‘Opt-out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support
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...
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| Format: | Article |
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BMJ Publishing Group
2017
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| Online Access: | https://eprints.nottingham.ac.uk/33106/ |
| _version_ | 1848794558178000896 |
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| author | Campbell, Katarzyna Cooper, Sue Fahy, Samantha Bowker, Katharine Leonardi-Bee, Jo McEwen, Andy Whitemore, Rachel Coleman, Tim |
| author_facet | Campbell, Katarzyna Cooper, Sue Fahy, Samantha Bowker, Katharine Leonardi-Bee, Jo McEwen, Andy Whitemore, Rachel Coleman, Tim |
| author_sort | Campbell, Katarzyna |
| building | Nottingham Research Data Repository |
| collection | Online Access |
| description | 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. |
| first_indexed | 2025-11-14T19:18:06Z |
| format | Article |
| id | nottingham-33106 |
| institution | University of Nottingham Malaysia Campus |
| institution_category | Local University |
| last_indexed | 2025-11-14T19:18:06Z |
| publishDate | 2017 |
| publisher | BMJ Publishing Group |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | nottingham-331062020-05-04T18:43:56Z https://eprints.nottingham.ac.uk/33106/ ‘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 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. BMJ Publishing Group 2017-05-01 Article PeerReviewed Campbell, Katarzyna, Cooper, Sue, Fahy, Samantha, Bowker, Katharine, Leonardi-Bee, Jo, McEwen, Andy, Whitemore, Rachel and Coleman, Tim (2017) ‘Opt-out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support. Tobacco Control, 26 (3). pp. 300-306. ISSN 1468-3318 Smoking cessation; Pregnancy; ‘Opt-out’ referrals; Service development evaluation http://tobaccocontrol.bmj.com/content/26/3/300 doi:10.1136/tobaccocontrol-2015-052662 doi:10.1136/tobaccocontrol-2015-052662 |
| spellingShingle | Smoking cessation; Pregnancy; ‘Opt-out’ referrals; Service development evaluation Campbell, Katarzyna Cooper, Sue Fahy, Samantha Bowker, Katharine Leonardi-Bee, Jo McEwen, Andy Whitemore, Rachel Coleman, Tim ‘Opt-out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support |
| title | ‘Opt-out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support |
| title_full | ‘Opt-out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support |
| title_fullStr | ‘Opt-out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support |
| title_full_unstemmed | ‘Opt-out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support |
| title_short | ‘Opt-out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support |
| title_sort | ‘opt-out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support |
| topic | Smoking cessation; Pregnancy; ‘Opt-out’ referrals; Service development evaluation |
| url | https://eprints.nottingham.ac.uk/33106/ https://eprints.nottingham.ac.uk/33106/ https://eprints.nottingham.ac.uk/33106/ |