SMOKING INTERVENTIONS FOR LOW INCOME PREGNANT WOMEN

这个为期五年的示范和教育项目，提供商提供 吸烟干预项目+(PDSIP+)将实施和评估 多组分干预对戒烟效果的影响 文化多样性、社会经济弱势群体的维持率 孕妇(西班牙裔、美国黑人和高加索人)参加 妇女、婴儿和儿童(WIC)补充营养计划。三 提供者渠道将提供干预：L)WLC营养师 孕期和产后；2)产科医生(OB)和诊所工作人员 怀孕期间；3)儿科医生(PED)和诊所工作人员在 产后。以患者为中心、既省时又密集的干预 将使用协议。这种干预以前已经证明过了 全科内科医生和家庭医生使用时有效 有大量吸烟者，并可供WIC使用 营养学家。三个配对的马萨诸塞州WIC站点及其相关OB 和社区卫生中心内的儿科诊所将随机分配到 特殊干预(SI)或常规护理(UC)。SI站点将收到 在培训中以患者为中心进行干预，并建立办公室 支持干预的实践管理系统，包括 三个干预传递渠道的联结系统。统一通信站点 不会受到任何干预。 在三个SI站点中，每个站点都将进行组织评估 完成后，将成立健康中心运营委员会，以量身定做 在每个站点实施干预。然后，每个SI 提供商渠道(WLC、OB和PED)将接受干预培训 由一个有组织的小组计划和简短的个人跟踪组成 会话。书面问卷将在SI和UC的基线上完成 在SI提供商的培训后，并在一年内跟踪 SL和LC提供商。提供商对干预措施的遵守将是 通过患者退出访谈(SI和UC中的WIC提供商)衡量，图表 审计(仅限SI)和患者访谈中的回溯性患者报告。 符合条件的孕妇将在WLC期间进行基线面试 注册访问。涉及吸烟状况(包括唾液)的简短评估 报告的戒断的可替宁确认)、改变的阶段和报告 提供者的干预行为将发生在怀孕9个月时，3- 产后9个月。更全面的评估将是 在L产后6个月进行。维持停工和停工 总体无烟率将在每个评估点确定。这个 这项研究的结果将证明 链接提供者的多组件方案，这是可行的和 可概括到为低收入者服务的其他行为和其他环境， 多文化孕妇。

This five year Demonstration and Education project, the Provider-Delivered Smoking Intervention Project Plus (PDSIP+), will implement and evaluate the effect of a multicomponent intervention on the smoking cessation and maintenance rates of culturally-diverse, socioeconomically-disadvantaged, pregnant women (Hispanic, Black American and Caucasian) enrolled in the Women, Infants and Children (WIC) supplemental nutrition program. Three provider channels will deliver the interventions: l) WlC nutritionists during pregnancy and postpartum; 2) obstetricians (OB) and clinic staffs during pregnancy; and 3) pediatricians (PED) and clinic staffs during postpartum. A time-efficient yet intensive patient-centered intervention protocol will be used. This intervention has been previously demonstrated to be efficacious when used by general internists and family practitioners with a general population of smokers, and to be usable by WIC nutritionists. Three paired Massachusetts WIC sites and their related OB and PED clinics within Community Health Centers will be randomized to special intervention (SI) or usual care (UC). SI sites will receive training in the patient-Centered intervention, and establish an office practice management system to support intervention, which includes a system for linking the three channels of intervention delivery. UC sites will receive no intervention. In each of the three SI sites, an organizational assessment will be completed, a Health Center Operations Board will be established to tailor implementation of the intervention in each site. Then each of the SI provider channels (WlC, OB and PED) will receive intervention training consisting of a structured group program with brief individual followup sessions. Written questionnaires will be done at baseline of SI and UC providers at post-training of SI providers, and at one year followup of both Sl and LC providers. Provider adherence to the intervention will be measured by patient exit interviews (WIC providers in SI and UC), chart audit (SI only) and retrospective patient report in patient interviews. Eligible pregnant women will have a baseline interview during their WlC enrollment visit. A brief assessment involving smoking status (with saliva cotinine validation of reported cessation), stage of change and report of provider intervention behavior will occur at ninth month of pregnancy, 3- and 9-months postpartum. A more comprehensive assessment will be conducted at l- and 6-months postpartum. Maintenance of cessation and overall non-smoking rates will be determined at each assessment point. The results of this study will demonstrate the effectiveness of a multicomponent program of linked providers, which is feasible and generalizable to other behaviors and other settings serving low-income, multicultural pregnant women.