Promoting Smoke-Free Homes in Rural American Indian Households

摘要 无烟家庭是美国农村地区一种创新的、相对未被开发的癌症预防策略 印第安人社区。农村居民的吸烟率不仅比城市居民高，而且也更高 在美国印第安人中，相对于美国其他主要种族/民族，无烟家庭中，较少 在有吸烟成年人的家庭中很常见，可以减少二手烟(SHS)和支持 停止。拟议的研究建立在埃默里预防中心之间建立的伙伴关系基础上 研究中心(EPRC)和疾控中心资助的国家土著网络的两名成员评估 采用循证干预措施促进无烟住宅。部族间会议 密歇根州(ITCM)代表密歇根州12个联邦承认的部落；大平原部落首领健康 委员会(GPTLHB)代表四个州地区(北达科他州， 南达科他州、内布拉斯加州和爱荷华州)，外加一个服务区。利用参与性进程，EPRC合作 与ITCM和国家原住民网络一起为美国人调整无烟家庭干预 印第安人/阿拉斯加原住民(AI/AN)家庭。最初的干预措施是通过一系列研究进行评估的， 从有效到有效再到传播，并被列入NCI的循证癌症控制计划 网站。适应工作涉及一个系统的过程，包括关于创建无烟的10个重点小组 人工智能/人工智能家庭中的家庭和关于无烟家庭和传统使用的适当消息的投入 烟草与密歇根州、加利福尼亚州、俄克拉何马州和阿拉斯加州的部落。我们现在已经做好了测试的准备 适应性干预的有效性。使用参与式方法，通过指导来运作 共同决策的委员会，我们的目标是：1)预先测试和改进适应的无烟 家园：尊重我们的过去，保护我们的未来干预，以确保特定部落的文化适宜性 合作伙伴；2)评估调整后的干预措施对建立无烟家庭规则的影响 美国印第安人家庭使用随机等待名单对照试验，分别随访3个月和6个月， 并探讨其对无烟车辆、戒烟尝试、戒烟和支持吸烟的影响- 免费部落住房；3)对干预进行混合方法过程评估，以评估REACH， 采用、实施、背景影响以及来自部落、组织和 参与者观点，以及4)评估社区准备情况的变化，以解决无烟多单元问题 部落住房。这项研究建立在成功合作的基础上，有可能创造一种创新和 在农村地区推广无烟家庭和减少美国印第安人SHS的有效模式 非吸烟者和儿童与相关癌症的差异。我们伙伴关系的重要能力有很大的 如果事实证明干预有效，干预可能会得到广泛传播。

ABSTRACT Smoke-free homes are an innovative and relatively untapped strategy for cancer prevention in rural American Indian communities. Smoking rates are not only higher among rural than urban residents, but also higher among American Indians relative to other major racial/ethnic groups in the U.S. Smoke-free homes, less common in homes with adults who smoke, can reduce exposure to secondhand smoke (SHS) and support cessation. The proposed research builds on an established partnership between the Emory Prevention Research Center (EPRC) and two members of the CDC-funded National Native Network to evaluate the adaptation of an evidence-based intervention to promote smoke-free homes. The Inter-Tribal Council of Michigan (ITCM) represents 12 federally recognized tribes in Michigan; the Great Plains Tribal Leaders Health Board (GPTLHB) represents 17 sovereign American Indian nations within a four-state area (North Dakota, South Dakota, Nebraska and Iowa), plus a service area. Using a participatory process, the EPRC partnered with the ITCM and the National Native Network to adapt a smoke-free homes intervention for American Indian/Alaska Native (AI/AN) families. The original intervention was evaluated through a series of studies, from efficacy to effectiveness to dissemination, and is listed on NCI’s Evidence-Based Cancer Control Programs website. The adaptation involved a systematic process, including 10 focus groups on creating smoke-free homes in AI/AN families and input on appropriate messaging for smoke-free homes and traditional use of tobacco with tribes in Michigan, California, Oklahoma and Alaska. We are now well-positioned to test the effectiveness of the adapted intervention. Using a participatory approach operationalized through a Steering Committee with shared decision-making, our aims are to: 1) pre-test and refine the adapted Smoke-Free Homes: Respect our Past, Protect our Future intervention to ensure cultural appropriateness for specific tribal partners; 2) evaluate the impact of the adapted intervention on establishment of smoke-free home rules among American Indian households using a randomized wait-list controlled trial with three and six month follow-up, and explore its impact on smoke-free vehicles, cessation attempts, smoking cessation, and support for smoke- free tribal housing; 3) conduct a mixed methods process evaluation of the intervention to assess reach, adoption, implementation, contextual influences, and maintenance potential from tribal, organizational and participant perspectives, and 4) assess changes in community readiness to address smoke-free multi-unit tribal housing. This research builds on a successful collaboration with the potential to create an innovative and effective model for promoting smoke-free homes in rural areas, and for reducing SHS among American Indian nonsmokers and children and related cancer disparities. The significant capacity of our partnership has great potential for widespread dissemination of the intervention should it prove effective.