Smoking Cessation Support for Pregnant Women Provided by English Stop Smoking Services and National Health Service Trusts: A Survey

Abstract

Reducing smoking rates in pregnancy continues to be a public health priority. Given a recent UK government policy change resulting in The National Health Service (NHS) making a significant new contribution to cessation support in pregnancy in England, in addition to that of Local Authorities (LA), an up-to-date assessment of national support offered to pregnant women is needed. LA Stop Smoking Service (SSS) managers and representatives from maternity services in NHS Trusts were invited to participate in an online survey in autumn 2020. Topics included service configuration, staffing, practitioner consultations and treatments offered. The survey response rate was 66% (99/151) of LAs and 68% (95/140) of Trusts. Most LAs provided smoking support for pregnant smokers (78%), whereas under half (43%) of NHS Trusts did. Combination nicotine replacement therapy, i.e., a combination of a patch and short-acting product, was offered by LAs (92%) and Trusts (95%) and most commonly for 12 weeks duration, at 53% and 50%, respectively. Similar national online training was undertaken by those supporting women, with the majority undertaking the specialist pregnancy-specific module: LAs 60% and Trusts 79%. However, clinicians were reported to deliver specialist stop smoking support in over 50% of Trusts, whereas this was reported in only 16% of LAs. In England, both LA and NHS Trusts are currently delivering similar stop smoking support to pregnant women. Having nationally recognised treatment programmes and training allows for the delivery of consistent, evidence-based smoking cessation to pregnant women in different healthcare settings.

Exposure to Second-hand Smoke and Having Regular Family Physicians Are Associated With Cessation of Smoking During Pregnancy: A Population-based Study

“…The smoking cessation rate observed in our study is nearly one-third (33.9%) of the rates reported in previous studies 22–24 . One likely explanation could be the stricter inclusion criteria for pre-pregnancy smokers in our study; we included only the women who were regular smokers 3 months before knowing they were pregnant.…”

Investigating the cost‐effectiveness of three cessation interventions on a national scale using the Economics of Smoking in Pregnancy (ESIP) decision analytical model

“…Three surveys of English NHS Stop Smoking Services (NHS SSS) found that nearly all services which responded provided behavioural support and nicotine replacement therapy (NRT) [31–33]. Other interventions were rarely provided; only 14% reported using incentives and 11% reported using e‐cigarettes [33].…”

“…Defining, costing and estimating the quit rate of usual care for smoking cessation in pregnancy Three surveys of English NHS Stop Smoking Services (NHS SSS) found that nearly all services which responded provided behavioural support and nicotine replacement therapy (NRT) [31][32][33]. Other interventions were rarely provided; only 14% reported using incentives and 11% reported using e-cigarettes [33]. These were excluded from our definition of usual care.…”

Experts’ views on translating NHS support to stop smoking in pregnancy into a comprehensive digital intervention

“…Other studies suggest that barriers to access exist, including time constraints (e.g. because of childcare and work responsibilities) [ 16 ], a ‘postcode lottery’ in service availability and quality [ 16 , 18 ], finding services inflexible in terms of the treatment options offered [ 16 , 19 ], and fear of judgement by healthcare professionals [ 16 , 20 , 21 ]. In the UK, the NHS Long Term Plan smokefree pregnancy pathway [ 22 ] has recently been introduced to provide a more integrated system of maternity-led support, though it is unclear whether this will meet the support needs of those who find it hard or do not want to engage with standard interpersonal support as most barriers remain.…”