Financial incentives for quitting smoking in pregnancy: Are they cost-effective?

Aims: To evaluate whether adding financial incentives to usual care is cost-effective in encouraging pregnant women to quit tobacco smoking, compared with usual care alone.

Design: Cost-effectiveness analysis (CEA) and cost-utility analysis (CUA) from a health-care provider's perspective, embedded in the Smoking Cessation in Pregnancy Incentives Trial (CPIT III). Long-term analyses were conducted from the same perspective, using an existing Markov model over a life-time horizon.

Usual care in a multicentre randomised controlled trial of financial incentives for smoking cessation in pregnancy: qualitative findings from a mixed-methods process evaluation.

Objectives: Financial incentives are recommended by the UK's National Institute for Health and Care Excellence to aid smoking cessation in pregnancy. However, little is known about how implementation contexts might impact on their effectiveness. Variations in smoking cessation support (usual care) for pregnant women who smoke were examined qualitatively as part of a prospective process evaluation of the Cessation in Pregnancy Incentives Trial (CPIT III).

A protocol for the economic evaluation of the smoking Cessation in Pregnancy Incentives Trial III (CPIT III).

Introduction: Smoking results in an average 10-year loss of life, but smokers who permanently quit before age 40 can expect a near normal lifespan. Pregnancy poses a good opportunity to help women to stop; around 80% of women in the UK have a baby, most of whom are less than 40 years of age. Smoking prevalence during pregnancy is high: 17%-23% in the UK.

The smoking cessation in pregnancy incentives trial (CPIT): study protocol for a phase III randomised controlled trial.

Background: Eighty per cent of UK women have at least one baby, making pregnancy an opportunity to help women stop smoking before their health is irreparably compromised. Smoking cessation during pregnancy helps protect infants from miscarriage, still birth, low birth weight, asthma, attention deficit disorder and adult cardiovascular disease. UK national guidelines highlight lack of evidence for effectiveness of financial incentives to help pregnant smokers quit.

Development of a biochemical marker to detect current breast milk intake.

The WHO recommends exclusive breastfeeding for 6 months, but despite interventions, breastfeeding rates remain stubbornly low. Financial voucher incentives have shown promise but require a biomarker for validation of intake. This study aimed to develop a simple biochemical assay of infant urine that would tell if an infant was receiving any breast milk to validate maternal report.

Impact of maternal smoking on early childhood health: a retrospective cohort linked dataset analysis of 697 003 children born in Scotland 1997-2009.

Objective: Smoking during pregnancy is associated with adverse health impacts on mother and child. We used a large linked Scottish dataset to produce contemporary estimates of the impact on child health, particularly hospitalisation.

Design: Retrospective cohort study linking birth, death, maternity, infant health, child health surveillance and admission records.

Birth weight differences between those offered financial voucher incentives for verified smoking cessation and control participants enrolled in the Cessation in Pregnancy Incentives Trial (CPIT), employing an intuitive approach and a Complier Average Causal Effects (CACE) analysis.

Background: The Cessation in Pregnancy Incentives Trial (CPIT), which offered financial incentives for smoking cessation during pregnancy showed a clinically and statistically significant improvement in cessation. However, infant birth weight was not seen to be affected. This study re-examines birth weight using an intuitive and a complier average causal effects (CACE) method to uncover important information missed by intention-to-treat analysis.

Representativeness of the participants in the smoking Cessation in Pregnancy Incentives Trial (CPIT): a cross-sectional study.

Background: The limited representativeness of trial samples may restrict external validity. The aim of this study was to ascertain the representativeness of the population enrolled in the Cessation in Pregnancy Incentives Trial (CPIT), a therapeutic exploratory study to examine the effectiveness of financial incentives for smoking cessation during pregnancy.

Methods: CPIT participants (n = 492) were compared with all self-reported smokers at maternity booking who did not participate in the trial (n = 1982).

Reduced fetal growth in methadone-maintained pregnancies is not fully explained by smoking or socio-economic deprivation.

Aim: To determine if reduced fetal growth in infants of opioid-dependent mothers prescribed methadone maintenance in pregnancy is explained by cigarette smoking or socio-economic deprivation.

