Community Intervention to Reduce Tobacco Use among Pregnant Alaska Native Women

描述（由申请人提供）：为美国印第安人和阿拉斯加原住民在怀孕期间开发有效的戒烟干预措施是国家优先事项，将有助于美国减少与烟草相关的健康差距的公共卫生目标。在阿拉斯加西南地区，该项目将在那里进行，79%的阿拉斯加土著妇女在怀孕期间吸烟或使用无烟烟草（ST）。此外，在怀孕前3个月未使用烟草的妇女中，怀孕似乎是开始使用烟草的高风险时期，主要是性传播感染。我们的试点研究表明，在第一次产前检查时提供的以个人为基础的干预措施对孕妇的影响较低，并且戒烟率较低。针对整个社区（而不仅仅是孕妇）的干预工作可能更有效，以解决有关烟草使用的社会规范问题。因此，我们建议评估一种新颖的、多成分的、基于理论的干预措施的有效性，以减少怀孕期间的烟草使用，包括个体目标和社区层面的成分，由女性长者“土著姐妹”提供。干预措施建立在以有效的社区和个人为基础的戒烟方法和为美洲土著妇女提供预防癌症的健康顾问方法的基础上。作为干预措施的一部分，一项包括数字故事和其他小型媒体在内的社会营销活动将根据社区反馈进行开发。有针对性的部分将是6次30-40分钟的电话或家庭辅导，与孕妇进行。本R01项目是根据PAR-11-346提交的。它将分两个阶段进行。项目的各个方面将由社区咨询委员会指导。在第一阶段，我们将通过获取孕妇、家庭成员和老年人对信息内容和传递渠道的定性反馈，开发社会化营销组件。在第二阶段，我们将使用以村庄为分配单位的组随机设计来评估干预措施。将随机分配16个村庄接受干预或控制条件（常规护理），每个村庄有120名妇女参加。登记将在妊娠试验阳性时进行，这是产前护理的最早阶段，提高了干预的潜力

DESCRIPTION (provided by applicant): Developing effective tobacco cessation interventions during pregnancy for American Indian and Alaska Native people is a national priority and will contribute to the U.S. public health objective of reducing tobacco- related health disparities. In the southwest region of Alaska where the proposed project will take place, 79% of Alaska Native women smoke cigarettes or use smokeless tobacco (ST) during pregnancy. In addition, pregnancy appears to be a high risk period for initiation of tobacco use, primarily ST, among women reporting no use of tobacco 3 months before pregnancy. Our pilot study suggested that an individual-based intervention delivered at the first prenatal visit had low reach to pregnant women and poor tobacco abstinence rates. Intervention efforts targeting the entire community, not only pregnant women, to address social norms about tobacco use may be more effective. Thus, we propose to evaluate the efficacy of a novel, multi-component, theory-based intervention for reducing tobacco use during pregnancy, incorporating both individually targeted and community level components delivered by female elders "Native Sisters." The intervention builds on effective community and individual-based approaches for tobacco cessation and lay health advisor approaches for cancer prevention among Native American women. As part of the intervention, a social marketing campaign including digital stories and other small media will be developed with community feedback. Individually targeted components will be six 30-40 minute telephone or home-based peer counseling sessions with pregnant women. This R01 project is submitted in response to PAR-11-346. It will be conducted in two phases. All aspects of the project will be guided by a community advisory committee. In Phase I, we will develop the social marketing components by obtaining qualitative feedback from pregnant women, family members and elders on message content and delivery channels. In Phase II, we will evaluate the intervention using a group- randomized design with village as the unit of assignment. Sixteen villages will be randomly assigned to receive the intervention or control condition (usual care), with > 20 women enrolled from each village. Enrollment will occur at the time of a positive pregnancy test which is the earliest point of prenatal care, enhancing the intervention's potential reach. Both tobacco users and non-users will be eligible because many start to use during pregnancy. Assessments will be completed by enrolled women through 6 months postpartum. We will evaluate the efficacy of the intervention compared with the control condition on the biochemically confirmed 7-day point prevalence tobacco use rate at week 36 gestation and at 6 months postpartum. We will also examine the effect of the intervention on proposed social cognitive-theory based mediators of change including perceived self-efficacy for non-tobacco use and anti-tobacco norms. Our long term objective is to determine effective interventions for Alaska Native women that will ultimately reduce the risk of tobacco-related maternal, fetal, and infant adverse health outcomes.