identifying childbirth as an opportunity to address smoking for women with SUD. Furthermore, it supports the interconnectedness of triggers for smoking with those of other addictive substances, and the perceptual barrier tobacco is often not viewed as a drug by women with SUD. Findings demonstrate a need for increased health literacy and enhanced external supports around smoking cessation for this population.
authors.affiliation: School of Social Work, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH.
authors.forename: Shauna P
authors.initials: SP
authors.lastname: Acquavita
authors.affiliation: Central Clinic, University of Cincinnati Medical Center, Cincinnati, OH.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Talks
authors.affiliation: School of Social Work, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH.
authors.forename: Kayleigh
authors.initials: K
authors.lastname: Fiser
mesh_terms: D000328:Adult; D005260:Female; D017144:Focus Groups; D057220:Health Literacy; D006801:Humans; D009035:Mothers / Q000523:psychology*; D049590:Postpartum Period / Q000523:psychology; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D036301:Qualitative Research; D020377:Self Efficacy; D012907:Smoking / Q000009:adverse effects / Q000523:psychology*; D016540:Smoking Cessation / Q000523:psychology*; D000074606:Smoking Prevention; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000150:complications* / Q000523:psychology; D014481:United States; D055815:Young Adult