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

AIM: To research the subjective lay justifications expressed by smoking pregnant women to explain why they use cigarettes during pregnancy and to determine a typology for these justifications. BACKGROUND: Smoking pregnant mothers' awareness of the detrimental effects of smoking on foetal health frequently is a source of stress and cognitive dissonance (stemming from the contrast between viewing themselves as responsible mothers and smokers). One possible way to reduce these unpleasant feelings is acceptance or creation of beliefs allowing them to explain rationally why they continue this behaviour during pregnancy. DESIGN: Qualitative design. METHODS: Thematic analysis of the content of posts from the three largest Polish parenting on-line forums written between the time they were founded and 12 November 2012. The data were collected between September - October 2012. During the analysis of the selected 73 posts, each of which included subjective explanations of smoking during pregnancy, 151 fragments, each containing one lay justification, were identified and analysed. FINDINGS: Thirty-five subthemes of lay justifications assigned to two main themes were developed. The first main theme includes convictions that undermine the need to break the nicotine addiction and the positive aspects resulting from quitting. The second main theme comprises beliefs that question the possibility to abstain from smoking and exaggerate the barriers in the process of quitting. CONCLUSIONS: The creation of a typology of lay justifications might help nurses and midwives perform more effective anti-tobacco interventions geared specifically towards the thought patterns typical of pregnant women.