PhD defence L.B. (Leonieke) Breunis

Summary:

Raising a healthy generation of children begins with a smoke and alcohol free pregnancy. We found that alcohol consumption during pregnancy is often denied to the obstetric care provider, while it remains prevalent (5.3%). To quit smoking and drinking alcohol, pregnant women should be supported. An upcoming intervention to support these women is the provision of incentives. However, we identified adverse consequences of providing incentives to motivate smoking cessation during pregnancy, such as the risk of retaining personal autonomy. In addition, we found that women believe that smoking cessation support should be easily accessible. With the help of these insights, we developed the SAFER pregnancy intervention to promote smoking and alcohol cessation before and during pregnancy. Women were supported to quit smoking and using alcohol with group sessions, an online platform, and rewards. With this intervention 28% of participants, often challenged with problems related with a low socioeconomic status, quit smoking. Based on this thesis and existing research we conclude that rewards should be implemented in existing smoking support for pregnant women. None of the participating women consumed alcohol.
After birth, children must remain protected against smoking, for example using smoke-free zones. We showed that a smoke-free zone surrounding the Erasmus MC and two schools was highly supported by adults (76%) and paediatric patients (89%) and that the number of smokers in the zone almost halved following its implementation. The increase of smokers outside the border was much smaller than the decrease inside the border, showing that a smoke-free zone demotivates smoking. Pointing out the smoke-free policy to smokers inside the zone often elicited a positive or neutral response (64%) and lead to smokers leaving the zone or extinguishing their cigarettes (74%).