Maternal smoking is the largest modifiable risk factor affecting foetal and infant health in the developed world. While the number of New Zealand women who continue to smoke during pregnancy is a major health concern, prospective parenthood often provides motivation to stop smoking – giving health professionals a chance to increase smoking cessation rates by offering support during this time.
Leonie Godsiff was eight years old when she had her first smoke, and by 15, she was a full-time smoker. But at age 29, with her second child on the way, she gave up the habit for good – with the help of the Pepi First programme. “I was two and a half months pregnant and had been trying to cut down on smoking when my midwife visited and told me about the programme, so I decided to sign up,” says the Havelock mother-of-two. “I’m still smoke-free today, and my son is now six weeks old.”
The Nelson Marlborough Health initiative encourages mothers to quit smoking during pregnancy, by providing support and incentives at key milestones throughout pregnancy. “Pregnant women are a priority population and we really want to support these women to quit smoking,” says Karen Vis, Smokefree Coordinator, Nelson Marlborough Health. Based on a similar initiative run by Counties Manukau DHB, maternity incentives programme, Pepi First assigns a quit coach for one-on-one support in the form of home visits, as well as access to services and resources, such as nicotine replacement therapy. Support is provided throughout the pregnancy and into the postnatal period.
Leonie’s coach visited three times each trimester of her pregnancy, using a breath test to confirm she was smoke-free. If she passed the test, a voucher – from either The Warehouse or a supermarket – was given as a reward. Despite trying and failing to give up smoking many times over the years, Leonie says she was more determined than ever to kick the habit. “They can tell if you’ve had a smoke, so there’s no cheating. If the breath test reading for carbon monoxide is below 4, you get a voucher, which gave me extra motivation. I was so determined to quit that I passed the test every time. My coach is a lovely lady and she was really supportive and helpful, which made it even easier to give up. Also, when your baby is monitored and they show you exactly how much smoke is reaching them, it’s obviously a huge motivation as well.”
Along with the health benefits for herself and her sons, Leonie says saving money is another bonus. “The vouchers come in really handy when finances are tight and because smoking is so expensive, you’re saving money at the same time. I’ve told my friends about it and would recommend the programme to anyone.”
Karen says the initiative’s success rate for quitting is at an average of 55% (carbon monoxide validated at four weeks post-quit date), and the aim is for a smoke-free home by the time the baby is six weeks old. “We follow through with support for these women – and if they didn’t succeed with the programme, then the decision to quit can still be made postnatally. But the earlier they come to us for help on their quit journey, the more incentives they are eligible for.”
The programme’s success is also demonstrated in the data reported by LMCs through the Midwifery and Maternity Provider Organisation. It shows a dramatic decline in Māori women smoking during pregnancy since the programme started, with the overall rates also declining:
Pepi First is the first incentivised smoking cessation programme in the Nelson Marlborough region and there are other similar programmes available across the South Island. The success of the programme has led the team to begin developing a stop smoking incentive programme for whānau of children admitted to hospital with respiratory conditions.