Preventing Postpartum Smoking Relapse: A C-SHIP Based Text Messaging Intervention

描述（由申请人提供）：本申请涉及挑战领域（06）：使能技术和特定挑战主题，06- od (OBSSR)-101*，使用新技术来改善或衡量依从性，标题为“预防产后吸烟复发：基于C-SHIP的短信干预”。在这个国家，估计有40%的女性在怀孕期间戒烟。然而，这些妇女中高达80%的人在产后复发，尽管这对她们自己和她们的孩子有健康风险。产后复发预防提供了一个独特的机会，可以利用积极的行为改变（怀孕期间戒烟）来长期保护妇女及其家人的健康。然而，设计有效的吸烟干预措施来预防产后复发是具有挑战性的，这在很大程度上是由于这一人群，特别是低收入妇女的竞争需求和压力因素。新的、创新的干预交付模式需要提供三个关键组成部分：对持续的行为改变提供高水平的社会支持，同时解决与幼儿有关的新的心理和实际需求。通过移动电话发送短信（TM）是一种卫生信息技术，在许多卫生情况下作为一种干预渠道已被证明是有效的，在产后复发预防领域具有相当大的前景，但尚未得到应用。因此，本研究将开发和试点一种基于证据的认知行为TM干预，旨在减少怀孕前或怀孕期间立即戒烟的低收入少数民族妇女产后吸烟复发。在认知-社会健康信息处理（C-SHIP）框架以及健康传播最佳实践的指导下，将通过形成性评估和基于社区的参与性研究过程来制定纳入TM干预措施的信息，该过程包括文献审查和需求评估，然后通过信息起草、目标社区焦点小组和科学咨询小组的审查以及信息修订进行迭代循环。在进行试点测试之前，实际短信也将经过用户测试，短信系统和用于干预传递的专门配备的移动电话也将进行测试。一旦开发出干预措施，将通过全国妇女、婴儿和儿童诊所网络（WIC）的地方诊所招募的100名不同种族和民族的低收入妇女进行试点测试，以确定其可行性，为期1个月。干预将由四个部分组成：a)系统发起的短信：定期发送的短信，目标是基于c - ship的产后复发因素(即，旨在具有以下效果的短信：增加关于吸烟对婴儿、儿童和成人有害影响的知识/感知风险；影响决策平衡（增加赞成和减少反对继续戒烟）；减少初为人母的苦恼；影响信念（增加戒烟的自我效能感，减少宿命论）；促进自我调节策略和社会支持的运用；b) TXT渴望短信：参与者主动使用手机上的“TXT渴望”功能，请求接收基于c - ship的短信，当有吸烟的冲动或渴望时，提供支持和转移注意力；c) TXT失效短信：参与者主动使用手机上的“TXT失效”功能，请求接收基于c - ship的短信，该短信提供信息、激励和支持，帮助参与者恢复戒烟；D)与朋友和家人免费发短信和打电话，以增加预防复发的具体支持：鼓励参与者（通过短信和参与者指示）打电话和发短信给家人和朋友，以获得他们努力保持戒断的社会支持。将评估以下方面的可行性：a)完成（接收和打开）系统发起的短信；b)参与者发起的TXT渴望和TXT失效信息的传递；C)参与者对干预的满意度，通过使用口头问卷进行评估。作为次要目的，本研究还将在探索性的基础上研究干预对产后C- ship复发危险因素的影响，以及这些因素与吸烟状况的关系。这项检查将通过评估参与者在基线、一个月和三个月时的危险因素和吸烟状况来实施。TM预防复发干预有可能成为预防低收入、多种族妇女产后复发的突破性方法，因为它有可能全天候分娩；目标人群的可定制性；低成本、高效率的实施；参与者负担低；易于控制高剂量或可变剂量；针对性、量身定制应用；以及在现有医疗基础设施中传播的便利性。就刺激计划的影响而言，这项研究将为申请人所在的机构提供若干个人的持续就业机会，为小型和大型企业创造收入，并为低收入焦点小组和咨询小组社区参与者增加就业机会，他们将通过参与干预发展来培养技能。在美国，吸烟是可预防死亡的主要原因，是我们作为一个社会面临的最紧迫的公共卫生问题之一，特别是对于那些来自低收入少数族裔社区的人。拟议的研究旨在开发和试验一种技术创新和基于理论的干预措施，以减少少数民族和得不到充分服务的妇女的产后吸烟复发，从而改善她们及其子女的健康。该干预措施具有在现有医疗基础设施中广泛推广的潜力，因为它是循证的、高度可运输的和低成本的。

DESCRIPTION (provided by applicant): This application addresses Challenge Area (06): Enabling Technologies, and specific Challenge Topic, 06-OD (OBSSR)-101*, Using new technologies to improve or measure adherence, and is entitled "Preventing postpartum smoking relapse: A C-SHIP based Text Messaging intervention." In this country, an estimated 40% of women who smoke quit during their pregnancy. However, up to 80% of these women relapse in the postpartum period, despite the health risks for themselves and their children. Relapse prevention in the postpartum period offers a unique opportunity to capitalize on a positive behavioral change (cessation during pregnancy) to protect the health of women and their families over the long-term. Yet, the design of effective smoking interventions for postpartum relapse prevention is challenging, due in large part to the competing needs and stressors in this population, especially among low income women. New, innovative intervention delivery models are needed to provide three key components: high levels of social support for ongoing behavioral change, while simultaneously addressing the new psychological and practical demands associated with young babies. Text Messaging (TM) via mobile telephone is a health information technology with demonstrated effectiveness as an intervention channel in many health contexts and holds considerable promise in the area of postpartum relapse prevention, where it has yet to be applied. Therefore, this study will develop and pilot-test an evidence-based, cognitive-behavioral TM intervention designed to reduce postpartum smoking relapse among low-income minority women who have quit immediately before or during their pregnancies. Guided by the Cognitive-Social Health Information Processing (C-SHIP) framework, as well as by health communication best practices, the messages to be included in the TM intervention will be developed through a formative evaluation and community-based participatory research process that includes literature review and needs assessment followed by an iterative cycling through message drafting, review by target community focus groups and a scientific advisory panel, and message revision. The actual messages will also be