Introduction
Background of the study
Maternal smoking and stress during pregnancy complies with adverse health impacts on women and unborn child. Substantial numbers of women consistently prefer smoke during pregnancy; estimated prevalence disclosed that in 2023-2024; 7.4% women in England choose to smoke during pregnancy period (Pipe, Evans and Papadakis, 2022). Despite decreasing in rate of smoking in pregnant women; remaining numbers are underpinning major concerns associates with serious implications for fetus and mother. Whilst major emphasis impaired on maternal smoking; however, research reveals that paternal smoking is also a cause of concern contributing in pregnancy complication and potential development challenges for child associated with cardiovascular disease and abnormalities (Iyahen et al, 2023). Hence, paternal smoking [involving both maternal and paternal] during pregnancy or before conception allied with an increasing risk for child. This is leading to potential health complexities that adheres with lower birth weight, impaired lung development, premature birth and potential long-term behavioural and cognitive complexities (Califf and King, 2023).
For men and women with childbearing age; active and passive smoking corelates with reduction in fertility rate; females who smoke have higher abortion rates (Califf and King, 2023). Lack of education leading to develop serious consequences for new parents and child; smoking cessation program aims to enhance awareness in expectant mothers and fathers with regards to negative consequences of smoking. Existing studies depicts that smoking cessation programs leading to significant positive implication on children future heath by reducing complexities related to lower-birth weight, respiratory issues and abnormalities. However, effectiveness depends upon design and delivery of program tailored with diverse interventional strategies (Califf and King, 2023). There are diverse factors impacting effectiveness of program and those are; timing of intervention, access to care and healthcare provider support. Criticism of these program upholding the notion of inadequate behavioural pattern and lack of urge in parents to quit smoking.
The present research will be based on assessing the effectiveness of smoking cessation program among expectant mothers and new fathers within assessing its influence of children’s future health. Factors leading to impacting program efficacy will also be covered within review and subsequently-in-depth analysis would be done.
Aim and objectives
Aim
To evaluate the effectiveness of smoking cessation programmes for expectant mothers and new fathers within assessing their long-term impacts on children’s health outcomes.
Objectives
- To analyse existing literature on smoking cessation programmes tailored for new parents and their reported effectiveness
- To investigate the association between smoking cessation programmes and health outcomes of parents and children.
Key terms
Key terms are crucial domains used while searching relevant articles (Clark et al, 2021). the researcher has used accurate keywords such as “Smoking”, “Smoking Cessation Program”, “effectiveness”, “expectant mothers”, “new father”, “maternal smoking”, “paternal smoking”, parental smoking”, “long-term”, “impacts”, “children”, “factors” and “health outcomes”. These key words are related to research aim and therefore, these were used for searching studies so that information regarding research context could be allocated.
Database
Authentic database such as-PubMed, Biomed, NHS website and Medline were used by researcher for selecting peer-reviewed and quality articles. PubMed provides wide range of collection regarding health and social care topics and therefore, researcher selected this database (Bell and Walter, 2018). Whereas, BioMed and Medline considered as comprehensive, authentic and they provide diverse collection of peer-reviewed literature. Through NHS website; prevalence of smoking in UK and smoking cessation programmes effectiveness was witnessed. Thus, there were the databases used by analyst in study and accordingly, relevant articles selected and critiqued for drawing meaningful conclusion along with informing clinical practice.
Inclusion and Exclusion criteria
Table 1-Inclusion and Exclusion Criteria
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Inclusion Criteria |
Exclusion Criteria |
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The above-mentioned inclusion and exclusion criteria followed by researcher and accordingly, 10 articles [7-primary and 3-secondary] were selected. Through this criterion, researcher has set the protocols for selecting articles and accordingly, peer-reviewed articles were selected (Denscombe, 2021).
Sources credibility
The credibility of the sources was checked and it was reviewed that; all the articles are peer-reviewed. The authentic database was considered that supported in allocating accurate and relevant information (Clark et al, 2021). By following inclusion and exclusion criteria the creditability of the sources was maintained and accordingly, information was involved within research.
