Tobacco cessation intervention for pregnant women in Argentina and Uruguay: study protocol

Abstract

BackgroundArgentina and Uruguay are among the countries with the highest proportion of pregnant women who smoke. The implementation of an effective smoking cessation intervention would have a significant impact on the health of mothers and infants. The “5 A’s” (Ask, Advise, Assess, Assist, Arrange) is a strategy consisting of a brief cessation counseling session of 5–15 minutes delivered by a trained provider. The “5 A’s” is considered the standard of care worldwide; however, it is under used in Argentina and Uruguay.MethodsWe will conduct a two-arm, parallel cluster randomized controlled trial of an implementation intervention in 20 prenatal care settings in Argentina and Uruguay. Prenatal care settings will be randomly allocated to either an intervention or a control group after a baseline data collection period. Midwives’ facilitators in the 10 intervention prenatal clinics (clusters) will be identified and trained to deliver the “5 A’s” to pregnant women and will then disseminate and implement the program. The 10 clusters in the control group will continue with their standard in-service activities. The intervention will be tailored by formative research to be readily applicable to local prenatal care services at maternity hospitals and acceptable to local pregnant women and health providers. Our primary hypothesis is that the intervention is feasible in prenatal clinics in Argentina and Uruguay and will increase the frequency of women receiving tobacco use cessation counseling during pregnancy in the intervention clinics compared to the control clinics. Our secondary hypotheses are that the intervention will decrease the frequency of women who smoke by the end of pregnancy, and that the intervention will increase the attitudes and readiness of midwives towards providing counseling to women in the intervention clinics compared to the control clinics.Trial registrationClinicalTrials.gov. Identifier: NCT01852617

A Multifaceted Strategy to Implement Brief Smoking Cessation Counseling During Antenatal Care in Argentina and Uruguay: A Cluster Randomized Trial

“…A survey conducted in 20 public maternity hospitals in Buenos Aires, Argentina, and Montevideo, Uruguay in 2010 showed that only 10% of smokers were receiving brief counseling during prenatal care. 9 A survey conducted in Argentina in 2005, showed that only 22% of obstetrician/gynaecologists had received training in cessation counseling and 48.5% reported insufficient knowledge to provide cessation advice. Although 88.9% consistently advised women to stop smoking, three out of four providers believed it was acceptable for pregnant women to smoke up to six cigarettes per day.…”

Barriers and Promoters of an Evidenced-Based Smoking Cessation Counseling During Prenatal Care in Argentina and Uruguay

“…Except for clinic directors, a convenience sample for each segment was employed until reaching saturation. This research was conducted during August–November 2010 prior to implementing a randomized-cluster controlled trial [26]. …”

Accuracy of self‐reported smoking cessation during pregnancy

“…Women were eligible for the study if they attended one of 21 prenatal clinic clusters and delivered in one of 10 public hospitals in the Province of Buenos Aires, Argentina, or one of two hospitals in Montevideo, Uruguay, during October 2011–May 2012 (5). Within 12 h after delivery, trained interviewers asked eligible women two questions about their smoking status, and women who self-reported quitting smoking during pregnancy were asked to provide a saliva sample by chewing on the cotton swab insert from a Salivette ® (Sarstedt, Newton, NC, USA).…”