Kicking the habit: A study shows how more women
are successfully quitting smoking during pregnancy.

A social argument that can ethically split the nation in households up and down the country is – should women continue to smoke during pregnancy? The impact of smoking in pregnancy is well documented and includes miscarriage, perinatal mortality, low birth weight and sudden infant death syndrome. A figure shows that 30% of women in the UK continue to smoke during pregnancy. But a recently published study shows that an increased number of women, who are exposed to powerful social marketing techniques through ‘smoking cessation programmes’, are quitting smoking as a direct result, meaning healthier mothers and healthier children. (The full-published study has been attached to this news release).

Over a decade ago while working for the regional health authority in the North East of England, Ray Lowry, a consultant in public health medicine, first investigated the values and techniques of social marketing in the healthcare sector. After the initial research and development into social marketing, with guidance from Ray Lowry - Sunderland Primary Care Trust took on the mantle of the research. Social marketing is the art and science of promoting planned, targeted social change. The published study explores what it’s like to be a pregnant smoker in Sunderland, and looks at the development of a ‘model’ smoking cessation programme in the same area of the country. The paper identifies how techniques were developed and tailored to the needs of a pregnant smoker. This particular research programme technique was exclusively pioneered in the North East of England.

The concerning high rates of smoking in pregnancy in the North East of England have troubled the NHS for years, and many attempts of reducing the rates have failed. The study published this month in ‘Public Health – The Journal of the Royal Institute of Public Health’, tells of how focus groups were used to provide a valuable insight into the issues facing smoking pregnant women. By studying the transcripts of the focus groups, role-play exercises with actors were introduced to help the NHS staff to understand the intricacies of the subject matter. Recruitment of pregnant (and non-pregnant) smokers to the new smoking cessation programme in Sunderland increased 10-fold during the intervention phase, compared with neighbouring Primary Care Trust areas, who were running similar programmes. This is conclusive evidence that by using the social marketing research, it produces impressive results. Quit rates were significantly increased after the introduction and development of locally dedicated services for pregnant women. For the best health results for mother and child, women should consider giving up smoking before the conception of the child.

The priceless research findings were used to enforce an informative programme using social marketing techniques, these included informative poster and redesigned leaflet campaigns. The market research identified a number of barriers women face in relation to smoking cessation during pregnancy: unsatisfactory information and lack of enthusiasm or empathy from healthcare professionals figured highly in the results. This in mind, future information material needs to focus on solutions for women to give up smoking rather than just underlining the risks to their unborn child. Such solutions might include how to deal with cravings after giving up smoking, how to cope with anxieties about weight gain or how to cope with mood swings. Some women felt they were picking up ‘mixed messages’, saying they felt health professionals were trying to ‘nag them to quit’, but didn’t follow through with enthusiasm or empathy.

The research showed that in addition to the differences of the women’s lifestyles, there were also differences in motives for giving up smoking. For example, some women were motivated to give up for themselves and their baby, and so were more likely to stay off cigarettes after the birth. But some were motivated purely for the health of the baby and were more likely to return to smoking soon after the birth. This released the social pressure they had felt to give up during their pregnancy.

Ray Lowry, a consultant in public health medicine and a senior lecturer at Newcastle University – developed the concept and implementation of social marketing in the NHS and inspired Sunderland to undertake the intervention. Lowry said: “The research focussed on the women and their struggles. It gave us an important insight into the specific barriers in the way of women trying to give up smoking, and our aim was to find out what would encourage them to do so. We were able to motivate frontline NHS staff using role-players, redesigned leaflets and set up a user-friendly service to support the women effectively.

The modest success of the intervention shows how social marketing can bring about behaviour change in a hard-to-change population. These techniques are not fool-proof: it is only the diligent application and hard work by the participants that the success has been achieved.”

The intention of the public health research team is to implement the findings in other areas of the North East and then spread the successful intervention on a national scale. The study was entitled “Using social marketing to increase recruitment of pregnant smokers to smoking cessation service: the success story”.