Presentation of data and critiquing findings from literature
Theme 1- Effectiveness of Maternal Smoking Cessation Programme and E-health intervention
In the article of Bennett et al, (2014) key findings were depicting that pregnant women faces complexities if they continue to smoke; the purpose of the research was to determine the Model for Accessing to Maternal Smoking Cessation Support [MAMSS]; the study was undertaken for supporting pregnant women through NHS smoking services. The author has undertaken a qualitative and quantitative approach that was based on Quasi-experimental design; it was undertaken for period of 12 months and there were 146 pregnant women smokers from Four of Wales were recruited. The participants were recruited via implementing face-to face interaction and author has focused on undertaking their consent. The key findings from the data depicted that supporting pregnant women with regards to stopping smoking has become a challenging task; the proposed model MAMSS in the study is used within smoking cessation programmes.
This framework outlining about the ways in which pregnant women who smokes can get support from NHS smoking support services; this multi-pronged approach used within routine and screening at prenatal visits and personalised counselling has been given to new mother and fathers. These services led to supports pregnant women in stopping smoking and further assisted them with nicotine therapies after examining certain tests (Bennett et al, 2014). The findings of the study relate with current research context as it is signifying about the effectiveness of smoking programmes. The key strengths of the data comprehend with presenting the information in-depth manner while weakness complies with not involving direct response of the participants. The harm to patients was minimised through taking their consent and this shows that researcher was not biased. Research method has effectively used sample group and adequately the outcomes were presented. It can be said that whole research was carried out effectively and it was adhering with ethical components as patient confidentiality was met along with informing them about research context (Bennett et al, 2014). The findings and conclusion drawn within study is reliable and valid; it is significantly relating with the aim of research and further the article was a peer-reviewed articles that signifies that data is valid and authentic
On the other hand, the study of van Dijk et al, (2021) purpose was to implement a personalised eHealth intervention within smoking cessation programme for supporting pregnant women for quitting smoking through stress reduction. A randomised control trial was adopted within study and eHealth intervention was implied for eight weeks; 150 women from Netherlands were recruited through online platform. The trial was performed for consecutive eight weeks and this proves to be successful in reducing stress among pregnant women along with shaping their behavioural pattern (van Dijk et al, 2021). The aim of the study was to prove the effectiveness of intervention so this can be used within healthcare setting and smoking cessation programs.
The findings from the study of van Dijk et al, (2021) was significantly relating with research area; it proposed about an intervention which supported women in quitting smoking. Thus, it proves that smoking cessation programmes supports mothers to quit smoking and further reduces their stress. It proves to be evidence-based research that could be changed within evidence-based practice and subsequently, eHealth intervention used in healthcare practices. The data from the study profoundly recommending about eHealth intervention and its effectiveness that could be identified as its strength. Whereas, the study was lacking in comparing eHealth intervention with other interventions. Comparison among different types of intervention could have enhanced efficacy of the research. The researcher has approached significant sample group for undertaking research as the sample population was the pregnant women who wanted to quit smoking. The research was carried out in ethical manner as autonomy, confidentiality of the participants was maintained and informed consent form was given to them. RCT was undertaken throughout eight weeks and the changes in smoking habit of women were observed and majority of the expectant mothers were able to quit smoking (van Dijk et al, 2021). Thus, this proves that smoking cessation programmes develops awareness in mother and supports them to quit smoking.
