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Although long established that smoking in pregnancy is harmful, many women still find it difficult to quit for pregnancy, and many health professionals find it frustrating that they cannot help more. So pioneering work in the United Kingdom has examined the barriers to cessation in an innovative way (using role play with stakeholders) and produced important improvements in the interest shown in smoking cessation by both pregnant smokers and health professionals. The intervention followed years of research and development. Information derived focus groups provided insights into the issues facing smoking pregnant women. This information was then used to overcome barriers to smoking cessation using the principles of social marketing. The number of women recruited into a specially-designed smoking cessation support initiative was compared to women recruited into comparable groups in the North East. This innovative intervention has been a success: in generating ideas, guiding development of an customer-friendly service, and encouraging women to come forward for smoking cessation during their pregnancy. The target population have welcomed the approach and health professionals have enjoyed and benefited from the role play with professional actors.
Problem definition
The impacts of smoking in pregnancy are well documented1 (1 Health Education Authority (1997) Action on Smoking and Pregnancy, HEA London)and include a higher rate of miscarriage, perinatal mortality, low birth weight and sudden infant death syndrome2 (2 Blair PS. Smoking and sudden infant death syndrome. B MJ 1996;313: 195-8 )to name but a few. Approximately 30% of women who smoke in Great Britain continue to smoke during pregnancy3. Funding in the United Kingdom city of Sunderland was used to appoint a local champion to coordinate services for pregnant women who want to give up smoking. In Sunderland between April 2001 and March 2002 only 19 women set a quit date and 8 successfully quit smoking at the 4 week stage through the mainstream service.

Competitive analysis
The promotion activities of the tobacco industry are well known, and no exclusive analysis of activities in the target area were carried out. However, the generic, health service supplied smoking cessation services locally were aware of the impact of tobacco marketing on the local population.

Stakeholder analysis
Detailed work was done with stakeholders in the pregnancy-smoking condition: with the women themselves, and their “significant others” (Partners, parents, friends); health professionals (obstetric, medical, health promotion), as well as service providers, clinical managers and support groups. At the time the intervention was being planned, background work was being done developing the social marketing foundations, including research with many stakeholders in this and other areas of health-related issues.

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