Pregnant Smokers' Intention to Switch From Cigarettes to E-Cigarettes: A Reasoned Action Approach

Introduction: This study used the reasoned action approach (RAA) to examine 1) factors associated with pregnant smokers' intention to switch from cigarettes to e-cigarettes and 2) the influence that intention to switch had on future expectations to resume cigarette use postpartum. Methods: U.S. pregnant women (N = 267) who reported past 30-day use of cigarettes completed an online crosssectional survey between November and December 2019. A 30-item scale measured RAA constructs (intention, instrumental attitudes, experiential attitudes, injunctive norms, descriptive norms, perceived autonomy, and perceived capacity). A confirmatory factor analysis confirmed and structural equation modeling tested the RAA constructs' association with intention to switch and the relationship between intention to switch and future expectations to resume smoking after pregnancy. Results: The confirmatory factor analysis confirmed the seven-factor measurement model. Structural equation modeling found instrumental attitudes (beta = 0.43; p < .001) and descriptive norms (beta = 0.53; p < .001) were associated with intention to switch from cigarettes to e-cigarettes. However, there were differences between the constructs' relationships with intention between those who did and did not use e-cigarettes in the past 30 days. Intention to switch was inversely related with future expectations to resume smoking postpartum (beta = -0.13; p < .001). Conclusions: This study examined multiple facets of behavioral decision-making that may influence pregnant smokers' intention to switch to e-cigarettes during pregnancy. In this sample, pregnant people who believed switching from cigarettes to e-cigarettes was important and that other smokers commonly switched during pregnancy reported greater intention to switch. Novel theories, such as the RAA, may provide an optimal lens to understand pregnant smokers' behavioral decision-making process as they consider switching from cigarettes to e-cigarettes. (C) 2021 Jacobs Institute of Women's Health. Published by Elsevier Inc.