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

描述（由申请人提供）：FIRCA申请题为“孟买低收入社区女性吸烟者的无烟烟草使用和生殖健康”，建议探讨印度妇女在生育年龄越来越多地使用新型和高度上瘾的无烟烟草形式。印度妇女使用无烟烟草的人数急剧增加，已证明这会造成生殖健康问题，包括早产、出生体重低、死产和印度（低收入）妇女的孕产妇发病率。本研究将由国家生殖健康研究所（孟买）科学家Saritha Nair博士和副主任兼科学家Donta Balaiah进行，是NIH资助号1 R 01 DA 020393 - 01 A2的扩展。五个研究目标是：1）在西孟买一个大型低收入/贫民窟地区，对90名妇女和20名社区专家进行定性研究，探讨在生育史的三个阶段，即婚后、第一次（或第二次）怀孕期间和第二次与第四次怀孕之间，与无烟烟草相关的意义和做法。2)了解SL对低收入妇女的营销、推广和可用性; 3）对孟买西部一个低收入/贫民窟地区的400名已知愿意接受预防研究的妇女进行调查，每个生殖健康类别约125人。4)使用数据生成并评估研究社区妇女和其他受无烟烟草用途：影响的人对干预方法的社会接受程度：5）通过关于定性研究方法的能力建设培训，提高伙伴组织NIRRH在印度进行无烟烟草和生殖健康问题社会和行为干预研究的能力，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制定建议。拟议的研究将有助于文化和背景适当的干预措施，重点是在孟买低收入社区的妇女无烟烟草预防和戒烟。这项研究的顾问将包括P. C.古普塔博士国际公认的印度烟草使用/控制以及烟草使用、怀孕和女性发病率和死亡率专家Stephen Schensul博士，与合作伙伴在类似社区开展干预研究，内容涉及生活压力（tenshun）、生殖健康症状（kamjori和萨费德pani）、婚姻冲突和性传播感染/艾滋病毒风险。其他印度和美国顾问将根据主题每年参加能力建设讲习班。这项研究的意义在于它能够解决印度的一个严重公共卫生问题，即危险和上瘾的新形式无烟烟草明显增加，对妇女怀孕和发病率和死亡率可能产生严重影响，并为教育和其他形式的适当干预提供基础，以减少无烟烟草的使用，这种做法与妇女生活的其他方面交织在一起，在育龄妇女中。公共卫生相关性：这项研究解决了印度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成瘾形式的无烟烟草。进行研究的新方法，以突出文化和环境因素，促进无烟烟草使用的育龄妇女将有助于发展的情况和文化适当的干预措施在印度的背景下，和多层次的方法，可适用于不同社区的无烟烟草使用者在美国。

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.