A Smartphone Intervention for Pregnancy Smoking Cessation with Peer Support

项目摘要/摘要 2011-2018年间，罗马尼亚女性吸烟人数急剧增加，增幅接近30% 尝试戒烟的吸烟者比例下降了37%。烟草每年导致800多万人死亡 环游世界的一年。与烟草有关的疾病和死亡的负担在中低收入人群中最重 像罗马尼亚这样的国家(LMIC)，全世界11亿吸烟者中有80%生活在罗马尼亚。我们的工作表明， 在罗马尼亚，30%的女性在怀孕前吸烟，一半的吸烟者在怀孕期间继续吸烟。它是 解决怀孕期间吸烟问题至关重要，这是一个非同寻常的机会之窗 持续停药。此应用程序的目标是开发、实施和测试可行性和 基于深度裁剪的适应性移动戒烟APP干预的有效性 和一名自我提名的支持人员，并在罗马尼亚建设移动健康研究能力。我们建立在我们的 罗马尼亚有配偶支持的怀孕戒烟试验，包括正在进行的无烟 联合(SFT1.0)移动健康试点试验和戒烟电话咨询试验初步显示 有效性的证据，以及我们在罗马尼亚的伙伴关系。核心假设是，干预将 显示在增加积极支持、终止妊娠和 产后禁欲。这款应用程序在使用智能手机的独特功能方面将是新颖的，使用 强化学习(RL)和深度定制以不断适应干预，强调 越来越多的积极支持，吸烟者和戒烟者都使用这款应用程序。目标是：1.(R21 阶段)。开发和测试基于SFT2.0应用程序的移动戒烟的可行性和可接受性 在罗马尼亚，在孕期和产后给予戒除伴侣支持的干预；2.(R33阶段)。测试 基于SFT2.0 APP的戒烟干预效果与实施随机化 对照试验；3.(R21和R33期)。发展移动健康研究能力，提高个人和 加强罗马尼亚的机构研究能力，并扩大现有的国际研究网络。使用 关于预期结果，拟议的应用预计将增进对 一款基于智能手机的戒烟应用程序的有效性和实施 合作伙伴支持。这些结果预计将对整个系统产生可持续的积极影响 预防产前和产后吸烟作为干预措施有很高的潜力在 罗马尼亚的全民医疗体系，适用于美国和其他人口。国际贸易组织的发展 国际研究网络和个人和机构移动健康研究能力建设 预计将对中东欧和邻近地区的移动健康研究产生积极影响。

PROJECT SUMMARY/ABSTRACT Tobacco smoking among women in Romania increased dramatically, by close to 30%, between 2011-2018 and the share of smokers with quit attempts decreased by 37%. Tobacco kills more than 8 million people a year around the world. The burden of tobacco-related illness and death is heaviest in low- and middle-income countries (LMICs) like Romania, where 80% of the worldwide 1.1 billion smokers live. Our work showed that 30% of women smoke pre-pregnancy in Romania and half of the smokers continue during pregnancy. It is critically important to address tobacco smoking during pregnancy, an extraordinary window of opportunity for sustained cessation. The objectives of this application are to develop, implement, and test the feasibility and effectiveness of an adaptive mobile pregnancy tobacco cessation app-based intervention using deep tailoring and a self-nominated support person, and to build mHealth research capacity in Romania. We build on our pregnancy smoking cessation trials with spousal support in Romania, including the ongoing Smoke Free Together (SFT1.0) mHealth pilot trial and the Quit Together telephone counseling trial that shows preliminary evidence of efficacy, and on our partnerships in Romania. The central hypothesis is that the intervention will show evidence of feasibility and effectiveness in increasing positive support, pregnancy cessation, and postnatal abstinence. The app will be novel in its use of the unique functionality of smartphones, use of reinforcement learning (RL) and deep tailoring to continuously adapt the intervention, the emphasis on increasing positive support, and the use of the app by both smoker and quit-partner. The aims are: 1. (R21 phase). Develop and test the feasibility and acceptability of the SFT2.0 app-based mobile smoking cessation intervention with quit-partner support during pregnancy and postpartum in Romania; 2. (R33 phase). Test the SFT2.0 app-based smoking cessation intervention in a hybrid effectiveness and implementation randomized controlled trial; 3. (R21 and R33 phases). Develop mHealth research capacity by enhancing individual and institutional research capabilities in Romania and expanding the existing international research network. With respect to expected outcomes, the proposed application is anticipated to advance understanding of the effectiveness and implementation of a smartphone-based app for pregnancy smoking cessation with quit- partner support. Such results are anticipated to have a system wide sustainable positive impact on the prevention of prenatal and postnatal smoking as the intervention has a high potential to be adopted in the universal health system in Romania, with applications to the US and other populations. The development of the international research network and the individual and institutional mHealth research capacity building is expected to positively impact mHealth research in CEE and the neighboring region.