Theme 2- Importance of smoking cessation programme for new fathers and its reported effectiveness
In the article of Shawe et al, (2019) it was articulated that men attending antenatal care and smoking cessation programmes were able to quit smoking in comparison to those fathers who never attendant such sessions. Shawe et al, (2019) followed a cross-sectional survey and 573 participants attending antenatal care from London Maternity units were approached face-to-face interaction was developed. Hence, researcher recruited new fathers and there was no biasness was undertaken and confidentiality of the participants were maintained. The findings were relevant from research area as it depicted that when males attend antenatal care with their partners then, it empowers them and further draws understanding regarding quitting smoking. Hence, this lead to enhance health outcomes of children in long-run by reducing the risk related to cardiovascular disease (Shawe et al, 2019). The strength of the study comprised with involving perception of fathers who have an urge to quit smoking for their children. It was evident that many fathers want to quit smoking however, they are unable and subsequently, personalised plan designed for them. No such weakness witnessed within study and no biasness found. O’Donnell et al, (2022) study emphasised on identifying factors that supports and hinders fathers’ ability to develop smoke-free home. Results of the study depicted that several fathers understood the risk of smoking and they try to quit it.
However, many fathers were unable to quit it due to stress factors. Hence, the findings specified that there are certain personal barriers that acts as a loophole in quitting smoking for fathers and in such case smoking cessation programme does not provide effective results. The study followed a qualitative approach and semi-structured interviews were undertaken; 18 fathers who smokes were recruited from Scotland through social media advertising (O’Donnell et al, 2022). The study has focused on presenting the personal opinion of fathers which can be considered as the strength; while weakness arouse with limited number of participants. There was no biasness identified within study and confidentiality of the participants was maintained. The findings of Shawe et al, (2019) and O’Donnell et al, (2022) relating with current research context as it is depicting about the effectiveness of smoking cessation programmes for new fathers.
Theme 2-Association between smoking cessation programmes and health outcomes of parents and children
Grant et al, (2020) emphasised on proving the association between smoking cessation programs and health outcomes of parent and children. 10 women from deprived areas within South Wales UK were approached and interview was conducted. The finding revealed that five women who never attended smoking cessation program quitted smoking and this led to enhance their and child wellbeing. On the other hand, 5 women were consistently smoking during pregnancy period faced adverse consequences such as low birth weight, premature child and respiratory issues. Author has effectively undertaken comparison between women and this can be considered as a key strength within article. The confidentiality of the participants was maintained and no biasness was performed. As per research context, suitable participants were approached “Women who smoked and quitted smoking during pregnancy”. However, this study further depicted about the barriers of smoking cessation program such as lack of awareness; from the interview it was identified that women were not aware about such kind of programmes and their timing which hindered their capabilities for accessing care.
In the article of Taylor et al, (2024) it was assessed that smoking in pregnancy period led to varied consequences; mothers who smoked consequently throughout pregnancy period faced issues low birth and obesity issues [at the age of 2 in child]. Whereas, mothers who quitted smoking and focused on maintaining their weight has not faced such kind of consequences. Cohort-based study was undertaken and 5612 women from UK population-based cohort were approached. The confidentiality of the participants was maintained throughout the study and no biasness witnessed within study. It was evident that undertaking interventions and promoting awareness regarding quitting smoking in pregnant women leads to ensure positive impacts on health and wellbeing of mothers and children in long run.
The study of Ussher et al, (2024) revealed that providing financial incentives for smoking cessation program during pregnancy and postpartum cessation is effective. These programmes must be implemented in postpartum cessation as well; many women go through depression during this phase and they started smoking and therefore, during such phase; smoking cessation program assist them while ensuring personalised counselling and further financial support was ensured to women. The study undertook a randomised control trial for 12 months and 462 women suffering from postpartum phase within NHS UK were approached. The study has not disclosed personal information of the participants and maintained ethics throughout the study. Appropriate recruitment strategy followed by researcher and subsequently, women suffering from postpartum phase was approached. The strength of the study is that it focused on the importance of smoking cessation program in post-partum phase as well. Based on the findings, this can be said that smoking cessation programme is essential for developing awareness in expectant mothers and fathers (Ussher et al, 2024).This complies with providing counselling to them and further recommend therapies based on the severity of situation; the behavioural pattern of individuals is shaped and they are encouraged towards adopting healthy lifestyle that enhances well-being of children in long run.
