Women’s perceptions of support from partners, family members and close friends for smoking cessation during pregnancy—combining quantitative and qualitative findings

Abstract

This article reports on data collected as part of a four‐phase study initiated to strengthen practice in the field of smoking cessation during pregnancy. It focuses on the perceived support pregnant smokers would receive for quitting smoking and how this support could be effectively used by incorporating the education of partners/family in smoking cessation intervention strategies. Both quantitative and qualitative methods were employed, and data were collected from pregnant smokers through semistructured interviews and self‐completed questionnaires. From the questionnaire data, the women reported that they would receive considerable support from their partners if they decided to stop smoking. The interviews, however, revealed that this support was ‘potential’ rather than ‘real’ and that the partners mostly made ‘token gestures’ such as smoking outside. None of the interviewed respondents reported receiving help in educating their partner/family about the risks of active and passive smoking, thus reducing the potential positive role they could play in smoking cessation. Whilst health professionals are aware of the important role the partner/family may play in successful smoking cessation interventions, these significant others are generally not involved. This study highlights the need for consideration to be given to providing opportunities for couples to be fully involved in smoking cessation interventions outside the antenatal environment.

Introduction

In the western world, the dangers of smoking in pregnancy for both mother and child have been well documented (Doll et al., 1994; Department of Health, 1998; Cnattingius et al., 1988), yet a significant number of women continue to smoke during pregnancy (Department of Health, 1998). National targets have been set to reduce the percentage of women who smoke during pregnancy from 23 to 15% by the year 2010. Within Northern Ireland, the Northern Health and Social Services Board (NHSSB) and its three provider trusts have set targets to reduce smoking in pregnancy by 1% each year.

The NHSSB acknowledged that achieving such targets would demand not only collaboration with staff in Trusts, but also recognition of the fundamental issues affecting smoking and pregnancy. As a result, a four‐phase project was initiated encompassing a holistic approach to smoking cessation (O’Doherty et al., 2000). Phase 1 of the project reviewed the literature, and researched professional views and opinion of best practice for the most effective interventions for smoking cessation during pregnancy. Phase 2 of the project resulted in a set of smoking cessation guidelines consisting of a nine‐point intervention framework for health professionals to follow (O’Doherty et al., 2000). Health professionals piloted the use of these guidelines in Phase 3 of the project (Waldron, 1999). Phase 4 accessed the views of the pregnant smoker on receiving advice from health professionals (McCurry et al., 2002). Whilst the primary aim of the final stage was to access the efficacy and relevance of the guidelines, the researchers took the opportunity to investigate issues that may influence the success of smoking cessation intervention strategies. This paper focuses on one of these issues—the role of the pregnant woman’s partner and family/friends.

Background

The association between maternal smoking in pregnancy and adverse effects on the fetus has now been well established (US Department of Health and Human Services, 1990; Floyd et al., 1993). Furthermore, in recent years a link has also been established between reduced birth weight and paternal smoking through the mother being exposed to passive cigarette smoke (Lazzaroni et al., 1990; Wakefield et al., 1998). Aside from this direct link between paternal smoking and pregnancy outcome, partner’s smoking behaviour has also been shown to have an association with smoking cessation among pregnant smokers (Wakefield et al., 1998). In fact, there is evidence that pregnant women whose partners smoke are less likely either to quit spontaneously or after taking part in a smoking cessation intervention (Ziebland and Mathews, 1998). In addition, women who managed to stop smoking whilst pregnant are more likely to relapse post‐partum if they have partners who smoke.

Support from partners and family/friends has often been shown to be an important factor in achieving long‐term cessation in the general population (Cohen and Lichensteib, 1990; Appleton and Pharoah, 1998) and research with pregnant smokers has indicated similar findings. Pregnant smokers themselves often acknowledge their partners as having an important influence over their smoking behaviour. In a study in Australia, pregnant women were asked to quit more often by their partners than by any other person even though 75% of their partners were also regular smokers (Wakefield and Jones, 1991). Many studies have shown that pregnant smokers are more likely to have partners and family members who smoke (Cnattingius et al., 1992; Wakefield et al., 1993). The presence of another smoker provides both the availability of cigarettes, the temptation to smoke and may potentially weaken their resolve to quit smoking (Wakefield et al., 1998). Smoking has been viewed as a shared social activity among family and friends, and can offer couples who smoke a pleasurable activity in which they can spend time together (Edwards and Sims‐Jones, 1998).

