Smoking in pregnancy greatly increases the risk of stillbirth - it is the single most important modifiable risk factor in pregnancy.
Teenagers in England are six times more likely to smoke than older mothers. Their pregnancies have a high risk of poor outcome; amongst women under 20, 8% have preterm births, and 11% have low birth weight babies. These rates are higher than among any other age group under 40, with implications for the child’s long term health.
With funding from the Department of Health, we are developing a stop smoking intervention that is:
- targeted specifically at young pregnant women
- convenient and cost-effective
The current pathway for quitting smoking (eg stop smoking services) is not meeting the needs of this group evidenced by the low referral rates and the high rate of young women who smoke in their pregnancies (2012 IFS).
Quit rates among the general smoking population have been improved four fold when the use of SSS are utilised compared with quitting alone (Ferguson et al, 2005).
Our own research with pregnant teens (Hill et al, 2013) has highlighted the low and negative perceptions of SSS by the target group and their preference to quit alone. By developing a specialist stop smoking intervention for young women during pregnancy, we hope to better enable local services to engage and treat this group of service users. In the long term, such an intervention can help to lower the number of women smoking during pregnancy and reduce the incidence of low birthweight and infant mortality.
This project will also have a long-term impact on reducing health inequalities. There is still a 70% gap in infant mortality between the richest and poorest groups, and smoking is one of several lifestyle factors which contribute to this difference. Reducing smoking in pregnancy will also decrease the prevalence of persistent health problems in children, including respiratory and behavioural problems resulting from exposure to tobacco use in the womb and in the home.
This new intervention will complement existing services and could be run by SSS, Children’s centres, local youth support services or teen midwives. By producing a new model that is efficient and effective we hope to increase access to services by young pregnant women and decrease smoking rates.
There is a significant amount of work going on at a local, regional and national level to reduce the prevalence of smoking during pregnancy. However, there is a lack of evaluated work that specifically addresses the needs of young pregnant women. There are projects such as the Smokefree Homes project in Kent and an Incentives Project in the North West whose findings may be useful in informing this project’s insights work. Particularly with regard to identifying the key workers with whom young women are comfortable to have challenging conversations.
The key to this project is engaging young women and local services from the outset. The current systems for engaging and supporting pregnant smokers result in the majority of women continuing to smoke in their pregnancy. Insights work will ensure this approach is right from the start. As part of this process we will identify key workers at a local level who are best placed to provide support and deliver training for approximately 50 staff to ensure they feel confident and competent to work with young women to support a quit. Early insight into how funding decisions are made and how decisions can be influenced regarding investment of resources in this particular area will also be key.