ENVIRONMENTAL TOBACCO SMOKE INTERVENTION IN LAKOTA FAMILY HOUSEHOLDS

在过去的40年里，美国普通人口的吸烟率一直在下降，但北方平原部落（包括奥格拉拉苏族和其他拉科塔部落）的商业烟草使用率却很高。在许多社区，这些部落群体的吸烟率超过50%，大约是美国普通人口的2.5倍。我们的主要研究目标是开发和测试一种文化定制的教育干预措施，以鼓励在有孩子的北方平原部落家庭中采用家庭吸烟限制。我们将进行一项随机对照试验，以测试一种新的生物标志物反馈干预。我们将180个家庭随机分为两组，一组只接受教育材料（对照组），另一组接受教育材料和尿毒素水平信息（例如，可替宁和烟草特有的亚硝胺）存在于来自家庭的一个孩子中（生物标志物干预）。可替宁是一种公认的暴露于烟草烟雾的标志物，干预措施将向吸烟家庭提供关于其子女实际暴露于环境烟草烟雾的反馈。这项研究的主要成果将是通过家庭空气质量监测器验证的家庭吸烟限制。我们的科学目标是：1）评估儿童尿毒素生物标志物反馈干预对家庭吸烟限制和家庭空气质量的影响; 2）确定实施教育和生物标志物反馈干预后3个月和6个月干预对健康相关生活质量的影响;确定干预对成年吸烟者吸烟的影响，包括戒烟准备、戒烟尝试和戒烟; 4）评估干预措施如何改变与吸烟行为相关的文化和社会因素，如传统烟草使用和家庭支持。我们假设，儿童毒素生物标志物反馈的干预将增加家庭吸烟限制的采用，而不仅仅是接受小册子和教育的效果。

While smoking rates have been declining within the U.S. general population for the past 4 decades, the Northern Plains tribes (which include the Oglala Sioux and other Lakota tribes) have experienced high rates of commercial tobacco use. The prevalence of smoking among these tribal groups is greater than 50% in many communities, roughly 2.5 times higher than the U.S. general population. Our primary study objective is to develop and test a culturally tailored educational intervention to encourage adoption of home smoking restrictions in Northern Plains' tribal households where children are present. We will conduct a randomized, controlled trial to test a novel biomarker feedback intervention. We will randomize 180 households to either receipt of educational materials only (control group), or receipt of educational materials plus information on urine toxin levels (e.g., cotinine and tobacco-specific nitrosamines) present in one child from the household (biomarker intervention). Cotinine is a well-recognized marker of exposure to tobacco smoke, and the intervention will provide feedback to smoking households about their children's actual exposure to environmental tobacco smoke. The primary outcome of this study will be the adoption of home smoking restrictions verified by a household air quality monitor. Our scientific aims are to: 1) Evaluate the impact of the child urinary toxin biomarker feedback intervention on the adoption of home smoking restrictions and on home air quality; 2) Determine the effect of the intervention on health-related quality of life 3 and 6 months after implementation of the educational and biomarker feedback intervention; Determine the effect of the intervention on adult smokers' cigarette use, including readiness to quit, quit attempts, and cessation; 4) Assess how the intervention changes cultural and social factors that relate to smoking behavior, such as traditional tobacco use and family support. We hypothesize that the intervention with child toxin biomarker feedback will increase the adoption of home smoking restrictions, beyond the effect of just receiving a brochure and education.