Community-Partnered Tobacco Control in Underserved Dominican Republic Communities

烟草流行的全球化造成了严重的发病率和死亡率负担， 中低收入国家所承受的影响越来越大。研究者之间的研究伙伴关系 来自烟草控制研究项目发达的高收入国家及其同行 在中低收入国家，需要采取有效措施来应对这一全球公共卫生危机。的 多米尼加共和国（DR）是反映拉丁美洲趋势的关键网站：它是一个中低收入国家， 烟草种植国，烟草使用量大，二手烟暴露水平高， 处于烟草控制的早期阶段。拟议的项目将评估基线知识、态度、 暴露，以及有关烟草使用和二手烟的行为，提供了一个随机对照的 围绕二手烟和戒烟进行社区合作干预试验， 并实施一项传播计划，以产生国家和区域影响，并将方法和成果转化为 适当地提供给其他服务不足的群体。将采用多方法评估方法，包括 定性社区评估，一系列定量调查（家庭监测， 社区和吸烟者队列调查，以及卫生保健提供者调查），以及 二手烟暴露。八个经济弱势社区将被随机分配到 滞后治疗设计中的干预或控制条件;将制定干预措施， 基于其他国家和当前DR试验的证据基础以及输入实施 从国家和地方灾难恢复工作组使用社区合作的方法。述干预 假设降低烟草使用率，增加无烟家庭的数量， 吸烟，提高对烟草使用和二手烟风险的认识并改变对烟草使用和二手烟风险的态度， 减少接触二手烟，并增加卫生保健提供者的干预措施- 相对于对照社区，地理和人口统计特征的差异 考察该项目还将邀请国际、国家和当地的灾难恢复工作组参与， 与主要合作伙伴交流研究结果，与区域合作伙伴共同主办国家DR烟草控制会议 代表，并制定其他行动步骤，在地方和区域传播调查结果和证据 基础设施、资源和基础设施。最后，该项目将与哥伦比亚大学协调， 罗切斯特临床和转化科学研究所，用于翻译当前的循证方法 和方法，并探讨是否有任何方法或 DR中拟议试验的干预措施可以转化为美国服务不足的群体， States.有效地使处于早期阶段的中低收入国家参与烟草控制研究将是 这对减少全球烟草使用和烟草引起的疾病负担至关重要。

The globalization of the tobacco epidemic poses significant morbidity and mortality burdens, with the brunt of impact increasingly borne by low-middle income countries. Research partnerships between investigators from high-income countries with well developed tobacco control research programs and their counterparts in low-middle income countries are needed to effectively address this global public health crisis. The Dominican Republic (DR) is a key site that mirrors the trends in Latin America: it is a low-middle income tobacco growing country with significant tobacco use and high levels of secondhand smoke exposure, and it is at a very early stage of tobacco control. The proposed project will assess baseline knowledge, attitudes, exposures, and behaviors regarding tobacco use and secondhand smoke, provide a randomized controlled trial of community-partnered interventions around secondhand smoke and tobacco cessation, and develop and implement a dissemination plan for national and regional impact and translation of methods and results to other underserved groups as appropriate. A multimethod assessment approach will be used, to include qualitative community assessments (RAPs), a series of quantitative surveys (household surveillances, community and smoker cohort surveys, and health care provider surveys), and a biomarker assessment of secondhand smoke exposure. Eight economically disadvantaged communities will be randomized to intervention or control conditions in a lagged treatment design; interventions will be developed and implemented based on the evidence base from other countries and from a current DR trial, and on input from national and local DR workgroups using a community partnered approach. The intervention is hypothesized to decrease tobacco use rates, increase the number of smokefree homes, denormalize smoking, increase awareness of and change attitudes regarding tobacco use and secondhand smoke risks, decrease exposure to secondhand smoke, and increase health care provider intervention in intervention- relative to control communities, with differences by geographic and demographic characteristics to be examined. The project will also engage international, national, and local DR workgroups to maintain communication of findings to key partners, host a national DR tobacco control conference with regional representation, and develop other action steps for local and regional dissemination of findings and evidence based interventions, resources, and infrastructures. Finally, the project will coordinate with the University of Rochester Clinical and Translational Sciences Institute for translation of current evidence based approaches and methodologies for implementation in the DR, and to explore whether any methodologies or interventions from the proposed trial in the DR can be translated to underserved groups in the United States. Effectively engaging early stage low-middle income countries in tobacco control research will be critical to reducing tobacco use and the burden of tobacco-caused illnesses globally.