Women who receive health visitor support alongside smoking relapse prevention advice are more likely to remain smoke-free after childbirth, according to a study published today in the BMJ.
By Lisa Jones (Press and Research Communications Manager), Published
The team from City St George’s and University of East Anglia (UEA) tested ‘BabyBreathe’ – a programme designed to help women who quit smoking before or during pregnancy stay smoke-free after giving birth.
The BabyBreathe scheme provides one-to-one support from trained health visitors with digital tools, text message support, a dedicated website and app, and a relapse-prevention kit sent to families after birth.
The study found that women who received this intervention as intended, with support from trained health visitors, were significantly more likely to remain smoke-free 12 months after giving birth compared to those without health visitor support.
Professor Michael Ussher, Senior author and Professor of Behavioural Medicine at City St George’s School of Health & Medical Sciences, said:
“For many women, the support they receive to quit smoking during pregnancy does not continue after their baby is born, despite this being a time when returning to smoking can be particularly tempting."
A total of 886 women from England and Scotland who had successfully stopped smoking before or during pregnancy took part in the study. Participants were randomly assigned to receive either the BabyBreathe intervention or usual care, which offered no advice or support to prevent smoking relapse.
Although BabyBreathe was not delivered as intended for around one in five participants during the trial, either due to health visitor workforce pressures, missed appointments or administrative issues, health visitors provided one-to-one tailored advice and support to women in the intervention group. This was delivered at the end of pregnancy and immediately after the baby was born.
This support included advice on alternatives to try if they experienced urges to go back to smoking, as well as advice for partners and family members, and access to specially designed digital resources including the BabyBreathe app and website.
A relapse prevention 'kit' was also posted to women immediately after the birth of their baby and support continued for up to 12 months postpartum, at all routine health visitor appointments.
The intervention was the result of more than a decade of research and development involving women, families, health professionals and researchers – who worked together to co-design, develop and test this practical support package.
Health visitors play an important role
When researchers looked at participants who received the intervention as intended, 57.6 per cent remained smoke-free at 12 months in the BabyBreathe group, compared to 49.9 per cent for those with usual care.
These findings suggest that health visiting services could play a significant role in ensuring the consistent delivery of relapse-prevention support, therefore also supporting the health of the entire family by helping more mothers to remain smoke-free after giving birth.
Professor Caitlin Notley, Lead researcher and Professor of Addiction Sciences at UEA’s Norwich Medical School, said:
“Quitting smoking during pregnancy is an incredible achievement, but staying smoke-free after a baby is born can be just as challenging.
“Our research shows that when health visiting services are trained and supported to deliver specialist relapse prevention advice, they can make a real difference by significantly improving women's chances of staying smoke-free."
The researchers note several limitations of the study that impacted the primary analysis, including incomplete delivery of the BabyBreathe programme and low engagement with some of its components. The participant group was also more highly educated and less socioeconomically deprived than the wider population, which may have affected the programme’s overall effectiveness and limit how broadly the findings can be applied.
This research was funded by the National Institute for Health and Care Research (NIHR), and also conducted in collaboration with the University of Edinburgh, University of Exeter, University of Stirling, Glasgow Caledonian University, Institute of Health Visiting (iHV) and the Norfolk 0-19 Healthy Child Service.