Smoking in Pregnancy | Boltons Health Matters
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Smoking in Pregnancy

This is taken from Smoking in Pregnancy seminar on 10th March 2014, when Bolton's Council's Bump the Habit service was recognised nationally as best practice. This is an overview of the project and service produced by Liz Johnston, (Health Improvement specialist - Tobacco control, oral health, safe sleeping and childhood accident prevention).

Summary

A strategy to tackle high rates of smoking in pregnancy in Bolton

  • Data review to understand demographics of Bolton’s pregnant smokers
  • Stakeholder event to understand attitudes to existing pregnancy cessation service
  • Funding to re-brand our the SiP service & tender won by local design company
  • High profile campaign launch and support from Local Councillor for Health
  • Extensive campaign materials, website, Twitter account and a Facebook page
  • The service continues to operate as previously but now has its own highly recognisable identity, separate to the general Stop smoking service and a telephone number answered by ‘the bump team’.
  • Media and promotion throughout the three year campaign, including case studies of successful quitters.

Background

In 2011, tackling high rates of smoking in pregnancy was identified as a high priority for Bolton PCT as a strand of work to tackle health inequalities. A data review by the health intelligence team identified that Bolton has above regional and national average levels of women smoking at the time of delivery, though the proportion has been reducing steadily over the past decade. The 15-19 and 20-24 year olds are far more likely to smoke at time of delivery than the older age groups and they are the least successful in stopping smoking between maternity booking and delivery. During a two year period, only 49% of women who were smoking at the time of booking had successfully stopped smoking by time of delivery.  The smoking at time of delivery figure for Bolton would be considerably higher if it was not for the much lower rate evident in the Asian populations that make up a considerable proportion of births in Bolton.  Deprivation plays an important part in preventing women from stopping smoking during their maternity. There is a strong association between being able to quit and the deprivation gradient.

We held an event with key stakeholders to get thoughts and ideas on how to tackle the issue. The main theme that came out of the day was that even many professionals were not aware of the stop smoking in pregnancy service which then operated as part of the larger NHS stop smoking service. It was evident that it needed its own branding – a brand that was warm and friendly to young women and that health professionals would feel comfortable referring to.

Based on these findings, we were successful in obtaining some funding to re-brand our smoking in pregnancy service. We wrote a brief, sent it out to local design companies and invited them to come and pitch their ideas to us. The winning company came to us with the idea for ‘Bump the Habit’ and they then developed that brand using research with a young Mum’s group at Bolton College and spent two days in local children’s centres getting feedback on the exact design and colours to be used.

What did you do?

The campaign launched on the 24th of September 2012 at a local Childrens’ Centre. Our lead Councillor for health, Linda Thomas, opened the event with a speech and high profile coverage was given to the launch in the local Bolton News. The campaign materials include leaflets for clients and professionals, posters, two banner stands, appointment cards, a two week six sheet poster campaign in the town centre and a website www.bumpthehabit.org. The project also has a Twitter account and a Facebook page.

The service continues to operate as previously but now has its own highly recognisable identity, separate to the general Stop smoking service and a telephone number answered by ‘the bump team’. They have their own t-shirts made up so the two members of staff have their own separate uniform. Promotion will continue throughout the three year campaign, for example in March 2013, a press release was issued featuring a young client who had successfully quit smoking.

The Facebook page has worked well, and clients are encouraged to engage directly with by the Bump Team. Currently the page has one hundred and seven likes and each post on average is seen by about forty people. Using Facebook allows the project to effectively target what is effectively a very small niche market of young women who smoke who are pregnant in Bolton. Mass media marketing would not be feasible for a market of around seven hundred women per year but by using Facebook, the service can reach that small market very effectively.

What did you achieve?  Why do you think your project worked?

Currently 50% of women who smoke during pregnancy are referred in to the specialist Bump service. This figure has not changed significantly since the launch, which has promoted a plan for a piece of qualitative research with women who do not accept referral into the Bump the Habit service and consideration of an ‘opt out’ Smoking in Pregnancy pathway.

