Arkansas Center for Health Disparities (ARCHD) Bridge Funding

项目摘要/摘要-总体

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.