Introducing ‘opt-out’ referrals for pregnant women to stop smoking services: impact on smoking cessation

Abstract

To evaluate the impact on smoking cessation of an intervention involving routine carbon monoxide (CO) testing for pregnant women and ‘opt-out’ (whether requested or not) referrals to cessation services with CO>4ppm. ‘Opt-out’ referrals were introduced during 12-week antenatal scan appointments in one UK hospital Trust, in addition to standard care (‘opt-in’ referrals at 9-weeks appointments). Routine referral data at both appointments and referral outcomes (setting quit dates/self-reported abstinence) were collected during 6-months study period and a matched control period the previous year. Approximately 2300 women attended antenatal care in each period. Compared to the control period, over twice as many women in the study period set a quit date (2.5% (95% CI: 1.9% - 3.2%) and 5.3% (95% CI: 4.4% - 6.3%) respectively) and reported abstinence (2.0% (95% CI: 1.5% - 2.7%) and 4.1% (95% CI: 3.3% - 4.9%) respectively). Introduction of CO testing and ‘opt-out’ referrals led to a significant increase in smoking cessation in pregnancy, compared to the control period.