We have seen a decrease in the rate of smoking at deliver (SATOD) in Bolton steadily over the past three years. The last quarter of 2012-13 saw Bolton achieve its lowest ever rate of smoking at time of delivery.

Further evaluation is required but it is anticipated that the higher quality of referrals from health professionals (discussion about the Bump the Habit service, CO monitoring in target areas) has increased the successful quit rate.

Next steps

The project is part of a wider strategic drive to reduce smoking in pregnancy, driven by the smoking in pregnancy action group which is where partners from midwifery, health visiting, children’s centres, pharmacies and the Stop Smoking Service. There is an associated action plan, which the group monitor, which includes work to further strengthen the ‘Bump’ brand through continued marketing and press releases.

Also crucial to the success in reducing smoking in pregnancy has been the introduction of a CO monitoring pilot by midwifery to CO screen each new client on booking and also at every appointment if the women is a smoker. Anecdotally, midwives have told her that they feel the use of the CO monitor has encouraged women to accept a referral to the Bump the Habit Team. We are now going to do some further work to see if we can evaluate how well the CO screening is working and if we can look at expanding their use to all Bolton midwifery teams.

We are also proposing to develop research with pregnant women who are referred into the service by their midwife but never take up the offer of a home visit. Around 50% of women who are referred never take up the referral. We feel it is crucial to understand why they don’t take up the offer and how we can encourage more women to engage with the service.

Stopping smoking at any time has considerable health benefits and for people using secondary care services, there are additional advantages including shorter hospital stays and fewer complications. Secondary care providers have a duty of care to protect the health of, and promote healthy behaviour among, people who use, or work in, their services.  This guidance aims to support smoking cessation, temporary abstinence from smoking and smokefree policies in all secondary care settings. It recommends:

  • Strong leadership and management to ensure premises remain smokefree.
  • All hospitals have an on-site stop smoking service.
  • Identifying people who smoke, offering advice and support to stop.
  • Providing intensive behavioural support and pharmacotherapy as an integral component of secondary care.
  • Integrating stop smoking support in secondary care with support provided by community-based services.
  • Ensuring staff are trained to support people to stop smoking while using secondary care services.
  • Supporting staff to stop smoking or to abstain while at work.
  • Ensuring there are no designated smoking areas or staff-facilitated smoking breaks for anyone using secondary care services.

You can view the full guidance by clicking here: http://guidance.nice.org.uk/PH48

NICE's formal guidance on smoking cessation services.

Follow the link for full details: http://guidance.nice.org.uk/PH10

This guidance is for NHS and other commissioners, managers and practitioners who have a direct or indirect role in, and responsibility for, helping women to stop smoking when pregnant and following childbirth. This includes those working in: local authorities,education and the wider public, private, voluntary and community sectors.

It may also be of interest to women who:

  • are planning a pregnancy
  • are pregnant
  • have an infant aged up to 12 months (as well as their partners and families and other members of the public).

NICE says all pregnant women who smoke – and all those who are planning a pregnancy or who have an infant aged under 12 months – should be referred for help to quit smoking.

The eight recommendations include advice on:

  • How NHS professionals and others working in the public, community and voluntary sectors can identify women (including teenagers) who smoke when they attend an appointment or meeting.
  • How to refer them to NHS Stop Smoking Services (or the equivalent).
  • How NHS Stop Smoking Services staff (and staff from equivalent, non-NHS services) should contact and support all women who have been referred for help.
  • How to help their partners or ‘significant others’ who smoke.
  • When and how nicotine replacement therapy and other pharmacological support should be offered.
  • Training for professionals.

Follow the link for full details:http://guidance.nice.org.uk/PH26

In depth analytical topic report from the Public Health Intelligence Team into smoking during pregnancy in births to Bolton mothers looking at inequalities by deprivation and ethnicity.

Local tobacco control profile for Bolton. Indicators include (but not limited to) smoking attributable: mortality; hospital admissions; prevelance and hospital admissions.

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