Baby Be SmokeFree
Development and pilot of a novel web-based
cessation tool to support young pregnant
smokers
Beckie Lang, Annette Briley, Jenny Carter
At Tommy’s we believe that every pregnancy deserves
a happy ending.
Our Mission is to halve
the number of babies that die during pregnancy or birth
by 2030
We exist to save babies’ lives by funding research and
providing information on the causes and prevention of
miscarriage, premature birth and stillbirth.
Smoking in pregnancy (at the time of the study)
• 17% of women in the UK smoke throughout their pregnancy
(Bolling 2005)
• Teenage mothers are more likely to smoke during pregnancy
• 45% of teenagers compared to 9% of over 30’s
(Stats’on Smoking 2008)
• Proportion of mothers who smoke during pregnancy fell between 2000-2005
• Except in under 20’s – in which smoking increased by 6%
(Stats’on Smoking 2008)
• Pregnant women under the age of 20 were therefore the target
segment for this project.
Referral – the key issues in literature
• Midwives are not always referring because:
– Midwife client relationship (Aveyard et al 2004)
– Clients have severe social health problems (Lowry 2003, MacAskill 2008)
– Time (Condliffe et al 2004)
– Lack of enthusiasm (Lowry 2003)
• Pregnant women do not always admit to smoking (ASH 2008, McNeil 2001)
– Guilt and worries about health of the child (Todd 2003)
– Being afraid of failure (Usher 2005)
– Worries about being nagged (Lowry 2003)
Aveyard, P. Lawrence, T. Croghan, E. Evans (2004) Is advice to stop smoking from a midwife stressful for pregnant women who smoke? Data from a randomised controlled trial. Preventative Medicine Vol 40
Lowry R, Hardy, S. Jordan, C. Wayman G. (2003) Using social marketing to increase recruitment of pregnant smokers to smoking cessation service: a success story
MacAskill, S. Bauld, L, Tappin, D. Eadie, D. (2008) Smoking cessation support in pregnancy in Scotland. A report for the Department of Health, Scotland.
ASH (2008) Department of Health Consultation of the Future of Tobacco Control. Submission from Action on Smoking and Health.
McNeill (2001) Saliva cotinine as indicator of cigarette smoking in pregnant women. Addiction 96: 1001-6
Condliffe, L. McEwen, A.; West, R.(2004). The attitudes of maternity staff to, and smoking cessation interventions with, childbearing women in London. Midwifery,. Sep. 21(3) p233-40
Todd, AM. (2003) Barriers to smoking cessation in pregnancy: a qualitative study. British Journal of Community Nursing. Feb 8 (2)
Usher, M. Etter, JF. West, R. (2005) Perceived barriers and benefits o attending a stop smoking course during pregnancy . Patient education and counseling. June Vol 61. 3
Talking about cessation and
referral with clients
The views of 60 Teenage Pregnancy Midwives
Referring to smoking LSSS
For every 10 of my clients who smoke I would expect to refer the following number
to LSSS at booking
10
25.9%
9
1.7%
8
5.2%
7
15.5%
6
6.9%
5
15.5%
4
8.6%
3
10.3%
2
1.7%
1
8.6%
0
5
10
15
20
Percentage of midwives referring
25
30
Enabling factors
I feel confident that I can describe
the benefits of quitting to my clients
94% agree or strongly agree
Referring a client to LSSS helps her
to have the best chance of quitting
81% agree or strongly agree
I think that LSSS will offer a service that meet my teenage clients’ need
56% agree or strongly agree
I think that LSSS staff will be friendly and supportive
towards my clients
90% agree or strongly agree
Potential barriers to referral
Pregnant teenagers sometimes have more serious problems to deal with
• 64% agree or strongly agree (Majority)
Midwives are sometimes short of time at booking appointments
• 58% agree or strongly agree (Majority)
Midwives are sometimes concerned about damaging their relationship with
their clients
• 38% agree or strongly disagree (Significant minority)
• 46% disagree or strongly disagree (Majority)
Midwives are sometimes concerned they will make their clients
feel guilty about smoking
• 40% agree or strongly agree (Significant minority)
• 42% disagree or strongly disagree (Majority)
Smoking cessation and LSSS
Tommy’s qualitative research with 32 pregnant
teenagers who smoke or have quit during pregnancy
Smokers and motivated quitters included
Based on the Theory of Planned Behaviour
• Knowledge of:
– effects of smoking on the fetus
– help available to quit
• Attitudes towards:
– smoking in pregnancy
– quitting
• Beliefs about:
– LSSS
– NHS Pregnancy Smoking Helpline
• People who influence attitudes and beliefs
• Alternative message framing
Barriers to engaging with LSSS
• Talking to LSSS seen as a clear commitment to quitting
– Some women did not feel ready for that
• Want to quit alone – through their own will power
– want to take control/ make their own choices
“I’d rather do it on my own. I think if people try to make you do something then it just
doesn’t work.”
Pregnant, smoker
• Not convinced that LSSS can help them
“I really don’t see how someone can stop me from smoking, so that stops me from going to
see someone.”
