Smokeless Tobacco Use and Reproductive Health Among Married Women in a Low-income

描述（由申请人提供）：这份题为“孟买低收入社区妇女使用者的无烟烟草使用和生殖健康”的FIRCA申请，旨在探索印度妇女在育龄期越来越多地使用新型和高度成瘾性的无烟烟草。印度妇女使用无烟烟草的人数急剧增加，并已证明会造成生殖健康问题，包括（低收入）印度妇女的早产、出生体重过低、死胎和孕产妇发病率。这项研究将由dr。孟买国家生殖健康研究所的科学家Saritha Nair和副所长兼科学家Donta Balaiah，是NIH资助号1 R01 DA020393-01A2的延伸。这项研究的五个目标是：1)对孟买西部一个大型低收入/贫民窟地区的90名妇女和20名社区专家进行定性研究，研究在生育史的三个阶段，婚后立即，第一次（或第二次）怀孕期间以及第二次和第四次怀孕期间，无烟烟草的含义和做法。2)了解SL在低收入女性中的营销、推广和可用性；3)对孟买西部一个低收入/贫民窟地区的400名妇女进行调查，该地区已知接受预防研究，每个生殖健康类别约有125名妇女。4)利用数据产生和评估社会对研究社区妇女和其他受无烟烟草使用影响的人的干预方法的可接受性；5)通过开展定性研究方法、烟草对孕前、孕后和孕期发病率和死亡率的影响以及提案制定方面的能力建设培训，提高伙伴组织印度国家烟草健康研究所就印度无烟烟草和生殖健康问题开展社会和行为干预研究的能力。拟议的研究将有助于在文化和背景上适当的干预措施，重点关注孟买低收入社区妇女的无烟烟草预防和戒烟。该研究的顾问将包括P.C. Gupta博士，国际公认的印度烟草使用/控制专家以及烟草使用、怀孕和女性发病率和死亡率专家，Stephen Schensul博士，以及在类似社区进行生活压力（tenshun）、感知生殖健康症状（kamjori和safed pani）、婚姻冲突和性传播感染/艾滋病毒风险干预研究的合作伙伴。每年将根据主题增加其他印度和美国顾问参加能力建设研讨会。这项研究的意义在于，它能够解决印度一个关键的公共卫生问题，即危险和令人上瘾的新型无烟烟草明显增加，可能对妇女的怀孕、发病率和死亡率产生严重影响，并为采取教育和其他形式的适当干预措施提供依据，以减少育龄妇女使用无烟烟草，这种做法与她们生活的其他方面交织在一起。公共卫生相关性：本研究解决了印度特有的一个重大公共卫生问题，即生活在低收入城市社区的妇女越来越多地使用危险和成瘾形式的无烟烟草。开展研究的新方法，以突出影响育龄妇女使用无烟烟草的文化和背景因素，将有助于在印度背景下制定符合情况和文化的干预措施，并有助于制定可应用于美国不同无烟烟草使用者社区的多层次方法

DESCRIPTION (provided by applicant): This FIRCA application entitled "Smokeless Tobacco Use And Reproductive Health Among Women Users In A Low Income Community Of Mumbai" proposes to explore the use of new and highly addictive forms of smokeless tobacco increasingly used by Indian women during their reproductive years. Smokeless tobacco use is increasing dramatically among women in India and has been shown to contribute to reproductive health problems including premature birth, low birth weight, still birth and maternal morbidity among (low income) Indian women. The study will be conducted with Drs. Saritha Nair, Scientist and Donta Balaiah, Deputy Director and Scientist, National Institute for Research on Reproductive Health, Mumbai and is an extension of NIH Grant number 1 R01 DA020393-01A2. The five study aims are: 1) to conduct qualitative research with a sample of 90 women and 20 community experts in one large low income/slum area of Western Mumbai on the meanings, and practices associated with smokeless tobacco during three stages in reproductive history, immediately post marriage, during first (or second) pregnancy, and between 2nd and 4th pregnancy. 2) to understand marketing, promotion and availability of SL to low income women; 3) to conduct a survey with 400 women in one low income/slum area of western Mumbai known to be receptive to prevention studies, approximately 125 in each reproductive health category. 4) to use data to generate and evaluate social acceptability of intervention approaches with women in the study community and others affected by smokeless tobacco use: 5) to increase capacity of NIRRH, the partner organization, to conduct social and behavioral intervention research on smokeless tobacco and reproductive health issues in India through capacity building training on qualitative research methods, tobacco's implications for morbidity and mortality prior to, after and during pregnancy and proposal development. The proposed research will contribute to culturally and contextually appropriate interventions focused on smokeless tobacco prevention and cessation among women in low income communities of Mumbai. Consultants to the study will include P.C. Gupta, Ph.D. internationally recognized expert on tobacco use/control in India and tobacco use, pregnancy and female morbidity and mortality, Stephen Schensul, Ph.D., and partners conducting intervention research in a similar community on life stress (tenshun), perceived reproductive health symptoms (kamjori and safed pani) marital conflict and STI/HIV risk. Other Indian and U.S. consultants will be added to capacity building workshops each year based on topic. Significance lies in the study's capacity to address a critical public health problem in India, the apparent increase in risky and addictive new forms of smokeless tobacco with potentially serious implications for pregnancy and morbidity and mortality of women, and to provide the basis for educational and other forms of appropriate intervention to reduce smokeless tobacco use, a practice intertwined with other aspects of their lives, among women of reproductive age. PUBLIC HEALTH RELEVANCE: This study addresses a significant public health problem unique to the Indian context, the growing use of dangerous and addictive forms of smokeless tobacco among women living in low-income urban communities. New ways of conducting research to highlight the cultural and contextual factors contributing to smokeless tobacco use among women of reproductive age will contribute to the development of situationally and culturally appropriate interventions in the India context, and to multilevel approaches that can be applied to diverse communities of smokeless tobacco users in the U.S.