Reducing Tobacco Smoke Exposures among Low Income Children and Women Caregivers in the Arkansas Delta Region

项目总结/摘要 与ARCHD的主题一致，本研究的长期目标是减轻多重 烟草暴露，改善获得预防保健的机会，并减少慢性疾病的风险， 社会弱势的非裔美国妇女和儿童。非洲人吸烟率 美国（AA）阿肯色州妇女的吸烟率几乎是美国AA妇女吸烟率的两倍， 在这一组中，AR的发病率正在上升。健康差距往往与社会因素有系统的联系。 处于社会弱势地位的AA妇女和儿童获得预防性保健的机会较少 护理，不成比例的二手烟暴露率较高，以及无烟环境的暴露率较低 家庭政策与非政府组织相比。有大量的医疗保健提供者， AR三角洲地区农村县的基础设施不足，但供应商在激励方面发挥着重要作用。 妇女在家中实施无烟政策，以保护其子女。社区卫生工作者， 来自社区，可以对妇女的收养过程产生强大的影响， 对创新的认识-即，无烟政策，并说服他们考虑，采用和维持 创新。女性护理人员经常制定在家中吸烟的规则，但证据的传播- 农村社区的烟草控制政策进展缓慢。这种混合方法的研究将适用于一个 实施框架使用创新理论的扩散，健康信念模型，和理论 合理的行动，以指导制定和实施旨在提高 采取全面的无烟政策（禁止香烟、雪茄、电子烟和水烟） 在社会上处于不利地位的AA级妇女照料者家中， 18-50岁，居住在AR三角洲地区。我们的跨学科团队无烟联盟 阿肯色州、三县农村卫生网络和阿肯色州大学医学科学院将 实施一项小规模随机试验，测试干预措施的可行性并比较其结果 小组（社区卫生工作者+风险沟通材料+简短的动机咨询+烟草 对儿童的暴露反馈）与对照组（风险沟通材料）的主要 结果，家庭无烟政策的实施，以及次要结果，戒烟和吸烟 在3、6和12个月时减少。我们的目标是：1）在AA女性中进行半结构化访谈 护理人员（n = 30）和社区卫生工作者（n = 15）了解多层次和多领域的因素， 影响烟草使用和政策实践; 2）使用访谈数据来制定，调整和试点测试 使用6个女性护理人员焦点小组（n = 48）和利益相关者反馈的干预原型 评估干预对研究结果的影响（n = 206）。

PROJECT SUMMARY/ABSTRACT 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 (AA) Arkansan women is nearly double the overall smoking prevalence for AA women in the US and rates are increasing within this group in AR. Health disparities are often systematically linked to social disadvantage, with socially disadvantaged AA women and children having poorer access to preventive health care, disproportionately higher rates of secondhand smoke exposure, and lower exposure to smoke-free policies in the home compared to advantaged groups. There are enormous health care provider and infrastructure deficits in rural counties in the AR Delta region, yet providers play an important role in motivating women to implement smoke-free policies in the home to protect their children. Community health workers, who are from the community, could have a powerful influence on women's adoption processes by increasing the awareness of the innovation—i.e., smoke-free 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 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 of comprehensive smoke-free policies (ban on cigarettes, cigars, electronic cigarettes, and hookah and safekeeping products from children) in the homes of socially disadvantaged AA 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 outcomes for the intervention group (community health worker + risk communication materials + brief motivational counseling + tobacco exposure feedback on the child) to those for the control group (risk communication materials) on the primary outcome, implementation of smoke-free 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 AA women caregivers (n = 30) and community health workers (n = 15) to understand multi-level and -domain factors that influence tobacco use and policy practices; 2) use the interview data to develop, adapt, and pilot test the intervention prototypes using 6 focus groups of women caregivers (n = 48) and feedback from our Stakeholder Partnership Board; and 3) assess the influence of the intervention on the study's outcomes (n = 206).