title: Smoking Patterns and Receipt of Cessation Services Among Pregnant Women in Argentina and Uruguay.
abstract: BACKGROUND
  The 5A's (Ask, Advise, Assess, Assist, and Arrange) strategy, a best-practice approach for cessation counseling, has been widely implemented in high-income countries for pregnant women; however, no studies have evaluated implementation in middle-income countries. The study objectives were to assess smoking patterns and receipt of 5A's among pregnant women in Buenos Aires, Argentina and Montevideo, Uruguay.
  
  
  METHODS
  Data were collected through administered questionnaires to women at delivery hospitalizations during October 2011-May 2012. Eligible women attended one of 12 maternity hospitals or 21 associated prenatal care clinics. The questionnaire included demographic data, tobacco use/cessation behaviors, and receipt of the 5A's. Self-reported cessation was verified with saliva cotinine.
  
  
  RESULTS
  Overall, of 3400 pregnant women, 32.8% smoked at the beginning of pregnancy; 11.9% quit upon learning they were pregnant or later during pregnancy, and 20.9% smoked throughout pregnancy. Smoking prevalence varied by country with 16.1% and 26.7% who smoked throughout pregnancy in Argentina and Uruguay, respectively. Among pregnant smokers in Argentina, 23.8% reported that a provider asked them about smoking at more than one prenatal care visit; 18.5% were advised to quit; 5.3% were assessed for readiness to quit, 4.7% were provided assistance, and 0.7% reported follow-up was arranged. In Uruguay, those percentages were 36.3%, 27.9%, 5.4%, 5.6%, and 0.2%, respectively.
  
  
  CONCLUSIONS
  Approximately, one in six pregnant women smoked throughout pregnancy in Buenos Aires and one in four in Montevideo. However, a low percentage of smokers received any cessation assistance in both countries. Healthcare providers are not fully implementing the recommended 5A's intervention to help pregnant women quit smoking.
authors.affiliation: Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina; mberrueta@iecs.org.ar.
authors.forename: Mabel
authors.initials: M
authors.lastname: Berrueta
authors.affiliation: Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina;
authors.forename: Paola
authors.initials: P
authors.lastname: Morello
authors.affiliation: Clinical and Epidemiological Research Unit, Montevideo, Uruguay;
authors.forename: Alicia
authors.initials: A
authors.lastname: Alemán
authors.affiliation: Division of Reproductive Health/NCCDPHP, Centers for Disease Control and Prevention, Atlanta, GA;
authors.forename: Van T
authors.initials: VT
authors.lastname: Tong
authors.affiliation: Tulane School of Public Health and Tropical Medicine, New Orleans, LA.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Johnson
authors.affiliation: Division of Reproductive Health/NCCDPHP, Centers for Disease Control and Prevention, Atlanta, GA;
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Dietz
authors.affiliation: Division of Reproductive Health/NCCDPHP, Centers for Disease Control and Prevention, Atlanta, GA;
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Farr
authors.affiliation: Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina;
authors.forename: Agustina
authors.initials: A
authors.lastname: Mazzoni
authors.affiliation: Clinical and Epidemiological Research Unit, Montevideo, Uruguay;
authors.forename: Mercedes
authors.initials: M
authors.lastname: Colomar
authors.affiliation: Clinical and Epidemiological Research Unit, Montevideo, Uruguay;
authors.forename: Alvaro
authors.initials: A
authors.lastname: Ciganda
authors.affiliation: Clinical and Epidemiological Research Unit, Montevideo, Uruguay;
authors.forename: Laura
authors.initials: L
authors.lastname: Llambi
authors.affiliation: Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina;
authors.forename: Ana
authors.initials: A
authors.lastname: Becú
authors.affiliation: Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina;
authors.forename: Luz
authors.initials: L
authors.lastname: Gibbons
authors.affiliation: Division of Reproductive Health/NCCDPHP, Centers for Disease Control and Prevention, Atlanta, GA;
authors.forename: Ruben A
authors.initials: RA
authors.lastname: Smith
authors.affiliation: Tulane School of Public Health and Tropical Medicine, New Orleans, LA.
authors.forename: Pierre
authors.initials: P
authors.lastname: Buekens
authors.affiliation: Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina;
authors.forename: Jose M
authors.initials: JM
authors.lastname: Belizán
authors.affiliation: Department of Mother and Child Health Research, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina;
authors.forename: Fernando
authors.initials: F
authors.lastname: Althabe
mesh_terms: D001118:Argentina / Q000453:epidemiology; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000628:therapy; D016540:Smoking Cessation / Q000706:statistics & numerical data*; D014029:Tobacco Use Disorder / Q000453:epidemiology / Q000628:therapy; D014583:Uruguay / Q000453:epidemiology