CC BY-NC-ND 4.0 · Geburtshilfe Frauenheilkd 2021; 81(02): 214-223
DOI: 10.1055/a-1308-2376
GebFra Science
Original Article

Study on E-Cigarettes and Pregnancy (STEP) – Results of a Mixed Methods Study on Risk Perception of E-Cigarette Use During Pregnancy

Studie zu E-Zigaretten und Schwangerschaft (STEP) – Ergebnisse aus einer Mixed-Methods-Studie zur Risikowahrnehmung der E-Zigaretten-Nutzung in der Schwangerschaft
Laura Schilling
1   Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
3   Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
,
Jacob Spallek
1   Department of Public Health, Brandenburg University of Technology, Senftenberg, Germany
,
Holger Maul
2   Asklepios Klinik Barmbek, Hamburg, Germany
,
Sven Schneider
3   Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
› Author Affiliations

Abstract

Introduction E-cigarette use during pregnancy is a risk factor for maternal and fetal health. Early studies on animals showed that in utero exposure to e-cigarettes can have negative health outcomes for the fetus. There has been only limited research into the risk perceptions of e-cigarette use during pregnancy. This study was conducted to comprehensively characterize the constructs of risk perceptions with regard to e-cigarette use during pregnancy using an Integrated Health Belief Model (IHBM).

Methods Our STudy on E-cigarettes and Pregnancy (STEP) used a mixed methods approach, with the study divided into an initial qualitative part and a quantitative part. A netnographic approach was used for the first part, which consisted of the analysis of 1552 posts from 25 German-language online discussion threads on e-cigarette use during pregnancy. Using these qualitative results, a quantitative questionnaire was developed to explore risk perception constructs about e-cigarette use during pregnancy. This questionnaire was subsequently administered to pregnant women (n = 575) in one hospital in Hamburg, Germany. Descriptive and bivariate analysis was used to examine differences in risk perception according to participantsʼ tobacco and e-cigarette user status before and during pregnancy. While the study design, methods and sample have been extensively described in our recently published study protocol in the January 2020 issue of Geburtshilfe und Frauenheilkunde, this paper is devoted to a presentation of the results of our mixed methods study.

Results Themes related to perceived threats identified in the qualitative study part were nicotine-related health risks and potential health risks of additional ingredients. Perceived benefits were possibility and facilitation of smoking cessation and a presumed potential to reduce harm. The subsequent quantitative part showed that nearly all participants (99.3%) perceived e-cigarettes which contained nicotine as constituting a threat to the health of the unborn child. The most commonly perceived barrier was health-related (96.6%), while the most commonly perceived benefit was a reduction in the amount of tobacco cigarettes consumed (31.8%). We found that particularly perceived benefits varied depending on the participantʼs tobacco and e-cigarette user status.

Conclusion When considering future prevention strategies, the potential health risks and disputed effectiveness of e-cigarettes as a tool for smoking cessation need to be taken into account and critically discussed.

Zusammenfassung

Einleitung Die Nutzung von E-Zigaretten während der Schwangerschaft wird als Risikofaktor für die maternale und fetale Gesundheit diskutiert. Erste Studien an Tieren zeigen, dass die Exposition im Mutterleib zu negativen Gesundheitsoutcomes für den Fetus führen kann. Bisher wurden kaum Ergebnisse zur Risikowahrnehmung der E-Zigarette während der Schwangerschaft publiziert. Diese Studie wurde durchgeführt, um Konstrukte der Risikowahrnehmung der E-Zigaretten-Nutzung während der Schwangerschaft unter Verwendung eines integrierten Health-Belief-Modells (IHBM) umfassend zu charakterisieren.

Methoden Unsere Studie zur E-Zigarette und Schwangerschaft (STEP) verwendete einen Mixed-Methods-Ansatz, beginnend mit einem qualitativen Studienteil und einem anschließenden quantitativen Studienteil. Zunächst wurde ein netnografischer Ansatz verwendet, indem 1552 Beiträge in 25 deutschsprachigen Online-Diskussionssträngen, die sich mit dem Gebrauch von E-Zigaretten während der Schwangerschaft befassten, analysiert wurden. Basierend auf den qualitativen Ergebnissen wurde ein quantitativer Fragebogen entwickelt, in dem Konstrukte der Risikowahrnehmung der E-Zigaretten-Nutzung während der Schwangerschaft untersucht wurden. Dieser Fragebogen wurde anschließend an Schwangere (n = 575) in einem Krankenhaus in Hamburg verteilt. In deskriptiven und bivariaten Analysen wurden Unterschiede in der Risikowahrnehmung in Abhängigkeit von dem Tabak- und E-Zigaretten-Nutzerstatus vor und während der Schwangerschaft untersucht. Während das Studiendesign, die Methodik und die Stichprobe von STEP ausführlich in unserem kürzlich veröffentlichen Studienprotokoll in der Januar-Ausgabe 2020 von Geburtshilfe und Frauenheilkunde beschrieben wurde, widmet sich dieses Paper der Präsentation der Forschungsergebnisse unserer Mixed-Methods-Studie.

Ergebnisse Themen, die im Zusammenhang mit wahrgenommenen Bedrohungen im qualitativen Studienteil identifiziert wurden, waren nikotinbedingte Gesundheitsrisiken und potenzielle Gesundheitsrisiken zusätzlicher Inhaltsstoffe. Wahrgenommene Vorteile waren die Möglichkeit und Erleichterung der Raucherentwöhnung und die Vermutung, Schaden zu minimieren. Der anschließende quantitative Studienteil zeigte, dass beispielsweise fast alle Teilnehmerinnen (99,3%) E-Zigaretten mit Nikotin als Bedrohung für die Gesundheit des Ungeborenen empfanden. Die am häufigsten wahrgenommene Barriere war gesundheitsbezogen (96,6%), während der am häufigste wahrgenommene Nutzen in der Reduzierung der Tabakzigaretten (31,8%) lag. Wir stellten fest, dass insbesondere die wahrgenommenen Vorteile nach dem Nutzerstatus von Tabak- und E-Zigaretten variierten.

Schlussfolgerungen Im Kontext zukünftiger Präventionsmaßnahmen sollten potenzielle Gesundheitsrisiken und die umstrittene Wirksamkeit der E-Zigarette als Raucherentwöhnungsmittel berücksichtigt und kritisch diskutiert werden.



Publication History

Received: 22 June 2020

Accepted: 08 November 2020

Article published online:
08 February 2021

© 2021. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
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