Reducing Tobacco Smoke Exposures among Low Income Children and Women Caregivers in the Arkansas Delta Region

项目摘要/摘要 与建筑署的主题一致，这项研究的长期目标是减轻多重负担 烟草暴露，改善获得预防性护理的机会，减少慢性病的风险 社会处境不利的非裔美国妇女和儿童。非洲人吸烟的流行率 美国(AA)阿肯色州女性的吸烟率几乎是美国AA女性总体吸烟率的两倍 在AR中，这一组的费率正在上升。健康差距往往系统性地与社会 劣势，处于社会不利地位的再生障碍性贫血妇女和儿童获得预防性保健的机会较少 护理，暴露于二手烟的比例高得不成比例，以及暴露在无烟环境中的比例较低 家庭中的政策与优势群体相比。有大量的医疗保健提供者和 AR Delta地区农村县的基础设施不足，但供应商在激励方面发挥了重要作用 妇女在家里实施无烟政策，以保护她们的孩子。社区卫生工作者，谁 来自社区，可以通过增加妇女收养过程中的 意识到创新--即无烟政策--并说服他们考虑、采用和维持 创新。女性照顾者经常制定在家中吸烟的规则，但证据的传播- 农村社区的烟草控制政策进展缓慢。这项混合方法的研究将应用于 运用创新扩散理论、健康信念模型和健康信念理论的实施框架 指导制定和实施干预措施的合理行动，旨在增加 通过全面无烟政策(禁止香烟、雪茄、电子烟和水烟) 和儿童保管产品)在年迈的社会处境不利的AA妇女照顾者家中 18-50岁，居住在AR三角洲地区。我们的跨学科团队，无烟草联盟 阿肯色州，三县农村健康网络和阿肯色大学医学科学，将 实施一项小规模随机试验，以测试可行性并比较干预结果 小组(社区卫生工作者+风险沟通材料+简短励志咨询+烟草 关于儿童的暴露反馈)向控制组的反馈(风险宣传材料)在初级保健上 结果，在家中实施无烟政策，以及次要结果，戒烟和吸烟 在3个月、6个月和12个月时恢复。我们的目标是1)在AA女性中进行半结构化访谈 护理者(n=30)和社区卫生工作者(n=15)了解多层次和多领域的因素 影响烟草使用和政策实践；2)使用访谈数据来制定、调整和试行 使用6个女性照顾者焦点小组(n=48)的干预原型和我们利益相关者的反馈 评估干预对研究结果的影响(n=206)。

PROJECT SUMMARY/ABSTRACT Consistent with the theme of the ARCHD, the long-term goal of this study is to reduce the burden of multiple tobacco exposures, improve access to preventive care, and reduce the risk for chronic diseases among socially disadvantaged African American women and children. Cigarette smoking prevalence among African American (AA) Arkansan women is nearly double the overall smoking prevalence for AA women in the US and rates are increasing within this group in AR. Health disparities are often systematically linked to social disadvantage, with socially disadvantaged AA women and children having poorer access to preventive health care, disproportionately higher rates of secondhand smoke exposure, and lower exposure to smoke-free policies in the home compared to advantaged groups. There are enormous health care provider and infrastructure deficits in rural counties in the AR Delta region, yet providers play an important role in motivating women to implement smoke-free policies in the home to protect their children. Community health workers, who are from the community, could have a powerful influence on women's adoption processes by increasing the awareness of the innovation—i.e., smoke-free policies—and persuading them to consider, adopt, and sustain the innovation. Women caregivers often establish rules for smoking in the home, but the diffusion of evidence- based tobacco control policies in rural communities has been slow. This mixed-methods study will apply an implementation framework using the Diffusion of Innovation Theory, Health Belief Model, and Theory of Reasoned Action to guide the development and implementation of an intervention that aims to increase the adoption of comprehensive smoke-free policies (ban on cigarettes, cigars, electronic cigarettes, and hookah and safekeeping products from children) in the homes of socially disadvantaged AA women caregivers aged 18-50 years who live in the AR Delta region. Our transdisciplinary team, the Coalition for a Tobacco Free Arkansas, Tri-County Rural Health Network, and the University of Arkansas for Medical Sciences, will implement a small-scale randomized trial that tests the feasibility and compares outcomes for the intervention group (community health worker + risk communication materials + brief motivational counseling + tobacco exposure feedback on the child) to those for the control group (risk communication materials) on the primary outcome, implementation of smoke-free policy in the home, and the secondary outcomes, quitting and smoking reduction at 3, 6, and 12 months. Our aims are to 1) conduct semi-structured interviews among AA women caregivers (n = 30) and community health workers (n = 15) to understand multi-level and -domain factors that influence tobacco use and policy practices; 2) use the interview data to develop, adapt, and pilot test the intervention prototypes using 6 focus groups of women caregivers (n = 48) and feedback from our Stakeholder Partnership Board; and 3) assess the influence of the intervention on the study's outcomes (n = 206).