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

Campbell, Katarzyna; Cooper, Sue; Fahy, Samantha; Bowker, Katharine; Leonardi-Bee, Jo; McEwen, Andy; Whitemore, Rachel; Coleman, Tim

Authors

Samantha Fahy samantha.fahy@nottingham.ac.uk

JO LEONARDI-BEE jo.leonardi-bee@nottingham.ac.uk
Professor of Medical Statistics and Epidemiology

Andy McEwen Andy.mcewen@ucl.ac.uk

Rachel Whitemore

TIM COLEMAN tim.coleman@nottingham.ac.uk
Professor of Primary Care



Abstract

Background. In the UK, free smoking cessation support is available to pregnant women; only a minority access 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.

Methods. To assess impact of ‘opt-out’ referrals for pregnant smokers on SSS uptake and effectiveness, we conducted a ‘before-after’ service development evaluation. In a six-month ‘before’ period there was a routine ‘opt-in’ referral system for self-reported smokers at antenatal ‘booking’ appointments. In a six-month ‘after’ period, additional ‘opt-out’ referrals were introduced at 12 weeks ultrasound appointments; women with CO≥4ppm were referred to, and outcome data were collected from, local SSS.

Results. Approximately 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%-6.3%) compared to 57 (2.5%, 95%CI: 1.9%-3.2%) before implementation) and reported being abstinent four weeks later (93 (4.1%, 95%CI: 3.3%-4.9%) compared to 46 (2.0%, 1.5%-2.7%) before implementation).

Conclusions. In a hospital with an ‘opt-in’ referral system, adding CO screening with ‘opt-out’ referrals as women attended ultrasound examinations doubled numbers of pregnant smokers setting quit dates and reporting smoking cessation.

Journal Article Type Article
Publication Date May 1, 2017
Journal Tobacco Control
Print ISSN 0964-4563
Electronic ISSN 1468-3318
Publisher BMJ Publishing Group
Peer Reviewed Peer Reviewed
Volume 26
Issue 3
Pages 300-306
APA6 Citation Campbell, K., Cooper, S., Fahy, S., Bowker, K., Leonardi-Bee, J., McEwen, A., …Coleman, T. (2017). ‘Opt-out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support. Tobacco Control, 26(3), 300-306. https://doi.org/10.1136/tobaccocontrol-2015-052662
DOI https://doi.org/10.1136/tobaccocontrol-2015-052662
Keywords Smoking cessation; Pregnancy; ‘Opt-out’ referrals; Service development evaluation
Publisher URL http://tobaccocontrol.bmj.com/content/26/3/300
Copyright Statement Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0

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Copyright Statement
Copyright information regarding this work can be found at the following address: http://creativecommons.org/licenses/by/4.0





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