David Tappin

The use of incentives to promote smoking cessation is a promising technique for increasing the effectiveness of interventions. This study evaluated the smoking cessation outcomes and factors associated with success for pregnant smokers who registered with a pilot incentivised smoking cessation scheme in a Scottish health board area (NHS Tayside).

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. At present less than 4% stop during pregnancy. We aimed to establish a denominator for pregnant smokers in Scotland and describe the proportion who are referred to specialist services, engage in one-to-one counselling, set a quit date and quit 4 weeks later.

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.Main outcome measure Smoking status validated with cotinine measurement by maternal area deprivation category (Scottish Index of Multiple Deprivation).Results Reliance on self reported smoking status underestimated true smoking by 25% (1046/3475 (30%) from cotinine measurement v 839/3475 (24%) from self reporting, z score 8.27, P<0.001). Projected figures suggest that in Scotland more than 2400 pregnant smokers go undetected each year. A greater proportion of smokers in the least deprived areas (deprivation categories 1+2) did not report their smoking (39%) compared with women in the most deprived areas (22% in deprivation categories 4+5), but, because smoking was far more common in the most deprived areas (706 (40%) in deprived areas compared with 142 (14%) in affluent areas), projected figures for Scotland suggest that twice as many women in the most deprived areas are undetected (n=1196) than in the least deprived areas (n=642).Conclusion Reliance on self reporting to identify pregnant smokers significantly underestimates the number of pregnant smokers in Scotland and results in a failure to detect over 2400 smokers each year who are therefore not offered smoking cessation services.

Healthcare services often use a carbon monoxide (CO) breath test to validate self-reported smoking and to assess reductions in smoking habit. A cut-off level of ≥ 8 parts per million (p.p.m.) is used to identify smoking. This cut-off requires further validation in pregnant women.

The present chapter summarizes the findings of a case-control study conducted in Scotland to evaluate the risk of bed sharing in the con-text of sudden infant death syndrome. The study was performed between 1996 and 2000, and it specifically addressed the risk of bed sharing in relation to the age of the infant, the smoking status of the mother and breastfeeding. Comparisons are made with other large case-control studies evaluating the risk of bed sharing.

Background: The UNICEF Baby Friendly Initiative includes a community component to help women who want to breastfeed. This study aimed to document the health visitor role in promoting and supporting breastfeeding in Glasgow during 2000 and the effect it had on breastfeeding rates. Methods: Glasgow, UK, has a population of 906,000, with approximately 10,000 births per year. Glasgow has high levels of material deprivation and traditionally low breastfeeding rates. This was a cross-sectional study in January 2000 which used a postal questionnaire to document individual health visitors' interventions, activities and attitude towards breastfeeding. Infant's breastfeeding data collected routinely by the Child Health Surveillance programme from 1 August 1998 to 28 February 1999 was directly matched with interventions, activities and attitudes reported by their own health visitor. Results: 146/ 216 (68%) health visitors completed and returned the questionnaire. 5401 child health records were eligible and 3,294 (58.2%) could be matched with health visitors who returned questionnaires. 2145 infants had the first visit from 8 to 20 days of age and the second 3 to 7 weeks later. At the first postnatal visit 835 of 2145 (39%) infants were breastfed (median age of 13 days) and 646 (30%) continued to breastfeed at the second visit (median age 35 days). Infants being breastfed at the first visit were significantly more likely to be fed infant formula at the second visit if their health visitors had had no breastfeeding training in the previous two years (OR1.74 95% CI 1.13, 2.68). Conclusion: It is essential that Health Visitors are specially trained to support breastfeeding postnatally.

Objective To determine whether motivational interviewing—a behavioural therapy for addictions—provided at home by specially trained midwives helps pregnant smokers to quit. Design Randomised controlled non-blinded trial analysed by intention to treat. Setting Clinics attached to two maternity hospitals in Glasgow. Participants 762/1684 pregnant women who were regular smokers at antenatal booking: 351 in intervention group and 411 in control group. Interventions All women received standard health promotion information. Women in the intervention group were offered motivational interviewing at home. All interviews were recorded. Main outcome measures Self reported smoking cessation verified by plasma or salivary cotinine concentration. Results 17/351 (4.8%) women in the intervention group stopped smoking (according to self report and serum cotinine concentration < 13.7 ng/ml) compared with 19/411(4.6%) in the control group. Fifteen (4.2%) women in the intervention group cut down (self report and cotinine concentration less than half that at booking) compared with 26 (6.3%) in the control group. Fewer women in the intervention group reported smoking more (18 (5.1%) v 44 (10.7%); relative risk 0.48, 95% confidence interval 0.28 to 0.81). Birth weight did not differ significantly (mean 3078 g v 3048 g). Conclusion Good quality motivational interviewing did not significantly increase smoking cessation among pregnant women.

Objective: To examine the proposition that a used infant mattress is associated with an increased risk of sudden infant death syndrome. Design: Case-control study. Setting: Scotland (population 5.1 million, with about 53 000 births a year). Participants: 131 infants who died of sudden infant death syndrome between 1 January 1996 and 31 May 2000 and 278 age, season, and obstetric unit matched control infants. Main outcome measures: Routine use of an infant mattress previously used by another child and place of last sleep. Results: Routine use of an infant mattress previously used by another child was significantly associated with an increased risk of sudden infant death syndrome (multivariate odds ratio 3.07, 95% confidence interval 1.51 to 6.22). Use of a used infant mattress for last sleep was also associated with increased risk (6.10, 2.31 to 16.12). The association was significantly stronger if the mattress was from another home (4.78, 2.08 to 11.0) than if it was from the same home (1.64, 0.64 to 4.2). Conclusion: A valid significant association exists between use of a used infant mattress and an increased risk of sudden infant death syndrome, particularly if the mattress is from another home. Insufficient evidence is available to judge whether this relation is cause and effect. What is already known about this topic: The major risk factors for sudden infant death syndrome are sleeping prone and parental smoking One study has suggested that the syndrome is associated with sleeping on an infant mattress previously used by another child What this study adds: New case-control data show that the association between a previously used infant mattress and sudden infant death syndrome is valid When source of used mattress is categorised, the association is significant only if the mattress is from another home Insufficient evidence is available to judge whether this is a cause and effect relation