Health visitor support helps postnatal mothers stay smoke-free

Women who receive health visitor support alongside smoking relapse prevention advice are more likely to remain smoke-free after childbirth, according to new research.

The team, led by University of East Anglia (UEA) and involving the Institute of Health Visiting (iHV), tested ‘BabyBreathe’ – a programme designed to help women who quit smoking before or during pregnancy stay smoke-free after giving birth.

The scheme provides one-to-one support from trained health visitors with digital tools, text message support, a dedicated website and app, and a relapse-prevention kit sent to families after birth.

This major study published in the BMJ shows that women who received this intervention as intended, with support from trained health visitors, were significantly more likely to remain smoke-free 12 months after giving birth compared to those without health visitor support.

Vicky Gilroy, Director of Innovation and Research at the iHV, said:

“Health visitors and their teams are uniquely placed to support women in preventing smoking relapse as part of their universal offer.

“It has been a privilege to contribute to the BabyBreathe study and help develop the evidence of the importance of their role. The findings reinforce the need for all health visitors to receive training in this important area.”

Lead researcher Prof Caitlin Notley, Professor of Addiction Sciences at UEA’s Norwich Medical School, said:

“Quitting smoking during pregnancy is an incredible achievement, but staying smoke-free after a baby is born can be just as challenging.

“Too often, support ends once a woman has quit, even though the stressful months after birth are when many women are most at risk of returning to smoking.

“Our research shows that when health visiting services are trained and supported to deliver specialist relapse prevention advice, they can make a real difference by significantly improving women’s chances of staying smoke-free. That means better health for mothers, babies and entire families.”

How the research happened

A total of 886 women from England and Scotland who had successfully stopped smoking before or during pregnancy took part in the study, as part of a large-scale randomised, controlled trial.

Participants were randomly assigned to receive either the BabyBreathe intervention or usual care – the latter of which offered no advice or support to prevent smoking relapse.

Although BabyBreathe was not delivered as intended for around one in five participants during the trial, either due to health visitor workforce pressures, missed appointments or administrative issues, health visitors provided one-to-one tailored advice and support to women in the intervention group. This was delivered at the end of pregnancy and immediately after the baby was born.

This support included advice on alternatives to try if they experienced urges to go back to smoking, as well as advice for partners and family members, and access to specially designed digital resources including the BabyBreathe app and website.

A relapse prevention ‘kit’ was also posted to women immediately after the birth of their baby and support continued for up to 12 months postpartum, at all routine health visitor appointments.

The intervention was the result of more than a decade of research and development involving women, families, health professionals and researchers – who worked together to co-design, develop and test this practical support package.

‘Health visitors play an important role’

When researchers looked at participants who received the intervention as intended, 57.6% remained smoke-free at 12 months in the BabyBreathe group – compared to 49.9% for those with usual care.

These findings suggest that health visiting services could play a significant role in ensuring the consistent delivery of relapse-prevention support, therefore also supporting the health of the entire family by helping more mothers to remain smoke-free after giving birth.

Prof Notley said:

“Women of childbearing age who quit and stay non-smoking can reduce their risks of developing a smoking-related disease to almost the same level of risk as non-smokers.

“There are also great benefits for babies and children brought up by parents who do not smoke – in avoiding exposure to second-hand smoke, and in helping to prevent the next generation from taking up smoking.

“Until now, health visitors had no training on smoking relapse prevention. This meant that when women had made the extremely important – and difficult – health behaviour change of quitting smoking during pregnancy, no one picked up on this and gave them positive praise and support.

“This new approach extends the intensive support for initially quitting smoking that pregnant women are offered, going one step further to help women to stay smokefree in the long term.”

The researchers note several limitations of the study that impacted the primary analysis, including incomplete delivery of the BabyBreathe programme and low engagement with some of its components. The participant group was also more highly educated and less socioeconomically deprived than the wider population, which may have affected the programme’s overall effectiveness and limit how broadly the findings can be applied.

This research was led by UEA in collaboration with the Institute of Health Visiting (iHV), University of Edinburgh, City St George’s, University of London, University of Exeter, University of Stirling, Glasgow Caledonian University and the Norfolk 0-19 Healthy Child Service. These findings are part of a £1.5 million project funded by the National Institute for Health and Care Research (NIHR).

Read full paper in BMJ: Effectiveness of the BabyBreathe intervention for maintaining postpartum smoking cessation: multi-centre pragmatic randomised controlled trial

BMJ 2026; 394 doi: https://doi.org/10.1136/bmj-2026-100242 (Published 18 August 2026)
Cite this as: BMJ 2026;394:e100242

Bookings open for May iHV Insights

Our highly popular iHV Insights webinar programme continues with our next event for iHV members taking place on Thursday 27 May 2021, 3:30 to 4:30pm.

Being held in the build up to Child Safety Week which takes place 7-13 June, this iHV Insights will cover the topic of: “Preventing Accidents in Children”. It will focus on the health visiting skills and role to support preventing accidents in children.

