Title: Improving the effectiveness and reach of NHS support for smoking cessation in pregnancy
Funder: Department of Health (England)

Abstract: Aims and Objectives: To increase the uptake and effectiveness of NHS Stop Smoking Services for pregnant women (SSSP) by determining when and how NHS cessation support is best offered in pregnancy, refining and testing ‘self-help’ cessation methods which are attractive to and, therefore, likely to be used by the vast majority of mothers who do not currently access SSSP and investigating how ‘self-help’ support is best delivered by the NHS. Background: Maternal smoking in pregnancy is the biggest avoidable cause of fetal harm in the UK with 255,000 pregnancies exposed annually in England. Infants and children of smokers suffer higher morbidity and mortality and are more likely to become smokers themselves. Pregnancy motivates many women to try stopping smoking but very few use the effective NHS SSSP; most try to stop without help. ‘Self-help’ cessation methods are effective in pregnancy but are not systematically delivered by SSSP. Research Plans: We propose to: Survey all English SSSP, determining use of self-help, referral pathways / methods of engaging with smokers and principal models and costs of service provision; combining these with routinely available data on SSSP effectiveness to determine service design factors which most influence (cost) effectiveness. Survey a cohort of pregnant women to identify i) times in pregnancy when they are most receptive to and ii) predictors of propensity to engage with SSSP support (inc. self-help). Conduct phase II studies investigating the effectiveness and cost-effectiveness of two different strategies for identifying, referring and engaging pregnant smokers for SSSP support. Use a linked mother / infant primary care medical records cohort to monitor national trends in nicotine replacement therapy (NRT) use in pregnancy, compare women prescribed / not prescribed NRT and investigate impacts on infrequent fetal outcomes of NRT use in pregnancy Refine and estimate the likely uptake and effectiveness / cost-effectiveness of an interactive, SMS ‘text’ messaging ‘self-help’ intervention for smoking cessation in pregnancy delivered in routine NHS ante natal care settings. Research Team: We are academics from most UK research teams working on smoking in pregnancy, colleagues from NHS Nottingham City who commission and manage Nottingham’s NHS SSSP. Five team members are academics within Centres of Public Health Excellence centred on Nottingham (UKCTCS; - www.ukctcs.net) and Cambridge. We already collaborate substantially and are sufficiently integrated to implement our programme across dispersed research centres. Programme management: Strategic management will be from quarterly Steering Committee (SC) meetings of all applicants chaired by the Principal Applicant (PA). The SC will review progress across all worksteams, directing resources, as appropriate to ensure objectives are met. A Programme Manager (PM) will ensure efficient, operational management, integration of workstreams and optimal resource use. SC subgroups, convened by the PM, co-opting team members, as appropriate will manage workstreams Research Environment: Our strong track record of delivering smoking cessation research in obstetric environments includes sucessfully blending expertise to implement complex NHS research projects. We have strong links with relevant speciality groups of Collaborative Local Research Networks and in addition to the two Public Health Centres mentioned above, where further support is needed, we be able to access this through memberships of the NIHR School for Primary Care (Nottingham) and Public Health Research Consortium (York). Outputs and impact: The programme will deliver peer-reviewed publications and related outputs from year 3; findings could be implemented immediately increasing uptake of SSSP, providing support to thousands of extra women annually and helping many pregnant women to permanently stop smoking who would not otherwise have done so. Patient and public involvement: Strategic-level public input across the programme will come via a smokers’ panel, assembled in Bath by Linda Bauld for the UKCTCS. Individual-level input to workstreams will be sought by the PM from recent participants of smoking cessation studies, recruited via current projects. Methods used for eliciting women’s views on proposed research will ensure that these are clearly heard. Ethics: The PM will oversee REC / R & D approvals with help from UKCTCS staff. We are experienced in obtaining REC approvals and do not anticipate difficulties but have factored the likely protracted process of obtaining R & D approvals from multiple NHS trusts into programme timings. If funded, we would start the approvals process before research contracts are finalised. Resources: These are primarily for academic / NHS staff to conduct research and deliver interventions; for involvement of lay representatives and for core posts to support programme delivery.


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: STROKE;RESPIRATORY;CANCER AND NEOPLASMS;REPRODUCTIVE HEALTH AND CHILDBIRTH;CARDIOVASCULAR