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‘Opt-out’ referrals after identifying pregnant smokers using exhaled air carbon monoxide: impact on engagement with smoking cessation support
  1. Katarzyna A Campbell1,
  2. Sue Cooper1,
  3. Samantha J Fahy1,
  4. Katharine Bowker1,
  5. Jo Leonardi-Bee2,
  6. Andy McEwen3,
  7. Rachel Whitemore1,
  8. Tim Coleman1
  1. 1Division of Primary Care, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
  2. 2Division of Epidemiology and Public Health, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Nottingham, UK
  3. 3National Centre for Smoking Cessation and Training (NCSCT), London, UK
  1. Correspondence to Dr Katarzyna A Campbell, Division of Primary Care, School of Medicine, UK Centre for Tobacco and Alcohol Studies, University of Nottingham, Smoking and Pregnancy Research Office, Room 1406, Tower Building, University Park, Nottingham NG7 2RD, UK; kasia.campbell{at}nottingham.ac.uk

Abstract

Background In 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.

Methods To 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.

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% 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).

Conclusions In 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.

  • Cessation
  • Priority/special populations
  • Health Services

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

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