Promoting Smoke-Free Homes in Rural American Indian Households

摘要 无烟家庭是美国农村地区癌症预防的一种创新且相对未开发的策略 印第安人社区。农村居民的吸烟率不仅高于城市居民， 在美国印第安人相对于其他主要种族/民族群体在美国无烟家庭，少 常见于有吸烟成年人的家庭，可以减少接触二手烟（SHS）和支持 停止拟议的研究建立在埃默里预防中心与 研究中心（EPRC）和CDC资助的国家土著网络的两名成员， 调整循证干预措施，以促进无烟家庭。部落间理事会 密歇根州（ITCM）代表密歇根州12个联邦承认的部落;大平原部落领袖健康 委员会（GPTLHB）代表四个州（北达科他州， 南达科他州、内布拉斯加州和爱荷华州），加上一个服务区。环境审查委员会利用参与性进程， 与ITCM和国家土著网络合作，为美国人适应无烟家庭干预措施， 印第安人/阿拉斯加原住民（AI/AN）最初的干预措施是通过一系列研究进行评估的， 有效性到有效性到传播，并被列入NCI的循证癌症控制计划 网站适应涉及一个系统的过程，包括10个重点小组，创造无烟 家庭，并就无烟家庭和传统使用 在密歇根州、加州、俄克拉荷马州和阿拉斯加的部落中种植烟草。我们现在已经准备好测试 适应性干预的有效性。采用通过指导委员会运作的参与性办法， 我们的目标是：1）预先测试和完善适应无烟 家园：尊重我们的过去，保护我们的未来 2）评估调整后的干预措施对建立无烟家庭规则的影响， 美国印第安家庭使用随机等待名单对照试验，随访3个月和6个月， 并探讨其对无烟车辆、戒烟尝试、戒烟和支持吸烟的影响- 免费部落住房; 3）对干预措施进行混合方法过程评价，以评估覆盖范围， 采用、实施、环境影响以及部落、组织和 参与者的观点，以及4）评估社区对解决无烟多单位问题的准备程度的变化 部落住宅这项研究建立在一个成功的合作，有可能创造一个创新的， 促进农村地区无烟家庭和减少美洲印第安人SHS的有效模式 不吸烟者和儿童以及相关癌症的差异。我们的伙伴关系的重要能力有很大的 如果干预措施证明有效，则有可能广泛传播。

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.