A Computer-Assisted Brief Motivational Intervention for Smoking During Pregnancy

简介(申请人提供)：：背景。在美国，大约12%的孕妇在怀孕期间使用烟草产品(应用研究办公室，2004年；美国卫生与公众服务部，2003年)。孕期吸烟与广泛的负面影响有关，有强有力的证据表明死产、早产、胎龄偏小、婴儿延长住院和婴儿猝死的风险增加(Cnattingius，2004年)。尽管基于初级保健的行为干预在产前阶段有明显的效果，但多重障碍--包括时间限制、报销、意愿和培训--阻碍了此类干预措施的充分采用。目标。这项R21探索性/发展阶段I和早期阶段II研究将开发两种有效干预方法的简化的、基于计算机的版本，以增加它们的可行性、可复制性和可达性。方法。这项研究将制定(A)以计算机为基础的对孕期吸烟的简短干预，包括与计算机和计算机生成的量身定制的邮件的单一互动会话；(B)高度简化和计算机辅助的应急管理(CM)干预(加强了只有在产前检查时才提供不含可替宁的尿液，并且仅为那些要求提供样本的人提供尿液)。在基于专家和参与者反馈的迭代开发之后，我们将进行第一阶段临床试验，旨在评估修改后的干预措施的可行性和可接受性，并提供效果大小估计。报告在怀孕期间每天吸烟超过5支的非裔美国女性(N=160)将被随机分配到单独使用电脑的短暂干预、单独的CM、短暂干预加CM，或者在注意力控制条件下进行为期12周的基于实验室的随访。主要的结局测量将是后续尿可替宁验证的禁欲；出生结局数据也将被收集。讨论和公共卫生相关性。这项研究是朝着一种高成本效益、可复制、实用和规范的方法迈出的第一步，以减少孕妇的烟草使用。希望这样一个简化的计算机系统将促进产前诊所广泛采用有效的戒烟活动。

DESCRIPTION (provided by applicant): : BACKGROUND. Approximately 12% of pregnant women in the United States use tobacco products throughout pregnancy (Office of Applied Studies, 2004; U.S. Department of Health and Human Services, 2003). Smoking during pregnancy is associated with a wide range of negative effects, with strong evidence for increased risk of stillbirth, preterm birth, small size for gestational age, extended hospitalization of the infant, and SIDS (Cnattingius, 2004). Despite the clear efficacy of primary care-based behavioral interventions during the prenatal period, multiple obstacles?including limitations in time, reimbursement, willingness, and training?have prevented adequate adoption of such interventions. GOALS. This R21 exploratory/developmental Stage I and early Stage II study will develop simplified, computer-based versions of two efficacious intervention approaches in order to increase their feasibility, replicability, and reach. METHOD. This study will develop (a) a computer-based brief intervention for smoking during pregnancy, consisting of a single interactive session with the computer and computer-generated tailored mailings; and (b) a highly simplified and computer-assisted Contingency Management (CM) intervention (with reinforcement for cotinine-free urine being provided only at prenatal visits, and only for those who ask to provide a sample). Following iterative development based on expert and participant feedback, we will conduct a Phase I clinical trial designed to evaluate the feasibility and acceptability of the modified interventions, as well as to provide effect size estimates. African-American women (N = 160) who report smoking more than five cigarettes a day during pregnancy will be randomly assigned to computer-based brief intervention alone, CM alone, brief intervention plus CM, or attention control conditions with a 12-week lab-based follow-up. The primary outcome measure will be urinary cotinine-verified abstinence at follow-up; birth outcome data will also be collected. DISCUSSION AND PUBLIC HEALTH RELEVANCE. This study is the first step towards what could prove to be a highly cost-effective, replicable, practical, and prescriptive method for decreasing tobacco use among pregnant women. It is hoped that such a simplified, computer- based system will promote the widespread adoption of effective smoking cessation activities in prenatal clinics.