1. Smoking in Pregnancy Reward Scheme(Significant Other Supporter Scheme) Tina Williams Head of Training and Development July 2011

2. 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 Vision A tobacco free future for our children Mission To 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

3. 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’

4. 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 Duration and Outcome Measures

5. 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

6. The Mechanism Providing: • Increased motivation and relapse prevention via a financial reward • 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

7. Love2shop Flexi - Card

8. 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

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

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

11. Signing Up – Participating PCTs Agree 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

12. 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

13. 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

14. 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

15. 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

16. 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 Protocol 11. All today’s presentations 12. Evidence file 13. Database for service use and reporting Training Event • Training event • Comprehensive training for the operational scheme lead for each PCT September 2010 • 23 PCT’s agreed to participate and attendedthe event

17. Progress to May 2011

18. Q2 – cumulative summary of resultsGreater Manchester

19. Q2 – cumulative summary of resultsCheshire & Merseyside

20. Q2 – cumulative summary of resultsCumbria & Lancs

21. Conclusion No matter how successful the scheme finally proves the desired reduction in SATOD won’t happen… SATOD data collection is unreliable