SMOKING INTERVENTIONS FOR LOW INCOME PREGNANT WOMEN

这个为期五年的示范和教育项目， 吸烟干预项目+（PDSIP+）将实施和评估 多组分干预对戒烟的影响， 文化多样性、社会经济处境不利、 孕妇（西班牙裔、美国黑人和高加索人）参加了 妇女、婴儿和儿童补充营养方案。 三 供应商渠道将提供干预措施：l）WIC营养师 在怀孕期间和产后; 2）产科医生（OB）和诊所工作人员 在怀孕期间;和3）儿科医生（PED）和诊所工作人员在 产后一个时间效率高，但密集的以患者为中心的干预 协议将被使用。这种干预之前已经得到证实 当被普通内科医生和家庭医生使用时， 适用于一般吸烟人群，并可供WIC使用 营养学家三个成对的马萨诸塞州WIC站点及其相关OB 社区卫生中心内的PED诊所将被随机分配到 特殊干预（SI）或常规护理（UC）。SI研究中心将收到 培训以病人为中心的干预措施，并建立一个办公室 实践管理系统，以支持干预，其中包括 建立一个连接三个干预提供渠道的系统。UC研究中心 不会受到任何干预。 在三个SI站点中的每一个站点，将进行组织评估， 完成后，将建立一个健康中心运营委员会， 在每个站点实施干预措施。每个SI 提供者渠道（WlC、OB和PED）将接受干预培训 包括一个结构化的小组计划， sessions.将在SI和UC基线时进行书面问卷调查 在SI提供者的培训后，以及对 SI和LC提供商。提供者对干预的依从性将是 通过患者离职面谈（SI和UC的WIC提供者）测量，图表 稽查（仅限SI）和患者访谈中的回顾性患者报告。 符合条件的孕妇将在其WLC期间进行基线访谈 入组访视涉及吸烟状况的简要评估（用唾液 可替宁验证报告的停止），变更阶段和报告 提供者干预行为将发生在怀孕第九个月，3- 产后9个月。 更全面的评估将是 在产后1个月和6个月进行。维持停火和 在每个评估点，将确定总体不吸烟率。的 这项研究的结果将证明一个有效的 链接供应商的多组件程序，这是可行的， 可推广到其他行为和其他为低收入服务的环境， 多元文化孕妇

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.