Reducing Tobacco Exposures Among African American Women and Children
Condition: Tobacco Use; Second Hand Tobacco Smoke
Study type: Interventional

Summary: 
      Secondhand smoke exposure in the home can causes sudden infant death syndrome (SIDS), asthma,
      respiratory illnesses, and ear infections in children. In addition to cigarette smoke,
      exposure to other tobacco products can further compromise the safety of children in the home.
      This study aims to reduce the burden of multiple tobacco exposures, improve access to
      preventive care, and reduce the disproportionate risk for chronic diseases, including cancer,
      among African American women and children living in the Arkansas Delta region. Our central
      hypothesis is that messages delivered by a community health worker that aim to modify
      knowledge, attitudes, beliefs, and subjective norms may influence the perceived threat of
      tobacco exposures and provide cues for African American women caregivers to implement
      comprehensive smokefree policies to protect their children from the harms of tobacco and
      in-turn, influence their quitting.
    

Detailed description: 
      Cigarette smoking among African American women in Arkansas is nearly double the prevalence
      for African American women in the United States. Historical trends show increasing lung
      cancer mortality among African American Arkansan women. Further, secondhand (SHS) exposure is
      highest among African Americans and persons living in poverty. Declines in SHS exposure are
      much slower among these groups than their comparative groups. Smokefree policies in the home
      can reduce SHS exposure and increase quit attempts. To date, few trials have investigated how
      to increase the adoption and implementation of evidence-based strategies to reduce SHS
      exposure in the homes of women caregivers in rural disadvantaged communities. Our study will
      develop and test the feasibility and efficacy of brief motivational counseling and
      risk-communication messages delivered by community health workers (CHWs) on the
      implementation of comprehensive smokefree policies (e.g. ban on cigarettes, cigars,
      e-cigarettes, and safekeeping of tobacco products from children) in the home. The specific
      aims are to 1) conduct semi-structured interviews among African American women caregivers
      (WCGs) and CHWs to understand risk perceptions, knowledge, attitudes, beliefs, and safety
      practices related to tobacco products and sociocultural and environmental influences on
      tobacco use and policy practices; 2) use the interview data to develop, adapt, and pilot test
      educational materials, motivational counseling, and tobacco exposure feedback using an
      iterative process of six focus groups of WCGs; and 3) assess the influence of the
      intervention on the primary outcome, implementation of comprehensive smokefree policies, and
      secondary outcomes, 7-day point prevalence abstinence and smoking reduction. H3:1 Compared to
      WCGs in the control group (n = 103), WCGs in the intervention group will be more likely to
      implement CS policies (n = 103); H3:2. will have higher 7-day point prevalence abstinence and
      smoke fewer cigarettes per day at 1, 3, 6, and 12 months; and H3:3. their attitudes will
      mediate the effects of tobacco exposure biofeedback on the outcomes. The data from this study
      could 1) greatly enhance the adoption of voluntary comprehensive smokefree policies in a
      state where the strength of state-level tobacco control policies is low and 2) reduce the
      risk for smoking-attributable mortality, including cancer, among socially disadvantaged women
      and children.
    

Intervention name(s): Treatment; Control
Intervention type(s): Behavioral; Behavioral
Intervention description(s): The CHWs will go to the homes of the WCGs who enroll in the study and will use a culturally-adapted motivational interviewing protocol, educational messages pilot tested during the formative research phase, and biofeedback based on the child's saliva sample and WCG's carbon monoxide. Saliva samples will be collect from one child in the home at baseline and final. Baseline saliva data and carbon monoxide monitoring will be used to develop feedback that aims to motivate WCGs to implement and sustain comprehensive smoke free policies. The intervention will last 6 months. We will measure changes in primary and secondary outcomes at multiple assessment points.; Following baseline assessment, at 1, 3, and 6 months, WCGs in the control group will educational materials in the mail. Final follow-up assessments will occur at 12 months.
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Participants will be randomized into two groups based on the baseline assessment of CS policy (no policy/partial policy). WCGs in the treatment group will receive a three-session dose at 1, 3, and 6 months. During each treatment group session, the CHW will provide the tobacco biofeedback, motivational interviewing and educational materials at the end of the session. WCGs in the control group will receive by mail the same series of educational materials received by the treatment group at 1, 3 and 6 months. Survey and other assessments will be collected at baseline, 1, 3, 6, and 12 months.
Masking: Single (Care Provider)
Primary purpose: Prevention
Keywords: secondhand smoke, African Americans, policies, tobacco use