Theme 3- Factors impacting smoking cessation programmes
Findings of Vila-Farinas et al, (2024) strongly supported smoking cessation programs among pregnant women; in the study it was determined as non-pharmacological intervention that supports in shaping the behavioural pattern of pregnant women; the implication of health belief model proves to be effective for encouraging the behaviour of pregnant women. The study has further focused on the factors impacting smoking cessation programme such as low budget and ineffective planning. This hampers the quality of delivery and as a result wider individuals are not able to access the benefits.
Vila-Farinas et al, (2024) was a systematic review; author has presented detailed search strategy that could be considered as strength of the study. The findings within study addressing current research context by articulating about the effectiveness of smoking cessation programs and the barriers which are needed to be focused out. The scoping review by Connolly et al, (2024) stated that consistent smoking during pregnancy creates adverse impact on children health; it can further lead to severe concerns in long run. The study depicted that primary care proves to be suitable area for organising smoking cessation intervention as it is considered as first point of care and thereby, it supports in accessing number of individuals. Smoking cessation promotion in antenatal care proves to be important for developing awareness in expectant mothers and new fathers.
The systematic review and network meta-analysis by Li et al, (2023) elucidated that exposure of pregnant women and newborn to second-hand smoke develops adverse maternal and neonatal health outcomes. New fathers must be aware of this harm and they must quit smoking as this can result in drastic outcomes. Hence, the study has revealed that it is essential to create awareness regarding second-hand smoke and their adverse impacts on pregnant women. 10 different databases were accessed by researcher and subsequently, information from articles were taken for developing findings. The author has maintained ethical guidelines by including quality sources and subsequently, information was taken. The strengths of the review associates with evidence-based data that can be used within clinical practice. However, there was no such limitation witnessed within study. Within this, the article has emphasised on the factors which are creating barrier for individuals in accessing smoking cessation programs.
People from rural and deprived areas are not able to access the program due to lack of awareness (Li et al, 2023). Furthermore, lack of support from healthcare professional can impact the efficacy of programme; throughout this program it is important to undertake consistent interaction with expectant mothers and fathers and accordingly, consistent counselling should be given to them. It supports in encouraging parents to quit smoking and subsequently, effective health outcomes could be gained.
Discussion
From the allocated information it is evident that smoking cessation programmes leading to shape behavioural pattern of expectant mothers and new fathers. These interventions make individuals aware about the negative consequences of smoking that can develop adverse influence on children in long-term. However, individuals belong from lower-socioeconomic background are not able to access these programmes and this is depicting about unequal distribution of healthcare tailored interventions (Bennett et al, 2014). There is need to emphasise on this area and accordingly; robust strategy should be undertaken which ensures that individuals from different background can access smoking cessation programmes and accordingly, awareness could be developed in them regarding prohibiting smoking ((van Dijk et al, 2021). Collective synthesis of studies developed significant insights and it was evident that parental smoking develops cardiovascular risk for mother and children in long-term.
Supporting pregnant women for stopping smoking proves to be a complex public health concern; NHS stop smoking services within Wales is further recognised as a “Stop Smoking Wales” program. This is considered as one of the successful smoking cessation programs which led to support varied parents in quitting smoking (van Dijk et al, 2021). This works with the implication of Health Belief Model; this is considered as a theoretical model which is used for undertaking health promotion strategies. The aim of smoking cessation programs underpins with developing awareness in expectant mothers and new fathers; the consequences are discussed with them and they are further motivated to change their behavioural trait (Ho et al, 2022). These programs are concerned with counselling, prescriptions regarding nicotine replacement therapy, healthy diet and varied incentives; the motive is to improving health of parents and child.
From the research it is evident that smoking cessation program proves to be effective in quitting smoking for new parents; they have been empowered and their reproductive health has been improved (Creager and Hamburg, 2022). Further, this led to decreases the risk of premature death in child while improving health outcomes of mother. Moreover, these programs have been proven effective in reducing cardiovascular disease, cancer and chronic obstructive pulmonary disease. Findings reported that improved life expectancy rate has been witnessed in parents and child and further their quality of life improved to greater extent. These programmes further raised awareness that best time for quitting smoking is before getting pregnant (Shawe et al, 2019). However, quitting it any time in pregnancy leads to ensure benefits to mother and child health. However, there are varied factors impacting the effectiveness of program and this associates with lack of access and awareness specifically for individuals belongs from deprived areas. Pregnant women who live in rural areas are not able to attend this program, often, new fathers are not aware about such programs.
