1. Development and evaluation of SmokeFree Baby: A smoking cessation smartphone app for pregnant smokers Ildiko Tombor, PhD Student Health Behaviour Research Centre UCL Tobacco and Alcohol Research Group (UTARG) SSA annual conference 2014

2. 1 Professor Robert West Professor Susan Michie Dr Lion Shahab Dr Jamie Brown David Crane Dr Joanne Neale Dr Caitlin Notley Aleksandra Herbec Milagros Ruiz Farah Desai & the Pregnancy Network Claire Garnett Daniel West Jamie West Matthew West Research teamContributors Funding Acknowledgements

3. Background Next steps Intervention development

4. 3 CHD Stroke Atherosclerosis COPD Pneumonia Periodontitis Nuclear cataract At least 13 different types of cancer Preterm delivery Placental abruption Placenta previa Low birth weight Sudden infant death syndrome Fetal growth restriction Decreased lung function Middle ear disease Behaviour and learning problems Smoking during pregnancy: Health effects U.S. Department of Health and Human Services, 2004, 2006, 2014; Ross et al., 2014

5. 4 NHS Information Centre. Infant Feeding Survey, 2010 Smoking during pregnancy: Prevalence 26% smoke in the 12 months before or during pregnancy 12% smoke throughout pregnancy

6. 5 Smoking during pregnancy: Support Low uptake and poor adherence among pregnant smokers 5,8. Insufficient evidence of its safety and efficacy 5 Combination NRT can be effective 6 Better health of the infants at age 2 7 Face-to- face/telephone/group support 1 Financial incentives 1-3 Self-help materials 2,4 Numerous barriers: fear of judgment and disappointment, poor access to support etc. 9 Behavioural support Nicotine Replacement Therapy 1 Chamberlain et al., 2013; 2 Bauld & Coleman, 2009; 3 Higgins et al., 2012; 4 Naughton et al., 2008; 5 Coleman et al., 2012; 6 LBrose et al., 2013; 7 Cooper et al., 2014; 8 Tappin et al., 2010; 9 Ingall et al., 2010.

7. 6 Digital smoking cessation interventions Digital aids can be effective in the general population 1-6 Heterogeneity in quality, outcomes and design Lack or poor description of intervention content Poor adherence to established guidelines Effectiveness is yet to be confirmed in pregnancy 1 Myung et al., 2009; 2 Shahab & McEwen, 2009,; 3 Whittaker et al., 2009; 4 Civljak et al., 2010; 5 Hutton et al., 2011; 6 Chen et al., 2012; 7 Brown et al., 2014; 8 Devris et al., 2013; 9 Naughton et al., 2012; 10 Pollak et al., 2013; 11 Herbec et al., 2014 Relative benefit in low socioeconomic groups (‘StopAdvisor’) 7 Women and young people are more likely to engage with digital aids 8 Websites, text- messaging can be feasible and acceptable for pregnant smokers 9-11

8. 7 Theoretical basis West & Brown, 2013 Michie et al., 2011 Evidence-baseTransparency in reporting Multi-phase strategy A priori principles Collins et al., 2011 Craig et al., 2008

9. 8 Development stage Phase 1 – Exploratory work Development stage Phase 1 – Exploratory work Identify theoretical base & Review of the literature Exploratory work & Needs assessment (Study 1-6) Step 1 Step 2 Development stage Phase 2 – Intervention design Development stage Phase 2 – Intervention design Feasibility & Piloting stage Piloting phases Feasibility & Piloting stage Piloting phases Identify intervention components Step 3 Design prototype intervention Step 4 User testing and refinement of the SmokeFree Baby app Step 5 Evaluation of intervention components Step 6 1.Positive smoker identity as a barrier to quitting smoking [published in: Drug Alcohol Depen, 2013, 133(2)] 2.Post-quit non-smoker identity as a predictor of maintained quit success [under review: in Addictive Behaviors] 3.Meta-ethnographic systematic review of smoker identity [accepted in: Health Psychology] 4.Health Care providers views on digital interventions [in press: Journal of Smoking Cessation] 5.COM-B behavioural analysis of pregnant smokers [paper in preparation] 6.Behaviour change techniques used in a smoking cessation website for pregnant smokers (‘MumsQuit’) [paper in preparation]

10. Target behaviour Goal setting Review goal

11. 10 Social support Pre-quit features Feedback & RewardEngagement 80 Built-in user testing Push notifications Self-monitoring

12. 11 Minimal Identity change Intensive To foster a new ‘non-smoker’ identity (reflective motivation) Building on identity motives (continuity, belonging, meaning etc.) (Vignoles et al., 2011) Providing potential role models Facilitating emotional attachment with the baby

13. 12 Stress relief MinimalIntensive To improve mental skills to cope with stress and negative emotional states (psychological capability) Facilitating action planning Prompting relaxation exercise

14. 13 Health effects MinimalIntensive To improve knowledge of health consequences of smoking and benefits of quitting (psychological capability) Delivering content through interactive features Using a life-span perspective to provide information about health consequences

15. 14 Face-to-Face support MinimalIntensive To provide easy access to and facilitate the uptake of stop-smoking support resources in the locality (physical opportunity) Including videos of a real-life advisor talking about the support offered Providing access to quitlines and local services

16. 15 Behavioural substitution MinimalIntensive To provide distraction from urges to smoke (automatic motivation) Facilitating action planning Using built-in distraction quiz Using built-in distraction game

17. 16 Factorial experiment (2 5 design) to test the effectiveness (main effects) of individual intervention components (‘modules’) Think-aloud user-testing study with pregnant smokers Analysis of helpfulness/usability ratings of intervention contents What happens next? www.smokefreebaby.co.uk

18. Thank you! Email: ildiko.tombor.11@ucl.ac.uk