Perinatal Attentional Retraining Intervention for Smoking (PARIS) for Minority Women

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ABSTRACT Racial and ethnic minorities and women experience a disproportionate burden of smoking-related diseases, including cancer and heart disease. Maternal smoking is the leading cause of cancer mortality in the mother, and is associated with adverse pregnancy outcomes and increased infant morbidity and mortality. This further compounds the disparities in adverse birth outcomes experienced by racial and ethnic minorities. Nearly half of women who smoke prior to pregnancy achieve abstinence during pregnancy. Unfortunately, nearly 80% of abstinent women relapse within a year after delivery. Despite considerable study, there are few strategies that effectively combat smoking relapse in this population. This is especially true for minority women who are less likely to receive treatment and more likely to relapse to smoking postpartum than non-Hispanic whites. Smokers exhibit an “attention bias” for smoking-related cues. Attentional bias plays a role in the maintenance or escalation of smoking by increasing subjective cravings and directly affecting cigarette seeking behavior. Attentional retraining (AR) using the visual probe task has been used experimentally to reduce attentional bias and blunt cue-provoked craving. Stress and negative affect are considered major drivers of relapse, especially in women. AR is effective at attenuating anxiety related to transition stress, such as that experienced by women postpartum. The overarching goal of this pilot project is to test a novel technique, the use of smartphones to administer AR, as an intervention for smoking relapse prevention in postpartum women. AR will target both smoking cues and stress cues. We will assess whether AR reduces attentional bias, blunts cue-provoking smoking cravings after delivery, attenuates stress, and reduces smoking lapses. We propose to randomize 50 abstinent pregnant African American and/or Hispanic smokers to receive either the AR or control visual probe task. Participants will be asked to carry around a smartphone as they go about their daily lives for 2 weeks in their last month of pregnancy. The smartphone will sound an alert randomly during the day, at which time participants will be asked to respond to a short set of questions assessing subjective states; this will be followed by a request to complete the AR (or control) procedures. This same procedure will be repeated for 2 weeks in the first postpartum month. Outcome measures include attentional bias for smoking and stress stimuli, self-reported craving and perceived stress, and percentage of days and number of cigarettes smoked during the trial. This application is designed to confirm the feasibility and process parameters of the study, and obtain preliminary data on the efficacy of the intervention and the components that comprise the intervention. If AR shows promise as a treatment, it will be tested in a larger randomized controlled trial. The proposed project is a novel intervention for postpartum minority women that builds on the naturally occurring period of abstinence, and has the potential to consolidate and extend abstinence beyond pregnancy.