‘Opt-out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support

• Published in: Tobacco control 2017-05, Vol.26 (3), p.300-306
• Main Authors: Campbell, Katarzyna A, Cooper, Sue, Fahy, Samantha J, Bowker, Katharine, Leonardi-Bee, Jo, McEwen, Andy, Whitemore, Rachel, Coleman, Tim
• Format: Article
• Language: English
• Subjects: Adult; Appointments & personnel changes; Carbon monoxide; Carbon Monoxide - analysis; Data collection; Electronic health records; Female; Humans; Identification; Medical records; Midwifery; Pregnancy; Pregnancy Complications - diagnosis; Pregnancy Complications - epidemiology; Pregnancy Complications - prevention & control; Prenatal care; Prenatal Care - organization & administration; Referral and Consultation - organization & administration; Referral and Consultation - statistics & numerical data; Research Paper; Smoking; Smoking cessation; Smoking Cessation - methods; Smoking Prevention; Ultrasonic imaging; United Kingdom; Womens health; Young Adult
• ISSN: 0964-4563; 1468-3318
• DOI: 10.1136/tobaccocontrol-2015-052662

BackgroundIn the UK, free smoking cessation support is available to pregnant women; only a minority accesses this. ‘Opt-out’ referrals to stop smoking services (SSS) are recommended by UK guidelines. These involve identifying pregnant smokers using exhaled carbon monoxide (CO) and referring them for support unless they object.MethodsTo assess the impact of ‘opt-out’ referrals for pregnant smokers on SSS uptake and effectiveness, we conducted a ‘before–after’ service development evaluation. In the 6-month ‘before’ period, there was a routine ‘opt-in’ referral system for self-reported smokers at antenatal ‘booking’ appointments. In the 6-month ‘after’ period, additional ‘opt-out’ referrals were introduced at the 12-week ultrasound appointments; women with CO≥4 ppm were referred to, and outcome data were collected from, local SSS.ResultsApproximately 2300 women attended antenatal care in each period. Before the implementation, 536 (23.4%) women reported smoking at ‘booking’ and 290 (12.7%) were referred to SSS. After the implementation, 524 (22.9%) women reported smoking at ‘booking’, an additional 156 smokers (6.8%) were identified via the ‘opt-out’ referrals and, in total, 421 (18.4%) were referred to SSS. Over twice as many women set a quit date with the SSS after ‘opt-out’ referrals were implemented (121 (5.3%, 95% CI 4.4% to 6.3%) compared to 57 (2.5%, 95% CI 1.9% to 3.2%) before implementation) and reported being abstinent 4 weeks later (93 (4.1%, 95% CI 3.3% to 4.9%) compared to 46 (2.0%, 1.5% to 2.7%) before implementation).ConclusionsIn a hospital with an ‘opt-in’ referral system, adding CO screening with ‘opt-out’ referrals as women attended ultrasound examinations doubled the numbers of pregnant smokers setting quit dates and reporting smoking cessation.