I016 PRENATAL TOBACCO CESSATION INTERVENTION FOR WOMEN IN LATIN AMERICA

Argentina and Uruguay are among the countries with the highest proportion of pregnant women who smoke, showing a prevalence of near 20%. The implementation of an effective smoking cessation intervention would have a significant impact on the health of mothers and children. 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, which is considered the standard of care worldwide. However, less than 10% of pregnant women who smoke receive this intervention during antenatal care in Argentina and Uruguay. We will design a multifaceted intervention to implement the “5 A’s” strategy. Midwife facilitators working in antenatal care facilities will be identified and trained to deliver the “5 A’s” to pregnant women and will then disseminate and implement the program. The intervention will be tailored by formative research to be readily applicable to local antenatal care services, as well as to be acceptable to local pregnant women and health providers. To evaluate the effectiveness of this intervention we will conduct a two-arm, parallel cluster randomized controlled trial in 20 antenatal care facilities in Argentina and Uruguay. Our primary hypothesis is that the intervention is feasible in antenatal care facilities in both countries and will increase the frequency of women receiving tobacco use cessation counseling during pregnancy. Our secondary hypothesis is that the intervention will decrease the frequency of women who smoke by the end of their pregnancies. Antenatal care facilities (in health centers or hospitals) will be randomly allocated to either an intervention or a control group after a baseline data collection period. The 10 facilities in the control group will continue with their standard in-service activities. A follow-up data collection will be conducted immediately after delivery. The study will be conducted in 48 months.