PRWC Studies

The Impact of All Forms of Smoking During Pregnancy on Perinatal Immune Responsiveness and Birth Outcomes in Appalachia 

Kristin Ashford, Jefferey Ebersole, Keisa Fallin-Bennett, Frances Feltner, Ellen Hahn, Joshua Lile, Okoli Chizimuzo, Mary Kay Rayens

5R01DA0406094-02 | Sponsor: National Institute on Drug Abuse


The overall goal of the parent award is to determine the effects of e-cigs on perinatal biomarkers and select birth outcomes in pregnant and postpartum women.


  1. To determine the association of trimester-specific smoking behaviors (conventional-only, e- cigarettes-only, and dual-conventional plus e-cig) with a. serum cotinine, b. expired carbon monoxide; c. serum immune markers; and d. NNAL  throughout pregnancy and postpartum.
  2. To determine the association of trimester-specific tobacco use (conventional, e-cigarettes-only, and dual use) with birth outcomes (gestational age at birth, birth weight)

An Administrative Supplement was awarded in Year 2 expanding the parent study aims:

  1. To expand recruitment to additional sites, with particular emphasis on recruiting additional EC and dual users
  2.  To explore the potential association between first trimester cannabis use on prenatal biomarkers (serum cotinine/nicotine; expired carbon monoxide; serum immune markers: IL-2, IL-6, IL-10, CRP, TNF, MMP-8; and NNAL/NNK) among current tobacco users (conventional, EC, and dual users).
  3. To examine the potential association between first trimester cannabis use and birth outcomes (gestational age at birth, birth weight) among current tobacco users (including cigarette smokers, EC, and dual users).

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Behavioral and Enhanced Perinatal Intervention for Cessation: Reducing Tobacco use Among Opioid Addicted Women

Kristin Ashford, Amanda Fallin-Bennett, Michelle Lofwall, Niraj Chavan, Teresa Waters

5R34DA046005-02 | Sponsor: National Institute on Drug Abuse


This pilot services effectiveness research trial aims to test feasibility and efficacy of a Behavioral and Enhanced Perinatal Intervention for Cessation (B-EPIC) of tobacco use in an established MAT clinic.


  1. To determine the impact of the B-EPIC intervention on maternal tobacco use and stage of change during and after pregnancy compared to the tobacco treatment as usual (TAU) control group among women with opioid dependence receiving MAT.
  2. To determine the impact of B-EPIC on tobacco-related adverse health outcomes including: gestational age at birth, birthweight; NAS diagnosis and severity; and number of infant ear and respiratory infections during the first 5-6 months.
  3. To compare health care utilization and costs incurred by pregnant patients that receive the B-EPIC intervention versus TAU, with estimates of the incremental cost-effectiveness of the B-EPIC intervention. Outcomes will include medical record data, such as length in days of maternal hospitalization, and infant outcomes (number of days in NICU, and number of sick infant outpatient or emergency department (ED) visits).

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Tobacco Use in Pregnancy Intervention for Cessation 

Kristin Ashford, Kathleen Winter, Jeffrey Talbert, Jing Li, Agatha Critchfield, Mary Kay Rayens, Amanda Fallin-Bennett

Sponsor: VI2P, University of Kentucky 


To test the effectiveness and implementation success of the novel delivery of an established tobacco cessation treatment among pregnant women in Kentucky.


  1. To determine the impact of ToPIC on maternal and infant health outcomes compared to baseline and compared to patients receiving care at a control clinic.
  2. To measure implementation effectiveness of ToPIC in the participating clinic through assessment of a.) facilitators/barriers to delivery; b) fidelity of implementation; c) identification of strategies to maximize the facilitators and overcome implementation barriers to implementation; and d) identification of potential modifications that could be made to maximize implementation.

