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

项目摘要 在美国，吸烟仍然是可预防的过早死亡的主要原因，特别是对 少数族裔和低收入人口。公共住房和多单元住房与烟草密切相关- 相关的差异，因为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，同时也是最不可能进入无烟家庭的人 环境。例如，纽约市住房管理局(NYCHA)的居民吸烟率更高，报告 来自外部的二手烟暴露较高，并被高密度烟草零售店包围 与其他纽约人相比的环境。公共房屋处于无烟政策的前列 有动静。2016年，住房和城市发展部要求所有住房当局采取无烟政策，这影响到所有人 全国3300个住房当局和120万户家庭。NYCHA是最大的公共住房提供商 在全国，它在326个公共住房开发项目中容纳了40多万人，涉及2400多个 全市的建筑。截至2018年7月，NYCHA所有住房单元都采用了无烟政策，影响了所有 属性。这项政策的执行是此类政策中最大的一项，这是审查这一政策的重要机会。 并减少与公共住房相关的烟草危害。到目前为止，还没有随机对照试验(RCT) 测试遵守策略对居民吸烟行为和二手烟的影响 曝光。建议的设计将是行政区分层、四臂、析因设计、集群RCT，将 在NYCHA的不同开发项目中随机选择128栋建筑(每臂32栋)作为目标。我们会 招募并跟踪随机选择的8名居民，按吸烟状况分层-4名吸烟者和4名不吸烟者- 每栋大楼(n=1024)分成四个分支：(1)搬迁/停止，(2)居民认可，(3)搬迁/ 戒烟加居民认可和(4)标准方法(每臂256名参与者)。结果 将使用唾液可替宁和居民调查来衡量吸烟行为和 在4个时间点：基线、干预后2、6和12个月的二手烟暴露。定性的 还将通过关键线人访谈、焦点小组和对建筑物的感官观察来收集数据。 这种混合的方法，事前与事后对比随机对照试验设计由经验丰富、跨学科的 与NYCHA和一个利益相关者咨询委员会合作的团队。目标包括通过实验测试政策 合规干预减少个人吸烟行为(目标1)；减少二手烟暴露 (目标2)，并确定每栋建筑周围的烟草零售环境是否缓和了关系 合规干预与吸烟相关结果之间的关系(目标3)。这个综合性的社区 积极参与和从社会生态角度了解情况的区域合作研究支持设计和实施干预措施，以 为与烟草相关的差距负担较大的人群优化无烟住房合规。

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.