Community Intervention to Reduce Tobacco Use among Pregnant Alaska Native Women

减少阿拉斯加原住民孕妇烟草使用的社区干预

基本信息

批准号：
8467852
负责人：
Christi A Patten
金额：
$ 60.35万
依托单位：
MAYO CLINIC ROCHESTER
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-07-01 至 2018-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8467852
关键词：
Address Advisory Committees Alaska Alaska Native American Indian and Alaska Native American Indians Cause of Death Cessation of life Communities Counseling Elderly Enrollment Family member Feedback Female Focus Groups Health Home environment Individual Infant Intervention Interview Malignant Neoplasms Malignant neoplasm of lung Mediating Mediator of activation protein Native Americans Native-Born Outcome Phase Pilot Projects Postpartum Period Pregnancy Pregnancy Tests Pregnant Women Prenatal care Prevalence Public Health Randomized Relapse Reporting Risk Role Self Efficacy Sister Smokeless Tobacco Social Marketing Telephone Testing Time Tobacco Tobacco Use Cessation Tobacco use Treatment Efficacy Visit Woman Work Yukon-Kuskokwim Delta base cancer prevention cigarette smoking community intervention design digital effective intervention fetal fetal tobacco exposure health disparity high risk intervention effect member men native elder novel peer pregnant prenatal public health relevance reduce tobacco use response smoking cessation social cognitive theory social norm theories tobacco abstinence tobacco control treatment as usual

项目摘要

DESCRIPTION (provided by applicant): Developing effective tobacco cessation interventions during pregnancy for American Indian and Alaska Native people is a national priority and will contribute to the U.S. public health objective of reducing tobacco- related health disparities. In the southwest region of Alaska where the proposed project will take place, 79% of Alaska Native women smoke cigarettes or use smokeless tobacco (ST) during pregnancy. In addition, pregnancy appears to be a high risk period for initiation of tobacco use, primarily ST, among women reporting no use of tobacco 3 months before pregnancy. Our pilot study suggested that an individual-based intervention delivered at the first prenatal visit had low reach to pregnant women and poor tobacco abstinence rates. Intervention efforts targeting the entire community, not only pregnant women, to address social norms about tobacco use may be more effective. Thus, we propose to evaluate the efficacy of a novel, multi-component, theory-based intervention for reducing tobacco use during pregnancy, incorporating both individually targeted and community level components delivered by female elders "Native Sisters." The intervention builds on effective community and individual-based approaches for tobacco cessation and lay health advisor approaches for cancer prevention among Native American women. As part of the intervention, a social marketing campaign including digital stories and other small media will be developed with community feedback. Individually targeted components will be six 30-40 minute telephone or home-based peer counseling sessions with pregnant women. This R01 project is submitted in response to PAR-11-346. It will be conducted in two phases. All aspects of the project will be guided by a community advisory committee. In Phase I, we will develop the social marketing components by obtaining qualitative feedback from pregnant women, family members and elders on message content and delivery channels. In Phase II, we will evaluate the intervention using a group- randomized design with village as the unit of assignment. Sixteen villages will be randomly assigned to receive the intervention or control condition (usual care), with > 20 women enrolled from each village. Enrollment will occur at the time of a positive pregnancy test which is the earliest point of prenatal care, enhancing the intervention's potential reach. Both tobacco users and non-users will be eligible because many start to use during pregnancy. Assessments will be completed by enrolled women through 6 months postpartum. We will evaluate the efficacy of the intervention compared with the control condition on the biochemically confirmed 7-day point prevalence tobacco use rate at week 36 gestation and at 6 months postpartum. We will also examine the effect of the intervention on proposed social cognitive-theory based mediators of change including perceived self-efficacy for non-tobacco use and anti-tobacco norms. Our long term objective is to determine effective interventions for Alaska Native women that will ultimately reduce the risk of tobacco-related maternal, fetal, and infant adverse health outcomes.

描述（由申请人提供）：为美洲印第安人和阿拉斯加原住民在怀孕期间制定有效的戒烟干预措施是国家优先事项，并将有助于实现减少烟草相关健康差异的美国公共卫生目标。在拟议项目所在的阿拉斯加西南部地区，79% 的阿拉斯加原住民妇女在怀孕期间吸烟或使用无烟烟草 (ST)。此外，对于怀孕前 3 个月未吸烟的女性来说，怀孕似乎是开始使用烟草（主要是 ST）的高风险期。我们的试点研究表明，在第一次产前检查时实施的基于个人的干预措施对孕妇的影响较小，戒烟率也较低。针对整个社区（而不仅仅是孕妇）的干预措施可能会更有效，以解决有关烟草使用的社会规范。因此，我们建议评估一种新颖的、多成分的、基于理论的干预措施在减少怀孕期间烟草使用方面的功效，其中结合了由女性长者“本土姐妹”提供的个人目标和社区层面的成分。该干预措施建立在有效的社区和个人戒烟方法以及美国原住民妇女癌症预防的非专业健康顾问方法的基础上。作为干预措施的一部分，将根据社区反馈制定包括数字故事和其他小型媒体在内的社会营销活动。针对个别目标的组成部分将是针对孕妇的六次 30-40 分钟的电话或家庭同伴咨询会议。此 R01 项目是根据 PAR-11-346 提交的。它将分两个阶段进行。该项目的各个方面都将由社区咨询委员会指导。在第一阶段，我们将通过获取孕妇、家庭成员和长辈对信息内容和传递渠道的定性反馈来开发社交营销组件。在第二阶段，我们将采用以村庄为分配单位的分组随机设计来评估干预措施。将随机分配 16 个村庄接受干预或对照条件（常规护理），每个村庄招募 20 名以上的妇女。登记将在妊娠检测呈阳性时进行，这是产前护理的最早阶段，从而增强了干预的潜力抵达。吸烟者和非吸烟者都有资格，因为许多人在怀孕期间开始吸烟。评估将由登记的女性在产后 6 个月内完成。我们将评估干预措施与对照条件相比对妊娠第 36 周和产后 6 个月经生化证实的 7 天点流行率烟草使用率的效果。我们还将研究干预措施对基于社会认知理论的变革中介因素的影响，包括对非烟草使用和反烟草规范的感知自我效能。我们的长期目标是确定对阿拉斯加原住民妇女的有效干预措施，最终降低与烟草相关的孕产妇、胎儿和婴儿不良健康结果的风险。