Contingency Management for Smoking Cessation in Pregnant Minority Women

描述(由申请人提供)：这项研究的长期目标是通过改善针对少数族裔孕妇和产后妇女的戒烟和复发预防干预措施，减少与烟草相关的母婴健康结果差异，这些妇女在戒烟研究中的比例明显偏低。这项研究将探讨以奖励为基础的应急管理方法的可行性和有效性，以增加社会经济上处于不利地位的少数民族怀孕吸烟者的戒烟和预防复发。首先，将对10名怀孕的低收入少数吸烟者进行预测试，然后根据可接受性调查和焦点小组数据进行改进。接下来，将进行一项试点研究。从一家大型教学医院的产科门诊招募的60名处境极其不利的少数族裔妇女，她们报告每天吸烟，并符合其他资格标准(例如，18岁或以上；&lt；28周孕周)，将被随机纳入两个研究条件之一：1)标准心理教育干预(6周，个人管理，针对怀孕的戒烟课程，目前在诊所实施；QSN-SP)；2)标准心理教育干预加应急管理(提供以生物化学证实的戒烟为条件的激励；QSN-CM)。两组都将通过过期一氧化碳和唾液持续水平进行戒断监测，从戒烟第一天开始，一直持续到产后3个月。只有QSN-CM组的参与者将获得经过生化验证的戒酒强化，有机会赢得价值从大约1美元到100美元的奖品(“鱼缸”或“奖杯”方法)。主要研究结果包括：干预、出席和完成；持续、长期和点流行的烟草戒断(经过生化验证的自我报告)。次要结果包括：孕产妇和婴儿的健康结果(例如，胎龄；婴儿出生体重、身长和头围；分娩/新生儿并发症；婴儿生长和呼吸健康)。这项研究还将检查影响治疗反应的因素(例如，抑郁、压力)。结果将通过后续研究检查(分娩和产后6个月)和医院病历审查来评估。结果应该促进关于促进和维持弱势怀孕妇女戒烟的有效方法的科学知识，并提供支持更大规模随机对照试验所需的初步可行性和有效性数据。

DESCRIPTION (provided by applicant): The long-term goal of this research is to reduce tobacco-related disparities in maternal and infant health outcomes by improving smoking cessation and relapse prevention interventions for minority pregnant and postpartum women, who have been significantly underrepresented in smoking cessation research. This study will examine the feasibility and efficacy of a prize-based contingency management approach for increasing smoking cessation and preventing relapse among socioeconomically disadvantaged minority pregnant smokers. First, the intervention will be pretested with 10 pregnant low-income minority smokers and then refined based on acceptability survey and focus group data. Next, a pilot study will be conducted. 60 highly disadvantaged minority women, recruited from the outpatient obstetric clinics at a large teaching hospital, who report daily smoking and who meet other eligibility criteria (e.g., 18 years or older; < 28 weeks gestational age) will be enrolled ad randomized to one of two study conditions: 1) Standard Psychoeducational Intervention (6- week, individually-administered, pregnancy-specific Quit Smoking Now curriculum, as currently implemented in the clinic; QSN-SP); 2) Standard Psychoeducational Intervention plus Contingency Management (provision of incentives contingent on biochemically-verified abstinence; QSN-CM). Abstinence monitoring via expired carbon monoxide and salivary continues levels will occur in both groups beginning on the first quit day and continuing through 3-months postpartum. Only participants in the QSN-CM group will be reinforced for biochemically-verified abstinence with chances to win prizes ranging in value from approximately $1 to $100 ('fishbowl' or 'prize bowl' method). Primary study outcomes include: intervention attendance and completion; and continuous, prolonged and point prevalence tobacco abstinence (self-report with biochemical verification). Secondary outcomes include: maternal and infant health outcomes (e.g., gestational age; infant birth weight, length and head circumference; delivery/neonatal complications; infant growth and respiratory health). The study will also examine factors (e.g., depression, stress) influencing treatment response. Outcomes will be assessed through follow-up research exams (delivery and 6-months postpartum) and hospital chart reviews. Results should advance scientific knowledge regarding effective methods for promoting and maintaining smoking abstinence among pregnant disadvantaged women and provide preliminary feasibility and efficacy data needed to support a larger randomized controlled trial.