Promoting Smoke-Free Homes in Rural American Indian Households

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ABSTRACT Smoke-free homes are an innovative and relatively untapped strategy for cancer prevention in rural American Indian communities. Smoking rates are not only higher among rural than urban residents, but also higher among American Indians relative to other major racial/ethnic groups in the U.S. Smoke-free homes, less common in homes with adults who smoke, can reduce exposure to secondhand smoke (SHS) and support cessation. The proposed research builds on an established partnership between the Emory Prevention Research Center (EPRC) and two members of the CDC-funded National Native Network to evaluate the adaptation of an evidence-based intervention to promote smoke-free homes. The Inter-Tribal Council of Michigan (ITCM) represents 12 federally recognized tribes in Michigan; the Great Plains Tribal Leaders Health Board (GPTLHB) represents 17 sovereign American Indian nations within a four-state area (North Dakota, South Dakota, Nebraska and Iowa), plus a service area. Using a participatory process, the EPRC partnered with the ITCM and the National Native Network to adapt a smoke-free homes intervention for American Indian/Alaska Native (AI/AN) families. The original intervention was evaluated through a series of studies, from efficacy to effectiveness to dissemination, and is listed on NCI’s Evidence-Based Cancer Control Programs website. The adaptation involved a systematic process, including 10 focus groups on creating smoke-free homes in AI/AN families and input on appropriate messaging for smoke-free homes and traditional use of tobacco with tribes in Michigan, California, Oklahoma and Alaska. We are now well-positioned to test the effectiveness of the adapted intervention. Using a participatory approach operationalized through a Steering Committee with shared decision-making, our aims are to: 1) pre-test and refine the adapted Smoke-Free Homes: Respect our Past, Protect our Future intervention to ensure cultural appropriateness for specific tribal partners; 2) evaluate the impact of the adapted intervention on establishment of smoke-free home rules among American Indian households using a randomized wait-list controlled trial with three and six month follow-up, and explore its impact on smoke-free vehicles, cessation attempts, smoking cessation, and support for smoke- free tribal housing; 3) conduct a mixed methods process evaluation of the intervention to assess reach, adoption, implementation, contextual influences, and maintenance potential from tribal, organizational and participant perspectives, and 4) assess changes in community readiness to address smoke-free multi-unit tribal housing. This research builds on a successful collaboration with the potential to create an innovative and effective model for promoting smoke-free homes in rural areas, and for reducing SHS among American Indian nonsmokers and children and related cancer disparities. The significant capacity of our partnership has great potential for widespread dissemination of the intervention should it prove effective.