user-tested prior to being pilot-tested, as will the text messaging system and the specially equipped mobile phones to be employed in intervention delivery. Once the intervention is developed, it will be pilot-tested to determine its feasibility through delivery over a 1 month timeframe with 100 racially and ethnically diverse, low income women recruited through local clinics of the national network of Women, Infants, and Children's Clinics (WIC). The intervention will consist of four components: a) system-initiated text messages: text messages sent on a scheduled basis that target C-SHIP-based postpartum relapse factors (i.e., messages designed to have the following effects: increase knowledge/perceived risk regarding the harmful effects of smoking on infants, children, and adults; impact decisional balance (increase the pros and decrease the cons of continued abstinence); reduce the distress of new motherhood; influence beliefs (increase self-efficacy for remaining quit and decrease fatalism); and promote the utilization of self-regulatory strategies and social support; b) TXT crave messages: participant-initiated use of a "TXT crave" function on the mobile phone to request receipt of a C-SHIP-based text message that provides support and distraction when an urge or craving to smoke is experienced; c) TXT lapse messages: participant-initiated use of a "TXT lapse" function on the mobile phone to request receipt of a C-SHIP-based text message that provides information, motivation, and support to help the participant resume cessation; d) free texting and calling with friends and family to increase relapse prevention- specific support: participants will be encouraged (through text messages and participant instructions) to call and text family and friends to receive social support for their efforts to remain abstinent. The following dimensions of feasibility will be assessed: a) completion (receipt and opening) of system- initiated text messages; b) transmission of participant-initiated TXT Crave and TXT lapse messages; c) participant satisfaction with the intervention as assessed through use of a verbally administered questionnaire. As a secondary aim, the study will also examine, on an exploratory basis, impact of the intervention's on C- SHIP-based postpartum relapse risk factors and the association of these factors with smoking status. This examination will be implemented through an assessment of participants on the risk factors and smoking status at baseline, one month, and three months. The TM relapse prevention intervention has the potential to serve as a breakthrough approach to preventing postpartum relapse among low-income, ethnically diverse women, given its potential for around-the- clock delivery; customizability for the target population; low-cost, time-efficient implementation; low participant burden; easily controlled dosing at high or variable levels; targeted and tailored application; and ease of dissemination into the current healthcare infrastructure. In terms of stimulus impact, this study will provide for continued employment of several individuals at the applicants' institution, generate revenue for both a small and a large business, and enhance employment opportunities for the low income focus group and advisory panel community participants who will build skills through their participation in intervention development. H Smoking, the leading cause of preventable death in the U.S., is one of the most pressing public health issues that we face as a society, particularly among those who are from lower income minority communities. The proposed study is designed to develop and pilot test a technologically innovative and theory-based intervention to reduce postpartum smoking relapse among minority and underserved women in order to improve both their health and the health of their children. The intervention has the potential for wide-scale dissemination into the current care infrastructure, as it is evidence-based, highly transportable, and low-cost.