Vaz L R, Coleman T, Fahy S J, Cooper S, Bauld L, Szatkowski L, Leonardi-Bee J
UK Centre for Tobacco and Alcohol Studies, Division of Primary Care, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, NG7 2RD, UK.
Institute for Social Marketing, UK Centre for Tobacco and Alcohol Studies, University of Stirling, Stirling, FK9 4LA, UK.
BMC Health Serv Res. 2017 Aug 8;17(1):545. doi: 10.1186/s12913-017-2502-y.
The UK National Health Service provides Stop Smoking Services for pregnant women (SSSP) but there is a lack of evidence concerning how these are best organised. This study investigates influences on services' effectiveness and also on their propensity to engage pregnant smokers with support in stopping smoking.
Survey data collected from 121/141 (86%) of SSSP were augmented with data from Hospital Episode Statistics and the 2011 UK National Census. 'Reach' or propensity to engage smokers with support was defined as the percentage of pregnant smokers setting a quit date with SSSP support, and 'Effectiveness' as the percentage of women who set a quit date who also reported abstinence at four weeks later. A bivariate (i.e. two outcome variable) response Markov Chain Monte Carlo model was used to identify service-level factors associated with the Reach and Effectiveness of SSSP.
Beta coefficients represent a percentage change in Reach and Effectiveness by the covariate. Providing the majority of one-to-one contacts in a clinic rather than at home increased both Reach (%) (β: 6.97, 95% CI: 3.34, 10.60) and Effectiveness (%) (β: 7.37, 95% CI: 3.03, 11.70). Reach of SSSP was also increased when the population served was more deprived (β for increase in Reach with a one unit increase in IMD score: 0.55, 95% CI: 0.25, 0.85), had a lower proportion of people with dependent children (β: -2.52, 95% CI: -3.82, -1.22), and a lower proportion of people in managerial or professional occupations (β: -0.31, 95% CI: -0.59, -0.03). The Effectiveness of SSSP was decreased in those areas that had a greater percentage of people >16 years with no educational qualifications (β: -0.51, 95% CI: -0.95, -0.07).
To engage pregnant smokers and to encourage them to quit, it may be more efficient for SSSP support to be focussed around clinics, rather than women's homes. Reach of SSSP is inversely associated with disadvantage and efforts should be made to contact these women as they are less likely to achieve abstinence in the short and longer term.
英国国民医疗服务体系为孕妇提供戒烟服务（SSSP），但缺乏关于如何最佳组织这些服务的证据。本研究调查了对服务效果的影响以及对其促使怀孕吸烟者接受戒烟支持的倾向的影响。
从141个SSSP中的121个（86%）收集的调查数据，用医院事件统计数据和2011年英国全国人口普查数据进行补充。“覆盖面”或促使吸烟者接受支持的倾向被定义为在SSSP支持下设定戒烟日期的怀孕吸烟者的百分比，“效果”被定义为设定戒烟日期且四周后报告戒烟的女性的百分比。使用双变量（即两个结果变量）响应马尔可夫链蒙特卡罗模型来确定与SSSP的覆盖面和效果相关的服务层面因素。
β系数表示协变量导致的覆盖面和效果的百分比变化。在诊所而非家中提供大部分一对一接触，会增加覆盖面（%）（β：6.97，95%置信区间：3.34，10.60）和效果（%）（β：7.37，95%置信区间：3.03，11.70）。当所服务的人群贫困程度更高时（IMD得分每增加一个单位，覆盖面增加的β值：0.55，95%置信区间：0.25，0.85）、有受抚养子女的人口比例更低时（β：-2.52，95%置信区间：-3.82，-1.22）以及管理或专业职业的人口比例更低时（β：-0.31，95%置信区间：-0.59，-0.03），SSSP的覆盖面也会增加。在16岁以上无学历人口比例更高的地区，SSSP的效果会降低（β：-0.51，95%置信区间：-0.95，-0.07）。
为促使怀孕吸烟者并鼓励她们戒烟，SSSP的支持集中在诊所周围而非女性家中可能更有效。SSSP的覆盖面与不利条件呈负相关，应努力联系这些女性，因为她们在短期和长期内戒烟的可能性较小。