Recent mum and motivated quitter
“I wouldn't want to be around a load of other people speaking about myself when I don't know them. I just
see it as people who do drugs and stuff who go to that type of thing.”
Recent mum and motivated quitter
• Some negative perceptions of LSSS
“Pretty bossy I reckon, saying you can’t do this or that and all things like that.”
Recent mum and smoker
Message testing
• Focusing on consequences of smoking during pregnancy
• Relevant and accessible to young women
• Tone: factual not alarmist
• Information delivered sequentially
• Range of messaging about the risks of smoking
– Increased risk premature birth
– Impact of carbon monoxide and other toxins on baby’s heart rate
– Baby may become addicted to nicotine
Increased risk of premature birth
• Babies of smokers are more likely to be born too soon
• Babies that are born too soon are more likely to suffer from
severe breathing problems, stunted growth, diabetes and
heart disease
• Babies that are born too soon are more likely to have to stay
in hospital after the mother goes home and may need help
breathing and controlling their body temperature
“I knew that that happened to premature babies, but I didn’t realise it was
anything to do with smoking.”
Pregnant and smoking
“Yeah it’s scary. You could go home without your baby so it’ll need looking
after because of you.”
Recent parent and motivated quitter
Impact of nicotine on baby’s heart
• Every time you take a drag on a fag 4,000 chemicals enter
your body
• Within two and a half minutes of starting a cigarette these
chemicals make your heart pump faster
• Five minutes later your baby’s heart does the same
“That’s a lot of chemicals. Imagine that all going into your child and it’s
only small.”
Pregnant and smoking
“For the baby it’s not good is it, not really….. It’s not just about you any
more is it?”
Smoking and pregnant
Summary
• Teenagers know that smoking in pregnancy is dangerous but they
do not understand the specific risks
• Midwives are talking to teenagers about the dangers of smoking in
pregnancy and the importance of stopping smoking
• Midwives are not always referring their smoking clients to LSSS
• Teenagers believe that:
– They could quit on their own
– LSSS could not tell them anything new
– LSSS could not provide the kind of support that would help them to quit
– LSSS are judgemental and will give them a ‘hard time’
• Teenagers a very aware of the social stigma of smoking during
pregnancy and feel guilty about their smoking
• Teenagers do not always admit to smoking when asked
Baby Be SmokeFree
Self-Referral Tool
www.tommysbabybe.org.uk
Insight to Intervention
Insight
Research
•Prematurity impacts
•4000 chemicals
•Stigma
•‘Will LSSS judge me?’
•Problems of
quitting alone
Main Video Clip
•Type of service
•‘Its an addiction, so
how can LSSS help’?
‘Are LSSS supportive?’
•Strategies used
•NRT
•‘What if I fail?’
Video Interview
with LSSS advisor
•A personal service
•Non-judgemental
approach
•Call back service
to minimise cost
Video interview
with Helpline
•Not wanting to
admit to smoking
•Stigma and worry
about being judged
Self-referral
option
Direct impact of
4000 chemicals
in each cigarette
on the baby
Flash animation
progress of smoke
through mother
to baby
Presentation title in footer
13 April 2015
20
21
Piloting
• Inner city tertiary referral centre in area with high teen pregnancy
• Routine 10-14 week ultrasound appointment (trigger point?)
• Women aged between 16-19y invited to view BBSF by research
midwife
Participants
• 94 women identified within study period
• 74 approached and 36 agreed to participate
• 16 of these were smokers
Women’s views of BBSF
Presentation title in footer
13 April 2015
Number of women
Women’s behavioural intention
following viewing BBSF
23
Additional findings
• N=15 (9 smokers, 6 quitters) Aged 16-19y
• Seven individual interviews, four paired interviews plus follow-up
call.
• BBSF was successful in:
– improving the target audience’s attitudes, beliefs, knowledge and
understanding of the negative impacts of smoking in pregnancy.
– Accurately representing the target group (women related to those in the
videos)
• There were mixed results:
– in behavioural intentions. After viewing BBSF most smokers reported a
much higher motivation to quit.
– In facilitating a quit attempt with LSSS.
Family Nurse Partnership feedback
• n-= 23
• Clips of other young women talking about cessation most
appealing (70%)
• Cost calculator most helpful (65%)
• 35% of nurses were showing the opening film with women,
48% some of the time.
• Opening film usually lead to further exploration of the site
(90%)
• Requests for the site to be available as a mobile app and a
website
FNP thoughts on effectiveness of BBSF
Adjustments to BBSF and Next steps
•BBSF chat to an advisor removed and support
information provided instead.
•Qualitative research with young women by UCL to
understand what would make them quit to facilitate
further development of the BBSF suite of resources.
•Exploration of a teen specific strand of the LSSS –
3-5 pilot sites nationally for testing the concept.
Tommy’s
Health Campaigns
For further information on the Baby Be SmokeFree campaign please
contact:
Dr Beckie Lang
Health Campaigns Manager 07887617195/ blang@tommys.org