Smoking in Pregnancy Reward Scheme

(Significant Other Supporter Scheme)

Tina Williams Head of Training and Development

July 2011

Smokefree North West

Who are we?SFNW is a regional body funded by the regions Primary Care Trusts to support and enhance their tobacco control activities

VisionA tobacco free future for our children

MissionTo prevent tobacco related health inequalities by breaking the cycle of children and young people’s addiction and exposure to tobacco through the delivery of a comprehensive tobacco control strategy

Aim of the Scheme

To increase the number of pregnant women and quitting smoking and maintaining their quit attempt up to and

beyond 2-months post partum

‘Relapse Prevention’

Duration and Outcome Measures

• Start - 1st September 2010• End – 27th November 2010

• Pregnant women with an EDD up to 17th September 2011

• Allows for delivery 10-days overdue plus 2-months post partum

• Bench Mark:

– Reduction in NW SATOD 18% (2010) to 14%

• Launch:

– September 2010

• Participation:

– 22 PCTs across NW

Evaluation• Supported by Professor Linda Bauld Stirling University

– Impact of the scheme• Enhancers• Added value• Barriers

– Perspectives• Pregnant women and their significant others• Clinicians and advisors• Administration

• Local Snap Shot Evaluation throughout July 2011– Questionnaire to all women participating in the scheme during the

month

The Mechanism

Providing:

1. Increased motivation and relapse prevention via a financial reward

2. Financial reward– £20 reward for achieving a 4-week quit– £20 for every month smoke free– £20 for maintaining smokefree lifestyle for

2-months after the birth

Love2shop Flexi - Card

Added Value

Promoting a smokefree pregnancy as a lifestyle change for pregnant women, their partners and families have wide ranging benefits including:

– Reducing the negative health impact on the foetus and the new born

– Reduced risk of SIDS– Reducing the negative health impact to the pregnant woman– Decrease in the number of infants and children exposed to

secondhand smoke– Denormalising of smoking in the home and the wider

community– Increasing the potential for short-term abstinence to become

life-long

Financial Case

• International evidence suggests that for every £1.00 spent interventions to reduce smoking in pregnancy result in a saving £4.00

Financial Benefits

• Cost of a home birth• Normal birth

£457• With complications

£693• Cost of transfer to obstetric

unit £237

• Cost of a birth in an Obstetric Unit

• Normal birth £833• With complications £1,413• Caesarean section without

complications £1,912• Caesarean section with

complications £2, 638

Intrapartum Care of Healthy Women and their Babies: Clinical Guidelines 2007National Collaborating Centre for Women and Children’s Health(Costs based on 2004)

Signing Up – Participating PCTsAgree to:• Manage the scheme effectively at local level

– Follow the scheme guidance – Establish and manage an effect audit trail for the

management of the ‘Reward Cards’• Recruit and support eligible pregnant woman to participate in

the scheme • A commitment to see participants monthly and CO validate• Aiming to support 37 ‘successful’ quitters between September

1st 2010 and 14th November 2011• Maintain a robust effective records of progress and activity• Maintain a robust database • Provide quarterly feedback to SFNW• Attend a quarterly practice sharing network meeting• Support the evaluation of the project

Who is eligible to join the scheme?

• Any pregnant smoker who has quit for 4-weeks and who is at high risk of relapse– Living in a challenging environment– Living with a smoker– Teen Pregnancy

• Professional Judgement

Signing up - The Pregnant Woman

• Sign an agreement which includes:• Staying smokefree – not even a puff – throughout the

pregnancy and for two months following the birth• Asking a non-smoking friend, relative or partner to provide

relapse prevention support throughout the pregnancy and for two-months beyond (Significant Other)

• Attend monthly session with their advisor throughout the pregnancy and for two-months beyond

• Undertake CO monitoring on a monthly basis throughout the pregnancy and for two-months beyond

• Complete and evaluation form about the support received to stay smokefree

The Significant Other Supporter Role• Increased social support and encouragement• A friendly ear when the going gets tough!• Someone with a positive relationship with the pregnant woman

– Close friend– Mum– Family member – Partner– Stop smoking advisor – if necessary

• Reward – £40 if the woman remains smoke-free throughout the

pregnancy and for two months after the birth

Signing Up – The Significant Other

• Sign an agreement which includes:• Support the pregnant woman in staying quit throughout the

pregnancy and for at least two months after the birth• Attend sessions with the pregnant woman

– Minimum of 2• 4-week quit appointment • 2-month follow-up• More if possible

• Take part in CO monitoring• Complete an evaluation form on how I helped my friend stay

smokefree

Training Event Resource pack on a stick• The business case• Reward scheme flow chart• Client monitoring form• Contract for the client• Significant other tips leaflet• Job seekers allowance declaration• Appointment card• Reward Card Client Receipt Record• FAQ’s• Media Handling Protocol11. All today’s presentations12. Evidence file13. Database for service use and

reporting

Training event 1. Comprehensive training

for the operational scheme lead for each PCT September 2010

2. 23 PCT’s agreed to participate and attendedthe event

Progress to May 2011

Q2 – cumulative summary of resultsGreater Manchester

PCT No. of participants No. quit at 2 months post partum

Ashton, Leigh & Wigan 44 13

Bolton 19 4

Bury 6 0

HMR 5 0

Oldham 10 0

Salford 12 3

Stockport 10 0

Tameside & Glossop 5 0

Trafford No data received

Total: 111 20

Q2 – cumulative summary of resultsCheshire & Merseyside

PCT No. of participants No. quit at 2 months post partum

C&E Cheshire 2 2

Halton & St Helens 24 6

Knowsley 27 7

Liverpool 8 2

Sefton 31 6

Warrington 12 0

Wirral 8 0

Total: 112 23

Q2 – cumulative summary of resultsCumbria & Lancs

PCT No. of participants No. quit at 2 months post partum

Blackpool 28 2

Central Lancs 22 4

Cumbria 8 3

East Lancs 30 3

Blackburn with Darwen No data received

North Lancs No data received

Total: 88 12

Regional Total: 311 55

Conclusion

No matter how successful the scheme finally proves the desired reduction in SATOD won’t

happen…

SATOD data collection is unreliable