title: Implementation of routine biochemical validation and an 'opt out' referral pathway for smoking cessation in pregnancy.
abstract: OBJECTIVE
  To introduce an 'opt out' referral pathway for smoking cessation in pregnancy and to compare different methods for identifying pregnant smokers in maternity care.
  
  
  METHODS
  Pilot study that analysed routine data from maternity and smoking cessation services with biochemical validation of smoking status.
  
  
  METHODS
  Dudley and South Birmingham, England.
  
  
  METHODS
  A total of 3712 women who entered the referral pathway-1498 in Dudley and 2214 in South Birmingham.
  
  
  METHODS
  Routine monitoring data on smoking at maternity booking, referral to smoking cessation services, number of women who set quit dates set and short-term (4-week) self-report smoking status. Comparison of self-report, carbon monoxide (CO)-validated and urinary cotinine-validated smoking status for a subsample (n = 1492) of women at maternity booking.
  
  
  RESULTS
  In Dudley 27% of women who entered the opt out referral pathway were identified as smokers following CO testing. Of those referred to the smoking cessation services, 19% reported stopping smoking at 4-week follow-up. In South Birmingham 17% were smokers at booking, with 5% of those referred recorded as non-smokers at 4 weeks. The number of women quitting did not increase during the study when compared with the previous year, despite higher referral rates in both areas. An optimum cut-off CO measurement of 4 parts per million (p.p.m.) was identified for sensitivity and specificity.
  
  
  CONCLUSIONS
  The introduction of an opt out referral pathway between maternity and stop smoking services resulted in more women being referred for support to quit but not higher numbers of quitters, suggesting that automatic referral may include women who are not motivated to stop and who may not engage with services. Routine carbon monoxide monitoring introduced as part of a referral pathway should involve a cut-off of 4 p.p.m. to identify smoking in pregnancy.
authors.affiliation: School of Management, University of Stirling, Stirling, UK. Linda.Bauld@stir.ac.uk
authors.forename: Linda
authors.initials: L
authors.lastname: Bauld
authors.forename: Lucy
authors.initials: L
authors.lastname: Hackshaw
authors.forename: Janet
authors.initials: J
authors.lastname: Ferguson
authors.forename: Tim
authors.initials: T
authors.lastname: Coleman
authors.forename: Gordon
authors.initials: G
authors.lastname: Taylor
authors.forename: Ruth
authors.initials: R
authors.lastname: Salway
mesh_terms: D000328:Adult; D002248:Carbon Monoxide / Q000032:analysis; D003367:Cotinine / Q000652:urine; D004739:England; D005260:Female; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010865:Pilot Projects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control*; D011295:Prenatal Care / Q000379:methods* / Q000458:organization & administration; D012372:ROC Curve; D012017:Referral and Consultation / Q000458:organization & administration / Q000706:statistics & numerical data*; D057566:Self Report; D012907:Smoking / Q000378:metabolism; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D000074606:Smoking Prevention; D016896:Treatment Outcome
chemical_list: D002248:Carbon Monoxide; D003367:Cotinine