Smoking Cessation in Pregnancy A review of the Challenge Linda Bauld Hilary Wareing Hazel Cheeseman

Challenge set The Tobacco Control Plan for England set out national targets to reduce smoking in pregnancy rates to 11% by 2015 However, in 2012 rate of decline showed signs of slowing In March 2012, the then Public Health Minister set a challenge to the healthcare community to reduce smoking in pregnancy rates The Challenge Group, including ASH, the Royal College of Midwives, the Lullaby Trust, Tommy’s and others was established to help achieve the target

First Challenge Group report published in recommendations categorised into 6 themes: –Data collection –Implementing NICE guidance –Training –Communication between health professionals –Communication with the public –Research needs

Achievements by October 2015 Smoking in pregnancy rates reached below the 11% national ambition (2015/2016 SATOD Q1 10.7% Q2 10.4%) Engagement of PHE, NHS England and others Communication materials for professionals and pregnant women Evidence of improving relationships across NHS and public health Wider implementation of NICE guidance Roll out of models such as BabyClear

However challenges still remain…

Remaining Challenge 70,000 infants are born to mothers who smoke every year Each year, maternal smoking in the UK causes an estimated: –5000 miscarriages –2200 premature births –300 stillbirths High inequalities between the rich and poor Huge regional disparities Many recommendations from the 2013 report are yet to be implemented

Inequalities between rich and poor

Regional disparities

Gaps in implementation

Risks to future progress Limited engagement of CCGs Need for some groups of professionals to take a stronger role The loss or erosion of specialist stop smoking services in local authorities lack of clarity about local roles in relation to smoking in pregnancy and a subsequent lack of accountability for funding and delivery

Challenge Group Update Report 2015 The new report highlights seven priority areas for national action on smoking in pregnancy As well 37 refreshed recommendations reflecting progress made since 2013, changes to the system and the input of health professionals across the country.

Seven priority areas for national action 1.A new national ambition to reduce smoking in pregnancy to less than 6% by 2020 target

Seven priority areas for national action 2.National leadership to provide clarity about the roles local authorities and local NHS organisations and others should play in tackling smoking in pregnancy. 3.A robust and consistent national data collection system implemented across the country 4.Training of professionals to tackle smoking in pregnancy must be nationally mandated. 5.Opt-out referral of all pregnant women who smoke to specialist services must become standard practice across the country. 6.Public Health England and NHS England should publish a shared national communications strategy on tackling smoking among pregnant women. 7.Research funders should continue to support high quality studies to help inform policy and practice on the best ways to help women stop smoking in pregnancy.

Next steps nationally Next Tobacco Control Plan for England –Smoking in pregnancy to be a priority area for action –Government to take on board Challenge Group recommendations –Shared responsibility across all parts of NHS and public health

Next steps locally Seeking to implement NICE guidance Building and maintaining partnerships –Stillbirth care bundle –Materials for professionals and pregnant women Ensuring a specialist provision for pregnant women

Challenge Group Resources A review of the challenge

Challenge Group Resources Smoking in pregnancy mapping project report and case studies –Identification of pregnant smokers –Referral to Stop Smoking Services –Engagement with Stop Smoking Services –Supporting quitting –Relapse prevention –Awareness raising with pregnant women –Awareness raising in the wider community –Awareness raising with health and social care professionals

Challenge Group Resources Continued... –Behavioural insights –Smokefree homes –Partners/significant others –Whole systems approach –E-cigarettes –Social media –Incentives –Increased use of CO monitors

Challenge Group Resources Use of electronic cigarettes in pregnancy : A guide for midwives

Challenge Group Resources Shared key messages

Challenge Group Resources Carbon monoxide screening : advice for professionals

Challenge Group Resources Test your breath : information for pregnant women

Challenge Group Resources Available at: Or maternity units can order hard copies from: iPiP | Improving Performance in Practice, 16a - 18a Market Place, Warwick, CV34 4SL Tel

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