Promoting Smoke-free Homes in Lakota Communities.

二手烟（SHS）被认为是A类致癌物，没有安全的暴露水平。 据估计，SHS每年导致3，000多名非吸烟者死于肺癌。的广泛 随着立法限制在工作场所和其他公共场所吸烟，大多数美国公众现在住在州 法律来防止SHS暴露。然而，非自愿接触SHS的主要地方仍然是， 现在发生在家里。来自南达科他州的拉科塔部落夏延河苏族部落的不吸烟者， 不成比例地分担SHS的负担，特别是在家中。我们自己最近的发现表明， 夏延河苏族成人不吸烟者的可替宁水平等于那些经常看到的积极吸烟者。 由于这一人群的吸烟率高达50%，SHS的后果已经显现出来 包括儿童哮喘和婴儿猝死综合症的高发率。进一步 使问题复杂化的是，商业烟草产品在仪式和文化活动中的使用扩大， 这在非美洲印第安人社区是不常见的。因此，消除SHS 以文化上适当的方式进行接触是减少儿童发病率和死亡率的一个基本步骤， 夏延河苏族部落和其他北方平原部落。 我们的主要研究目标是测试一种文化定制的干预措施，以鼓励家庭收养。 夏延河苏族部落家庭中不吸烟者的吸烟限制。我们提出 进行随机对照试验，以开发、实施和评估文化定制的SHS 有和没有尿生物标志物反馈的宣传培训。生物标记反馈是一种干预 提供高度个性化反馈的方法，在这种情况下，包括尿烟草特异性水平 进一步表征家庭吸烟负面后果证据的致癌物标志物 我们的具体目标是：1）评估有关二手烟的知识、态度和信念 接触和感知的障碍，以采取吸烟限制在部落成员家庭对 夏延河苏族部落保留地。根据我们之前的工作，我们预计很少有参与者知道 与SHS暴露相关的危险。我们预计很少有人有无烟家庭; 2）增加， 实施并评估非吸烟者尿可替宁和致癌物生物标志物反馈干预， 采取家庭吸烟限制。我们希望接受倡导的非吸烟成年人 使用尿液生物标志物反馈的培训更有可能确认在吸烟期间需要限制吸烟。 他们的家庭比那些只接受宣传培训，和; 3）确定的效果， 实施宣传和生物标志物后6个月对健康相关生活质量的干预 反馈干预我们假设，干预将与改善健康相关的 生活质量，超过了宣传培训的对照组所经历的任何改善。

Secondhand smoke (SHS) is recognized as a class A carcinogen and has no safe level of exposure. SHS is estimated to contribute to over 3,000 lung cancer deaths in non-smokers annually. With widespread legislation restricting smoking in workplaces and other public venues, most of the U.S. public now live in states with laws to protect against SHS exposure. Yet, the primary place in which involuntary exposure to SHS still occurs is now in homes. Nonsmokers from the Cheyenne River Sioux Tribe, a Lakota tribe from South Dakota, disproportionately share the burden of SHS, especially in their homes. Our own recent findings show that Cheyenne River Sioux adult nonsmokers have cotinine levels equal to those regularly seen in active smokers. With smoking prevalence as high as 50% among this population, the consequences of SHS already manifest in this Tribe, including high prevalences of childhood asthma and sudden infant death syndrome. Further complicating matters, the expanded use of commercial tobacco products for ceremonial and cultural practices is creating challenges not typically seen in non-American Indian communities. Therefore, eliminating SHS exposure in a culturally appropriate manner is a fundamental step in decreasing morbidity and mortality among Cheyenne River Sioux Tribe and other Northern Plains Tribes. Our primary study objective is to test a culturally tailored intervention to encourage adoption of home smoking restrictions in Cheyenne River Sioux Tribal households where nonsmokers are present. We propose to conduct a randomized, controlled trial to develop, implement and evaluate a culturally tailored SHS advocacy training both with and without urinary biomarker feedback. Biomarker feedback is an intervention method that provides highly personalized feedback including, in this instance, levels of urinary tobacco-specific pro-carcinogen markers that further characterize evidence of the negative sequelae of smoking in homes Our Specific Aims are to 1) Assess knowledge, attitudes and beliefs about secondhand smoke exposure and perceived barriers to adoption of smoking restrictions in tribal member households on the Cheyenne River Sioux Tribe Reservation. Based on our prior work we expect that few participants know about the dangers associated with SHS exposure. We expect that few have smoke-free homes; 2) Augment, implement, and evaluate a nonsmokers’ urinary cotinine and carcinogen biomarker feedback intervention on the adoption of household smoking restrictions. We expect that the nonsmoker adults who receive advocacy training with urinary biomarker feedback will be more likely to affirm that smoking restrictions are needed within their households than those just receiving advocacy training only, and; 3) Determine the effect of the intervention on health-related quality of life 6 months after implementation of advocacy and biomarker feedback intervention. We hypothesize that the intervention will be associated with improved health-related quality of life, beyond any improvement experienced by advocacy training-only control group.