Phone-Based Postpartum Continuing Care: Smoking Cessation Beginning in Pregnancy

基于电话的产后持续护理：从怀孕开始戒烟

• 批准号: 8386735
• 负责人: Victoria Hope Coleman-Cowger
• 金额: $ 25.09万
• 依托单位: CHESTNUT HEALTH SYSTEMS, INC.
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-15 至 2015-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8386735
• 关键词: Abstinence; Address; Advisory Committees; African American; American College of Obstetricians and Gynecologists; Appointment; Asthma; Baltimore; Behavioral; Birth; Breast Feeding; Bronchitis; Caring; Cause of Death; Centers for Disease Control and Prevention (U.S.); Cessation of life; Child; Childbirth; Chronic; Cigarette; Clinic; Clinical Trials; Control Groups; Cotinine; Counseling; Education; Educational process of instructing; Effectiveness; Environmental Tobacco Smoke; Exposure to; Family member; First Pregnancy Trimester; Focus Groups; Goals; Health; Health Professional; High Prevalence; Hotlines; Human Milk; Infant; Intervention; Life; Literature; Low income; Maryland; Minority; Modeling; Monitor; Mothers; Motivation; Nicotine; Outcome; Passive Smoking; Physicians; Pilot Projects; Population; Postpartum Period; Postpartum Women; Pregnancy; Pregnant Women; Preventive; Preventive Intervention; Procedures; Protocols documentation; Public Health; Randomized; Recovery; Recruitment Activity; Relapse; Relative (related person); Reporting; Risk; Sampling; Schedule; Second Pregnancy Trimester; Services; Smoke; Smoking; Stress; Sudden infant death syndrome; Telephone; Testing; Third Pregnancy Trimester; Time; Tobacco use; United States; United States Dept. of Health and Human Services; United States Substance Abuse and Mental Health Services Administration; Visit; Woman; Work; aged; base; checkup examination; disorder later incidence prevention; effective intervention; evidence base; flexibility; follow-up; improved; infant monitoring; premature; prenatal; prevent; quitline; respiratory; skills; smoking cessation; standard care; standard of care; transmission process; unborn child; urban area; willingness

DESCRIPTION (provided by applicant): The large majority of women who quit smoking during pregnancy relapse in the first six months postpartum, highlighting a need for effective postpartum continuing care that supports women through the challenging postpartum period when stress is high and motivation to stay quit may decline. Existing relapse prevention interventions (typically delivered during pregnancy) have been found to be of little benefit during the postpartum period, suggesting the need for a more formal continuing care approach. Phone-based protocols for smoking cessation have been widely disseminated and effective because they address the need for flexible access, but are passive and not typically utilized by women in the postpartum period. The proposed pilot study will develop and test a Phone-based Postpartum Continuing Care (PPCC) model that draws from existing evidence-based protocols--the 5 A's and Recovery Management Checkups (RMC)-- shown to be effective with other populations. The experimental PPCC will reinforce the importance of abstinence, relapse prevention, and reduced smoking through proactive re-intervention (i.e., RMC) with the 5 A's at times when postpartum women are more likely to relapse, and provide education and monitoring of the infant's direct and indirect exposure to nicotine through breastfeeding and secondhand smoke. We will evaluate PPCC's effectiveness relative to a passive referral to a 24/7 hotline, which is current standard care.., Approximately one hundred thirty women in their first or second trimester of pregnancy who were nicotine-dependent in the past year, currently smoke, or quit within the past 90 days will be recruited at their first prenatal appointment at the Maryland Women's Center (MWC) in Baltimore, Maryland. All women will receive the clinic's standard of care for smoking cessation--the 5 A's --during pregnancy from their physician. Half will be randomly assigned to an experimental group getting PPCC for 6 months postpartum and half to a control group receiving only a referral to a passive 24/7 state quit line postpartum. It s expected that in the 6 months following childbirth women in the experimental PPCC (relative to those in the control group) will: a) smoke fewer cigarettes, b) smoke fewer days, c) go longer before postpartum relapse, d) have less time between relapse and talking to a health professional about smoking, e) have less time between relapse and resumption of abstinence , f) smoke fewer times while breastfeeding, g) smoke fewer times while in the same room as the infant, and h) reduce their infant's cotinine levels. The aims of this pilot project are to develo PPCC from existing evidence-based approaches, demonstrate the feasibility of implementing the PPCC intervention with at least 80% compliance and at least 80% follow-up at each wave, and evaluate the effect size associated with receiving standard care vs. standard care + PPCC in order to understand the promise of and appropriate power required for a larger clinical trial. PUBLIC HEALTH RELEVANCE: Smoking is a leading cause of death and other negative health outcomes. While a high percentage of women quit smoking during pregnancy, the majority relapse in the first 6 months postpartum. We propose developing and pilot testing a phone-based postpartum continuing care (PPCC) protocol based on existing evidence- based approaches to increase smoking cessation, reduce relapse, increase early re-intervention, and reduce infant exposure to environmental tobacco smoke in the postpartum period.