Based on the research literature highlighting how a partner or close family/friends can influence smoking cessation, the nine‐point intervention framework developed by the NHSSB included the education of the women’s partner/family. This article discusses the potential role of partner and friends in helping women quit smoking during pregnancy, and how health professionals could make this role more effective.

Methodology

Data were collected through both qualitative and quantitative methods, and participants either took part in a semistructured interview or completed a questionnaire.

The participants were identified from three health and social care settings within the NHSSB area, i.e. a hospital maternity unit, a community midwifery team and a GP practice. During the 10‐week study period, every pregnant smoker attending a clinic for antenatal care was informed about the study and asked if their contact details could be forwarded to the research team. At this stage, the health professionals also recorded demographic details of the women that would allow subsequent comparisons to be made between participants and non‐participants. The health professionals stressed that their only input into the research was to obtain contact details and that the subsequent decision made by the women about participation or non‐participation in the study would not affect their antenatal care.

The first 25 women whose contact details were recorded were assigned to the qualitative section of the study. A member of the research team contacted these women, explained in more detail the nature of the study, and arranged an appropriate time and place for the recorded interviews to take place.

Self‐completed questionnaires were distributed by the health professional to all other smokers attending antenatal appointments. These were returned directly to the research team in the stamped addressed envelopes provided. A reminder was sent to all non‐responders after 2 weeks. Those not responding at this stage were sent a further reminder and another questionnaire.

The questionnaire comprised both closed‐ and open‐ended questions, and took approximately 15 min to complete. It comprised various sections eliciting data about basic demographic details, implementation of the guidelines, smoking status, social support and intervention methods. Questionnaire responses were analysed using the SPSS statistical package. The interview schedule was similar in content to the questionnaire, and these taped interviews were transcribed verbatim and emergent themes identified.

Ethical approval to carry out the study was sought from a local Research Ethical Committee. Informed consent was sought prior to the interviews and participants were informed of their right to terminate the interview at any time.

Results

Sociodemographic details

Only seven women did not wish their contact details to be passed to the research team. The age of these respondents ranged from 17 to 33 years, four were married/living as married, three were single and their gestation stage ranged from 14 to 38 weeks. A total of 138 questionnaires were distributed and 69 completed questionnaires returned, giving a response rate of 50% to the quantitative element of the study. One‐to‐one semistructured interviews were carried out with 15 pregnant smokers. This was reduced from the original 25 as some of the women who agreed to participate repeatedly failed to keep their interview appointment, some miscarried and others had given birth prematurely.

Table I provides the sociodemographic details of the respondents from both the quantitative and qualitative phases of the study. The age of the participating women ranged from 16 to 40 years and their gestation age from 11 to 38 weeks. Both married and single women, and those employed and unemployed participated in the study. Women interviewed had similar characteristics to those completing the questionnaire in terms of age, marital status, gestation stage, employment status and educational attainment (Table I). Demographic details recorded by the health professionals (age, marital status, gestation stage and employment status) indicated that characteristics of participants and non‐participants were similar.

Results from questionnaires

Womens’ smoking behaviour

The majority of the women (71.0%, n = 49) had been smokers for over 5 years. A high percentage (84.1%, n = 58) of the women reported that they had tried to quit the habit at some stage and 86.2% (n = 50) of these women had made more than one attempt to do so. Since becoming pregnant, 73.9% (n = 51) of the women would ‘really like to quit’, 24.6% (n = 17) would ‘really like to cut down’ and one women was not interested in changing her smoking behaviour.

