Smoking Resumption-Prevention in Postpartum Women

描述（由申请人提供）：大多数在怀孕期间戒烟的妇女产后恢复。以前的复发预防计划取得了令人失望的结果。拟议的干预措施解决了以前的方案的局限性，评估妇女的多个风险方面，创建一个风险简介，分流妇女到适当的干预强度水平，匹配妇女的风险干预，产后10个月继续干预，并将妇女转介到社区资源。在本研究中，我们将：a）评估我们的干预措施对延迟或预防妇女产后恢复吸烟的有效性，B）探索风险因素的相对贡献（依赖性、准备性、自我效能、感觉厌恶、为胎儿停止、伴侣吸烟、抑郁和体重问题）到产后吸烟，c）描述风险因素变化的自然过程，d）描述戒断或复吸发生的背景，e）估计干预措施的成本。将进行一项两组随机试验。样本将为来自北卡罗来纳州两个研究中心的450名18岁或以上的孕妇，这些孕妇在怀孕期间戒烟。妇女将在怀孕28至32周之间接受筛查，了解其风险因素，并将其分为四个层次的阶梯护理之一，其中包括一次面对面的咨询会议和至少一次电话会议，怀孕期间和产后10个月的7 - 12次电话会议。自我决定理论，社会认知理论，跨理论模型和复发预防理论的概念，从怀孕到产后的过渡相关的将指导干预策略，包括动机访谈，提高自我效能，预测和规划高风险的养育和社会情况，以及使用药物治疗。随机分配到对照组的女性将接受预防复发小册子和常规护理。将在基线、产后6周、产后6个月和产后12个月收集关于吸烟状态和风险变量的定量数据，并将在产后12个月收集定性数据。生存曲线分析将用于确定至首次恢复吸烟时间的主要结局。有效的复吸预防干预措施将推动我们实现2010年健康人烟草目标。公共卫生相关性：怀孕是许多妇女戒烟的时候;然而，许多人在婴儿出生后又重新吸烟。为防止吸烟而制定的计划并不十分有效。我们建议测试一项计划，其强度与女性的特征相匹配，以帮助延迟或防止重新吸烟。我们的总体目标是帮助在怀孕期间戒烟的妇女成为终身不吸烟者。

DESCRIPTION (provided by applicant): The majority of women who stop smoking during pregnancy resume postpartum. Previous relapse prevention programs have had disappointing results. The proposed intervention addresses the limitations of previous programs by assessing women on multiple risk dimensions, creating a risk profile, triaging women to an appropriate level of intervention intensity, matching the intervention to women's risks, continuing the intervention for 10 months postpartum, and referring women to community resources. In this study we will: a) evaluate the efficacy of our intervention to delay or prevent women's return to smoking postpartum, b) explore the relative contribution of risk factors (dependence, readiness, self efficacy, sensory aversion, stopped for the fetus, partner smoking, depression, and weight concerns) to postpartum smoking, c) describe the natural course of change of risk factors, d) describe the context in which abstinence or resumption occurs and, e) estimate the costs of intervention delivery. A two arm randomized trial will be conducted. The sample will be 450 pregnant women age 18 or older from two North Carolina sites who stopped smoking during pregnancy. Women will be screened abut their risk factors between 28 and 32 weeks of pregnancy and triaged to one of four levels of stepped care that includes one in person counseling session and at least one telephone session during pregnancy and from 7 12 telephone sessions over 10 months postpartum. Concepts from the self determination theory, social cognitive theory, transtheoretical model, and relapse prevention theory that are relevant for the transition from pregnancy to postpartum will guide the intervention strategies that include motivational interviewing, enhancing self efficacy, anticipating and planning for high risk parenting and social situations, and the use of pharmacotherapies. Women randomized to the control arm will receive a relapse prevention booklet and usual care. Quantitative data on smoking status and risk variables will be collected at baseline, 6 weeks and 6 and 12 month postpartum and qualitative data will be collected at 12 months. Survival curve analysis will be used to determine the primary outcome of time to first smoking resumption. An efficacious resumption prevention intervention will move us toward the Healthy People 2010 tobacco goals for women. PUBLIC HEALTH RELEVANCE: Pregnancy is a time when many women quit smoking; however, many return to smoking after the baby is born. Programs developed to prevent this return to smoking have not been very effective. We are proposing to test a program whose intensity is matched to women's characteristics to help delay or prevent return to smoking. Our overall goal is to help women who quit smoking during pregnancy become lifetime nonsmokers.