Perinatal Attentional Retraining Intervention for Smoking (PARIS) for Minority Women

摘要 少数族裔和妇女遭受与吸烟有关的疾病的不成比例的负担，包括 癌症和心脏病。母亲吸烟是导致母亲癌症死亡的主要原因，并与 不良妊娠结局和婴儿发病率和死亡率增加。这进一步加剧了 种族和族裔少数群体经历的不良生育后果。近一半怀孕前吸烟的女性 在怀孕期间实现禁欲。不幸的是，近80%的禁欲妇女在分娩后一年内复发。 尽管有相当多的研究，但在这一人群中，有效对抗吸烟复发的策略很少。这是 对于少数族裔女性来说尤其如此，她们接受治疗的可能性较小，而且更有可能再次吸烟。 比非西班牙裔白人产后要好。吸烟者对与吸烟有关的线索表现出“注意力偏向”。注意偏向 通过增加主观渴望和直接影响吸烟，在吸烟的维持或升级中发挥作用 寻求行为。使用视觉探测任务的注意力再训练(AR)已在实验中用于减少 注意力偏向和迟钝的暗示引发的渴望。压力和负面情绪被认为是复发的主要驱动因素， 尤其是在女性身上。AR在减轻与过渡压力相关的焦虑方面是有效的，比如女性所经历的那样 产后。这个试点项目的首要目标是测试一种新技术，即使用智能手机进行管理 作为预防产后妇女吸烟复发的干预措施。AR将同时针对吸烟线索和 压力信号。我们将评估AR是否减少了注意力偏向，减缓了产后引发的吸烟欲望， 缓解压力，减少吸烟。我们建议将50名禁欲怀孕的非裔美国人和/或 西班牙裔吸烟者接受AR或控制视觉探测任务。参赛者将被要求携带一个 在怀孕的最后一个月里，他们在两周的时间里每天都在使用智能手机。这款智能手机听起来将是一种 在白天随机发出警报，届时参与者将被要求回答一组简短的问题 主观状态；之后将请求完成AR(或控制)程序。同样的过程将会 在产后第一个月重复两周。结果测量包括对吸烟和压力的注意力偏向 刺激、自我报告的渴望和感知的压力，以及在调查期间吸烟的天数和数量 审判。本申请旨在确认研究的可行性和工艺参数，并获得初步的 关于干预措施的效果和构成干预措施的组成部分的数据。如果AR显示出作为一种 治疗方面，它将在一个更大的随机对照试验中进行测试。拟议中的项目是一种新的干预措施 产后少数民族妇女，建立在自然发生的禁欲时期，并有可能 巩固和扩大怀孕后的禁欲。

ABSTRACT Racial and ethnic minorities and women experience a disproportionate burden of smoking-related diseases, including cancer and heart disease. Maternal smoking is the leading cause of cancer mortality in the mother, and is associated with adverse pregnancy outcomes and increased infant morbidity and mortality. This further compounds the disparities in adverse birth outcomes experienced by racial and ethnic minorities. Nearly half of women who smoke prior to pregnancy achieve abstinence during pregnancy. Unfortunately, nearly 80% of abstinent women relapse within a year after delivery. Despite considerable study, there are few strategies that effectively combat smoking relapse in this population. This is especially true for minority women who are less likely to receive treatment and more likely to relapse to smoking postpartum than non-Hispanic whites. Smokers exhibit an “attention bias” for smoking-related cues. Attentional bias plays a role in the maintenance or escalation of smoking by increasing subjective cravings and directly affecting cigarette seeking behavior. Attentional retraining (AR) using the visual probe task has been used experimentally to reduce attentional bias and blunt cue-provoked craving. Stress and negative affect are considered major drivers of relapse, especially in women. AR is effective at attenuating anxiety related to transition stress, such as that experienced by women postpartum. The overarching goal of this pilot project is to test a novel technique, the use of smartphones to administer AR, as an intervention for smoking relapse prevention in postpartum women. AR will target both smoking cues and stress cues. We will assess whether AR reduces attentional bias, blunts cue-provoking smoking cravings after delivery, attenuates stress, and reduces smoking lapses. We propose to randomize 50 abstinent pregnant African American and/or Hispanic smokers to receive either the AR or control visual probe task. Participants will be asked to carry around a smartphone as they go about their daily lives for 2 weeks in their last month of pregnancy. The smartphone will sound an alert randomly during the day, at which time participants will be asked to respond to a short set of questions assessing subjective states; this will be followed by a request to complete the AR (or control) procedures. This same procedure will be repeated for 2 weeks in the first postpartum month. Outcome measures include attentional bias for smoking and stress stimuli, self-reported craving and perceived stress, and percentage of days and number of cigarettes smoked during the trial. This application is designed to confirm the feasibility and process parameters of the study, and obtain preliminary data on the efficacy of the intervention and the components that comprise the intervention. If AR shows promise as a treatment, it will be tested in a larger randomized controlled trial. The proposed project is a novel intervention for postpartum minority women that builds on the naturally occurring period of abstinence, and has the potential to consolidate and extend abstinence beyond pregnancy.