Adaptation and Evaluation of a Culturally- and Gender-Relevant Tobacco Cessation among Women in Brazil: An Integrated mHealth Approach

摘要 《世界卫生组织烟草控制框架公约》 确定了对妇女及其烟草相关问题的理解以及 将制定与性别相关的烟草控制工作作为优先事项。但有一个 缺乏关于性别相关戒烟计划有效性的研究， 特别是在资源匮乏的环境中（包括美国），考虑到 医疗保健系统的局限性和优势。我们开发并建立了 基于理论的、与文化和性别相关的社区卫生工作者干预措施 为低收入的巴西妇女提供的戒烟计划， 公共卫生系统。这个应用程序代表了我们的性别相关的延续， 巴西的烟草控制工作，建议调整这种CHW提供的烟草 戒烟计划将通过移动的设备（App）与移动健康支持相结合。我们 提出一个综合的CHW-mHealth应用程序，该应用程序（a）具有文化和性别相关性，（B） 是基于理论（社会认知理论），（c）认为巴西的现有结构， （d）将根据有效的干预措施进行调整， 其他mHealth应用程序的突出特点，已被证明是成功的， 吸引用户。在R21阶段，我们将进行调整并确定可行性 与移动健康戒烟应用程序集成的CHW提供的干预措施 （参与者的互动应用程序和社区卫生工作者的跟踪系统） 在所有参与的利益攸关方中，对干预措施进行预测试和试点测试。在R33 在第一阶段，我们将评估综合CHW-mHealth戒烟的有效性 通过以城镇为随机单位的分组随机试验进行干预（8个城镇， N=344）。对照组将与之前的干预相同（由 由CHW进行家访，期间参与者计划参加戒烟活动 社区公共卫生诊所的程序）以进行比较。我们假设 在6个月时，接受综合CHW-mHealth干预的女性吸烟者将 显著较高的7天时点戒烟率（定义为过去7天内不吸烟） d）的吸烟者比对照组的女性吸烟者多。自我报告将通过 测量30%参与者呼出的一氧化碳水平。如果显示为 有效，这种方法可以作为一种模式，为人口为基础的干预，在低， 资源环境，包括美国农村和弱势妇女。

ABSTRACT The World Health Organization (WHO) Framework Convention on Tobacco Control has identified the understanding of women and their tobacco-related issues as well as the need for the development of gender-relevant tobacco control efforts as priorities. However, there is a paucity of studies addressing the efficacy of gender-relevant tobacco cessation programs, particularly in low-resource settings (including the U.S.), that take into consideration the limitations and strengths of a health care system. We developed and established the efficacy of a theory-based, culturally- and gender-relevant Community Health Worker (CHW) intervention for low-income Brazilian women that augments the tobacco cessation program offered through the public health system. This application represents the continuation of our gender-relevant tobacco control efforts in Brazil by proposing the adaptation of this CHW-delivered tobacco cessation program to be integrated with mHealth support through mobile devices (App). We are proposing an integrated CHW-mHealth application that (a) is culturally- and gender-relevant, (b) is theory-based (Social Cognitive Theory), (c) considers the existing structure of the Brazilian health care system, and (d) will be adapted based on an efficacious intervention as well as salient features of other mHealth applications that have been shown to be successful in engaging users. During the R21 phase, we will make the adaptations and determine feasibility of a CHW-delivered intervention that is integrated with a mHealth tobacco cessation application (interactive App for participants and tracking system for CHWs) through formative assessments among all involved stakeholders, pretesting, and pilot testing of the intervention. In the R33 phase, we will assess the effectiveness of the integrated CHW-mHealth tobacco cessation intervention through a group randomized trial with towns as the unit of randomization (8 towns, N=344). The comparison group will be the same as the previous intervention (consisting of a home visit by a CHW during which the participant is scheduled to attend the tobacco cessation program at the neighborhood public health clinic) to allow for comparisons. We hypothesize that at 6-months, women smokers who receive the integrated CHW-mHealth intervention will have significantly higher 7-day point prevalence abstinence (defined as no cigarettes in the past 7 days) than women smokers in the control condition. Self-report will be verified through measurement of exhaled carbon monoxide levels among 30% of participants. If shown to be effective, this approach could be utilized as a model for a population-based intervention in low- resource settings, including rural and disadvantaged women in the U.S.