SMS scheduled gradual reduction text messages to help pregnant smokers quit

怀孕期间吸烟会给胎儿和母亲带来严重的健康风险。不幸的是，大约一半的妇女在怀孕后继续吸烟；这一比率在过去十年中并没有显著下降。显然需要有效的干预措施。令人鼓舞的是，大多数女性在得知自己怀孕后减少了吸烟，而且大多数人都表示希望通过减少吸烟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。有计划的逐渐减少（SGR）可能是促进孕妇戒烟的有效方法。与认知行为咨询一起，SGR已被证明可以帮助未怀孕的吸烟者戒烟，而不是突然停止或自我断奶的方法。理想情况下，SGR可以通过像短信这样的方式传递，大多数怀孕的吸烟者都很熟悉。我们的试点工作显示了SGR + CBT方案的可行性、可接受性和初步效果。这项工作的最终产品将是一个可传播的、准备实施的程序。这项为期五年的研究旨在评估SGR + CBT通过短信在不同种族的怀孕吸烟者中促进戒烟的效果。建议采用双臂随机对照设计。符合条件的孕妇（N=522，每组261）将被随机分配到：第1组，通过短信短信加短信支持信息和自助材料进行SGR (N= 261)；第2组，短信支持信息和自助材料（N= 261）。主要结果测量是在怀孕结束时经生化验证的7天点普遍禁欲。次要结局是妊娠末期长期戒烟、妊娠期间经生化验证的减少吸烟、产后3个月戒烟和早产。这个项目的意义在于，目前还没有容易传播的有效项目来帮助孕妇戒烟。一种自动定制的短信干预有望惠及许多孕妇，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.