Characterizing Nicotine Withdrawal in Pregnant Smokers

描述（由申请人提供）：这是研究资助的第二次也是最后一次修订，旨在描述怀孕吸烟者尼古丁戒断的特征。在美国，孕妇吸烟是导致妊娠结局不佳、儿童发病率和死亡率的主要可预防原因。尽管80%的怀孕吸烟者报告说在怀孕期间认真考虑过戒烟，但大多数人甚至一周都戒不掉。为怀孕期间戒烟制定了有效的干预措施，但戒烟率很低，通常在20%以下。在未怀孕的吸烟者中，尼古丁戒断被认为是在早期吸烟复发中起重要作用的一个因素，并被广泛研究。据我们所知，只有两篇关于怀孕期间尼古丁戒断的报道：Albrecht及其同事（1999）对怀孕青少年的回顾性研究和我们小组最近的前瞻性试点研究（Heil et al, 2006）。考虑到近30年来对怀孕期间戒烟的研究，这在这方面的文献中是一个惊人的差距。我们最初的初步研究产生了两个开创性的发现。首先，我们观察到，怀孕的吸烟者在戒烟前报告的戒断症状水平明显升高。其次，即使有这种戒烟前的提升，我们也能够在持续戒烟5天的怀孕吸烟者中验证一些戒断症状，并确定其发生率，大小和急性时间过程。虽然这是向前迈出的重要一步，但我们的初步研究提出了关于怀孕吸烟者尼古丁戒断症状的额外问题。这两个目的，构成了拟议的研究旨在跟进和扩展在这一领域的文献。首先，我们建议对戒烟前升高的戒断症状进行彻底检查，比较怀孕吸烟者与怀孕非吸烟者和非怀孕女性吸烟者的水平，以阐明症状增加的来源。其次，我们建议对怀孕期间的尼古丁戒断进行更全面和严格的表征，增加样本量并延长我们的试点研究的时间过程。这项拟议的研究将与一项正在进行的临床试验合作，测试基于凭证的激励措施促进怀孕期间戒烟的有效性。作为试验的一部分，我们将分析从戒烟的孕妇中收集的尼古丁戒断数据，并将结果与戒烟的非怀孕女性吸烟者和怀孕非吸烟者的结果进行比较。公共卫生相关性：拟议的研究有可能为孕妇尼古丁戒断提供重要的新信息。这些新知识可能有助于开发更有效的治疗方法，以解决我国最令人生畏的药物滥用问题之一。

DESCRIPTION (provided by applicant): This is the second and final revision of a research grant to characterize nicotine withdrawal in pregnant smokers. Maternal cigarette smoking is the leading preventable cause of poor pregnancy outcomes and pediatric morbidity and mortality in the U.S. While 80% of pregnant cigarette smokers report seriously thinking about quitting while pregnant, most are unable to quit for even one week. Efficacious interventions have been developed for smoking cessation during pregnancy, but cessation rates are low, typically under 20%. One factor thought to play a substantial role in early smoking relapse and extensively investigated in non- pregnant smokers is nicotine withdrawal. To our knowledge, there are only two reports on nicotine withdrawal during pregnancy: a retrospective study in pregnant adolescents by Albrecht and colleagues (1999) and our group's recent prospective pilot study (Heil et al., 2006). Given nearly 30 years of research on smoking cessation during pregnancy, this represents a striking gap in this literature. Our initial pilot study resulted in two seminal findings. First, we observed that pregnant smokers report substantially elevated levels of withdrawal symptomatology prior to the cessation attempt. Second, even with this pre-cessation elevation, we were able to validate a number of withdrawal symptoms in pregnant smokers who sustained abstinence for five days and establish their incidence, magnitude, and acute time course. While a significant step forward, our pilot study raised additional questions about nicotine withdrawal symptomatology in pregnant smokers. The two aims that make up the proposed study are designed to follow up and extend the literature in this area. First, we propose performing a thorough examination of pre- cessation elevated withdrawal symptomatology, comparing levels in pregnant smokers to those in pregnant non-smokers and non-pregnant female smokers in an effort to elucidate the source of the increased symptomatology. Second, we propose performing a more comprehensive and rigorous characterization of nicotine withdrawal during pregnancy, increasing the sample size and lengthening the time course from our pilot study. The proposed study will partner with an ongoing clinical trial testing the efficacy of voucher-based incentives to promote smoking cessation during pregnancy. We will analyze nicotine withdrawal data collected from pregnant women who abstain as part of this trial and compare results to those of abstinent non-pregnant female smokers and pregnant non-smokers. PUBLIC HEALTH RELEVANCE: The proposed study has the potential to contribute important new information about nicotine withdrawal among pregnant women. Such new knowledge may contribute to the development of more effective treatments for one of our nation's most daunting drug abuse problems.