SCH: INT: Harnessing the Power of Technology: MOMBA for Postpartum Smoking

 描述(申请人提供)：女性吸烟会导致肺癌、食道癌、喉癌、喉癌、肾癌、膀胱癌、胰腺癌、胃癌和子宫颈癌，以及急性髓系白血病。在美国，吸烟是代价最高的健康风险行为，也是可预防的死亡的主要原因。具体到怀孕，吸烟仍然是美国可预防的不良妊娠结局的主要原因。虽然许多女性能够在怀孕期间获得戒烟，但产后再次吸烟仍然是一个挑战，高达80%的怀孕期间戒烟的女性在产后12个月内复发。目前的指导方针建议戒烟时使用药物和咨询。帮助妇女在产后保持节欲的最有效方法之一是应急管理(CM)，即为保持节欲向人们提供财政或其他激励措施。虽然在围产期妇女使用CM时观察到了中到大的效果，但这种效果只在受控良好的临床环境中得到证明，主要是因为目前的干预需要频繁(平均每周一次)到办公室就诊。虽然正在进行的办公室访问接触是进一步加强禁欲的潜在来源，但对于一些希望实现和维持禁欲的人来说，这也可能是参与的一种威慑，例如有大量育儿负担的产后妇女。与临床医生和研究人员频繁的、通常是每周一次的办公室访问也很难推广到当前的医疗保健系统，这表明有必要采取替代战略，在临床试验之外和社区环境中更广泛地传播戒烟策略。技术的利用有望实现 这个目标。我们将为这一应用开发的技术干预包括金融激励措施，即通过名为“Momba Smoking”的智能手机应用程序提供的“应急管理”，以及旨在与智能手机无线接口以测量呼气一氧化碳的一氧化碳传感器。这一应用程序与NCI的使命和优先事项直接相关，以提高癌症预防方面的效率和推出新的临床试验。 吸烟是癌症和癌症死亡的主要原因。这一应用程序建议通过使用技术和传感器，将帮助妇女在产后期间保持戒烟状态(应急管理)的最有效干预措施之一从临床环境转换到社区环境。这项创新的临床试验直接符合NCI的使命和优先事项，即提高临床试验的效率和启动，并以有效和富有想象力的形式利用新的干预研究。

 DESCRIPTION (provided by applicant): Smoking in women causes cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, pancreas, stomach, and cervix, as well as acute myeloid leukemia. Smoking is the single most costly health risk behavior and the leading cause of preventable death in the United States. Specific to pregnancy, smoking remains the leading cause of preventable poor pregnancy outcomes in the United States. While many women are able to obtain abstinence in pregnancy, relapse to smoking postnatally remains a challenge, with up to 80% of women who stop smoking in pregnancy relapsing within 12 months postpartum. Current guidelines recommend medications and counseling for smoking cessation. One of the most effective methods to assist women in remaining abstinent in the postpartum period is contingency management (CM), or the provision of financial or other incentives to people for remaining abstinent. Although moderate to large effect sizes have been observed in the use of CM with perinatal women, this efficacy has been demonstrated only in well-controlled clinical settings, largely because the intervention, as currently delivered, requires frequent (on average, weekly) office visits. While the ongoing contact of office visits is a potential further source of reinforcement for abstinence, it may also be a deterrent to participation for some who would like to achieve and sustain abstinence, such as postpartum women who have a substantial childcare burden. Frequent, usually weekly, office visits with clinicians and study personnel are also difficult to generalize to the current health care system suggesting the need for alternative strategies to more widely disseminate smoking cessation strategies outside of clinical trials and into community settings. The utilization of technology holds promise to achieve this goal. The technological intervention we will develop for this application consists of financia incentives, termed "contingency management" delivered via a smartphone application named 'Momba Smoking' and a carbon monoxide sensor designed to interface wirelessly with a smartphone to measure breath carbon monoxide. This application aligns is directly related to NCI's mission and priorities to improve the efficiency and launch of novel clinical trials in cance prevention. Smoking is a leading cause of cancer and death from cancer. This application proposes to translate one of the most effective interventions to assist women in remaining abstinent to smoking in the postpartum period (contingency management) from clinical to community settings through the use of technology and sensors. This innovative clinical trial directly aligns with NCI's mission and priorities to improve the efficiency and launch of clinical trials and to utilize new research on interventions in effective and imaginative forms.