Exploring the adequacy of smoking cessation support for pregnant and postpartum women
Bibliographic record
Abstract
BACKGROUND: Smoking in pregnancy exemplifies the relationship between tobacco use and health inequalities. While difficulty reaching and engaging this population in cessation support is often highlighted in the literature, there is limited research that explores the factors that shape the provision and use of support by this subpopulation. Using Ontario, Canada, as a case study, this study examines how the use of cessation support by women is encouraged or discouraged by cessation policy, programming and practice; how geographical and sociocultural factors influence provision and uptake of support; and how barriers and challenges can be addressed through a comprehensive approach. METHODS: Semi-structured, in-depth interviews with key informants (31) and pregnant or postpartum women (29) were conducted to examine the cessation needs of this subpopulation, barriers to the provision and uptake of cessation support and directions for policy, service provision and programming. RESULTS: Key barriers included: the absence of a provincial cessation strategy and funding, capacity and engagement/accessibility issues. Geographical features presented additional challenges to provision/uptake, as did the absence of resources tailored to Aboriginal women and adolescents. Key informants recommended a comprehensive cessation strategy to facilitate coordination of cessation resources provincially and locally and elucidated the need for capacity building within tobacco control and within reproductive, child and maternal health. Participants also highlighted the need to further develop tobacco control policies and target the social determinants of health through poverty reduction, housing and education support. The provision of incentives, transportation, childcare and meals/snacks; adoption of woman-centred, harm-reduction and stigma reduction approaches; and promotion of programs through a variety of local venues were recommended by participants to address engagement and accessibility issues. CONCLUSIONS: The current cessation system in Ontario is not equipped to adequately reduce smoking among pregnant and postpartum women. A comprehensive, multi-sector strategy designed to provide tailored and sustainable support through different system entry points is needed. A cultural shift in practice is also necessary to eliminate mixed messaging, strengthen practice and encourage open channels of communication about smoking between women and their providers. The study highlights the need to address smoking among women in a more holistic manner and for capacity building strategies that focus on strengthening providers' competency and confidence in practice. Future research should explore: capacity building strategies, especially among rural and remote communities; the smoking and cessation experiences of different subpopulations of pregnant and postpartum women; the effectiveness of tailored strategies; and interventions that address smoking among partners and other family members.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".