Smoking cessation in pregnant women with mental disorders: a cohort and nested qualitative study
Smoking cessation in pregnant women with mental disorders: a cohort and nested qualitative study
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DOI：
10.1111/1471-0528.12059
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发表时间：
2013-02-01
影响因子：
5.8
通讯作者：
Marteau, T. M.
中科院分区：
文献类型：
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作者：
Howard, L. M.;Bekele, D.;Marteau, T. M.
目的探讨妊娠期精神障碍吸烟者接受戒烟服务的可能性是否低于无精神障碍的妊娠期吸烟者;妊娠期精神障碍吸烟者是否存在戒烟障碍。设计队列研究辅以横断面调查和巢式定性研究。设置三个产科服务，伦敦，英国。有精神障碍和无精神障碍的怀孕吸烟者。方法对400例连续怀孕吸烟者的病例记录进行了检查;将数据与在其他两个站点常规收集的845例怀孕吸烟者的数据进行三角分析;使用定性方法对27例怀孕吸烟者进行了访谈。主要结果测量接受戒烟服务的转介;感知戒烟障碍。结果经助产士记录有精神障碍的妊娠吸烟者占队列的四分之一（97，23%），更容易接受转诊戒烟服务（69%对56%，调整后比值比1.70，95%置信区间1.032.79），但更有可能在分娩时仍吸烟（69% vs 56%，调整后比值比2.63，95%置信区间1.414.92）。在有或无精神障碍的妇女中，7.7%的后续产前检查记录了关于吸烟的讨论。被诊断患有精神障碍的怀孕吸烟者报告说，他们和卫生从业人员没有优先考虑吸烟建议，因为担心对心理健康产生不利影响。结论精神障碍孕妇戒烟的积极性更高，但戒烟难度更大。因此，将心理健康置于吸烟之上可能会导致这一群体的健康不平等加剧。需要对精神障碍患者进行有效的戒烟干预研究。
Objective To investigate whether 1) pregnant smokers with mental disorders are less likely to accept referrals to smoking cessation services compared with pregnant smokers without disorders; 2) they experience specific barriers to smoking cessation. Design Cohort study supplemented by cross-sectional survey and nested qualitative study. Setting Three maternity services, London, UK. Population Pregnant smokers with and without mental disorders. Methods Case notes were examined on a cohort of 400 consecutive pregnant smokers; data were triangulated with routinely collected data on 845 pregnant smokers at two other sites; 27 pregnant smokers were interviewed using qualitative methods. Main outcome measures Acceptance of referral to smoking cessation services; perceived barriers to quitting. Results Pregnant smokers with a mental disorder recorded by midwives were one-quarter of the cohort (97, 23%), were more likely to accept referral to smoking cessation services (69% versus 56%, adjusted odds ratio 1.70, 95% confidence interval 1.032.79), but more likely to still smoke at delivery (69% versus 56%, adjusted odds ratio 2.63, 95% confidence interval 1.414.92). Discussion about smoking was documented in 7.7% of subsequent antenatal visits in women with or without mental disorders. Pregnant smokers with diagnosed mental disorders reported that they and health practitioners did not prioritise smoking advice because of concern about adversely impacting mental health. Conclusions Pregnant women with mental disorders appear more motivated, yet find it more difficult, to stop smoking. Prioritisation of mental health over smoking may therefore lead to increasing health inequality for this group. Research into effective smoking cessation interventions is required for those with mental disorders.