Background Babies born to smokers weigh on average 200 g less than those born to non-smokers and are at 40% higher risk of being born preterm. The relative risk of admission to Neonatal Intensive Care units (NICU) for infants of smokers is increased by at least 20%. Parents of infants admitted to NICU may feel helpless and overwhelmed at a time when their baby is critically ill. Stopping smoking, or remaining abstinent, is one of the few things that parents can do to significantly improve the longer-term recovery and health of their offspring, yet stressed parents are at increased risk of smoking relapse. NICU admission may represent a ‘teachable moment’ where parents are receptive to smoking cessation.
Methods Qualitative focus groups and interviews with parents and family members of babies admitted to NICUs. Participants were purposively sampled (n=60) from NICUs across two large UK teaching hospitals, seeking maximum variation in smoking status, parental/familial status, ethnicity and socioeconomic status. Qualitative topic guides sought feedback on potential intervention approaches, considering ‘who’ might introduce, ‘what’ might be the content, and ‘when’ an intervention might be delivered. Data were collected face to face by dedicated neonatal research nurses. All data were audio recorded and transcribed verbatim. Inductive thematic analysis of data was conducted by two members of the research team, independently reviewing coding to reach consensus on emergent themes.
Results Parents appear amenable to smoking cessation and express surprise that the subject is not addressed. Immediate addressing of smoking status would not be appropriate on acute admission to NICU due to stress and concerns regarding the newborn, but timely support is needed to reach those willing to quit, and those who had quit during pregnancy but were at high risk of relapse. Support might best be delivered by a NICU nurse with specialist training. Support with cessation and relapse prevention through information about smoke-free homes, nicotine replacement therapy and/or support to use nicotine in significantly less harmful ways (e.g. vaping) were identified as promising routes for intervention. Parents welcomed ongoing support following discharge from NICU and were amenable to digital options.
Conclusion There is presently little dedicated support for smoking cessation, relapse prevention or smoke-free homes for families of NICU babies. Parents are amenable to support and consider a focus on smoke-free homes as a less stigmatising way in which smoking may be discussed and cessation promoted to improve the health of premature babies.
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