Arkansas Center for Health Disparities (ARCHD) Bridge Funding

项目摘要/摘要--总体 健康差距是阿肯色州的一个重大问题，需要研究来消除它们。这个 发展和支持研究人员和社区，他们可以进行研究以阐明 这些差异背后的机制并测试实现卫生公平的战略的有效性是 必不可少的。在拟议的过渡性资助年度，我们将继续完成对少数群体健康的研究 差异，促进培训多样化的研究队伍，传播研究成果，促进 通过阿肯色州健康差距中心(ArchD)的活动开展合作和伙伴关系。 作为卓越中心，ArchD以15年的强大协作工作为基础，继续其主题 专注于开发多学科、多水平的研究，以降低以下疾病的慢性病风险因素 在社会上处于不利地位的非裔美国人中存在着显著的健康差距 社区，目标是改善健康和生活质量，并最终消除健康 差距。建筑署将维持三个核心单位-一个行政核心，以提供全面协调和 管理中心活动，包括协调共同数据要素、评价和 方法专业知识；调查员开发核心，以继续进行早期试验项目计划 调查人员并提供指导和指导；以及社区参与和传播 核心，以扩大和促进与社区和其他组织的公平、可持续、协作关系 协调研究成果向不同受众群体的传播。《中心》 将继续两个完整的研究项目，两个项目都使用社区卫生工作者模式来提供干预措施 弱势非裔美国人人口，即农村社区的非洲裔美国女性烟草使用者 最近还监禁了感染艾滋病毒风险很高的非裔美国人。我们还将继续促进 针对少数群体健康差距的其他研究，这些研究的传播可能有助于努力 在政策、计划和环境方面创造系统性的变化，以减少和消除健康差距。 与建筑署的主题一致，这项研究的长期目标是减轻 多种烟草暴露，改善获得预防性护理的机会，降低慢性病风险 在社会处境不利的非裔美国妇女和儿童中。吸烟人群的吸烟情况 阿肯色州的非裔美国女性吸烟率几乎是非裔美国女性的两倍 美国的女性和AR中的非裔美国女性的比例正在上升。健康差距 往往系统性地与社会劣势和处于社会劣势的非裔美国妇女联系在一起 儿童获得预防性医疗保健的机会更少，二手房的比例更高 吸烟暴露，以及与优势群体相比，在家中接触无烟政策的风险较低。 AR三角洲的农村贫困县存在巨大的医疗保健提供者和基础设施赤字 然而，供应商在激励妇女在家中实施无烟政策方面发挥着重要作用 来保护他们的孩子。来自社区的社区卫生工作者可能会有一个强大的 通过提高对创新的认识来影响妇女的收养过程--在这种情况下， 无烟政策-并说服他们考虑、采用和维持创新。女性照顾者 经常为在家中吸烟制定规则，但循证烟草控制政策在 农村贫困社区发展缓慢。这项混合方法研究将应用一个实施 使用创新扩散理论、健康信念模型和理性行动理论的框架 指导制定和实施旨在增加采用率和 实施全面无烟政策(禁烟、雪茄、电子烟、水烟 和儿童保管产品)在社会弱势的非裔美国妇女的家中 居住在AR三角洲地区的18-50岁的照顾者。我们的跨学科团队， 阿肯色州无烟区、三县农村健康网和阿肯色州医学大学 将实施一项小规模随机试验，测试可行性并比较 干预组(社区卫生工作者风险沟通材料简介激励 咨询烟草暴露对儿童的反馈)给对照组(风险宣传材料) 主要结果是在家中实施无烟政策，次要结果是戒烟 在3、6和12个月时减少吸烟。我们的目标是1)在以下人员中进行半结构化面试 非裔美国妇女了解影响烟草使用和政策的多层次和多领域因素 实践；2)使用访谈数据来开发、适应、试行干预原型；以及3)评估 干预对研究结果的影响。

PROJECT SUMMARY/ABSTRACT - OVERALL Health disparities are a significant problem in Arkansas, arguing for research to eliminate them. The development and support of researchers and communities who can conduct research to elucidate the mechanisms underlying these disparities and test the effectiveness of strategies to achieve health equity is essential. In the proposed bridge funding year, we will continue to complete research in minority health disparities, promote the training of a diverse research workforce, disseminate research findings, and foster collaborations and partnerships through the activities of the Arkansas Center for Health Disparities (ARCHD). The ARCHD builds on 15 years of strong, collaborative work as a Center of Excellence, continuing its thematic focus on developing multidisciplinary, multilevel research that reduces chronic disease risk factors for which there are significant health disparities among socially disadvantaged African American communities, with a goal of improving health and quality of life and ultimately eliminating health disparities. ARCHD will maintain three core units – an Administrative Core to provide overall coordination and management of Center activities, including the coordination of common data elements, evaluation, and methods expertise; an Investigator Development Core, to continue a pilot project program for early stage investigators and to provide mentorship and guidance; and a Community Engagement and Dissemination Core, to expand and facilitate equitable, sustainable, collaborative relationships with community and other stakeholders and to coordinate dissemination of research findings to diverse audience segments. The Center will continue two full research projects, both using a community health worker model to deliver interventions to disadvantaged African American populations, i.e., female African American tobacco users in rural communities and recently incarcerated African Americans at high risk of contracting HIV. We will also continue to foster additional research addressing minority health disparities, the dissemination of which may inform efforts to create systematic change in policies, programs, and environments to reduce and eliminate health disparities. 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 Arkansan women is nearly double the overall smoking prevalence for African American women in the United States and rates are increasing among African American women in AR. Health disparities are often systematically linked to social disadvantage and socially disadvantaged African American women and children have poorer access to preventive health care, disproportionately higher rates of secondhand smoke exposure, and lower exposure to smokefree policies in the home compared to advantaged groups. There are enormous health care provider and infrastructure deficits in rural distressed counties in the AR Delta region, yet providers play an important role in motivating women to implement smokefree policies in the home to protect their children. Community health workers, who are from the community, could have a powerful influence on womens’ adoption processes by increasing the awareness of the innovation—in this case, smokefree 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 distressed 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 and implementation of comprehensive smokefree policies (ban on cigarettes, cigars, electronic cigarettes, hookah and safekeeping products from children) in the homes of socially disadvantaged African American 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 the efficacy of the intervention group (community health worker + risk communication materials + brief motivational counseling + tobacco exposure feedback on the child) to the control group (risk communication materials) on the primary outcome, implementation of smokefree 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 African American women to understand multi-level and -domain factors that influence tobacco use and policy practices; 2) use the interview data to develop, adapt, pilot test the intervention prototypes; and 3) assess the influence of the intervention on the study’s outcomes.