Smoking Cessation, Maintenance, and Relapse Experiences Among Pregnant and Postpartum Adolescents: A Qualitative Analysis

Abstract Purpose To understand the experiences and processes of smoking cessation, maintenance, and relapse for pregnant and postpartum adolescents, whose perspectives and needs might be different from other age groups. Methods We conducted in-depth semistructured interviews with 52 pregnant and postpartum adolescents using tools of grounded theory analysis. Results Spontaneous smoking cessation during pregnancy was reported by most participants. This was generally explained as resulting from knowledge about the harmful effects of tobacco on the fetus, intense emotional reactions to this knowledge, or unpleasant tobacco- and pregnancy-related physical symptoms. Relapses were common, however. Most participants experienced guilt when they relapsed during pregnancy. Postpartum relapse was less fraught, as many participants no longer considered their smoking to negatively affect their infants. This was found even among adolescents who were breastfeeding. Participants who did maintain cessation postpartum typically reported support from smoke-free families and environments. Conclusions The results of this study suggest a constellation of protective factors that contribute to smoking cessation and maintenance during and after pregnancy, as well as risk factors that contribute to temporary or permanent relapses. These results can inform future research and interventions on tobacco prevention among pregnant and postpartum adolescents. Several promising strategies for intervention development are discussed.