SCH: INT: Harnessing the Power of Technology: MOMBA for Postpartum Smoking

描述（由申请人提供）：女性吸烟可导致肺癌、食道癌、喉癌、口腔癌、咽喉癌、肾癌、膀胱癌、胰腺癌、胃癌和宫颈癌，以及急性髓细胞白血病。吸烟是美国最昂贵的健康风险行为，也是可预防死亡的主要原因。具体到怀孕，吸烟仍然是美国可预防的不良妊娠结局的主要原因。虽然许多妇女能够在怀孕期间戒烟，但产后复吸仍然是一个挑战，高达80%的妇女在怀孕期间戒烟后12个月内复吸。目前的指南建议使用药物和咨询来戒烟。协助妇女在产后期间保持禁欲的最有效方法之一是应急管理，即向保持禁欲的人提供经济或其他奖励。虽然在围产期妇女使用CM时观察到了中等至大的效应量，但这种疗效仅在控制良好的临床环境中得到证实，主要是因为目前提供的干预措施需要频繁（平均每周）的办公室访视。虽然持续的办公室访问是一个潜在的进一步加强禁欲的来源，它也可能是一个威慑参与的一些谁想要实现和维持禁欲，如产后妇女谁有大量的育儿负担。临床医生和研究人员的频繁（通常每周一次）办公室访视也很难推广到当前的医疗保健系统，这表明需要替代策略，以便在临床试验之外和社区环境中更广泛地传播戒烟策略。技术的应用有望实现 这个目标我们将为该应用开发的技术干预包括经济激励，称为“应急管理”，通过名为“Momba Smoking”的智能手机应用程序和一氧化碳传感器提供，该传感器旨在与智能手机无线连接以测量呼吸一氧化碳。该应用程序与NCI的使命和优先事项直接相关，以提高癌症预防新临床试验的效率和启动。

DESCRIPTION (provided by applicant): Smoking in women causes cancers of the lung, esophagus, larynx, mouth, throat, kidney, bladder, pancreas, stomach, and cervix, as well as acute myeloid leukemia. Smoking is the single most costly health risk behavior and the leading cause of preventable death in the United States. Specific to pregnancy, smoking remains the leading cause of preventable poor pregnancy outcomes in the United States. While many women are able to obtain abstinence in pregnancy, relapse to smoking postnatally remains a challenge, with up to 80% of women who stop smoking in pregnancy relapsing within 12 months postpartum. Current guidelines recommend medications and counseling for smoking cessation. One of the most effective methods to assist women in remaining abstinent in the postpartum period is contingency management (CM), or the provision of financial or other incentives to people for remaining abstinent. Although moderate to large effect sizes have been observed in the use of CM with perinatal women, this efficacy has been demonstrated only in well-controlled clinical settings, largely because the intervention, as currently delivered, requires frequent (on average, weekly) office visits. While the ongoing contact of office visits is a potential further source of reinforcement for abstinence, it may also be a deterrent to participation for some who would like to achieve and sustain abstinence, such as postpartum women who have a substantial childcare burden. Frequent, usually weekly, office visits with clinicians and study personnel are also difficult to generalize to the current health care system suggesting the need for alternative strategies to more widely disseminate smoking cessation strategies outside of clinical trials and into community settings. The utilization of technology holds promise to achieve this goal. The technological intervention we will develop for this application consists of financial incentives, termed "contingency management" delivered via a smartphone application named 'Momba Smoking' and a carbon monoxide sensor designed to interface wirelessly with a smartphone to measure breath carbon monoxide. This application aligns is directly related to NCI's mission and priorities to improve the efficiency and launch of novel clinical trials in cancer prevention.