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ClOUUD Registry

Kristin Ashford,  Andrea McCubbin


The registry will collect and store core data for care and outcome evaluation of pregnant and postpartum women with opioid and substance use disorders, and their infants receiving care at the University of Kentucky PATHways and Beyond Birth clinics. 


Efforts to Maximize Perinatal Outcomes in Women at Risk 

Kristin Ashford, John O’Brien, Karen Playforth, Corrine Williams

Sponsor: Centers for Medicare and Medicaid Services


A prospective multicenter study of pregnant women receiving Medicaid assistance with repeated measures design will be used to evaluate the EMPOWR model of five distinct centering arms identified to address the unique challenges to Kentucky women: 1) Psychosocial; 2) Tobacco Use and/or Substance Abuse; 3) Diabetes/Obesity; 4) International Hispanic; and 5) Obstetric/Medical Risk Factors.


  1. To improve the rate of cervical length measurement with a coordinated evidence based intervention strategy.
  2. To better coordinate substance abuse and tobacco abuse treatment.
  3. To enhance the care of women with metabolic disorders arising from the epidemic of obesity.
  4. To better address stressors during pregnancy particularly in women who are victims of domestic violence.


PATHways Beyond Birth: A program evaluation

Kristin Ashford, Agatha Critchfield, Amanda Fallin-Bennett

Sponsor: Kentucky Department of Mediaid Services; Rita and Alex Hillman Foundation


The overall goal is to evaluate the UK Healthcare Beyond Birth Program.


  1. Improvement in the number of perinatal women who achieve abstinence or sustain maintenance
  2. Increase the proportion of women qho do not place their children in foster care
  3. Improve maternal pyschosocial wellness 
  4. Increase the proportion of women participating in life skills training 

For more information:


Model of care for pregnant women with opioid use disorder, and infants with opioid exposure: A pilot study [Opioid Collaboration CTSA]

Sherry Weitzen, Jessia Coker, Kristin Ashford, Amanda Fallin-Bennett, Marcela Smid

Sponsor: CTSC Inter-instituational Pilot Award Program


To determine core data elements required for care and outcome evaluation of pregnant and postpartum women with opioid use disorders (OUD), and their infants with intrauterine opioid exposure, who are receiving perinatal care at the University of Kentucky. Additionally, our team will develop and test a data collection instrument for the identified core data elements. This is a multi- site study and the collaborating sites are affiliated with University of Arkansas for Medical Sciences, the University of Utah, and the University of New Mexico.


  1. The team will determine core data elements required for care and outcome evaluation of perinatal women with OUD, and develop a standardized data collection instrument to be used during the perinatal and postpartum periods for women with opioid use disorder and their infants.
  2. We propose to test the feasibility of using the developed tool and collecting the core measures identified in SA1 through use of the CCTS sponsored REDCap data management software.
  3. We will conduct focus groups with key stakeholders, including patients and providers, to better understand the priorities regarding services, priorities for treatment, and impact of collecting data to evaluate core measures.


Get Fit and Quit Program

Amanda Fallin-Bennett, Kristin Ashford

Sponsor: Building Interdisciplinary Research Careers in Women's Health (BIRCWH)


Get Fit and Quit (GFAQ) is an 8-week, group-centered, tobacco cessation program for women in residential treatment for substance use disorder (SUD).  This pilot-tested, community-engaged holistic tobacco treatment program integrates tobacco cessation education with physical activity and group support to help participants replace their smoking behaviors with alternative healthy coping strategies. 


  1. To evaluate the impact of the GFAQ program on tobacco use behaviors and attitudes among women living in a residential treatment facility
  2. To determine the impact of the GFAQ program on psycho-social wellness among the targeted population
  3. To determine the impact of the GFAQ program on physical activity among the target population


JUUL Use among College Student: Biomarkers, Behaviors and Respiratory Health

Kylie Doherty (Undergraduate Research Intern), Kristin Ashford (Faculty Advisor)

Sponsor: University of Kentucky College of Nursing Pilot Funding

Purpose: The purpose of this study is to examine differences in inflammatory markers, respiratory health, and behaviors among a group of undergraduate college students who have used Electronic Nicotine Devices(ENDS) within the past 30 days.


