{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T04:08:27Z","timestamp":1791000507303,"version":"4.1.0"},"reference-count":50,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,2,19]],"date-time":"2026-02-19T00:00:00Z","timestamp":1771459200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["NIHR302474"],"award-info":[{"award-number":["NIHR302474"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000276","name":"Department of Health and Social Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,24]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Pregnant women who use specialist perinatal mental health services are more likely to be smokers at the time of giving birth than those without mental illness. This study explored health professionals\u2019 experiences of providing smoking cessation support to pregnant women with complex and severe mental illness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Online video semi-structured interviews were conducted in England, October 2023-2024, with 20 National Health Service healthcare professionals whose role included discussing smoking cessation with pregnant women with mental illness. Using job descriptions, participants were categorized \u201csignposters\u201d (n\u2009=\u200911) or \u201cstop smoking practitioners\u201d (n\u2009=\u20099). Interview topic guides and data analysis were guided by the Theoretical Domains Framework.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Reported barriers to effective provision of smoking cessation support included prioritizing mental health over smoking cessation and being cautious about communicating harms of smoking in case it caused women\u2019s mental health to deteriorate. Health professionals also lacked confidence that pregnant women with mental illness could quit. Lacking knowledge about the relationship between mental health and smoking was a barrier, specifically for many \u201csignposters.\u201d Facilitators included having capacity for health professionals to be responsive to women\u2019s needs, offering flexibility, and effective integration of smoking cessation services within maternity and mental health care settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Barriers to effective smoking cessation support included prioritizing mental illness over smoking cessation advice and a pessimistic view that pregnant women with mental illness would struggle to quit smoking. Facilitators included full integration of services and adapting to women\u2019s needs by offering flexible timing and delivery of smoking cessation support.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Implications<\/jats:title>\n                    <jats:p>This study shows multiple areas which may be impacting on the effectiveness of smoking cessation support available to pregnant women with mental illness. Future research could address some of the barriers identified in the study including prioritizing mental health over smoking cessation, addressing health professionals\u2019 beliefs that pregnant women with mental illness are unlikely to quit smoking, training on communicating harms of smoking and improving knowledge on effect of smoking on mental health. Future research could also focus on sharing good practice including appointment flexibility and full integration of smoking cessation services within maternity and perinatal mental health services.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ntr\/ntag037","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T12:26:49Z","timestamp":1771331209000},"page":"1666-1673","source":"Crossref","is-referenced-by-count":3,"title":["Healthcare professionals\u2019 experiences of supporting pregnant women with mental illness with their smoking behaviors: a qualitative study"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2552-8322","authenticated-orcid":false,"given":"Ellie","family":"Jones","sequence":"first","affiliation":[{"name":"Department of Applied Health Sciences, School of Applied Health Sciences, College of Medicine and Health, University of Birmingham , Edgbaston, Birmingham B15 2TT ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amelia","family":"Casey","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences, School of Applied Health Sciences, College of Medicine and Health, University of Birmingham , Edgbaston, Birmingham B15 2TT ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine","family":"MacArthur","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences, School of Applied Health Sciences, College of Medicine and Health, University of Birmingham , Edgbaston, Birmingham B15 2TT ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7303-4805","authenticated-orcid":false,"given":"Tim","family":"Coleman","sequence":"additional","affiliation":[{"name":"Centre for Academic Primary Care, University of Nottingham , Nottingham NG7 2RD ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jelena","family":"Jankovic","sequence":"additional","affiliation":[{"name":"Birmingham and Solihull Mental Health Foundation Trust, Perinatal Mental Health Service , Birmingham B15 3RB ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beck","family":"Taylor","sequence":"additional","affiliation":[{"name":"Warwick Medical School, University of Warwick , Coventry CV4 7AL ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,19]]},"reference":[{"issue":"9774","key":"2026092405565620100_ref1","doi-asserted-by":"publisher","first-page":"1331","DOI":"10.1016\/s0140-6736(10)62233-7","article-title":"Major risk factors for stillbirth in high-income countries: a systematic review and meta-analysis","volume":"377","author":"Flenady","year":"2011","journal-title":"Lancet."},{"issue":"5","key":"2026092405565620100_ref2","doi-asserted-by":"publisher","first-page":"589","DOI":"10.1093\/humupd\/dmr022","article-title":"Maternal smoking in pregnancy and birth defects: a systematic review based on 173 687 malformed cases and 11.7 million controls","volume":"17","author":"Hackshaw","year":"2011","journal-title":"Hum Reprod Update"},{"key":"2026092405565620100_ref3","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1186\/s12889-015-1552-5","article-title":"Maternal smoking and the risk of still birth: systematic review and meta-analysis","volume":"15","author":"Marufu","year":"2015","journal-title":"BMC Public Health"},{"key":"2026092405565620100_ref4","doi-asserted-by":"publisher","first-page":"b3754","DOI":"10.1136\/bmj.b3754","article-title":"Contribution of smoking during pregnancy to inequalities in stillbirth and infant death in Scotland 1994-2003: retrospective population based study using hospital maternity records","volume":"339","author":"Gray","year":"2009","journal-title":"BMJ."},{"issue":"1","key":"2026092405565620100_ref5","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1186\/s12884-021-03729-1","article-title":"Health outcomes of smoking during pregnancy and the postpartum period: an umbrella review","volume":"21","author":"Av\u015far","year":"2021","journal-title":"BMC Pregnancy Childbirth"},{"issue":"7","key":"2026092405565620100_ref6","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1111\/add.14183","article-title":"Estimating the health-care costs of children born to pregnant smokers in England: cohort study using primary and secondary health-care data","volume":"113","author":"Vaz","year":"2018","journal-title":"Addiction."},{"key":"2026092405565620100_ref7","volume-title":"Estimating the Costs to the NHS of Smoking in Pregnancy for Pregnant Women and Infants. 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