I’m gonna do what I wanna do when I wanna do it and no one can tell me otherwise.” Despite asserting their ‘choice’, many participants struggled to maintain this privileged position of control because nearly all had tried but failed to quit while pregnant. While some women had made a quit attempt because they were advised to do so by their midwife, Sunitinib PDGFR others had tried to stop smoking because they recognised the harms continued smoking presented to their unborn child.

Women in this latter group had to contend with ongoing complications and the guilt these caused: “ I always blame myself because I know it was my smoking… I don’t want to have another sick baby” and all felt the stigma of smoking while pregnant: “you know …it just looks wrong. You know, you feel bad. You feel really

bad and you feel guilty.” The resulting dissonance weighed heavily as women wanted the best outcomes for their children, even though their continued smoking conflicted with this goal. While a minority acknowledged their smoking was controlled by an addiction, the general dominance of control and choice metaphors in participants’ discourse suggested three potential cessation message themes that we developed and tested in phase 2. The first two used affect-laden approaches to challenge the reasoned positions smokers had constructed. Specific messages illustrated the effects of smoking on babies who had

no choice in being exposed to toxins, and the consequences children face when their parents are harmed by smoking. The final theme used a rational approach to support smoke-free behaviours; messages recognised smokers’ autonomy and promoted children’s right to a smoke-free life. Phase 2: Affect, responsibility and reason The first two themes depicted unwell babies and showed the distress of children who could become tobacco orphans; these messages elicited strong emotional reactions from participants. Comments focused on how smoking would harm unborn children, and participants often used words such as ‘suffer’, ‘affect’ and ‘feel’: “no matter who you hide it from, the child will still suffer for it”, and “your baby’s always going to feel it so he’ll know you’re smoking.” These emotionally-laden responses recognised that children lacked choice and would AV-951 bear the consequences of their mothers’ actions: “for something so little and small that hasn’t even entered this world yet, already they have chances taken from them.” The strong emotional engagement with the messages meant very few advanced counter-arguments. Feelings of fear and shame elicited directly challenged participants’ behaviour: “I think that’s so sad….It’s like you’re responsible… like they can’t make choices for themselves… Like you’ve gotta make the right ones for them.