‘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

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.

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

• Journal Article Type: Article
• Acceptance Date: Apr 20, 2016
• Online Publication Date: May 25, 2016
• Publication Date: May 1, 2017
• Deposit Date: May 5, 2016
• Publicly Available Date: May 25, 2016
• 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
• DOI: https://doi.org/10.1136/tobaccocontrol-2015-052662
• Keywords: Smoking cessation; Pregnancy; ‘Opt-out’ referrals; Service development evaluation
• Public URL: https://nottingham-repository.worktribe.com/output/858557
• Publisher URL: http://tobaccocontrol.bmj.com/content/26/3/300
• Contract Date: May 5, 2016