Arkansas Center for Health Disparities (ARCHD) Bridge Funding

项目总结/摘要-总体 健康差距是阿肯色州的一个重要问题，人们主张进行研究以消除这些差距。的 发展和支持研究人员和社区，他们可以进行研究， 这些差距背后的机制，并测试战略的有效性，以实现健康公平是 具有本质意义在拟议的桥梁资助年度，我们将继续完成少数民族健康方面的研究 差异，促进多样化研究队伍的培训，传播研究成果，并促进 通过阿肯色州健康差异中心（ARCHD）的活动开展合作和伙伴关系。 ARCHD建立在15年的强大，协作工作作为一个卓越的中心，继续其主题 重点发展多学科，多层次的研究，减少慢性疾病的危险因素， 在社会弱势的非裔美国人中， 社区，目标是改善健康和生活质量，并最终消除健康 差距。ARCHD将保持三个核心单位-行政核心提供全面协调， 中心活动的管理，包括共同数据元素的协调，评估， 方法专业知识;研究者发展核心，继续早期阶段的试点项目计划 调查员，并提供辅导和指导;以及社区参与和传播 核心，扩大和促进与社区和其他 协调向不同受众群体传播研究成果的工作。中心 将继续两个完整的研究项目，都使用社区卫生工作者模型提供干预措施， 弱势的非洲裔美国人，即，农村社区的非裔美国女性烟草使用者 最近被监禁的非洲裔美国人感染艾滋病毒的风险很高。我们还将继续培养 对少数群体的健康差异进行更多的研究，传播这些研究结果可为以下努力提供信息： 在政策、方案和环境方面进行系统性变革，以减少和消除健康差距。 与ARCHD的主题一致，本研究的长期目标是减轻 多种烟草暴露，改善获得预防保健的机会，并降低慢性疾病的风险 在社会上处于不利地位的非裔美国妇女和儿童。吸烟流行率 阿肯色州的非裔美国妇女吸烟率几乎是非裔美国人的两倍 在美国的妇女和率正在增加的非洲裔美国妇女在AR。健康差距 通常与社会弱势和处于社会弱势的非裔美国妇女有系统的联系 儿童获得预防性卫生保健的机会较少， 与吸烟组相比，吸烟暴露和家庭无烟政策暴露较低。 在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， 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。妇女照料者 经常制定在家中吸烟的规则，但以证据为基础的烟草控制政策的传播， 农村贫困社区进展缓慢。本混合方法研究将应用一个实现 该框架使用创新扩散理论、健康信念模型和理性行动理论， 指导制定和实施旨在增加采用率和 实施全面无烟政策（禁止香烟、雪茄、电子烟、水烟 和儿童的有害产品）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岁的护理人员。我们的跨学科团队， 无烟草阿肯色州、三县农村卫生网络和阿肯色州大学医学中心 科学，将实施一项小规模的随机试验，测试的可行性，并比较疗效 干预组（社区卫生工作者+风险沟通材料+简短激励 咨询+对儿童的烟草暴露反馈）向对照组（风险沟通材料）提供 主要结果是在家中实施无烟政策，次要结果是戒烟 在3个月、6个月和12个月时减少吸烟。我们的目标是：1）进行半结构化面试， 非洲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，调整，试点测试干预原型; 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.