Services Grant Program for Residential Treatment for Pregnant and Postpartum Woman (PPW22) - Get Fit and Quit

ABSTRACT Tobacco use among pregnant women and women of childbearing age is one of the most preventable causes of maternal, infant, and fetal morbidity and mortality in the United States, yet comorbid tobacco use disorder is almost ubiquitous in women in residential treatment for substance use disorder (SUD). Moreover, women with substance use disorder, primarily opioids, who smoke during pregnancy increase the likelihood that their infants will experience Neonatal Abstinence Syndrome. To date, there are no tailored tobacco treatment interventions for women in residential treatment for substance use that have shown adequate efficacy to produce cessation. Get Fit and Quit (GFaQ) is an evidence-based tobacco treatment intervention tailored specifically to address the barriers to success, challenges, and opportunities posed by residential treatment settings for women of childbearing age and pregnant women. GFaQ incorporates group tobacco treatment counseling, physical activity, and pharmacotherapy education and provision delivered by nurse facilitators who are dual certified as tobacco treatment specialists and group physical activity instructors. Simply, GFaQ is designed to equip women in residential treatment for SUD with the tools they need to be successful with making a quit attempt and living a more active life. Previous iterations of the GFaQ program were 8 weeks in length (to be referred to as GFaQ 8.0 moving forward). GFaQ 8.0 showed consistently positive results over six cohorts of pilot testing (n = 65 total), with participants demonstrating significant reductions in tobacco use (cigarettes per day (CPD)), Expired Air Carbon Monoxide (EACO), and nicotine dependence, as well as a sharp increase in confidence to quit. Despite these positive outcomes, recruitment and retention of participants continued to be persistent programmatic barriers due to the program length (8 weeks) and voluntary nature of enrollment. To address these barriers, GFaQ 8.0 has been revised into a 4-week program (to be referred to as GFaQ 4.0 moving forward) with plans to be integrated into the mandatory Health and Wellness curriculum at the three different Chrysalis House locations in Lexington, Kentucky. Since Health and Wellness credit is part of the graduation requirements for all women undergoing treatment at the Chrysalis House facilities, the goal is to serve approximately 80-100 women per year for 5 years pending annual contract renewal (anticipated 5 year goal = 400-500). Each session will include 60 minutes of facilitated discussion about tobacco cessation and healthy living followed by an invitation to participate in 30 minutes of physical activity (such as walking or jogging). At each session, emphasis will be placed on the benefit of replacing smoking with the positive behavior of physical activity. Demographic information will be collected at Week 1, and smoking measures (self-reported CPD) and EACO will be evaluated at the beginning (Week 1) and end (Week 4) of the program. The purpose of this project is to test the feasibility and acceptability of incorporating a consolidated version of GFaQ, known as GFAQ 4.0, into the mandatory curriculum of the Chrysalis House residential treatment program. More specifically, the aims of this study are: 1) Test the feasibility of the newly-revised GFaQ 4.0 intervention; and 2) Determine the acceptability of the GFaQ 4.0 intervention to participants (women in residential treatment for substance use disorder) and residential treatment facility employees (staff and providers). Our expected outcomes are refinement of the condensed program and permanent incorporation into the facility’s treatment curriculum. GFaQ 4.0 has the capacity to promote prevention of tobacco-associated health disparities in maternal and child morbidity and mortality, including Neonatal Abstinence Syndrome, in this high-risk population.