Spouse/partners’ smoking behaviour

The majority of women completing the questionnaire (64.9%, n = 37) had partners who were also current smokers. Over half of these men (54.1%, n = 20) had not changed their smoking behaviour since their partner became pregnant. Others had ‘cut down’ (37.8%, n = 14) or changed to a lower tar brand (n = 1) and one woman reported that her husband had increased his cigarette intake.

When asked about the smoking behaviour of their family/friends, women completing the questionnaire reported that over half of those whom they see regularly would be current smokers (58.2%, n = 39).

Help with quitting smoking

Results from the questionnaire regarding factors felt to be important (and most important) in helping women to stop smoking whilst pregnant are detailed in Table II. A high percentage of women (66.7%) considered that if their partner, family or friends gave up smoking it would be an important factor in helping them to quit. In fact, 18.8% felt this would be the single most important factor that would help them to quit smoking when pregnant.

Only 26.5% (n = 18) of women who completed the questionnaire reported that the education of partners and family had been suggested to them by a health professional, even though this was one of the guidelines highlighted in the NHSSB nine‐point intervention framework.

Pressure and support from partner

The majority of women who completed the questionnaire (77.2%, n = 44) strongly agreed/agreed with the statement ‘my spouse/partner wants me to stop smoking while I am pregnant’ as shown in Table III.

The women were asked to score, on a scale from 1 to 10, how much pressure their partner had put on them to quit smoking (1 = none; 10 = a great deal). The resulting score of 6.1 (SD = 3.44, n = 58) would indicate that partners were exerting some pressure on these women to quit smoking. Women with partners who were current smokers received less pressure to quit (5.0, SD = 3.33, n = 37) than women with partners who had never smoked (8.0, SD = 2.8, n = 17). The Mann–Whitney U‐test was used to test the difference in the rank of scores from these two groups. Results indicated that women whose partners had never smoked felt they had greater pressure exerted on them than women with partners who smoked (U = 155, P < 0.01).

Women were also asked to score on a scale from 1 to 10, how supportive they thought their partners would be of them quitting smoking. The high score achieved (8.1, SD = 2.88, n = 58) would indicate that woman felt they would receive considerable support from their partners if they tried to quit smoking. No significant differences were observed in the support score achieved from women with partners who smoked and those with non‐smoking partners.

Pressure and support from family/friends

The questionnaire also included similar questions about the pressure and support women received from their family and friends. The resulting mean score of 5.0 (SD = 3.12, n = 69) would indicate that family and friends do not put as much pressure on women to stop smoking as their partners do. Even so, women still believed that their family/friends would be supportive of them stopping smoking as indicated by the mean score of 7.5 (SD = 2.88, n = 69).

Even though women perceived that they would receive less pressure and support from family/friends than from their partner, the majority of women strongly agreed/agreed with the statement that ‘my family/friends want me to stop smoking while I am pregnant’ as shown in Table III.

Results from interviews

The semistructured interviews provided the opportunity to probe respondents about the influence of their partner and family/friends in helping or hindering their efforts to stop smoking. In particular, the qualitative data shed more light on their interpretations of ‘pressure’ and ‘support’ from their partners.

Womens’ smoking behaviour

The women interviewed considered that they were ‘committed’ smokers who had all been smoking from an early age. However, most of these women reported that they had managed during their pregnancy to cut down the number of cigarettes they had previously smoked. Whilst this was a conscious decision taken by some women, for others the physical symptoms of nausea and ‘morning sickness’ had helped them to cut down. However, for some women, the number of cigarettes smoked subsequently increased when the ‘morning sickness’ diminished:

With the morning sickness and all that, I didn’t feel like smoking very much so it really wasn’t hard to cut down at that stage but the better you feel the more you sort of smoke because the more you want them.

Spouse/partners’ smoking behaviour

One of the 15 women interviewed did not have a partner. Those who did reported that four did not smoke, three had ‘cut‐down’ on the number of cigarettes they smoked and seven were reported as not having changed their smoking behaviour. Some respondents did not describe their partners as being smokers because the latter smoked only a few cigarettes a day. Therefore, they did not see their partner’s smoking behaviour as a problem. Some found it difficult to estimate how many cigarettes their partners actually smoked. One woman who described her partner as a ‘three roll‐ups a day’ person went on to say:

He is not a smoker‐smoker. I would call and he can go without them…well it doesn’t affect me because he wouldn’t smoke in the house anyway. It’s only if we were out having a drink or whatever, or while he’s at work, or travelling to work or travelling home from work.

