SMS scheduled gradual reduction text messages to help pregnant smokers quit

怀孕期间吸烟对胎儿和母亲的健康构成严重威胁。不幸的是，大约一半的妇女在怀孕时继续吸烟;这一比例在过去十年中没有显著下降。显然需要有效的干预。有希望的是，大多数女性在得知怀孕后会减少吸烟，并且大多数人报告希望通过减少而不是突然戒烟来戒烟。然而，自我断奶往往是无效的，并破坏了完全戒烟的努力。计划逐步减量（SGR）可能是促进孕妇戒烟的有效方法。SGR，沿着认知行为咨询，已被证明可以帮助非怀孕吸烟者戒烟，而不是冷火鸡或自我断奶方法。SGR可能理想地通过SMS短信等方法传递，大多数怀孕吸烟者都熟悉这种方法。我们的试点工作显示了SGR + CBT项目的可行性、可接受性和初步疗效。这项工作的最终产品将是一个可传播的、随时可以实施的方案。这项为期五年的研究旨在评估SGR加CBT通过短信在促进不同种族的怀孕吸烟者样本中戒烟的有效性。拟定为两组随机对照设计。合格的妊娠女性（每组N=522，261）将被随机分配至：第1组，通过短信+短信支持信息和自助材料进行SGR（n=261）或第2组，短信支持信息和自助材料（n=261）。主要的结局指标是在妊娠结束时经生化验证的7天点普遍禁欲。次要结局是妊娠结束时的长期戒烟，妊娠期间经生物化学验证的吸烟减少，产后3个月的戒烟和早产。该项目的意义在于，目前还没有一个易于推广的有效方案来帮助孕妇戒烟。一项自动化的、量身定制的短信干预措施有望覆盖许多孕妇，并减少怀孕期间的吸烟。

Smoking in pregnancy poses serious health risks to the fetus and mother. Unfortunately, about half of women continue to smoke when becoming pregnant; this rate has not decreased significantly in the past decade. Effective interventions clearly are needed. Promisingly, most women reduce smoking when learning of their pregnancy, and most report desiring to quit via reduction rather than cold turkey. However, self-weaning often is ineffective and undermines total cessation efforts. Scheduled gradual reduction (SGR) might be an effective way to promote cessation among pregnant women. SGR, along with cognitive behavioral counseling, has been shown to help non-pregnant smokers quit above cold turkey or self-weaning methods. SGR might be ideally delivered via a method like SMS text messaging, with which most pregnant smokers are familiar. Our pilot work shows feasibility, acceptability, and preliminary efficacy of this SGR + CBT program. The end product of this work would a disseminable ready-to-be-implemented program. The proposed five-year study is designed to evaluate the efficacy of SGR plus CBT via SMS text messaging in promoting smoking cessation among a racially diverse sample of pregnant smokers. Proposed is a two-arm randomized controlled design. Eligible pregnant women (N=522, 261 per arm) will be randomized to: Arm 1, SGR via SMS text messaging plus SMS Support Messages and self-help materials (n=261) or Arm 2, SMS Support Messages and self-help materials (n=261). The primary outcome measure is biochemically validated 7-day point prevalent abstinence at the end of pregnancy. Secondary outcomes are prolonged abstinence at the end of pregnancy, biochemically-validated smoking reduction during pregnancy, smoking abstinence at 3-months postpartum, and preterm birth. The significance of this project is that no easily disseminable effective programs exist to help pregnant women quit smoking. An automated, tailored text messaging intervention shows promise to reach many pregnant women and reduce smoking during pregnancy.