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：
8878201
负责人：
Christi A Patten
金额：
$ 17.64万
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 2016-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8878201
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 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土著人民在怀孕期间制定有效的戒烟干预措施是国家的优先事项，将有助于美国公共卫生的目标，以减少烟草相关的健康差异。在拟议项目的阿拉斯加西南地区，阿拉斯加79％的土著妇女在怀孕期间抽烟或使用无烟烟草（ST）。此外，怀孕似乎是烟草使用的高风险时期，主要是在怀孕前3个月不使用烟草的妇女中。我们的试点研究表明，在第一次产前访问时进行的基于个体的干预措施对孕妇和较差的烟草禁欲率的影响很低。针对整个社区（不仅孕妇）解决有关烟草使用的社会规范的干预措施可能更有效。因此，我们建议评估一种新型，多组分，基于理论的干预措施在妊娠期间减少烟草使用的功效，并结合女性长者“本地姐妹”所提供的单独靶向和社区水平的成分。该干预措施以有效的社区和基于个人的方法为基础，用于戒烟和外行健康顾问方法，以预防美洲原住民妇女的癌症。作为干预的一部分，将通过社区反馈来开发包括数字故事和其他小型媒体在内的社会营销活动。与孕妇的单独目标组件将是六个30-40分钟的电话或家庭同行咨询会议。该R01项目是根据Par-11-346提交的。它将分为两个阶段。该项目的所有方面将由社区咨询委员会指导。在第一阶段，我们将通过获得孕妇，家庭成员和成年人的定性反馈来开发社会营销组成部分，以了解消息内容和交付渠道。在第二阶段，我们将使用与村庄作为任务单位的小组随机设计评估干预措施。将有16个村庄随机分配接受干预或控制状况（通常的护理），每个村庄均有20名妇女。入学率将在阳性妊娠测试时发生，这是最早的产前护理点，增强了干预的潜力抵达。烟草使用者和非用户都有资格，因为许多人在怀孕期间开始使用。评估将由招收的妇女在产后6个月完成。我们将评估干预措施的疗效与生物化学确认的对照条件相比，在第36周妊娠和产后6个月的生化点患病率烟草使用率为7天。我们还将研究干预对基于社会认知理论的变革的介体的影响，包括对非烟草使用和反烟科规范的自我效能感。我们的长期目标是确定对阿拉斯加土著妇女的有效干预措施，这些妇女最终将降低与烟草相关的母亲，胎儿和婴儿不良健康结果的风险。