Another respondent, when asked if her partner smoked a lot, replied:

Naw, about 20 a day…18–20 a day. He wouldn’t be a heavy smoker

When asked how many cigarettes their partners smoked, there was a tendency to have many attempts at estimating, with the final figure being less than at the first attempt. It was almost as though some respondents were ‘defending’ their partner’s smoking behaviour.

Those who ‘underplayed’ their partners’ smoking status tended to put the onus to stop smoking on themselves and did not recognize that their partners’ smoking influenced their motivation to stop smoking. However, many others did recognize that it was not easy for them to reduce or quit smoking while their partners smoked:

Whenever I’m with him and he lights up…I do the same…I do smoke a lot more whenever I’m with him.

If you’re not thinking of a cigarette and somebody lights up, you automatically think, Oh! I’ll have one too, you know.

I think if he stops…then I might be able to try that wee bit harder, if he did stop.

Partners’ support

There was little evidence in the participant’s responses that their partners had changed their own smoking behaviour substantially. Four reported that their partners did ‘cut‐down’ on the number of cigarettes, but the extent to which they did so could not be reliably estimated. Modifications in their smoking habits seemed to be mostly confined to not smoking indoors or putting the window down in the car while both partners smoked. Smoking outdoors was reported as the main way their partners helped them to stop smoking. Some women felt that going outside curtailed their smoking:

You tend not to dander out that often for a cigarette, whereas if you have it in the house, it’d be easier ‘to pick up’.

Sometimes the resolve to smoke outside weakens and the partner returns to his usual habit. This has an effect on the women’s smoking as well:

I think for the first wee while, he’d be great, he wouldn’t smoke around me…but eventually after two weeks that was him back to smoking around me again, so…I can’t, I couldn’t see him stopping smoking around me, so…he would influence me to smoke again, I would say, definitely.

Some respondents reported that both partners had made ‘pacts’ several times before in their attempt to stop smoking and that they had failed.

Overall from the comments made by respondents one can conclude that their partners’ support did not actually extend to stopping to smoke. The most they could offer were half‐hearted attempts and token gestures to help the women to reduce or stop smoking.

Pressure from partners

All respondents reported that there was no pressure on them from their partners to stop smoking. It was clear that they interpreted ‘pressure’ as an order from their partner to stop smoking. On the other hand, ‘nagging’ and frequent ‘lectures’ were not perceived as pressure:

Oh…he would love me to give up…he’d go on, you know, if you were smoking…but he wouldn’t actually say ‘You’ve got to stop smoking’, or anything like that.

…he’s worse than Mummy, he lectures and lectures and lectures.

One respondent whose husband did not give up smoking reported that there was no pressure from him for her to stop smoking. On further probing, she reported that they had argued about it and he had ‘made her feel guilty’.

Sometimes the partners took ‘drastic’ actions in their bid to get the women to reduce or stop smoking. Such actions included ‘taking the cigarettes to work’, ‘hide the cigarettes in the house’, ‘take all the ashtrays away’, ‘counting how many cigarettes were left in the packet’ and even ‘leaving the wife with no money’:

He’ll come in and if the cigarettes are sitting, he’ll take them away and put them somewhere where I don’t know where they are. Then because I can’t smoke I’ll say to him ‘Well, go to the shop and get me some’ but he just keeps saying that they are no good for me.

The men who did not smoke or who had ‘cut‐down’ seemed to ‘dislike’ or even ‘hate’ the fact that their partners smoke. These women reported more nagging and arguments than those whose partners were smokers.

