Background: A Cochrane review about smoking cessation in pregnancy concluded that interventions can reduce the proportion of smokers, and the incidence of low birthweight and preterm births (Lumley et al. 2009). The review did not investigate to what extent interventions benefit disadvantaged women. Arblaster and colleagues (1996) proposed that promising interventions for reducing health inequalities include: systematic intensive approaches to health care; multiple components built on a multi-disciplinary approach; improvement in access; involvement of peers; attempts to address the needs of the population; and health education when combined with social support or structural strategies. Objectives: To conduct a secondary-analysis of a review of smoking cessation in pregnancy, in order to assess the impact of interventions on health inequalities. Further the current study examines whether interventions matching those Arblaster and colleagues propose as promising for reducing health inequalities are more effective. Methods: Subgroup analyses were conducted to assess the relative impact of interventions on women differing in their socioeconomic status (SES), ethnicity and age. Assessment of effectiveness of different elements of interventions was conducted. These elements include structural measures, social networks or incentives; addressing the expressed concerns of pregnant smokers; and involving pregnant smokers, their partners or their community in the intervention design. Results: In relation to becoming smoke-free in late pregnancy, interventions were equally successful whether women had low SES or not. Too few data were available to allow further analysis of ethnic minority, or younger women. Interventions with incentives were more effective than those without. Interventions were as effective with or without peer support, or if they were designed in collaboration with pregnant smokers. Conclusions: As smoking cessation programmes are effective for low SES women, it is important that programmes are widely implemented. Analysis is ongoing to identify promising elements for smoking cessation interventions.
References
Lumley J, Chamberlain C, Dowswell T, Oliver S, Oakley L, Watson L. (2009) Interventions for promoting smoking cessation during pregnancy. In: the Cochrane Database of Systematic Reviews, 2009: Issue 3. Art. No.: CD001055. DOI: 10.1002/14651858.CD001055.pub2
Arblaster L. (1996) A systematic review of the effectiveness of health service interventions aimed at reducing inequalities in health. Journal of Health Services Research and Policy 1: 93-103.