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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

基本信息

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
项目类别：
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

项目摘要

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妇女在产后的前六个月复发，强调需要有效的产后持续护理，以支持妇女度过具有挑战性的产后时期，此时压力很大，戒烟的动机可能会下降。现有的复发预防干预措施（通常在怀孕期间实施）已被发现在怀孕期间收效甚微