  1. To examine differences in nicotine dependence, oral cotinine and cytokine levels (Interleukin (IL), 1 a, 1 ß, 246810, TNF a,CRP, MMP8), and patterns of respiratory health between college students who report current use of ENDS and non-ENDS users.
  2. To compare gender differences in ENDS-use behaviors, and biomarkers in a sample of undergraduate college students.


The Kentucky Perinatal Action for Concurrent Tobacco Treatment (K-PACT) Program

Kristin Ashford, Andrea McCubbin, Janine Barnett, Letitia Ducas

 Sponsor: Kentucky Cabinet for Health and Family Services, Department for Behavioral Health, Developmental and Intellectual Disabilities

Purpose: This program was created in partnership with Kentucky Opioid Response Effort (KORE) program to provide a comprehensive targeted response to Kentucky's opioid crisis by expanding delivery of perinatal tobacco treatment for opioid use disorders. We will provide perinatal tobacco treatment education trainings to Kentucky providers delivered online via the UK CECentral Platform.

Modules will address:

  1. Basics of Perinatal Tobacco Treatment: Breaking Through to Cessation
  2. Tobacco Treatment with Special Populations, including perinatal women and women of childbearing age with substance use disorder.
  3. Electronic Cigarettes and the Perinatal Women, Families and their Children
  4. Cessation interventions using behavior modification methods: GET FIT and QUIT, a program integrative physical activity to replace perinatal smoking behaviors.



Implementation of a Transvaginal Ultrasound (TVU) Surveillance Program in Women with a History of Previous Preterm Birth: Disseminating Evidence Based Practices for Reducing Preterm Birth in Appalachian Kentucky: 

Niraj Chavan, Jing, Li, John O'Brien, Arnold Stromberg

UL1TR001998; K12DA035150 | Sponsor: UK CCTS, the National Center for Research Resources and the National Center for Advancing Translational Sciences, NIH; UK BIRCWH: ORWH and NIDA grant

Purpose: This project seeks to identify key areas of knowledge deficits, as well as attitudes, practices and perceived barriers among prenatal care providers and patients in Eastern Kentucky towards TVU cervical length screen, with the attempt to decrease preterm birth rates in the future. We propose to adopt a dissemination and implementation science approach using the Consolidated Framework for Implementation Research (CFIR) as the guiding framework.


  1. Determine the knowledge, perceptions and attitudes of practicing obstetric providers and patients with respect to implementation of cervical length screening.
  2. Develop an implementation strategy for promoting the use of transvaginal ultrasound for cervical length surveillance in women with a prior preterm birth in eastern KY.
  3. Pilot the implementation of a structured program targeted at increasing the uptake of TVU screening and evaluate the acceptability and feasibility of such an intervention.


Developing and Implementing a Pilot Program of Universal Cervical Length through Virtual Educational and outReach (CLEVER) to address Disparities in Preterm Birth: the CLEVER study

Niraj Chavan, Jing Li, Mairead Moloney, John O'Brien

 | Sponsor: AMAG Pharmaceuticals, Inc. 

Purpose: The overall goal of the project is to design and pilot the implementation of a universal TVU cervical length screening program at two community based clinics in Appalachian KY, using online instructional media and telehealth surveillance.


  1. Develop and pilot the implementation of a universal TVU cervical length screening program through provider and patient education and telehealth surveillance, and evaluate the change in update of TVU cervical length screening.
  2. Evaluate the feasibility and acceptability of implementing universal TVU cervical length screening at two community-based sites in Appalachian Kentucky.
  3. Evaluate the feasibility and acceptability of telemedicine as a platform for healthcare delivery among a subset of patients noted to have a short cervix on TVU cervical length screening.