Australian Women's Perspectives on Preventing Postpartum Relapse or Quitting Smoking or Vaping in the Postpartum Year.

introductionHigh postpartum smoking relapse rates indicate opportunities to address nicotine dependence. Data on postpartum vaping are scarce. This study explored postpartum women's perspectives on support for quitting or preventing relapse to smoking and vaping.

methodsPostpartum women who smoked or quit during pregnancy completed brief telephone interviews at 2, 4, 6, and 12 months postpartum (May 2023-December 2024). Interviews included the question: In the ideal world, what support would you need to help you stop smoking or vaping or stay quit? Inductive content analysis was conducted. Responses were examined by timepoint and by four smoking/vaping status groups (quit nicotine products during pregnancy [QPreg]; quit postpartum [QPP]; never quit [NQ]; relapsed postpartum [R]) was explored.

resultsOf 832 invited, 770 (93%) consented, 566 (74%) completed at least one interview. The proportion in each group was consistent across timepoints: QPreg (21%-23%; n = 53-111), QPP (9%-11%; n = 25-47), NQ (56%-57%; n = 140-284), and R (10%-14%; n = 34-57). Also consistent across time were smoking prevalence (59%-61%), vaping prevalence (7%-8%), and dual use with combustible tobacco (7%-9%). Six main categories: I don't know/nothing; Health professional support; Physical health; Mental-emotional health; Social-environmental health; Public health, and 22 generic categories were interpreted. Coding patterns were generally consistent across timepoints, with some subgroup differences: R participants more often referenced Regulation and policy (Public health); NQ and R groups' responses cited Stress; QPreg and QPP groups highlighted Babies and children as motivators; NQ participants more often mentioned NRT [nicotine replacement therapy]/medication and Nothing. Low vaping prevalence and lack of distinction in responses limited conclusions about vaping-specific support.

conclusionsThis study highlights the diverse and evolving support preferences of postpartum women across smoking and vaping trajectories. Women identified interventions addressing stress, mental health, and regulatory environments and supporting parenting motivations as being helpful. Findings underscore the importance of nuanced, subgroup-specific strategies to sustain nicotine cessation postpartum. IMPLICATIONS: This study adds to our (presently limited) understanding of what postpartum Australian women think could support them to stop smoking/vaping or stay quit. Women commonly said they did not know. This uncertainty itself highlights the need for more proactive, tailored approaches in both policy and practice to help women identify and access effective support. Those who did offer ideas identified social-environmental support from family/friends/partners, as well as support from health professionals, as important. Women who had relapsed postpartum acknowledged the role of regulation and policy such as the cost of tobacco; those who had never quit and those who had relapsed commonly mentioned stress, and those who had quit in pregnancy or postpartum identified the positive impact of babies and children on their smoking/vaping.