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

摘要。截至2020年6月中旬，西班牙裔/拉丁裔和 美国的非洲裔美国人/黑人是非西班牙裔美国人的4倍和5倍。 白色人。纽约市（NYC）在疫情初期成为COVID-19的震中，令人不安 与新冠肺炎相关的差异模式迅速出现。快速加速诊断服务不足 人口（RADx-UP）计划支持对NIH个人奖励的补充，以增加COVID-19检测 在服务不足的人群中。对于此提案，我们利用纽约市当前项目的基础设施 (NCI R 01 CA 220591“无烟住房政策对烟草烟雾暴露影响的评估”）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。的 负责接触者追踪的纽约市公立医院系统（NYC Health +Hospitals）和一套强大的 社区合作伙伴执行数据知情，社区参与的研究，以制定和测试战略 在纽约公共住房居民中增加COVID-19检测的采用。NYCHA是最大的公共 住房管理局在北美，超过400，000正式居民居住在15%的国家的公共 住房单位。家庭收入中位数为20，000美元，大约90%的NYCHA居民是黑人， 或者西班牙裔我们的目标是：1）发展可持续的社区参与基础设施， 以及未来在纽约市公共住房中部署基于证据的COVID-19检测和疫苗接种方案 2）量化公屋居民在COVID检测和SARS CoV-2感染方面的不公平现象; 3)让NYCHA居民和社区组织合作伙伴参与主要数据收集， 分析以了解检测、隔离和后续护理的障碍;以及4）检测社区知情 提高考试录取率的战略。具体来说，我们的目标是进行一项群集随机对照试验， 测试为社区卫生工作者和居民团队增加导航服务的附加值 导航器提供COVID-19检测转诊选项菜单。我们将比较影响范围， COVID-19诊断检测的可接受性和采用。通过利用强有力的伙伴关系， 支持实时前瞻性监测的市政数据源，以及快速扩展的测试阵列 这项执行情况研究提供了一个前所未有的机会，以确定有效的战略， 在大量高需求人群中，COVID风险和健康结果的差异。调查结果将用于 制定在全国多单元和公共住房环境中实施测试战略的指南。

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.