Smoking Resumption-Prevention in Postpartum Women

描述（由申请人提供）：大多数在怀孕期间戒烟的妇女在产后恢复吸烟。以前的复发预防项目的结果令人失望。建议的干预措施通过从多个风险维度评估妇女，创建风险概况，将妇女分类到适当的干预强度水平，将干预与妇女的风险相匹配，在产后10个月继续干预，并将妇女转介到社区资源，解决了以前项目的局限性。在本研究中，我们将：A)评估我们的干预措施延迟或防止妇女产后重新吸烟的效果，b)探索风险因素（依赖性、准备度、自我效能、感觉厌恶、为胎儿停止吸烟、伴侣吸烟、抑郁和体重问题）对产后吸烟的相对贡献，c)描述风险因素变化的自然过程，d)描述发生戒断或恢复的环境，e)估计干预交付的成本。将进行两组随机试验。样本将是450名18岁或以上的孕妇，她们来自北卡罗来纳州的两个地方，在怀孕期间戒烟。在怀孕28至32周期间，将对妇女进行风险因素筛查，并将其分类到四个级别的阶梯式护理之一，其中包括一次面对面咨询会议和怀孕期间至少一次电话会议，以及产后10个月以上的7至12次电话会议。自我决定理论、社会认知理论、跨理论模型和复发预防理论的概念将指导干预策略，包括动机性访谈、增强自我效能、预测和规划高风险养育和社会情境，以及药物治疗的使用。随机分配到对照组的妇女将接受复发预防小册子和常规护理。在基线、产后6周、产后6个月和产后12个月收集吸烟状况和风险变量的定量数据，在产后12个月收集定性数据。生存曲线分析将用于确定首次复吸时间的主要转归。有效的恢复预防干预将使我们朝着2010年妇女健康人群烟草目标迈进。公共卫生相关性：怀孕是许多妇女戒烟的时期；然而，许多人在孩子出生后又重新吸烟。为防止这种重新吸烟而制定的计划并不是很有效。我们建议测试一个项目，其强度与女性的特点相匹配，以帮助推迟或防止吸烟。我们的总体目标是帮助在怀孕期间戒烟的妇女成为终身不吸烟者。

DESCRIPTION (provided by applicant): The majority of women who stop smoking during pregnancy resume postpartum. Previous relapse prevention programs have had disappointing results. The proposed intervention addresses the limitations of previous programs by assessing women on multiple risk dimensions, creating a risk profile, triaging women to an appropriate level of intervention intensity, matching the intervention to women's risks, continuing the intervention for 10 months postpartum, and referring women to community resources. In this study we will: a) evaluate the efficacy of our intervention to delay or prevent women's return to smoking postpartum, b) explore the relative contribution of risk factors (dependence, readiness, self efficacy, sensory aversion, stopped for the fetus, partner smoking, depression, and weight concerns) to postpartum smoking, c) describe the natural course of change of risk factors, d) describe the context in which abstinence or resumption occurs and, e) estimate the costs of intervention delivery. A two arm randomized trial will be conducted. The sample will be 450 pregnant women age 18 or older from two North Carolina sites who stopped smoking during pregnancy. Women will be screened abut their risk factors between 28 and 32 weeks of pregnancy and triaged to one of four levels of stepped care that includes one in person counseling session and at least one telephone session during pregnancy and from 7 12 telephone sessions over 10 months postpartum. Concepts from the self determination theory, social cognitive theory, transtheoretical model, and relapse prevention theory that are relevant for the transition from pregnancy to postpartum will guide the intervention strategies that include motivational interviewing, enhancing self efficacy, anticipating and planning for high risk parenting and social situations, and the use of pharmacotherapies. Women randomized to the control arm will receive a relapse prevention booklet and usual care. Quantitative data on smoking status and risk variables will be collected at baseline, 6 weeks and 6 and 12 month postpartum and qualitative data will be collected at 12 months. Survival curve analysis will be used to determine the primary outcome of time to first smoking resumption. An efficacious resumption prevention intervention will move us toward the Healthy People 2010 tobacco goals for women. PUBLIC HEALTH RELEVANCE: Pregnancy is a time when many women quit smoking; however, many return to smoking after the baby is born. Programs developed to prevent this return to smoking have not been very effective. We are proposing to test a program whose intensity is matched to women's characteristics to help delay or prevent return to smoking. Our overall goal is to help women who quit smoking during pregnancy become lifetime nonsmokers.