Friday, 22 April 2016

How do pregnant women justify smoking?

Eliza Goszczyńska
Kamila Knol-Michałowska
Alicja Petrykowska

How do pregnant women justify smoking? A qualitative study with implications for nurses’ and midwives’ anti-tobacco interventions

Despite widespread knowledge of the harmfulness of smoking during pregnancy, this behaviour is a challenge in the majority of the Euro-American world. Smoking during pregnancy, the knowledge about its harmful effects and social pressure to abstain from smoking generate a cognitive dissonance among expectant mothers (stemming from the contrast between viewing themselves as responsible mothers and smokers). One way of diminishing such stress and mental discomfort is their subjective rationalisation that quitting during this period is unnecessary, impossible, ineffective and even detrimental. To improve anti-tobacco interventions, it was imperative to perform an analysis of pregnant smoking women’s explanations of continuing the behaviour, which allow them to subjectively rationalise it. Conducting this analysis seems crucial also since previous research has not focused on a detailed recognition of such thought patterns (numerous authors have examined only their selected elements, i.e. barriers to quitting during pregnancy).Most of these studies were face-to-face interviews, which might have influenced the content/spectrum of the women’s responses, especially considering that the topic of the interviews is not socially accepted. Therefore, there existed a need to perform a qualitative, unobtrusive study.

Thereafter, the aim of the paper in question was to recognise pregnant smoking women’s thinking patterns called lay justifications, to present their diversity and to create their typology. To achieve it a qualitative, unobtrusive study based on the thematic analysis of the content of the textual data collected from internet forums where women presented reasons for smoking during pregnancy was conducted. The source of data collection were three parenthood on-line forums most popular in Poland in terms of the number of registered users (, and

The analysis allowed for identification of 35 sub-themes of lay justifications assigned to two main themes. The first main theme was questioning the need to refrain from smoking and its positive effects. It consisted mostly of the ways mothers diminish the feeling of risk resulting from smoking (i.e. convictions that the addiction to nicotine is harmless in a particular trimester, withdrawal might negatively influence the pregnancy, smoking harmfulness can be compensated for by the love offered to the child). What is important, some women claimed that they had built these subjective justifications based on the health professionals’ authority. The analysis showed that some of these mothers over-interpreted the medical recommendations to justify the behaviour. The second identified main theme of lay justifications was questioning the possibility to quit smoking and exaggerating the barriers to achieve this (i.e. putting the blame on others, namely smoking: to mollify negative emotions stirred by the societal pressure to quit smoking during pregnancy, to rebel against the societal pressure imposed on expectant mothers to combat the addition, due to lack of social support to refrain from smoking, or because of undertaking the behaviour by the members of the closest environment).

The paper concluded with practical recommendations for the medical staff concerning anti-tobacco counselling for smoking pregnant women stemming from the identified spectrum of expectant mothers’ lay justifications.

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