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Determinants and Trajectories of Smoking Cessation, Maintenance, and Relapse Among Pregnant and Postpartum Adolescents: A Qualitative Study

Funding Agency: Robert Wood Johnson Foundation Smoke-Free Families Program

Dates: 2001-2003

Staff: Norm Constantine (principal investigator), Jana Kay Slater (co-investigator), Julie Carroll (research associate), Mieko Davis (research associate)

Preliminary Results: National Conference on Tobacco or Health presentation

There are several compelling reasons to study pregnant and postpartum adolescents as a distinct subpopulation with regard to smoking cessation and relapse. First, there are few published studies focused on smoking cessation and relapse among pregnant and postpartum adolescents. Second, smoking rates for pregnant adolescents are higher than for all other age groups of pregnant women. Third, pregnant adolescents typically differ from adult pregnant women on many characteristics potentially related to smoking cessation, therefore, we do not know the extent to which smoking cessation research on pregnant adults can be generalized to adolescents.

PHI's Center for Research on Adolescent Health and Development is conducting an exploratory qualitative study to address key knowledge gaps related to smoking cessation and relapse among pregnant and postpartum adolescents. We employ the methods of grounded theory, a general methodology for developing theory that is deeply grounded in data systematically gathered and analyzed. This approach has special utility in studies to create new and theoretically expressed understandings of an understudied phenomenon, such as adolescent pregnancy and smoking cessation.

The study has two specific aims: (1) to develop a theoretical framework that explains the processes and experiences of smoking cessation, maintenance, and relapse by pregnant and postpartum adolescents, and (2) to provide a theoretical foundation for potential intervention approaches and strategies specifically targeted to this group. The study addresses the following research questions: (1) for pregnant and postpartum adolescents, what are the key processes and experiences of smoking cessation, maintenance, and relapse during pregnancy and through six months postpartum? and (2) for pregnant and postpartum adolescents, which individual and environmental factors and interactions of factors, influence smoking cessation, maintenance and relapse, during pregnancy and through six months postpartum?

Our target population comprises low-income pregnant and postpartum adolescents, predominately white, Hispanic, and African American, between the ages of 14 and 19, who: (1) have had lifetime use of 100 or more cigarettes; (2) have smoked at least 10 cigarettes during the three months prior to discovery of pregnancy; and (3) have abstained from smoking for at least 30 consecutive days during the pregnancy. Interviews are being conducted with a total of 60 adolescent participants, with some participants selected for follow-up interviews. Participants are selected based on evolving theoretical sampling considerations, but all will fall within the birth status range of three months pre-delivery to twelve months postpartum. We also will conduct four focus groups, two with adolescents and two with adult professionals. We will share our developing theory with these participants and facilitate constructive conversations in which they respond to and critique our work, and offer confirming or differing interpretations of our data.

Data management and analysis occur in coordination with data collection throughout the course of the study, and are enhanced by the use of ATLAS/ti qualitative analysis software. Our primary analytic activities consist of: (1) interview transcription, (2) open coding, (3) axial and selective coding, (4) process analysis, and (5) validation of the theoretical scheme. The specialized tools of microanalysis and memos and diagrams are used extensively.

We expect the proposed study to provide a key component of the inceptive theory development and knowledge-building needed in the understudied area of smoking cessation, maintenance, and relapse among pregnant and postpartum adolescents. The resulting knowledge should stimulate further research, as well as development and evaluation of interventions.