Community Outreach and Biomarker Feedback for Smoke-Free African American Homes

在生命早期暴露于环境烟草烟雾（ETS）会增加婴儿猝死的风险 综合征、哮喘和呼吸道感染导致5,000多人过早死亡， 美国的孩子每年。非洲裔美国儿童遭受的后果不成比例， ETS暴露与有充分记录的婴儿猝死和哮喘的发生率较高。虽然根为 这些差异是复杂的（例如，贫穷、住房条件差、环境过敏原）、暴露 是导致发病率和死亡率过高的一个显著且可迅速逆转的原因。我们建议 通过向吸烟父母/护理人员提供文化敏感的生物标志物反馈来解决这一缺陷， 他们的孩子接触烟草毒素。我们将使用以客户为中心的动机增强咨询 风格来进行干预。此外，社区卫生工作者（CHW）提供这种干预措施， 将进一步增加所提出的生物标志物反馈干预的显著性。有了这些点， 考虑到这一点，我们提出了一个两组随机临床试验（N=180），以确定文化的有效性， 记录儿童暴露于烟草毒素（NNAL、尼古丁、可替宁）的敏感生物标志物反馈 减少非裔美国儿童在家中接触ETS。参与者（即，吸烟的父母或 护理人员）将随机接受两种治疗之一： Tx 1：一般家庭安全干预-联系对照组（主要生物标志物反馈） Tx 2：家庭ETS减少干预-治疗组（烟草特异性生物标志物反馈） 我们假设，烟草特异性生物标志物反馈将导致家庭ETS（空气尼古丁）降低， 通过增加父母戒烟和/或采用完全的家庭禁烟令。 这项研究将确定一项创新和有效的战略，减少非洲人的ETS暴露。 美国儿童所提出的文化敏感的生物标志物反馈的递送可以作为一种方法， 为未来努力将个性化医疗的承诺带给服务不足的人群提供模板。

Exposure to environmental tobacco smoke (ETS) early in life increases the risk of sudden infant death syndrome, asthma, and respiratory infections contributing to more than 5,000 premature deaths among children in the US each year. African American children suffer disproportionately from the consequences of ETS exposure with well documented higher rates of sudden infant death and asthma. While the roots for these disparities are complex (e.g., poverty, poor housing conditions, environmental allergens), exposure to ETS is a prominent and quickly reversible cause of excess morbidity and mortality. We propose to address this deficit by providing culturally-sensitive biomarker feedback to the smoking parent/caregiver on their child's exposure to tobacco toxins. We will use a client centered motivationally enhanced counseling style to deliver the intervention. Further, delivery of this intervention by community health workers (CHWs) will further increase the salience of the proposed biomarker feedback intervention. With these points in mind, we propose a two-arm randomized clinical trail (N=180) to determine the efficacy of culturally sensitive biomarker feedback documenting a child's exposure to tobacco toxins (NNAL, nicotine, cotinine) to reduce home ETS exposure among African American children. Participants (i.e., the smoking parent or caregiver) will be randomized to receive one of two treatments: Tx1: General Home Safety Intervention - Contact Control Group (Lead Biomarker Feedback) Tx2: Home ETS Reduction Intervention - Treatment Group (Tobacco-Specific Biomarker Feedback) We hypothesize that tobacco-specific biomarker feedback will result in decreased home ETS (air nicotine levels) through increased parental smoking cessation and/or adoption of complete home smoking bans. This study will identify an innovative and effective strategy for reducing ETS exposure among African American children. The proposed delivery of culturally sensitive biomarker feedback can serve as a template for future efforts to bring the promise of personalized medicine to underserved populations.