Cancer Control Research5RC1CA145063-02
Miller, Suzanne M.
PREVENTING POSTPARTUM SMOKING RELAPSE: A C-SHIP BASED TEXT MESSAGING INTERVENTION
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.