Project I

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

The long term goals of Project 1 are 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 living in rural Arkansas Delta counties. Lung cancer incidence and mortality among African American Arkansas women have not changed, while rates have decreased among white Arkansan women and among other racial/ethnic groups nationwide. Cigarette smoking causes 90% of all lung cancers and smoking among African American women in Arkansas is higher than observed among African American women nationwide. Studies suggest that African Americans, those who are poor, and with low education have higher levels of exposure to secondhand smoke (SHS), as indicated by cotinine levels. Further, disadvantaged African American women are less likely than advantaged African American women to live in homes with a complete smoking ban. Comprehensive smokefree policies in the home can play a critical role in reducing tobacco exposures and increasing quitting, but, policy implementation is often a challenge.

Grounded in the Diffusion of Innovation Theory, Health Belief Model, and Theory of Reasoned Action, our central hypothesis is that messages delivered by a community health worker that aim to modify knowledge, attitudes, beliefs, and subjective norms may influence women caregivers’ perceived threat of tobacco exposures and provide cues for women caregivers to implement comprehensive policies to protect their children from the harms of tobacco, and in-turn, influence their quitting. Our study seeks to fill a significant gap in our understanding of the efficacy of brief counseling and risk communication messages delivered by community health workers on the adoption and implementation of comprehensive policies (e.g. ban on cigarettes, cigars, electronic cigarettes, hookah, pipes, and safekeeping products [e.g. smokeless tobacco and electronic cigarettes liquids] from children) in the home. We expect that community health workers can influence a woman caregiver’s policy adoption process by providing preventive care in rural areas where there are health care provider and infrastructure deficits. Further, negative attitudes toward and knowledge of second/third hand tobacco exposures and the acute toxicity of electronic cigarette liquids to children may motivate women to quit smoking. No studies have previously measured the effects of a comprehensive ban or changes in policy adoption and implementation on each tobacco policy measure (e.g. ban on cigarettes, cigars, hookah). Our transdisciplinary community-academic team will implement a small-scale randomized trial that will compare the efficacy of the intervention (community health worker + risk communication materials + brief motivational counseling + tobacco exposure biofeedback on the child) to the control group (risk communication materials).

Specific Aims

Aim 1: Conduct semi-structured interviews among African American women caregivers (n = 30) and community health workers (n = 15) 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.

Aim 2: Use the interview data to develop, adapt, and pilot test educational materials, motivational counseling, and tobacco exposure biofeedback using an iterative process of six focus groups of women caregivers (n = 48).

 Aim 3: Assess the influence of the intervention on the primary outcome, implementation of comprehensive policies; and secondary outcomes, 7-day point prevalence abstinence and smoking reduction. H3:1 Compared to women caregivers in the control group (n = 103), women caregivers in the intervention group will be more likely to implement comprehensive 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; H3:3. and their attitudes will mediate the effects of tobacco exposure biofeedback on the outcomes.

Impact: The study’s data will provide insight on how to fill health care provider gaps, increase the adoption of voluntary comprehensive policies, and reduce the risk for smoking-attributable morbidity and mortality among socially disadvantaged women and children living in rural distressed communities in Arkansas.

Team Members

  • Pebbles Fagan, Ph.D., MPH, Principal Investigator
  • Naomi Cottoms, MA, Subaward PI/Co-Investigator
  • Keneshia Bryant-Moore, Ph.D., RN, FNP-BC, Co-Investigator
  • Katherine Donald, BA., Subaward Co-Investigator
  • Ping-Ching Hsu, Ph.D., MS, Co-Investigator
  • Joseph Su, Ph.D., MPH, Co-Investigator
  • Anna Huff-Davis, BS, Co-Investigator/Recruitment Specialist
  • Huyen Vi Le Do, BS, Lab Technician

Project II

Linking High-Risk Jail Detainees to HIV pre-exposure prophylaxis:PrEP-LINK

Criminal justice (CJ) involved individuals have extremely high prevalence of risk factors associated with HIV infection including poverty, substance use, transactional sex, high numbers of sex partners, high prevalence of sexually transmitted infections and mental illness. African Americans (AA) are at disproportionate risk for both incarceration and HIV infections.  A growing body of evidence highlights the efficacy of a once daily medication, emtricitabine/tenofovir, also known as pre-exposure prophylaxis (PrEP), in reducing HIV acquisition. However, structural and social barriers can undermine optimal PrEP uptake, adherence, and retention in care and must be addressed especially among those with recent CJ experience. This study will provide a novel exploration of facilitators and barriers to PrEP; allow us to target hard to reach populations, and substance use, therefore, advancing intervention approaches to improve minority health or to reduce health disparities.

Specific Aims

Aim 1: Perform a qualitative assessment of facilitators and barriers to PrEP uptake among AA high-risk jail detainees, systems, and interactor levels.

Aim 2: Develop the PrEP-LINK intervention and perform an open label evaluation with AA high-risk HIV negative individuals being discharged from the Pulaski County Jail.

Aim 3: Conduct a pilot RCT of the PrEP-LINK intervention among AA high-risk HIV negative individuals being released from the Pulaski County jail.

Team Members

  • Nickolas Zaller, Ph.D., Principal Investigator
  • Lauren Brinkley-Rubenstein, Ph.D., MS, MA, Subaward PI (University of North Carolina, Chapel Hill)
  • Sarah A. Marshall, Ph.D., MPH, Co-Investigator
  • Melissa Zielinksi, Ph.D., MA, Co-Investigator
  • Taylor Neher, Project Coordinator