Design: Retrospective cohort study.

Setting: Inner-city maternity unit in Scotland.

Bed sharing when parents do not smoke: is there a risk of SIDS? An individual level analysis of five major case-control studies.

Objective: To resolve uncertainty as to the risk of Sudden Infant Death Syndrome (SIDS) associated with sleeping in bed with your baby if neither parent smokes and the baby is breastfed.

Design: Bed sharing was defined as sleeping with a baby in the parents' bed; room sharing as baby sleeping in the parents' room. Frequency of bed sharing during last sleep was compared between babies who died of SIDS and living control infants.

The cessation in pregnancy incentives trial (CPIT): study protocol for a randomized controlled trial.

Background: Seventy percent of women in Scotland have at least one baby, making pregnancy an opportunity to help most young women quit smoking before their own health is irreparably compromised. By quitting during pregnancy their infants will be protected from miscarriage and still birth as well as low birth weight, asthma, attention deficit disorder and adult cardiovascular disease. In the UK, the NICE guidelines: 'How to stop smoking in pregnancy and following childbirth' (June 2010) highlighted that little evidence exists in the literature to confirm the efficacy of financial incentives to help pregnant smokers to quit.

Smoking prevalence and smoking cessation services for pregnant women in Scotland.

Background: Over 20% of women smoke throughout pregnancy despite the known risks to mother and child. Engagement in face-to-face support is a good measure of service reach. The Scottish Government has set a target that by 2010 8% of smokers will have quit via NHS cessation services.

Reliability of self reported smoking status by pregnant women for estimating smoking prevalence: a retrospective, cross sectional study.

Objective: To determine what impact reliance on self reported smoking status during pregnancy has on both the accuracy of smoking prevalence figures and access to smoking cessation services for pregnant women in Scotland.

Design: Retrospective, cross sectional study of cotinine measurements in stored blood samples.

Participants: Random sample (n=3475) of the 21 029 pregnant women in the West of Scotland who opted for second trimester prenatal screening over a one year period.

'Breathe': the stop smoking service for pregnant women in Glasgow.

Objective: to develop a pragmatic service for pregnant smokers.

Design: identification and referral of pregnant smokers to specialist services using self-report gathered on routine pregnancy booking questionnaire augmented by a carbon monoxide breath test. Engagement by specialist smoking cessation midwives using telephone contact with the offer of clinic-based counselling for women who want help.

CATCH: development of a home-based midwifery intervention to support young pregnant smokers to quit.

Objective: to develop, implement and evaluate a supportive midwifery intervention, Community Action on Tobacco for Children's Health (CATCH), to help young pregnant smokers to quit.

Design: action research project funded from April 2002 to June 2005.

Setting And Participants: CATCH was based in a single hospital maternity unit in the West of Scotland and targeted a deprived population of pregnant smokers aged 25 years and under.

Infant feeding attitudes and knowledge among socioeconomically disadvantaged women in Glasgow.

Objectives: This study: (1) investigated infant feeding attitudes and knowledge among socioeconomically disadvantaged mothers in an urban community with historically low breastfeeding rates, (2) examined the influence of women's social networks on infant feeding attitudes and decisions, and (3) validated a measure of infant feeding attitudes and knowledge in this population (Iowa Infant Feeding Attitude Scale, IIFAS).

Methods: Women attending a prenatal clinic (n=49) reported on: (1) demographics, (2) infant feeding attitudes and knowledge (IIFAS), (3) feeding intent, (4) opinions about breastfeeding in public, and (5) social networks. Feeding method at discharge was abstracted from hospital charts.

Do poor nutrition and display screens affect visual acuity in children?

Two studies conducted in Scotland have shown an increase in visual acuity (VA) screening failure among primary school-aged children in recent years. Two other trends were observed during the same period - an increase in children bringing packed lunches to school, and increased access to display screen equipment (DSE) including television, computers and hand-held computer games. This study set out to assess if either DSE use of poor diet could be linked with visual acuity screening failure in Scottish primary school children.