Tobacco treatment incorporating contingency management, nicotine replacement therapy, and behavioral counseling for pregnant women who use substances: a feasibility trial

Frontiers in Psychiatry

Psychiatry

Billie Bonevski¹  Yvonne Bonomo²  Paul Haber³  Gillian S. Gould⁴  John Attia⁵  Daniel Barker⁵  Natasha Perry⁶  Amanda L. Brown⁷  Adrian J. Dunlop⁸  Melissa A. Jackson⁸  Amanda L. Baker⁹  Julie Blandthorn^1,10 

[1] College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia;Department of Medicine, University of Melbourne, Parkville, VIC, Australia;Women's Alcohol and Drug Service, The Royal Women's Hospital, Parkville, VIC, Australia;Drug and Alcohol Clinical Research Improvement Network, St. Leonards, NSW, Australia;Edith Collins Centre, Sydney Local Health District, Camperdown, NSW, Australia;Sydney Medical School, University of Sydney, Sydney, NSW, Australia;Faculty of Health, Southern Cross University, Coffs Harbour, NSW, Australia;Hunter Medical Research Institute, New Lambton Heights, NSW, Australia;Hunter New England Health Local Health District, Newcastle, NSW, Australia;Hunter New England Health Local Health District, Newcastle, NSW, Australia;School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia;Hunter Medical Research Institute, New Lambton Heights, NSW, Australia;Hunter New England Health Local Health District, Newcastle, NSW, Australia;School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia;Hunter Medical Research Institute, New Lambton Heights, NSW, Australia;Drug and Alcohol Clinical Research Improvement Network, St. Leonards, NSW, Australia;School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia;Women's Alcohol and Drug Service, The Royal Women's Hospital, Parkville, VIC, Australia;

关键词: tobacco treatment;    smoking cessation;    substance use disorders;    pregnancy;    contingency management;    counseling;    nicotine replacement therapy;   

DOI  :  10.3389/fpsyt.2023.1207955

 received in 2023-04-18, accepted in 2023-07-17,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionMost pregnant women with substance use problems smoke, and few will quit during their pregnancy. Tobacco treatment is often overlooked, with the focus usually placed on other substance use. Additionally, few targeted effective treatments for this group exist. To address this, the feasibility of an intensive tobacco treatment incorporating contingency management (CM) that featured non–face-to-face delivery was examined.MethodsA single-arm pre-post design feasibility trial was conducted in three antenatal services that support women who use substances in metropolitan Australia. Participants were over the age of 15, had <33-week gestation, and smoked tobacco daily. They received financial incentives for daily carbon monoxide-verified smoking abstinence or reduction through an internet-based CM programme, nicotine replacement therapy (NRT) posted to women and partners or household members who smoked and telephone-delivered behavioral counseling from study enrolment to birth.ResultsOf the 101 referrals, 46 women (46%) consented. The mean (SD) age was 31(±6) years, and the gestation period was 22(±6) weeks. Nineteen (41%) of those enrolled were retained for 12-week postpartum. Of 46 women, 32 (70%) utilized CM; 32 (70%) used NRT for ≥2 weeks; 23 (50%) attended ≥1 counseling session; and 15 (22%) received NRT for partners/household members. Fifteen (33%) were verified abstinent from tobacco at delivery after a median (IQR) period of abstinence of 65(36–128) days. All non-smokers at birth utilized NRT and financial incentives, and 9/15 (60%) utilized counseling. Four (9%) were abstinent at 12-week postpartum. Median cigarettes smoked/day reduced from baseline to delivery (10(6–20) to 1(0-6) p =< 0.001). Women who quit smoking had more education (72% vs. 33% p =< 0.02), completed more CO samples (median (IQR) 101(59–157) vs. 2(0–20) p =< 0.001), and received more incentives (median (IQR) $909($225–$1980) vs. $34($3–$64) p =< 0.001). Intervention acceptability was rated favorably by participants (9 items rated 0–10 with scores >5 considered favorable).DiscussionThis study demonstrated the feasibility and acceptability of a consumer-informed, non–face-to-face intensive tobacco treatment, highlighting the potential of remotely delivered technology-based CM to reduce the health impact of tobacco smoking in high-priority populations. The intervention demonstrates scale-up potential. Future studies should extend treatment into the postpartum period, utilizing new technologies to enhance CM delivery and improve counseling provision and partner support.Clinical trial registrationhttps://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374196, ACTRN1261800056224.

【 授权许可】

Unknown   
Copyright © 2023 Jackson, Brown, Baker, Bonevski, Haber, Bonomo, Blandthorn, Attia, Perry, Barker, Gould and Dunlop.