MOTIVATIONAL ENHANCEMENT THERAPY FOR PREGNANT SMOKERS

吸烟对妊娠结局的不利健康影响是显著的和代价高昂的。尽管这些风险广为人知，但近四分之一的女性在怀孕期间继续吸烟。此外，来自弱势背景的妇女在怀孕吸烟者中的比例过高。需要创新的戒烟干预措施来提高怀孕吸烟者的戒烟率，特别是在社会经济水平较低的人群中。这项拟议的研究评估了基于动机增强疗法(MET)的理论创新的产前戒烟干预的可行性和有效性。将采用随机、对照、组间前测/后测设计，比较MET与常规护理对降低孕妇吸烟率的作用。67名年龄至少16岁并在大学公共诊所就诊的怀孕吸烟者将被分配到这两组中的每一组。除了实现更高的禁酒率，我们预计MET干预将在几个功能领域产生重大变化(例如，应对、自我效能、变化准备)。吸烟结果将通过客观(唾液可替宁分析)和自我报告措施进行评估。Logistic回归程序将用于检查治疗后吸烟组的差异。重复测量方差分析将用于评估与治疗相关的其他功能领域的变化。MET策略和技术的实施采用了一种移情、非对抗性但具有指导性的咨询风格，以增强动机并减少对变化的矛盾心理。MET干预包括四次咨询会议和一个阶段的基于变化的个性化反馈信，在8周内交付。第一次咨询将在妇女第一次产前检查期间在诊所进行，随后的三次咨询将通过电话进行。将使用治疗手册、训练有素的咨询师、能力检查和依从性评级量表来验证治疗的忠诚度。这项研究将为一种新的、创新的干预措施对怀孕吸烟者的有效性提供重要的理论和经验信息，并将为更大规模的有效性试验提供基础。

Adverse health effects of cigarette smoking on pregnancy outcomes are significant and costly. Despite the well-publicized risks, almost one-quarter of women continue to smoke throughout pregnancy. Further, women from disadvantaged backgrounds are over-represented among pregnant smokers. Innovative smoking cessation interventions are needed to increase quit rates in pregnant smokers, particularly in low socioeconomic populations. The proposed study evaluates the feasibility and efficacy of theoretically innovative prenatal smoking cessation intervention based on Motivational Enhancement Therapy (MET). A randomized, controlled, pretest/posttest, between groups design will be employed to compare MET with usual care for reducing smoking rates among pregnant women. Sixty-seven pregnant smokers, at least 16 years of age and attending a university-based, public clinical will be assigned to each of the two groups. In addition to achieving higher abstinence rates, we expect that the MET intervention will produce significant changes in several domains of function (e.g. coping, self- efficacy, readiness to change). Smoking outcomes will be assessed via objective (saliva cotinine analyses) and self-report measures. Logistic regression procedures will be used to examine posttreatment smoking group differences. Repeated measures analysis of variance will be used to evaluate treatment related changes in other domains of functioning. MET strategies and techniques are implemented using an empathic, non- confrontational yet directive counseling style to enhance motivation and reduce ambivalence about change. The MET intervention consists of four counseling sessions and one stages of change based, personalized feedback letter delivered over 8-weeks. The first counseling session will occur at the clinic during a woman's first prenatal visit with the three subsequent sessions being conducted by telephone. Therapy manuals, trained counselors, competency checks, and adherence rating scales will be used to verify treatment fidelity. This research will contribute important theoretical and empirical information concerning the efficacy of a new and innovative intervention for pregnant smokers and will provide the basis for larger effectiveness trials.