Some women reported that there was more pressure at the start of the pregnancy but that this eased off later on:

I had pressure at the start, a lot at the start but that seems to have eased now. [Woman towards the end of her pregnancy]

Family and social support

Overall respondents reported that close family members and friends would be supportive if they decided to stop smoking. However, they felt that they put little pressure on them to do so. Occasionally, their mother or mother‐in‐law would make some comments, but, by and large, they reported that the extended family members ‘kept out’ and did not discuss their smoking. Those women whose friends smoke found that they smoked more while in their company. Others felt the social pressure not to smoke when in company of friends who had stopped:

All of them have stopped…so that’s another reason why I want to go off them. There’s no fun there any more with them… It’s only when you are out socially or whatever that you would think they have all quit but I haven’t.

In general, friends tended to think that it was ‘none of their business’ to’ interfere with their smoking habits’. However, they reported that some family members and friends continued to smoke in the presence of these pregnant women:

I’ve a brother who smokes and he said ‘Well, if you want to stop smoking, don’t be thinking I’m not smoking in front of you’… That is his attitude, so if I was going to stop smoking I would just have to avoid him.

If my friends came to my house and I said that I had stopped smoking, I know one of them who wouldn’t smoke but the rest of them would just carry on and smoke.

Finally, most of the women felt that their partners and family friends would be unwilling to receive smoking cessation advice from a health professional as part of a smoking and pregnancy initiative.

Combining and contrasting quantitative and qualitative findings

While the qualitative data broadly support the data from the questionnaire, they provide more insight as to the type of ‘pressure’ put on these women and how, in turn, they interpreted it. The interviews also examined, in some detail, what ‘support’ meant.

In the questionnaire, a higher percentage of partners (41.0%) were reported to have changed their smoking habit than in the interviews (27.3%). This could be because it is easier to give a socially desirable answer (that their partners are supportive) to a questionnaire than when faced by an interviewer keen to probe. On the other hand, this difference may reflect the real situation of two different samples. The sample sizes for the questionnaire and the interviews were too small to draw firm conclusions. The interviewees also found it difficult to estimate how much their partners had ‘cut‐down’, thus throwing some doubt on the reliability of such data.

On a scale from 1 to 10 measuring the amount of pressure put on the women to stop smoking, the overall mean score was 6.1, indicating a fair degree of pressure. This was reflected in the interview data, where most women reported that their partners ‘nagged’ or ‘lectured’ them. The findings from the interviews showed that those partners who did not smoke or had ‘cut‐down’ put more pressure than those who smoked. The high score of 8.0 recorded by respondents with ‘non‐smoking’ partners supported this. The interviews also showed the type of actions partners resorted to when putting pressure on these women. These included hiding the cigarettes, counting how many were left in the packet and, in some cases, not leaving money for them to buy cigarettes.

Responses from the questionnaire showed that the women believed that there would be considerable support from their partners (mean score of 8.1 on a scale from 1 to 10) if they wanted to quit smoking. The interviews revealed that this support was more ‘potential’ than ‘real’. They consisted of many half‐hearted attempts to cut‐down and token gestures such as smoking outside the house or putting the window down in the car when smoking. Although these actions had little effect on helping the women to reduce or stop smoking, all of them reported their partners as supportive. Relying mainly on the quantitative data, in this case, would have been misleading.

Support from family and friends was also considered to be high as indicated by responses to the questionnaire (mean score of 7.5). In the interviews, the women reported that the influence of family and friends on their smoking was marginal. Generally they ‘kept‐out’ and did not discuss their smoking. The interview data also showed that some family members and close friends did not alter their smoking behaviour in the presence of these pregnant women.

Discussion

Whilst the main aim of phase four of the overall smoking cessation initiative was to evaluate the efficacy of the smoking cessation guidelines (McCurry et al., 2002), the research design afforded the opportunity to further investigate the role of smoking in pregnant women’s lives and factors that may impinge on effective intervention. This paper discusses the potential benefit of involving pregnant smoker’s partners and friends in smoking cessation intervention strategies, and the use of guidelines to help implement their involvement.

