Smokeless Tobacco Use and Reproductive Health Among Married Women in a Low-income

描述(由申请人提供)：这份名为《孟买低收入社区女性吸烟者的无烟烟草使用和生殖健康》的申请旨在探索印度妇女在生育期间越来越多地使用新的、高度上瘾的无烟烟草形式。无烟烟草在印度妇女中的使用正在急剧增加，并已被证明导致了生殖健康问题，包括早产、低出生体重、死产和(低收入)印度妇女的孕产妇发病率。这项研究将与孟买国家生殖健康研究所副主任兼科学家Saritha Nair博士和Donta Balaiah博士一起进行，是NIH第1号补助金R01 DA020393-01A2的延伸。这五项研究的目的是：1)在孟买西部一个大的低收入/贫民窟地区，对90名妇女和20名社区专家进行定性研究，探讨无烟烟草在生育史的三个阶段、婚后立即、第一次(或第二次)怀孕期间以及第二次和第四次怀孕之间的含义和实践。2)了解向低收入妇女推销、推广和提供SL的情况；3)对孟买西部一个已知愿意接受预防研究的低收入/贫民窟地区的400名妇女进行调查，每个生殖健康类别约有125名妇女。4)利用数据生成和评估对研究社区妇女和其他受无烟烟草使用影响的妇女采取的干预措施的社会可接受性：5)提高伙伴组织NIRRH的能力，通过能力建设培训，在印度开展关于无烟烟草和生殖健康问题的社会和行为干预研究，培训内容包括定性研究方法、烟草对怀孕前、怀孕后和怀孕期间发病率和死亡率的影响以及提案的制定。拟议的研究将有助于在文化上和背景上适当的干预措施，重点关注孟买低收入社区妇女的无烟烟草预防和戒烟。这项研究的顾问将包括P.C.Gupta博士，国际公认的印度烟草使用/控制和烟草使用、怀孕和女性发病率和死亡率专家，Stephen Schensul博士，以及在类似社区进行干预研究的合作伙伴，这些合作伙伴在一个类似的社区进行关于生活压力(Tenshun)、公认的生殖健康症状(kamjori和Safed pani)、婚姻冲突和性传播感染/艾滋病毒风险的干预研究。每年将根据主题增加其他印度和美国顾问参加能力建设研讨会。这项研究的重要意义在于有能力解决印度的一个关键公共卫生问题，即危险和令人上瘾的新型无烟烟草明显增加，可能对妇女的怀孕、发病率和死亡率产生严重影响，并为在育龄妇女中减少无烟烟草的使用提供教育和其他形式的适当干预的基础，无烟烟草的使用与妇女生活的其他方面交织在一起。公共卫生相关性：这项研究解决了印度背景下特有的一个重大公共卫生问题，即生活在低收入城市社区的妇女越来越多地使用危险和令人上瘾的无烟烟草形式。开展研究以突出导致育龄妇女使用无烟烟草的文化和背景因素的新方法，将有助于在印度背景下制定适合情况和文化的干预措施，并促进可应用于美国不同无烟烟草使用者社区的多层次方法。

DESCRIPTION (provided by applicant): This FIRCA application entitled "Smokeless Tobacco Use And Reproductive Health Among Women Users In A Low Income Community Of Mumbai" proposes to explore the use of new and highly addictive forms of smokeless tobacco increasingly used by Indian women during their reproductive years. Smokeless tobacco use is increasing dramatically among women in India and has been shown to contribute to reproductive health problems including premature birth, low birth weight, still birth and maternal morbidity among (low income) Indian women. The study will be conducted with Drs. Saritha Nair, Scientist and Donta Balaiah, Deputy Director and Scientist, National Institute for Research on Reproductive Health, Mumbai and is an extension of NIH Grant number 1 R01 DA020393-01A2. The five study aims are: 1) to conduct qualitative research with a sample of 90 women and 20 community experts in one large low income/slum area of Western Mumbai on the meanings, and practices associated with smokeless tobacco during three stages in reproductive history, immediately post marriage, during first (or second) pregnancy, and between 2nd and 4th pregnancy. 2) to understand marketing, promotion and availability of SL to low income women; 3) to conduct a survey with 400 women in one low income/slum area of western Mumbai known to be receptive to prevention studies, approximately 125 in each reproductive health category. 4) to use data to generate and evaluate social acceptability of intervention approaches with women in the study community and others affected by smokeless tobacco use: 5) to increase capacity of NIRRH, the partner organization, to conduct social and behavioral intervention research on smokeless tobacco and reproductive health issues in India through capacity building training on qualitative research methods, tobacco's implications for morbidity and mortality prior to, after and during pregnancy and proposal development. The proposed research will contribute to culturally and contextually appropriate interventions focused on smokeless tobacco prevention and cessation among women in low income communities of Mumbai. Consultants to the study will include P.C. Gupta, Ph.D. internationally recognized expert on tobacco use/control in India and tobacco use, pregnancy and female morbidity and mortality, Stephen Schensul, Ph.D., and partners conducting intervention research in a similar community on life stress (tenshun), perceived reproductive health symptoms (kamjori and safed pani) marital conflict and STI/HIV risk. Other Indian and U.S. consultants will be added to capacity building workshops each year based on topic. Significance lies in the study's capacity to address a critical public health problem in India, the apparent increase in risky and addictive new forms of smokeless tobacco with potentially serious implications for pregnancy and morbidity and mortality of women, and to provide the basis for educational and other forms of appropriate intervention to reduce smokeless tobacco use, a practice intertwined with other aspects of their lives, among women of reproductive age. PUBLIC HEALTH RELEVANCE: This study addresses a significant public health problem unique to the Indian context, the growing use of dangerous and addictive forms of smokeless tobacco among women living in low-income urban communities. New ways of conducting research to highlight the cultural and contextual factors contributing to smokeless tobacco use among women of reproductive age will contribute to the development of situationally and culturally appropriate interventions in the India context, and to multilevel approaches that can be applied to diverse communities of smokeless tobacco users in the U.S.