描述（由申请人提供）：绝大多数在怀孕期间戒烟的女性在产后前六个月都会复发，这凸显了有效的产后持续护理的必要性，以支持女性度过充满挑战的产后时期，因为产后压力很大，戒烟的动力可能会下降。现有的复发预防干预措施（通常在怀孕期间实施）被发现在怀孕期间收效甚微。 产后期，表明需要采取更正式的持续护理方法。基于电话的戒烟方案已被广泛传播且有效，因为它们满足了灵活获取的需求，但它是被动的，通常不被产后妇女使用。 拟议的试点研究将开发和测试基于电话的产后持续护理 (PPCC) 模型，该模型借鉴了现有的循证协议——5 A 和恢复管理检查 (RMC)——已被证明对其他人群有效。实验性 PPCC 将在产后妇女更有可能复吸时通过 5A 的主动再干预（即 RMC）强调戒烟、预防复吸和减少吸烟的重要性，并提供教育和监测婴儿通过母乳喂养和二手烟直接和间接接触尼古丁的情况。我们将评估 PPCC 相对于被动转介到 24/7 热线（这是当前标准护理）的有效性。大约 130 名处于妊娠早期或中期妊娠的女性，她们在过去一年中依赖尼古丁、目前吸烟或在过去 90 天内戒烟，将在第一次产前预约时被招募。 位于马里兰州巴尔的摩的马里兰妇女中心 (MWC)。所有女性在怀孕期间都将接受医生提供的诊所标准戒烟护理（5A）。一半将被随机分配到在产后 6 个月接受 PPCC 的实验组，一半被分配到仅接受产后被动 24/7 状态戒烟热线转介的对照组。预计在分娩后 6 个月内，实验 PPCC 中的女性（相对于对照组）将：a) 减少吸烟，b) 吸烟天数减少，c) 产后复发前的吸烟时间更长，d) 复发与与健康专业人员谈论吸烟之间的时间较短，e) 复发与恢复戒烟之间的时间较短，f) 母乳喂养时吸烟次数较少，g) 母乳喂养时吸烟次数较少 h) 降低婴儿的可替宁水平。 该试点项目的目的是根据现有的循证方法开发 PPCC，证明实施 PPCC 干预的可行性，每轮至少有 80% 的依从性和至少 80% 的随访率，并评估与接受标准护理与标准护理 + PPCC 相关的效应大小，以了解更大规模临床试验的前景和所需的适当力度。 公共卫生相关性：吸烟是死亡和其他负面健康结果的主要原因。虽然大部分女性在怀孕期间戒烟，但大多数在产后前 6 个月内又复发了。我们建议在现有循证方法的基础上开发和试点测试基于电话的产后持续护理（PPCC）方案，以提高戒烟率，减少复吸，增加早期再干预，并减少婴儿在产后接触环境烟草烟雾的机会。