Exploring Greek midwives' knowledge, attitudes, and practices in perinatal smoking: A cross-sectional study

Smoking during pregnancy remains a significant global public health concern. Midwives, as frontline healthcare providers, play a crucial role in supporting smoking cessation among pregnant women. This study aimed to explore the factors associated with the implementation of smoking practices by midwives in Greece.

We conducted a cross-sectional survey between December 2022 and December 2023 among 150 midwives working in the 1st and 2nd Health Districts of Greece, as well as in private practices. Data were collected using a self-administered, anonymized questionnaire assessing demographics, knowledge, opinions, perceptions, and smoking cessation practices. Composite scores were calculated for knowledge, opinions, perceptions, and practices. Exploratory factor analysis was applied to examine the structure of midwives' opinions and perceptions. Multivariate linear regression was used to identify independent predictors of smoking cessation practices.

Among the respondents, 78% had not received formal education on smoking cessation, although 77.3% expressed a desire for training. Only 35.3% recognized that secondhand smoke affects newborns, and 32.7% felt confident in supporting pregnant women to quit smoking. Factor analysis identified two key dimensions: midwives' contribution to smoking cessation during pregnancy, and information and help to stop smoking during pregnancy, explaining 27.7% and 16.9% of the variance, respectively. Multivariate regression revealed that both factors were independently associated with more frequent implementation of smoking cessation practices (p<0.05).

The study underscores the pivotal role of midwives in smoking cessation during pregnancy and highlights the importance of perceptions, self-efficacy, and access to information in shaping their practices. Targeted education and institutional support are essential to strengthen midwives' capacity to deliver effective smoking cessation interventions. These findings can inform policy and training programs aiming to improve maternal and neonatal outcomes by reducing tobacco use during pregnancy.