Evaluation of Smoke-Free Housing Policy Impacts on Tobacco Smoke Exposure and Health Outcomes

抽象的。到2020年6月中旬，新冠肺炎将拉美裔/拉丁裔和 美国的非裔美国人/黑人人数是非西班牙裔的4倍和5倍 白人。纽约市(纽约市)在疫情爆发和令人不安的早期成为新冠肺炎的震中 与COVID相关的差异模式迅速出现。快速加速服务不足的诊断 人口(RADX-UP)倡议支持对美国国立卫生研究院个人奖项的补充，以增加新冠肺炎检测 在服务不足的人群中。对于这项提案，我们利用纽约市当前项目的基础设施 (NCI R01CA220591“无烟住房政策对烟草烟雾暴露的影响评估”)和 纽约市住房管理局(NYCHA)和纽约市卫生局之间的长期合作伙伴关系。这个 负责接触者追踪的纽约市公立医院系统(NYC Health+医院)和一套强大的 社区合作伙伴执行了解数据、社区参与的研究，以制定和测试策略 在纽约市公共住房居民中更多地采用新冠肺炎测试。NYCHA是最大的公众 北美住房管理局，有40多万官方居民居住在全国15%的公众中 住房单元。家庭收入中位数为2万美元，大约90%的NYCHA居民要么是黑人 或者是西班牙裔。我们的目标是：1)开发可持续的社区参与基础设施，以引导当前 以及未来为纽约市公共住房部署循证新冠肺炎测试和疫苗接种方案 2)量化公屋居民在冠状病毒测试和SARS CoV-2感染方面的不平等； 3)让NYCHA居民和基于社区的组织合作伙伴参与主要数据收集和 分析以了解测试、隔离和后续护理的障碍；以及4)测试社区信息 增加测试吸收的策略。具体地说，我们的目标是进行整群随机对照试验，以 为社区卫生工作者(CHWS)和居民团队增加导航服务的附加值测试 导航员提供新冠肺炎测试推荐选项菜单。我们将比较对REACH的影响， 新冠肺炎诊断测试的可接受性和采用率。通过利用强大的合作伙伴关系，稳健 支持实时前瞻性监控和快速扩展的测试阵列的市政数据源 倡议，这项执行研究提供了一个无与伦比的机会，以确定有效的战略，以减少 在大量高需求人群中，新冠状病毒感染风险和健康结果存在差异。调查结果将用于 为在全国多单元和公共住房环境中实施测试战略制定指导方针。

ABSTRACT. By mid-June, 2020, COVID-19 associated hospitalization rates among Hispanic/Latino and African-American/Black persons in the United States were 4 and 5 times greater than that of non-Hispanic White persons. New York City (NYC) became the epicenter of COVID-19 early in the epidemic and disturbing patterns of COVID-related disparities rapidly emerged. The Rapid Acceleration of Diagnostics for Underserved Populations (RADx-UP) initiative supports supplements to individual NIH awards to increase COVID-19 testing among underserved populations. For this proposal, we leverage the infrastructure of a current project in NYC (NCI R01CA220591 “Evaluation of Smoke-Free Housing Policy Impacts on Tobacco Smoke Exposure”) and longstanding partnerships between the NYC Housing Authority (NYCHA), the NYC Health Department. The NYC public hospital system responsible for contact tracing (NYC Health +Hospitals) and a robust set of community partners to execute a data-informed, community-engaged research to develop and test strategies to increase adoption of COVID-19 testing among NYC public housing residents. NYCHA is the largest public housing authority in North America, with more than 400,000 official residents living in 15% of the nation’s public housing units. Median family income is $20,000, and approximately 90% of NYCHA residents are either black or Hispanic. Our aims are to: 1) Develop a sustainable community engagement infrastructure to guide current and future deployment of evidence-based COVID-19 testing and vaccination options for NYC Public Housing residents; 2) Quantify inequities in COVID testing and SARS CoV-2 infection among Public Housing residents; 3) Engage NYCHA residents and community based organization partners in primary data collection and analysis to understand barriers to testing, isolation and follow-up care; and 4) Test community-informed strategies to increase testing uptake. Specifically, we aim to conduct a cluster randomized controlled trial to test the added value of adding navigation services to teams of community health worker (CHWs) and resident navigators offering a menu of COVID-19 testing referral options. We will compare impacts on reach, acceptability and adoption of COVID-19 diagnostic testing. By capitalizing on strong partnerships, robust municipal data sources that support real-time prospective surveillance, and a rapidly expanding array of testing initiatives, this implementation study offers an unparalleled opportunity to identify effective strategies to reduce disparities in COVID risk and health outcomes in a large, high-need population. Findings will be used to develop guidance for implementing testing strategies in multi-unit and public housing settings nationally.