A Computer-Assisted Brief Motivational Intervention for Smoking During Pregnancy

描述（由申请人提供）：背景。在美国，大约12%的孕妇在整个怀孕期间使用烟草产品（应用研究办公室，2004年;美国卫生与公众服务部，2003年）。妊娠期间吸烟与广泛的负面影响相关，有强有力的证据表明死产、早产、小于胎龄儿、婴儿住院时间延长和SIDS的风险增加（Cnattingius，2004）。尽管在产前阶段，以初级保健为基础的行为干预措施具有明显的疗效，但多重障碍？包括时间、补偿、意愿和培训方面的限制？这就阻碍了对此类干预措施的充分采用。目标.这项R21探索性/开发性I期和早期II期研究将开发两种有效干预方法的简化、基于计算机的版本，以提高其可行性、可复制性和覆盖范围。法本研究将开发（a）一种基于计算机的妊娠期吸烟简短干预，包括与计算机的单一互动会话和计算机生成的定制邮件;以及（B）一种高度简化和计算机辅助的应急管理（CM）干预（仅在产前访视时提供无可替宁尿液的强化，仅针对要求提供样本的患者）。在基于专家和参与者反馈的迭代开发之后，我们将进行I期临床试验，旨在评估改良干预措施的可行性和可接受性，并提供效应量估计。报告在怀孕期间每天吸烟超过5支的非洲裔美国妇女（N = 160）将被随机分配到仅基于计算机的简短干预，仅CM，简短干预加CM或注意力控制条件下，并进行12周的实验室随访。主要结局指标将是随访时经尿可替宁验证的禁欲;还将收集出生结局数据。讨论和公共卫生相关性。这项研究是迈向减少孕妇吸烟的高成本效益、可复制、实用和规范方法的第一步。希望这样一个简化的、基于计算机的系统将促进产前诊所广泛采用有效的戒烟活动。

DESCRIPTION (provided by applicant): : BACKGROUND. Approximately 12% of pregnant women in the United States use tobacco products throughout pregnancy (Office of Applied Studies, 2004; U.S. Department of Health and Human Services, 2003). Smoking during pregnancy is associated with a wide range of negative effects, with strong evidence for increased risk of stillbirth, preterm birth, small size for gestational age, extended hospitalization of the infant, and SIDS (Cnattingius, 2004). Despite the clear efficacy of primary care-based behavioral interventions during the prenatal period, multiple obstacles?including limitations in time, reimbursement, willingness, and training?have prevented adequate adoption of such interventions. GOALS. This R21 exploratory/developmental Stage I and early Stage II study will develop simplified, computer-based versions of two efficacious intervention approaches in order to increase their feasibility, replicability, and reach. METHOD. This study will develop (a) a computer-based brief intervention for smoking during pregnancy, consisting of a single interactive session with the computer and computer-generated tailored mailings; and (b) a highly simplified and computer-assisted Contingency Management (CM) intervention (with reinforcement for cotinine-free urine being provided only at prenatal visits, and only for those who ask to provide a sample). Following iterative development based on expert and participant feedback, we will conduct a Phase I clinical trial designed to evaluate the feasibility and acceptability of the modified interventions, as well as to provide effect size estimates. African-American women (N = 160) who report smoking more than five cigarettes a day during pregnancy will be randomly assigned to computer-based brief intervention alone, CM alone, brief intervention plus CM, or attention control conditions with a 12-week lab-based follow-up. The primary outcome measure will be urinary cotinine-verified abstinence at follow-up; birth outcome data will also be collected. DISCUSSION AND PUBLIC HEALTH RELEVANCE. This study is the first step towards what could prove to be a highly cost-effective, replicable, practical, and prescriptive method for decreasing tobacco use among pregnant women. It is hoped that such a simplified, computer- based system will promote the widespread adoption of effective smoking cessation activities in prenatal clinics.