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：
8542807
负责人：
Victoria Hope Coleman-Cowger
金额：
$ 20.12万
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 2014-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8542807
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 public health relevance 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.

描述（由申请人提供）：绝大多数在产后头六个月妊娠复发期间戒烟的妇女，强调需要有效的产后继续护理，这些护理在充满挑战的产后压力很大，保持戒烟的动力可能会下降。现有的预防复发干预措施（通常在怀孕期间提供）在产后时期，表明需要采用更正式的持续护理方法。基于电话的戒烟协议已被广泛传播和有效，因为它们满足了灵活访问的需求，但是被动的，并且通常在产后时期不被女性使用。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，该模型从现有的基于证据的协议（5 A和恢复管理检查（RMC））中汲取了帮助，该协议与其他人群有效。实验性的PPCC将通过主动重新干预（即RMC）的戒酒，预防复发和减少吸烟的重要性，有时5 A的产后妇女更有可能复发，并通过母乳喂养和秒向吸烟和尼古丁进行教育和监测，并提供教育和监测。我们将评估PPCC相对于24/7热线的被动转介的有效性，这是当前的标准护理..，在过去一年中依赖于尼古丁的第一或第二三个月，大约一百三十名妇女在过去的90天内被吸烟，或者在过去的90天内被戒烟。马里兰州巴尔的摩的马里兰州妇女中心（MWC）。所有妇女都将获得诊所的戒烟标准（5 A）的医生怀孕。一半将被随机分配给一个实验组，在产后6个月内将PPCC归为一半，而将仅接收到被动24/7国家退出线产后的对照组。 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作为婴儿的空间，h）降低婴儿的可替宁水平。该试点项目的目的是从现有的基于证据的方法中脱离PPCC，证明了以至少80％的合规性实施PPCC干预的可行性，并且在每个波浪时至少进行了80％的随访，并评估与接受标准护理相关的效果大小与接受标准护理与标准护理 + PPCC相关的效果，以了解较大的临床临床试验的承诺，并需要适当的电力。