Smoking in pregnancy remains one of the leading preventable causes of poor maternal and infant health outcomes and is strongly associated with health inequalities. While many women want to stop smoking during pregnancy, not all feel ready or able to make an immediate quit attempt. Traditional stop smoking pathways can therefore miss opportunities to engage women who would benefit from additional support.
The Cut Down to Stop (CDTS) pathway was developed by Smokefree Families in Somerset to provide an alternative, person-centred approach for pregnant smokers who are not ready to quit immediately. Rather than requiring women to commit to an abrupt quit attempt, the pathway supports gradual smoking reduction, encourages engagement with specialist support, and uses tobacco dependency treatment interventions to help women move towards a smokefree pregnancy.
This evaluation explores the implementation, engagement and outcomes associated with the Cut Down to Stop pathway. It demonstrates how adapting support to meet women where they are can increase engagement with tobacco dependency treatment and create opportunities for behaviour change that may otherwise have been missed. The findings highlight the importance of offering choice, recognising individual readiness to change, and providing compassionate, non-judgemental support throughout pregnancy.
The evaluation also provides valuable insight into how services can reduce barriers to engagement for women facing complex challenges, helping ensure that those most at risk of smoking-related harm are not excluded from support. By creating an additional route into treatment, the pathway complements existing stop smoking interventions and strengthens efforts to reduce smoking in pregnancy.
The learning from this evaluation is relevant for maternity services, public health teams, tobacco dependency treatment providers and commissioners seeking innovative approaches to improve engagement, reduce health inequalities and support healthier pregnancies. It demonstrates how flexible, person-centred care can help women progress towards positive health outcomes, even when they are not initially ready to quit smoking completely.
You can download and read the full project evaluation HERE