The effectiveness of adapted, best practice guidelines for smoking cessation counseling with disadvantaged, pregnant smokers attending public sector antenatal clinics in Cape Town, South Africa.

AIM AND OBJECTIVES: To evaluate the effect of a smoking cessation intervention, based on best practice guidelines on the quit rates of disadvantaged, pregnant women in Cape Town, South Africa. DESIGN: Quasi-experimental using a natural history cohort as a control group, consisting of women attending antenatal care in 2006 and an intervention cohort, attending the same clinics a year later. SETTING: Four, public sector antenatal clinics in Cape Town staffed and managed by midwives. POPULATION: Pregnant women of low socio-economic status. METHODS: The natural history cohort received usual care, whilst the intervention cohort was offered self-help quit materials in the context of brief counseling by midwives and peer counselors. Smoking behavior was measured in early, mid and late pregnancy. The equivalence of the groups in terms of smoking profile, self-reported smoking and demographic variables was assessed at baseline. MAIN OUTCOME MEASURES: Quit rates measured by urinary cotinine towards the end of pregnancy (36-39 weeks gestation). RESULTS: The two cohorts were comparable at baseline. The difference in quit rates between the two cohorts in late pregnancy was 5.3% (95% CI: 3.2-7.4%, p < 0.0001) in an intention to treat analysis. There was also a significant difference in reduction of smoking of 11.8% (95% CI: 5.0-18.4%, p = 0.0006). CONCLUSION: A smoking cessation intervention based on best practice guidelines was effective among high risk, pregnant smokers in South Africa.