We are delighted to be joined by our expert panel of speakers, including:

Katrina Phillips, Chief Executive, Child Accident Trust
Toity Deave, iHV Fellow, Assoc Professor for Family & Child Health, Centre for Academic Child Health at University of the West of England, Bristol
Sue Hall-Wallace and Hayley Douglas-Jones, Clinical Leads for the Health Visiting Teams in South Warwickshire NHS Foundation Trust

The webinar will also be recorded and will be available to iHV members on our website after the event.

Please join us.

How to book for iHV members

Go to our EventBrite booking page and please use your iHV membership number as your access code. If you have any problems or enquiries please email [email protected] and we will be happy to help.

Once you have submitted your details, you will be able to select your ticket and proceed to checkout – please note that this webinar is free to iHV members.

Go to EventBrite booking page

Not an iHV member?

If you are not an iHV member, join us today to book your place on iHV Insights to access these resources and many other member benefits.

Previous iHV Insights

The great news is that all iHV Insights webinars are available for iHV members to access as a free member benefit after the event, as well as joining the live session. As a member you can access all of our previous iHV Insights webinars with their supported resources that includes topics on:

managing childhood illnesses;
domestic violence and abuse;
health visiting during a pandemic;
training as a health visitor during a pandemic;
supporting smoke-free families;
improving support for children with parents who are dependent on alcohol;
bereavement, the NBCP & Health Visiting
working with children with autism – resources to support your practice

Click here and login to catch up on our previous iHV Insights.

iHV publishes response to Prevention Green Paper

iHV partners with PHE in ground-breaking commitment to better mental health

The Institute of Health Visiting (iHV) has signed up to Public Health England’s (PHE) Prevention Concordat for Better Mental Health. This will see iHV work closely with PHE to take significant steps towards the promotion of good mental health and the prevention of mental health problems.

Dr Cheryll Adams CBE, Executive Director Institute of Health Visiting, with the iHV’s signatory certificate for Prevention Concordat for Better Mental Health

Dr Cheryll Adams CBE, Executive Director of the Institute of Health Visiting, said:

“The Institute is delighted to have been awarded as a Signatory for the Prevention Concordat for Better Mental Health. Our work in Perinatal and Infant Mental Health, in particular our Champions project, acts on the recognition that parental and infant mental health are crucial to good mental health across the life-course. We support our Champions at every local level to lead the shift towards prevention-focused care, enabling early help through the use of upstream interventions at every level of need.

“The Institute is absolutely committed to supporting local authorities, policy makers, parents, NHS clinical commissioners, service providers and the voluntary sector to promote a prevention-focused approach towards improving the public’s mental health.”

The Prevention Concordat Programme for Better Mental Health marked the first time that agencies across the community and care sectors came together to make prevention a priority for mental health. Now 74 organisations representing all sectors have signed up and committed to action. These organisations are benefiting from resources designed specifically to help local areas put in place effective prevention planning arrangements.

The promotion of good mental health is everyone’s responsibility and can only be achieved by working together. As a signatory to the concordat, we recognise that we can all contribute to improving mental health and wellbeing and reducing stigma, facilitate local and national action around preventing mental health problems and promote good mental health.

Lily Makurah, national lead for public mental health at PHE, said:

“The Prevention Concordat for Better Mental Health exists to help communities prevent mental health problems and promote good mental health. Through local and national action across sectors we can all contribute to improving mental health and wellbeing, improve outcomes and reduce stigmas for everyone. We’re delighted that the Institute of Health Visiting has joined the growing list of signatories.”

Find out more about Our Work in Mental Health

Background to the Concordat

Prevention Concordat for Better Mental Health and associated suite of resources.
The Prevention Concordat for Better Mental Health programme of work is one of the recommendations in the ‘Five Year Forward View for Mental Health’, published in 2016.

Institute of Health Visiting welcomes new NHS Long Term Plan

The Institute of Health Visiting very much welcomes the new NHS Long Term plan, in particular the new focus on investment into community and preventative services, and the commitment ‘….to consider whether there is a stronger role for the NHS in commissioning sexual health services, health visitors, and school nurses, and what best future commissioning arrangements might therefore be.’ (see NHS Long Term Plan page 33, 2.4).

Dr Cheryll Adams CBE, Executive Director iHV, said:

“This can’t happen soon enough as we continue to see fragmentation of health visiting services and a loss of very experienced health visitors across the country. This has been accompanied by an inevitable impact on the quality of services that the profession can now provide for babies and their families, our most vulnerable members of society. We know that this is leading to increased use of GP and A&E services, an increase in the number of children needing safeguarding protection, and that far too many children are starting school without adequate communication as well as other delays in their development. All these cause much greater expenditure for the state than the cost of providing a robust health visiting service and it is very encouraging to see prevention recognised in the ‘Plan’.

“We hope that this statement is the first step towards providing proper protection for primary preventative services, such as health visiting and school nursing, into the future and beyond. A cycle of investment and disinvestment, as has happened over at least the last 25 years, must now become a thing of the past so that England can be proud of the support it offers young families. Furthermore, society will feel the benefit of this with babies suffering less mental illness, less heart disease and less cancer in their later lives. These are all things that are impacted by what can happen to babies during pregnancy and the first months of life such as poor nutrition and being exposed to a poor emotional environment.

