Women who are disadvantaged have higher rates of smoking during pregnancy and are at higher risk of tobacco-related harm. Smoking cessation interventions have been developed for pregnant and parenting women who smoke however, improvements to smoking cessation interventions for rural, disadvantaged pregnant and parenting women are needed. A multiple case study design was used to (1) describe the level of implementation of a smoking cessation intervention, Expecting to Quit (ETQ), in five Healthy Baby Clubs (HBC) in western Newfoundland (2) describe barriers and facilitators to implementing ETQ and (3) collect preliminary evidence of its effectiveness among rural, disadvantaged pregnant and parenting women. This study describes implementation of ETQ from the perspective of pregnant and parenting women (n=12), managers (n=5), and HBC Mothers (n=6). It offers insight into factors (i.e., training, policies and procedures, acceptability, appropriateness of the program) associated with implementation of ETQ. Data were collected through: (1) in-person one-on-one interviews (2) focus group interviews (3) training evaluation questionnaires (4) knowledge, attitudes and beliefs questionnaires (5) socio-demographics and smoking behaviour questionnaires and (6) document review of annual reports, staff meeting minutes, and records of polices and procedures. Inductive analyses of data were undertaken including content analysis, constant comparison, and thematic analysis. Six integrated themes emerged: (1) Stigma and Judgment: Walking a Fine Line (2) Social Context, Health and Place: Rural Living Affects Women (3) Social Networks: Supporting Women Like Us (4) Community Empowerment: A Catalyst to Get the Message Across (5) Complexities in the Lives of Women: Just Trying to Get Through and (6) Tobacco Reduction: It is a Success. The integrated themes suggest that cessation interventions in this context must address each of these issues. These findings may provide guidance on how to reduce smoking among rural, disadvantaged pregnant and parenting women by enhancing awareness of the role that each of stigma and judgment social context, health, and place social networks community empowerment complexities of the lives of women and tobacco reduction play in implementing smoking cessation programs for pregnant and parenting women.
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