Community Intervention to Reduce Tobacco Use among Pregnant Alaska Native Women

减少阿拉斯加原住民孕妇烟草使用的社区干预

• 批准号: 8878201
• 负责人: Christi A Patten
• 金额: $ 17.64万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-07-01 至 2016-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8878201
• 关键词: Address; Advisory Committees; Alaska; Alaska Native; American Indian and Alaska Native; American Indians; Cause of Death; Cessation of life; Communities; Counseling; Elderly; Enrollment; Family member; Feedback; Female; Focus Groups; Health; Home environment; Individual; Infant; Intervention; Interview; Malignant Neoplasms; Malignant neoplasm of lung; Mediating; Mediator of activation protein; Native Americans; Native-Born; Outcome; Phase; Pilot Projects; Postpartum Period; Pregnancy; Pregnancy Tests; Pregnant Women; Prenatal care; Prevalence; Public Health; Randomized; Relapse; Reporting; Risk; Role; Self Efficacy; Sister; Smokeless Tobacco; Social Marketing; Telephone; Testing; Time; Tobacco; Tobacco Use Cessation; Tobacco use; Treatment Efficacy; Visit; Woman; Work; Yukon-Kuskokwim Delta; base; cancer prevention; cigarette smoking; community intervention; design; digital; effective intervention; fetal; fetal tobacco exposure; health disparity; high risk; intervention effect; member; men; native elder; novel; peer; pregnant; prenatal; reduce tobacco use; response; smoking cessation; social cognitive theory; social norm; theories; tobacco abstinence; tobacco control; treatment as usual

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.

描述(由申请人提供)：为美国印第安人和阿拉斯加原住民开发有效的孕期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。在计划实施该项目的阿拉斯加西南部地区，79%的阿拉斯加原住民妇女在怀孕期间吸烟或使用无烟烟草。此外，怀孕似乎是开始使用烟草的高危时期，主要是在怀孕前3个月报告不使用烟草的妇女中。我们的初步研究表明，在第一次产前访问时提供的以个人为基础的干预措施对孕妇的覆盖率较低，戒烟率较低。针对整个社区而不仅仅是孕妇的干预努力，可能会更有效地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、以理论为基础的干预措施，以减少怀孕期间的烟草使用，包括由女性长老“土著姐妹”提供的个人目标和社区层面的干预措施。该干预措施建立在有效的社区和基于个人的戒烟方法基础上，并为美洲原住民妇女的癌症预防提供健康顾问方法。作为干预措施的一部分，将开展一项社会营销活动，包括数字故事和其他小型媒体，并提供社区反馈。个别目标部分将是与孕妇进行六次30-40分钟的电话或家庭同伴咨询会议。本R01项目是根据PAR-11-346提交的。它将分两个阶段进行。该项目的所有方面都将由一个社区咨询委员会指导。在第一阶段，我们会从孕妇、家庭成员和长者那里收集有关讯息内容和传递渠道的优质反馈，从而发展社交营销部分。在第二阶段，我们将使用以村庄为单位的分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(通常护理)，每个村庄招募20名妇女。登记将在孕检阳性时进行，这是产前护理的最早点，增强了干预的潜力 伸手。吸烟者和非吸烟者都有资格，因为许多人是在怀孕期间开始吸烟的。评估将由登记的妇女在产后6个月内完成。我们将评估干预措施与对照条件对生化确诊的7天点流行率、妊娠36周和产后6个月的吸烟率的影响。我们还将检查干预对拟议的基于社会认知理论的变化中介的影响，包括对非烟草使用和反烟草规范的自我效能感知。我们的长期目标是为阿拉斯加土著妇女确定有效的干预措施，最终降低与烟草相关的孕产妇、胎儿和婴儿不良健康后果的风险。