Whilst the demographic details of participants were similar to those who were not involved in the study, the views expressed may not represent those of all pregnant smokers. It is possible that those who were unwilling to participate in the study were ‘hard‐core’ smokers who held different views to the women in this study. However, the strong relationship between maternal smoking and low levels of education often reported in research studies (Severson et al., 1995) was also reflected in this study. The educational attainment of the women was much lower than that reported in a recently completed population‐based study (http://www.ark.ac.uk/nilt). Given that the study was primarily investigating the smoking cessation advice provided by health professionals, it is possible that women gave more favourable responses with regard to the advice and support received. Using a self‐completed questionnaire and a researcher who was not a health professional provided some assurance against this. It is also recognized that differences reported by the two methodologies may have arisen from the views of different women. However, the demographic characteristics of the women and the overall results obtained using both methodologies were broadly similar, and thus it was considered that the qualitative methodology employed provided an additional insight into the perceived ‘support’ and ‘pressure’ from partners and family/friends reported in the questionnaires. Notwithstanding these limitations, the results reported give some indication of the potential role of partners and family/friends in smoking cessation interventions.

Smoking cessation is difficult to achieve, even among pregnant women who are generally motivated to quit. Much of the research conducted has reported that pregnancy is an ideal time to stop smoking and many women quit spontaneously before receiving any antenatal care. However, for those who continue to smoke, many contributory factors can make smoking cessation in pregnancy difficult to achieve. Despite the well‐known health dangers to mother and baby, smoking is not an activity with totally negative attributes. Some women use smoking as part of their coping strategy through difficult times during their pregnancy, others see it as a way of increasing the likelihood of a smaller baby and thus an easier birth (Graham, 1976). Smoking is often seen as a pleasurable activity that can be shared with partners, family and friends, and an activity that some are reluctant to let go of (Edwards and Sims‐Jones, 1998). The majority of women in this study had partners and family/friends who smoked regularly, which has been shown in many studies to increase the likelihood of pregnant women continuing to smoke (Cnattingius et al., 1992; Appleton and Pharoah, 1998; Wakefield et al., 1998).

The women in this study thought that their partners and family/friends would be supportive of them quitting smoking, although it was clear that this support did not extend to these significant others stopping smoking. Emotional support from partners and close family/friends has been shown in the past not to be associated with smoking cessation, whereas actual smoking behaviour change from these significant others was independently associated with quitting smoking (Appleton and Pharoah, 1998). Results from both the qualitative and quantitative sections indicate that women perceived the support from their partners to be greater than from family/friends. However, partners need to demonstrate ‘real’ smoking behaviour change rather than a temporary ‘token’ gesture. It has been demonstrated previously that many smokers cannot stop or alter their smoking behaviour without intensive help from health professionals (Thorax, 1998). Thus, those wishing to support their partner’s attempts to stop smoking may benefit from receiving smoking cessation advice themselves.

A high percentage of women in this study felt that their partner and family/friends giving up smoking would be an important factor in helping them to quit. These pregnant women are receiving continual smoking cessation advice during their antenatal care, whereas their partners and family/friends would have potentially more difficulty quitting without access to health professional’s advice. However, women were sceptical of their partners and family/friends receiving smoking cessation advice from a health professional involved in their antenatal care. Previous research has also shown that men were reluctant to accept smoking cessation advice when their partner was pregnant (Wakefield et al., 1998). Qualitative results from this study indicate that these significant others would be unwilling to participate in smoking cessation clinics as part of antenatal care. Whilst health professionals are trained to routinely provide smoking cessation advice to women at antenatal visits, the provision of this advice to others not directly involved in antenatal care is inherently more difficult. The use of some of the guidelines developed by the NHSSB helped health professionals provide a short structured smoking cessation intervention to all pregnant smokers (McCurry et al., 2002). However, the guideline about educating partners and family/friends was reported by the health professionals as difficult to follow (Waldron, 1999), and was not implemented in most cases (McCurry et al., 2002). Clearly the partners of these pregnant women are not comfortable with receiving smoking cessation advice at antenatal visits, whereas pregnant smokers accept it as an inevitable part of antenatal care (McCurry et al., 2002). Recent research conducted in Australia has shown the potential value of targeting couples in health promotion campaigns (Burke et al., 1999). Their research showed that health promotion programmes specifically designed for couples can achieve changes in behaviour and risk factors by building on the social support engendered by involving partners (Burke et al., 1999). It would seem that women in this study could benefit from a community‐based smoking cessation programme specifically targeted at couples where the support and pressure of their spouse/partner could be effectively utilized in an environment outside the antenatal setting. Smoking cessation interventions that focus exclusively on the pregnancy may be missing the opportunity to help women and their partners to quit permanently as men may feel coerced into receiving advice simply because of their partner’s pregnancy (Ziebland and Mathews, 1998).

