Professor Linda Bauld Professor of Socio-Management, School of Management, University of Stirling and UKCTCS
Abstract
This pilot aimed to evaluate an ‘opt out’ referral scheme for smoking cessation in pregnancy. It was conducted in Dudley and South Birmingham and involved a qualitative assessment of feasibility of implementation and quantitative assessment of changes in referral rates and smoking cessation rates prior to versus after introduction of the opt-out scheme involving carbon-monoxide (CO) screening. Sensitivity and specificity analysis for different cut-points in CO screening were also tested.
3712 pregnant smokers participated in the opt out referral element of the pilot - 1498 in Dudley, 2214 in South Birmingham. In Dudley 27% of women were identified as smokers following CO screening. Of those referred to cessation services, 19% reported stopping smoking at four weeks. In South Birmingham 17% were smokers with 5% of those referred recorded as non smokers at four weeks. Compared with the previous year, the number quitting did not increase during the study, despite higher referral rates.
The pilot also included a comparison of self report, CO-validated and urinary cotinine validated smoking status for a subsample (n=1492) of women. From this, an optimum cut-point of 4ppm was identified for CO screening.
The conclusions from the pilot were that automatic referral of pregnant smokers to stop-smoking services following expired-air carbon monoxide screening may not yield more quitters. Routine CO monitoring should involve a cut off of 4ppm to identify smoking in pregnancy