“We also hope that pledges for maternity services, such as continuity of care, will also be invested in for those receiving health visiting services. No one wants to discuss their problems with a stranger – trusted professionals in the community, such as health visitors, can literally change lives when their help is sought.

“In addition, we are delighted by the significant attention which the plan gives to addressing health inequalities. This is something which health visitors and the Institute see as key to creating healthy communities, so it’s very encouraging to see it so well articulated in the ‘Plan’.

“Whilst the commissioning of health visiting services is being re-examined as recommended by the Institute in its 10 year plan (September 2018), we call for the strengthening of training commissions in 2019 as a visual demonstration of the commitment to the professional contribution of health visitors as laid out in the ‘Plan’. This would start to rebuild the profession to a place where its impact can be felt once again.”

Go to NHS Long Term Plan

iHV welcomes DHSC focus on prevention

iHV publishes its 10-year plan for health visiting

The Institute of Health Visiting (iHV) has published its preferred plan for the relationship of health visiting with the NHS in the next 10 years.

As the NHS writes its new 10-year plan, with a specific focus on children, prevention and mental health, the Institute of Health Visiting has published its own recommendations for strengthening health visiting services alongside.

Dr Cheryll Adams CBE, Executive Director, Institute of Health Visiting said:

“Health visitors have a vital role in delivering early preventative services for infants and children, and in supporting parents through the emotional challenges of early parenthood. Unless there is a plan to strengthen health visiting services alongside the new NHS 10-year plan, it will be impossible to deliver on many of what we expect to be its worthy ambitions. We hope that our rationale, and the recommendations in our new position statement, will be taken seriously by those writing the plan.

Dr Adams continued:

“Moving health visiting commissioning completely from the NHS to local authorities, in October 2015, has created many challenges for the quality of services that health visitors have been able to deliver, and for the essential relationships that health visitors need to have with NHS partners. Part of the challenge has come from cuts to public health budgets, but it’s more complex than that – the loss of close relationships with NHS services, in particular with general practitioners, has also been very unhelpful.

“Three years of the local authority commissioning model has seen a loss of around 20% of the workforce and worryingly high levels of grade mix. Therefore, we are proposing a new joint NHS/Local Authority governance/commissioning model – this we hope will avoid such challenges for services to our most vulnerable members of society in the future.

Further recommendations

“Other recommendations include that every family should have at least nine universal contacts. This requires new investment into the profession, but that will be more than offset by savings in preventable treatment costs in later life. Nine core universal contacts being delivered by health visitors is becoming the norm for Welsh families, with Scottish families receiving eleven! This is based on the evidence of what can be achieved by providing robust health visiting services during the very early years – and English children shouldn’t be disadvantaged.”

Dr Adams concluded:

“Our position statement makes clear what we believe needs to happen to improve outcomes for children through strengthened health visiting – with a renewed focus on children’s services, improving mental health and prevention and reducing inequalities in the essential early years period. We are circulating it widely to decision makers and those concerned about giving every child the best start in life.”

Download iHV position statement - Health Visiting and the NHS in the next 10 years

New – iHV Local Authority Briefing (9): The Health Visiting contribution to Child Accident Prevention

Local authorities are charged with commissioning children’s public health services as part of a wider remit for children’s services.

This new briefing for commissioners of children’s services provides an overview of the central role that health visitors play in reducing unintentional injuries in the under-fives, along with the associated high personal and financial costs to children, families, communities and society.

Unintentional injuries in and around the home are a major cause of death and disability among the under-fives in England.

Local Authority Child Public Health Briefing (9): The Health Visiting contribution to Child Accident Prevention

Please share this Local Authority Public Health briefing with your local commissioners – along with the other briefings in the series (under the “For commissioners” section on the link below).

Working in partnership with your local authority

New Parent Tips – Preventing choking

New Parent Tips on Preventing choking are published.

Keeping your little one safe is vitally important to all parents. Babies and small children are at high risk of choking on small items because they examine unfamiliar objects by putting them in their mouths.

These parent top tips bring together a collection of evidence-based tips that new parents can put into practice today.

Go to Parent Tips - Preventing choking

Child Safety Week is for professionals in health visiting

Child Safety Week (6-12 June 2016) is CAPT’s (Child Accident Prevention Trust’s) annual campaign to reduce serious childhood accidents. The Week offers those working in health visiting a opportunity to engage with families to reduce the number of local children suffering serious accidents, one of health visitors’ 6 high impact areas for change.

Last year, Child Safety Week activities reached over 450,000 parents, carers, children and young people nationwide. It offers an opportunity for health visiting work to stand out and have a visible impact, particularly important in the current climate.

With your help, we can reach even more families with important safety messages.

Simply sign up for free resources

Sign up now, you’ll automatically be alerted when free resources for you to use to engage families and support your planning are available. You’ll also get a link to free downloadable activities for using with children and families.

Or to find out more go to www.childsafetyweek.org.uk.