In conclusion, this study has shown the potential support that women could receive from their partners and family/friends to quit smoking, and the apparent difficulty health professionals have in providing these significant others with advice within the antenatal setting. A guideline indicating the importance of educating partners and family/friends will not be of assistance if these significant others are unwilling to accept this advice when given as a consequence of their partner’s pregnancy. Whilst every opportunity should be taken by health professionals to offer smoking cessation advice to women during pregnancy, further consideration needs to be given about utilizing the potential support of partners and family/friends. Finally, many of the lessons emerging from the overall project are now being incorporated into the development of specialist support services for smoking cessation within the NHSSB area. Evaluation of these new support services may help to further enhance their smoking cessation programmes.

Table I.

Sociodemographic characteristics of participating women

	Completed questionnaires		Completed interviews
	n	%	n	%
Age
16–19	10	14.5	2	13.3
20–29	32	46.4	9	60.0
30–39	25	36.2	3	20.0
40+	2	2.9	1	6.7
Marital status
married/living as married	48	69.6	11	73.3
single	16	23.2	3	20.0
Single—no partner	5	7.2	1	6.7
Employment status
employed	38	55.1	7	46.7
unemployed	9	13.0	5	33.3
looking after the house	18	26.1	3	20.0
full time education	4	5.8	0	0
Highest educational qualification
GCSE or equivalent	27	45.0	6	60.0
GCE ‘A’ level or equivalent	2	3.3	1	6.7
higher qualification below degree	5	8.3	1	6.7
degree qualification or higher	4	6.7	0	0
other ‘trade’ qualification	3	5.0	2	13.3
no qualifications	19	31.7	5	33.3
Gestation stage (weeks)
<20	29	42.0	6	40.0
21–30	17	24.6	4	26.7
31–40	23	33.3	5	33.3

Table II.

Factors ranked important in helping women to quit smoking

	Mostimportantfactor (%)	Animportantfactor (%)
Knowing own baby was at risk	62.3 (n = 43)	84.1 (n = 58)
Self‐motivation	26.1 (n = 18)	69.6 (n = 48)
Nicotine replacement therapy	24.6 (n = 17)	59.4 (n = 41)
Something to occupy me	20.3 (n = 14)	58.0 (n = 40)
Partner, family/friends giving up	18.8 (n = 13)	66.7 (n = 46)
Less stress	18.8 (n = 13)	63.8 (n = 44)
Advice from the healthprofessionals	10.1 (n = 7)	59.4 (n = 41)
Hypnotherapy	8.7 (n = 6)	42.0 (n = 29)
Social pressure	4.3 (n = 3)	44.9 (n = 31)

Percentages do not add up to 100% as women could give more than one factor as a top priority.

Table III.

Women agreeing/disagreeing with the statement ‘My spouse/partner or family/friends want me to stop smoking while I am pregnant’

	Spouse/partner(%)	Family/friends(%)
Strongly agree	52.6	39.4
Agree	24.6	22.7
Neither agree nor disagree	19.3	37.9
Disagree	1.8	0
Strongly disagree	1.8	0
Total	100	100

Author notes

1Centre for Nursing Research, University of Ulster, Coleraine BT52 1SA, 2Northern Health and Social Services Board, Ballymena, BT43 6DA and 3Homefirst Community Trust, Ballymena, BT43 6DA, UK 4Correspondence to: K. Thompson; e‐mail: