A randomized controlled trial to support smoke-free policy compliance in public housing

项目摘要 烟草使用仍然是美国可预防的过早死亡的主要原因，特别是对于 少数民族和低收入人群。公共和多单元住房与烟草密切相关- 由于弱势群体最有可能居住在多单元住房中， 吸烟和二手烟暴露，同时也最不可能有机会获得无烟家庭 环境.例如，纽约市住房管理局（NYCHA）的居民吸烟率较高，报告 更多的二手烟暴露于外部来源，周围是高密度的烟草零售店 与其他纽约人相比。公共住房处于无烟政策的前沿 运动2016年，HUD要求所有住房当局采取无烟政策，这影响到所有人。 全国有3，300个住房管理局和120万户家庭。NYCHA是美国最大的公共住房供应商 在全国范围内;它在326个公共住房开发项目中容纳了40多万人， 全市建筑截至2018年7月，所有NYCHA住房单位都采取了无烟政策，影响所有人 特性.这项政策是同类政策中规模最大的一项， 减少公共场所的烟草危害。到目前为止，还没有随机对照试验（RCT）。 进行了测试的影响，遵守策略对居民吸烟行为和二手烟 exposure.拟定的设计将是一项行政区分层、四臂、因子设计、群集RCT， 目标128随机选择的建筑物（每臂32建筑物）在单独的NYCHA发展。我们将 招募并随访8名按吸烟状态分层的随机选择的居民- 4名吸烟者和4名非吸烟者- 每栋建筑物（n=1024）分为四个部分：（1）搬迁/停止，（2）居民认可，（3）搬迁/ 停止再加上居民的认可和（4）标准方法（每组256名参与者）。成果 将使用唾液可替宁和居民调查来纵向评估吸烟行为， 二手烟暴露在4个时间点：基线，干预后2，6和12个月。定性 此外，调查亦会透过访问主要资料提供者，焦点小组及对楼宇进行感官观察等方式收集资料。 这种混合方法，前后比较RCT设计由经验丰富的跨学科专家监督。 与纽约人道主义事务协调厅和一个利益攸关方咨询委员会建立伙伴关系。目的包括实验性地测试政策是否 依从性干预减少个人吸烟行为（目标1）;减少二手烟暴露 (Aim 2），并确定每栋建筑周围的烟草零售环境是否调节了这种关系 依从性干预和吸烟相关结果之间的关系（目标3）。这个综合性的社区 参与和社会生态知情的RCT支持干预措施的设计和实施， 优化与烟草有关的差异负担高的人口的无烟住房合规性。

Project Summary Tobacco use remains a leading cause of preventable premature death in the United States, especially for racial/ethnic minorities and low-income populations. Public and multiunit housing are closely tied to tobacco- related disparities as vulnerable populations are most likely to live in multiunit housing with the highest rates of smoking and secondhand smoke exposure, while also the least likely to have access to smoke-free home environments. For example, New York City Housing Authority (NYCHA) residents smoke at higher rates, report higher secondhand smoke exposure from an outside source and are surrounded by high density tobacco retail environments compared to other New Yorkers. Public housing is at the forefront of the smoke-free policy movement. In 2016, HUD mandated that all housing authorities adopt smoke-free policies, which affects all 3,300 housing authorities and 1.2 million households nationwide. NYCHA is the largest public housing provider in the nation; it houses more than 400,000 people in 326 public housing developments spanning over 2,400 buildings citywide. As of July 2018, all NYCHA housing units adopted a smoke-free policy affecting all properties. The implementation of this policy, the largest of its kind, represents a critical opportunity to examine and reduce public housing-related tobacco hazards. To date, no randomized controlled trials (RCT) have been conducted to test the effects of compliance strategies on resident smoking behavior and secondhand smoke exposure. The proposed design will be a borough-stratified, four-arm, factorial-design, cluster RCT that will target 128 randomly selected buildings (32 buildings per arm) in separate NYCHA developments. We will recruit and follow 8 randomly selected residents stratified by smoking status- 4 smokers and 4 non-smokers- per building (n=1024) into four arms: (1) relocation/cessation, (2) resident endorsement, (3) relocation/ cessation plus resident endorsement and (4)the standard approach (256 participants per arm). Outcomes will be assessed longitudinally using salivary cotinine and resident surveys to measure smoking behaviors and secondhand smoke exposures at 4 time points: baseline, 2, 6 and 12 months post-intervention. Qualitative data will also be collected via key informant interviews, focus groups and sensory observations of buildings. This mixed methods, pre-post with comparison RCT design overseen by a highly experienced, interdisciplinary team in partnership with NYCHA and a stakeholder advisory board. Aims include to experimentally test if policy compliance interventions reduce personal smoking behavior (Aim 1); reduce secondhand smoke exposure (Aim 2), and determine if the tobacco retail environment surrounding each building moderates the relationship between compliance interventions and smoking-related outcomes (Aim 3). This comprehensive, community engaged and social-ecologically informed RCT supports the design and implementation of interventions to optimize smoke-free housing compliance for populations with high burdens of tobacco-related disparities.