"What can I do? fight him?" Perceptions and Experiences in Reducing Secondhand Smoke Exposure during Pregnancy: A Qualitative Study among Israeli Women.

Abstract

Introduction: Second-hand smoke (SHS) exposure during pregnancy is associated with negative health outcomes. We aimed to explore Israeli pregnant women's perspectives on SHS exposure, with a focus on barriers and enablers to reducing SHS exposure at home and in the car.

Methods: Qualitative semi-structured telephone interviews with 68 women - 54 Jewish and 14 Arab. Inclusion criteria: pregnant or up to 12 months post-partum; living with a person who smokes; age 18-45; Hebrew or Arabic speakers. Participants could be from any smoking status. Interviews were analyzed according to a reflective and collaborative thematic approach supported by the Capability (C) Opportunity (O) Motivation (M)-Behaviour model.

Results: Participants knew SHS is harmful, but lack of specific knowledge (C) was evident across all smoking status groups and population groups (Jewish, Arab). Women harbored misconceptions regarding their SHS exposure (C), employing ineffective strategies to eliminate exposure. Many perceived smoking as a significant source of tension in their relationship with their partners (M). Women described feeling uncomfortable asking people to not smoke around them (O) and bemoaned the lack of support from health professionals (O). Women who never smoked or formerly smoked described situations where they felt trapped and helpless. Specifically, Arab participants reported social isolation(O). The living environment (e.g., building with no elevator) was a commonly mentioned barrier to reduce home SHS exposure (O).

Conclusions: Despite high motivation, the low level of knowledge and negotiation skills, misconceptions about exposure and effective strategies, together with insufficient support, lead to behaviors resulting in high SHS exposure.

Implications: This research explored women's experiences of SHS exposure during pregnancy, and barriers and enablers to reducing prenatal SHS exposure. Interventions need to empower pregnant women to feel confident in asking people not to smoke around them, focus on acquiring negotiation skills, raise awareness to actual exposure and increasee self-efficacy to use effective SHS reduction strategies. Interventions should be inclusive of all family members who smoke. These findings will inform the development of a digital intervention. Digital interventions have the potential for high reach among socially disadvantaged populations while allowing tailoring of individualized messaging to the pregnant woman and her partner.