Using qualitative research to inform interventions to reduce smoking in pregnancy in England: a systematic review of qualitative studies


Reducing smoking in pregnancy is central to England’s public health strategy. Evidence to inform it comes predominantly from quantitative studies, including a recent (2009) Cochrane review of interventions to promote smoking cessation in pregnancy. Such effectiveness reviews are essential; however, they do not provide information on the everyday contexts of smokers’ lives and the perceived barriers to making positive changes in health behaviours. An appreciation of contexts and barriers is important if interventions are to be appropriate for their target population.

This project aimed to improve the evidence base for interventions to reduce smoking in pregnancy through a systematic review of qualitative studies focusing on women’s smoking in the context of social disadvantage and/or pregnancy to help understand how the circumstances of mothers’ lives influence their smoking behaviour and attempts to quit. We compared our findings with the results of the Cochrane review to establish the extent to which contextual factors, including barriers to cessation, identified in the qualitative studies were addressed by the interventions.

This project has been completed and the findings are available via the links below.

Conducted by: CRD and the Department of Health Sciences, University of York

Further details

Project page on Public Health Research Consortium website


Executive summary

Short report

Graham H, Flemming K, Fox D, Heirs M, Sowden A. Cutting down: insights from qualitative studies of smoking in pregnancy. Health Soc Care Comm 2013; [Epub ahead of print]

Flemming K, Graham H, Heirs M, Fox D, Sowden A. Smoking in pregnancy: a systematic review of qualitative research of women who commence pregnancy as smokers. J Adv Nurs 2012;69(5):1023-36


Commissioned by the Department of Health Policy Research Programme, via The Public Health Research Consortium