title: Smoking cessation and social support during pregnancy : a longitudinal study of the impact of close relationship support on smoking cessation in pregnancy
Creators: name: Leonard Appleton, Peter
Publisher: name: University of Liverpool Repository
Year: 2023

description: Objectives: (1) To examine whether, for women who smoke before pregnancy, low social support is associated with failure to reduce or quit smoking during pregnancy. (2) To examine whether low social support could mediate the demonstrated association between social disadvantage and failure to reduce or quit smoking during pregnancy. Design: Cohort study. Ascertainment in early pregnancy, with follow-up in late pregnancy. Participants: A population based sample of pregnant women at 24 weeks gestation or less, resident in Clwyd, who smoked, or smoked until becoming pregnant (or planning to become pregnant), and booking for pregnancy care with a South Clwyd midwife. During a 16 month screening period, there were 939 eligible women. Of the 662 (70%) who participated at booking, 418 (63%) were assessed at follow-up. There was no evidence for non-response bias in smoking cessation rate, age, gestational age, or parity, at either time-point. Setting: Routine attendance at hospital and community antenatal clinics, or during routine midwife home visits. Measures: Self-reported cigarette consumption before pregnancy, and currently at each time-point Independent variable self-report measures in early pregnancy were: age, parity, gestational age, education, housing tenure, income supplement, social support (partner emotional support, family member support, partner smoking change, joint pregnancy planning, social contact smoking), adult attachment style, and depressive symptoms. Measures in late pregnancy were: current smoking, gestational age, partner smoking behaviour, and depressive symptoms. Results: In a multiple logistic regression model, failure to quit smoking in early pregnancy was independently associated with two categories of low social support (partner failing to reduce or quit smoking, and higher number of social network smokers), adult attachment style (low expectation of dependability of close relationships), living in rented housing, no education beyond school leaving age, higher level of prepregnancy cigarette consumption, and older age. Continuing smoking (i.e. failing to reduce, or quit) in early pregnancy was independently associated with one category of low social support (partner failing to reduce or quit smoking), living in rented housing, no education beyond school leaving age, receiving income supplement, prepregnancy cigarette consumption, and higher parity. Although univariate analyses demonstrated associations between socioeconomic status (SES) variables and social support, a mediation model was not supported by multivariate analysis. SES, social support, and prepregnancy smoking level, each independently contributed to odds of failure to quit, and failure to reduce. Using longitudinal data, logistic regression models of failure to maintain quitting, and maintainence of same level of smoking, confirmed the early pregnancy results, but with lowered statistical power. Depressive symptomatology was not associated with smoking change at either time-point. Conclusions: (1) One category of low social support, i.e. a partner's failure to reduce or quit smoking (75% of partners were prepregnancy smokers, and of these, 34% reduced or quitted) was robustly associated with women's failure to reduce or quit, and maintain change through pregnancy. Higher number of social network smokers was associated with failure to quit. (2) Low expectation of dependability of close relationships (perceived support) was associated with failure to quit at booking. (3) The association between SES and smoking cessation was not mediated by social support. Instead, there was evidence for additivity between SES and social support. (4) Intervention trials which incorporate routine behavioural targeting of partner smoking change are indicated. Behavioural mediators of the association between SES and smoking cessation have not been delineated, and further investigations are warranted.