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).
