Improving the effectiveness and reach of NHS support for smoking cessation in pregnancy

Smoking in pregnancy is an established public health problem in the developed world and the World Health Organisation (WHO) predicts that this will also reach epidemic proportions in developing countries in the near future.

Overview

Currently the only smoking cessation intervention that is proven to work in pregnancy is individual, face to face behavioural support, but, even in countries like England where women can access this at no cost, very few do.  This series of linked projects will investigate how the NHS currently provides smoking cessation support in pregnancy, how women feel about attempting cessation in pregnancy and when, in pregnany, they are most likely to accept support and to use this to try stopping smoking.  Self help support for smoking cessation is effective in pregnancy but this is not routinely provided within the NHS.  Consequently, a key feature of the programme is the development and testing of self help cessation support, delivered via a modality for receiving advice that the most disadvantaged in society are very familiar with; SMS text message.

Aims and objectives

The overall aim of all projects combined is to increase the uptake and effectiveness of the NHS Stop Smoking Services for Pregnant women (SSSP) by determining when and how NHS cessation support is best offered in pregnancy; refining and testing 'self-help' cessation methods which are attractive to and, therefore, likely to be used by the vast majority of mothers who do not currently access SSSP and investigating how 'self-help' support is best delivered by the NHS.

Update

The research team have had access to programme funds since the start of 2011 and progress is summarised below:

• Survey of all English Stop Smoking Services for Pregnant women (SSSP): Survey data will determine current use of self-help and other cessation interventions; permit understanding of referral pathways into SSSP and their methods for enaging smokers with support and will also descrive the principal models and costs of service provision.  Subsequently, by combining survey findings with routinely available data on SSSP effectiveness this project will elucidate those service design factors which most influence SSSP (cost) effectiveness.

An experienced research was appointed in June 2011; a database of survey recipients is currently being constructed; an online survey instrument has been designed and piloted and this will go 'live' in October.

• Cohort survey of pregnant women: This is the first longitudinal survey, in the UK, to investigate smoking behaviour before, during and after pregnancy to be implemented for over 20 years and will identify those times in pregnancy when women who smoke are most receptive to receiving smoking cessation support and also the predictors of women's propensity to enage with this.  REC and R&D approvals were obtained prior to receiving programme funds and all survey questionnaires have been finalised. 

Two researchers, appointed in July 2011, have implemented a comprehensive approach to distributing questionnaires, such that study recruitment has exceeded expectations since this went 'live' in August.

• Using primary care medical records data to investigate NRT prescribing in pregnancy: A linked mother/infact primary care medical records cohort will be used to monitor national trends in nicotine replacement therapy (NRT) use in pregnancy, compare women prescribed/not prescribed NRT and investigate impacts on infrequent fetal outcomes of NRT use in pregnancy. 

Exploratory analyses, using data from The Health Improvement Network (THIN) began in summer 2011.

• Refining and testing an SMS 'text' messaging 'self-help' intervantion, 'MiQuit': MiQuit delivers self help cessation support via SMS text messaging and has already shown potential efficacy in a feasibility trial.  The next phase of intervention development, refining the prototype intervention so that this can be routinely offered in NHS ante natal care settings, is taking place at the University of Cambridge.