Thus, this lead to reduce their capabilities with regards to quitting smoking and this develops adverse influence on mother and child health which becomes a major concern in long-term (O’Donnell et al, 2022). Thus, these are the structured loopholes existing in society and significant focus must be implied on this area; policymakers and healthcare settings should take corrective measures in this area. By employing multidisciplinary teams; supports can be ensured to such people.
Different healthcare professionals can collectively develop awareness in individuals living in deprived areas. Timing of intervention also plays essential role in developing awareness in individuals and therefore, appropriate timing should be determined before implementing programs (O’Donnell et al, 2022). In maternity care, counselling for new parents should be made mandatory and accordingly, they must be supported for quitting smoking. Overall, the finding significantly addressing research question as the effectiveness of smoking cessation programmes has been evident within results. Different themes have been developed from findings that emphasising on the effectiveness of programmes along with highlighting the factors leading to impacting programmes (Rajani, Mastellos and Filippidis, 2021). It is important to focus on the loopholes that is leading to reduce the effectiveness of smoking cessation program. By focusing on the loopholes significant Hence, there is need to take corrective measures in this area and accordingly awareness regarding program must be developed among new mothers and fathers.
Conclusion
Conclusively; the findings of the study depicted that smoking cessation programmes proves to be highly effective for newly expected mother and fathers. It is important to develop awareness regarding this context specifically in both mother and father so they can adopt healthy lifestyle which positively impacts health of mother and child. The research has developed significant insights regarding the inclusion of smoking cessation program in primary care so that wider individuals can be approached and awareness can be developed in them. Furthermore, the study has highlighted significant factors that is creating barriers within smoking cessation programme. People from deprived areas are not able to access the services as they are not aware about this and further lack of budget develops loopholes. Moreover, lack of support from healthcare professionals can lead to develop barriers in implementation of program. Hence, focus requires to be implied on all of these areas so that corrective measures can be taken and awareness could be developed. Thus, the findings have been clearly depicting that it is essential to promote smoking cessation programmes for expectant mothers and fathers so they can effectively look upon their health while maintaining healthy lifestyle.
Recommendations
On the basis of findings; there are certain aspects which needs to be focused out; the awareness regarding smoking cessation program must be developed in the individuals who are living in deprived areas. It is recommended to form multidisciplinary teams that comprised with different healthcare professionals and practitioners (Winkelman et al, 2021). Campaign in rural areas should be developed as this supports in gaining the attention of pregnant women and new fathers. Personalised counselling to new parents should be given and they must be made aware about the negative consequences of smoking for child and mother health. Furthermore, it is recommended healthcare organisations to set specific budgets so they can effectively implement smoking cessation programmes. One of the barriers aligns with lack of finance and therefore, it is essential to focus on this area and significantly, budget should be set so implementation of program can be done in effective manner (Kim and Lee, 2021). By focusing on this area, loopholes can be resolved and smoking cessation program can be promoted.
The campaign should be form for 6 months and throughout this period consistent interaction with new parents must be implemented. Duties and accountabilities of healthcare professionals and practitioners should be pre-decided so there is no issue regarding lack of professional support develop (Chan et al, 2023). It is further recommended to introduce smoking cessation programme in primary care as this supports in approached wider individuals and further creates awareness in them (Chan et al, 2023). Thus, significant focus must be implied on these areas so that barriers can be resolved and effective support to new mothers and fathers could be assured. The future research should be based on comparing different interventions for identifying most suitable intervention that leads to support in quitting smoking. Hence, these are the major recommendations which must be focused out for implementing smoking cessation programmes and promoting healthy lifestyle among new parents.
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