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

DESCRIPTION（由申请人提供）：女性吸烟会导致肺癌、食道癌、喉癌、口腔癌、肾癌、膀胱癌、胰腺癌、胃癌和宫颈癌，以及急性髓性白血病。在美国，吸烟是最昂贵的健康风险行为，也是导致可预防死亡的主要原因。具体到怀孕，吸烟仍然是美国可预防的不良妊娠结果的主要原因。虽然许多妇女能够在怀孕期间戒烟，但产后复吸仍然是一个挑战，高达80%的怀孕期间戒烟的妇女在产后12个月内复吸。目前的指南推荐戒烟药物和咨询。帮助妇女在产后保持禁欲的最有效方法之一是应急管理（CM），或提供财政或其他激励措施，以保持禁欲的人。虽然在围产期妇女使用CM中观察到中等到较大的效果，但这种效果仅在控制良好的临床环境中得到证明，主要是因为目前提供的干预措施需要频繁（平均每周）就诊。虽然办公室访问的持续接触是加强禁欲的潜在进一步来源，但对于一些想要实现和维持禁欲的人来说，这也可能是一种参与的威慑，例如产后妇女，她们有很大的育儿负担。与临床医生和研究人员的频繁（通常每周一次）办公室访问也很难推广到当前的卫生保健系统，这表明需要在临床试验之外和社区环境中更广泛地传播戒烟策略的替代策略。技术的应用有实现的希望

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 financial 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 cancer prevention.