Mobile behavioral intervention to reduce maternal drinking in South Africa

项目总结/摘要 本申请建议开发和测试一种基于技术的行为干预，以解决 南非产妇饮酒情况（SA）。南非的人均酒精消费率最高， 它是世界上最高的终身疾病之一，称为胎儿酒精谱 疾病（FASD）。产前饮酒往往与暴露于基于性别的暴力有关， 由于COVID-19的不确定性和经济影响，基于性别的暴力增加是一个主要原因， 关心最近的证据还表明，哺乳期饮酒会严重损害儿童的健康。 通过母乳喂养接触酒精的儿童的发育，以及产后 母乳喂养时饮酒与产前酒精暴露无关。平均母乳喂养 持续时间超过1年，超过40%的母亲有或没有产前饮酒史， 报告母乳喂养时饮酒。以社区为基础的行为干预， 管理有助于减少产前酒精使用，但劳动密集型，挑战的可行性， 在经济困难的社区广泛实施，特别是在COVID-19期间 社会接触有限的流行病。一种有效的行为干预，以减少酒精的使用， 妊娠和哺乳期需要制定经济上可接受和可行的方案， 弱势群体、交通不便的妇女或在COVID-19大流行期间 社交接触有限。拟议的干预措施将包括移动的呼气测醉器技术， 视情况提供财政奖励，以及基于文本的健康促进和性别暴力转诊， 母婴健康和心理社会问题，包括COVID-19对孕产妇的影响， 饮酒具体目标是（1）开发和预测试基于技术的行为干预，以帮助 通过形成性定性研究， 孕妇或哺乳期妇女，近期有饮酒史，诊所和社区 利益相关者，以及在南卡罗来纳州大都会角建立的社区合作委员会，以及（2） 通过以下方式审查对怀孕和哺乳期间饮酒进行干预的可接受性和可行性： 在60名孕妇或产后妇女中对基于移动的技术的平台进行试点测试。 将在随访时评估可接受性，可行性将包括招募能力、流程 措施和干预结果。有证据表明，拟议的 在干预之后，大型随机临床试验对于确定干预的有效性至关重要。 可以远程结合所提议的行为干预的潜在设置包括： 护理诊所、物质使用治疗项目和公共资助的母婴项目 在美国，美国和其他国家的人口。

PROJECT SUMMARY/ABSTRACT This application proposes to develop and test a technology-based behavioral intervention to address maternal alcohol use in South Africa (SA). SA reports the highest per capita rates of alcohol consumption in the world and has one of the world's highest rates of lifelong disorders called fetal alcohol spectrum disorders (FASD). Prenatal alcohol use is often associated with exposure to gender-based violence, and an increase in gender-based violence due to the uncertainty and economic impact of COVID-19 is of a major concern. Recent evidence also showed that alcohol use during lactation significantly compromises child development in children exposed to alcohol through breastfeeding, and the adverse effect of postpartum alcohol use while breastfeeding was independent of prenatal alcohol exposure. Average breastfeeding duration in SA is beyond 1 year, and over 40% of mothers with and without a history of prenatal drinking report alcohol use while breastfeeding. A community-based behavioral intervention involving case management helps reduce prenatal alcohol use but is labor intensive, challenging the feasibility of widespread implementation in economically disadvantaged communities especially during the COVID-19 pandemic with limited social contact. An efficacious behavioral intervention to reduce alcohol use during pregnancy and lactation needs to be developed that is acceptable and feasible in economically disadvantaged communities, for women with transportation difficulties, or during the COVID-19 pandemic with limited social contact. The proposed intervention will incorporate mobile breathalyzer technology, contingent financial incentives, and text-based health promotion and referrals on gender-based violence, maternal infant health, and psychosocial issues including the impact of COVID-19 in the context of maternal alcohol use. Specific aims are (1) to develop and pretest a technology-based behavioral intervention to help women abstain from alcohol use during pregnancy and lactation via formative qualitative research with women who are pregnant or breastfeeding with a recent history of alcohol use, clinic and community stakeholders, and an established Community Collaborative Board in Cape Metropole, SA, and (2) to examine the acceptability and feasibility of the intervention on alcohol use during pregnancy and lactation by pilot testing the mobile technology-based platform with 60 women who are pregnant or postpartum. Acceptability will be assessed at follow-ups, and feasibility will include recruitment capability, process measures, and intervention outcomes. With the evidence of acceptability and feasibility of the proposed intervention, a large randomized clinical trial will become essential to establish efficacy of the intervention. The potential settings that can remotely incorporate the proposed behavioral intervention include primary care clinics, substance use treatment programs, and publicly funded programs for maternal/infant populations in SA, the United States, and other countries.