title: Tobacco cessation intervention for pregnant women in Argentina and Uruguay: study protocol.
abstract: BACKGROUND
  Argentina 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.
  
  
  METHODS
  We 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.
authors: Fernando
authors: F
authors: Althabe
authors: Alicia
authors: A
authors: Alemán
authors: Agustina
authors: A
authors: Mazzoni
authors: Mabel
authors: M
authors: Berrueta
authors: Paola
authors: P
authors: Morello
authors: Mercedes
authors: M
authors: Colomar
authors: Alvaro
authors: A
authors: Ciganda
authors: Ana
authors: A
authors: Becú
authors: Luz
authors: L
authors: Gibbons
authors: Laura
authors: L
authors: Llambi
authors: María G
authors: MG
authors: Bittar Gonzalez
authors: Van T
authors: VT
authors: Tong
authors: Sherry L
authors: SL
authors: Farr
authors: Ruben A
authors: RA
authors: Smith
authors: Patricia M
authors: PM
authors: Dietz
authors: Carolyn
authors: C
authors: Johnson
authors: Pierre
authors: P
authors: Buekens
authors: José M
authors: JM
authors: Belizán
mesh_terms: D000328:Adult; D001118:Argentina / Q000453:epidemiology; D003376:Counseling; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008880:Midwifery; D010865:Pilot Projects; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D037841:Pregnant People; D011295:Prenatal Care / Q000379:methods*; D012907:Smoking / Q000453:epidemiology*; D020340:Tobacco Use Cessation / Q000379:methods*; D014583:Uruguay / Q000453:epidemiology
references: Stat Med. 2001 Feb 15;20(3):417-33
references: 11180311
references: Cochrane Database Syst Rev. 2004 Oct 18;(4):CD001055
references: 15495004
references: Lancet. 2001 May 19;357(9268):1551-64
references: 11377642
references: Lancet. 2004 Jun 12;363(9425):1934-40
references: 15194252
references: Paediatr Perinat Epidemiol. 1998 Oct;12 Suppl 2:1-3
references: 9805719
references: Nicotine Tob Res. 2008 Apr;10(4):607-12
references: 18418783
references: Am J Trop Med Hyg. 2008 Nov;79(5):755-9
references: 18981518
references: Addiction. 2001 Mar;96(3):495-505
references: 11255588
references: Paediatr Perinat Epidemiol. 2008 Jan;22 Suppl 1:42-60
references: 18237352
references: N Engl J Med. 2008 May 1;358(18):1929-40
references: 18450604
references: Am J Public Health. 1995 Feb;85(2):217-22
references: 7856781
references: Medicina (B Aires). 2008;68(1):48-54
references: 18416320
references: Acta Obstet Gynecol Scand. 2010;89(4):490-495
references: 20367427
references: JAMA. 1999 Oct 20;282(15):1458-65
references: 10535437
references: Health Educ Behav. 2002 Oct;29(5):608-19
references: 12238704
references: Paediatr Perinat Epidemiol. 1998 Oct;12 Suppl 2:59-74
references: 9805723
references: Stat Med. 2001 Feb 15;20(3):351-65
references: 11180306
references: Am J Public Health. 2008 Oct;98(10):1833-40
references: 18309125
references: Health Technol Assess. 2004 Feb;8(6):iii-iv, 1-72
references: 14960256
references: Nicotine Tob Res. 2010 Jul;12(7):685-94
references: 20472696
references: Aust N Z J Public Health. 1999 Feb;23(1):99-103
references: 10083699
references: World Health Forum. 1993;14(4):356-9
references: 8185784
references: Tob Control. 2000;9 Suppl 3:III80-4
references: 10982917