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

支持公共住房无烟政策合规性的随机对照试验

• 批准号: 10400908
• 负责人: Diana Hernandez
• 金额: $ 84.97万
• 依托单位: COLUMBIA UNIVERSITY HEALTH SCIENCES
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2025-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10400908
• 关键词: Address; Adopted; Adoption; Adult; Affect; Air; Area; Authorization documentation; Biological Markers; Biological Monitoring; Cessation of life; Cigarette; Cities; Communities; Cotinine; Data; Development; Disparity; Disparity population; Economics; Effectiveness; Environment; Experimental Designs; Focus Groups; Health Benefit; Home; Home environment; Household; Housing; Interdisciplinary Study; Intervention; Interview; Knowledge; Learning; Location; Low Income Population; Low income; Measures; Methods; Movement; Neighborhoods; New York City; Outcome; Participant; Passive Smoking; Patient Education; Patient Self-Report; Persons; Policies; Policy Compliance; Population; Predisposition; Process; Property; Provider; Public Housing; Random Allocation; Randomized, Controlled Trials; Reporting; Research; Resources; Sales; Salivary; Sampling; Sensory; Services; Smoke; Smoke-free home; Smoker; Smoking; Smoking Behavior; Smoking Status; Source; Surveys; System; Testing; Time; Tobacco; Tobacco use; United States; Vulnerable Populations; arm; authority; community engagement; density; design; disparity reduction; environmental tobacco smoke exposure; ethnic minority; experience; frontier; hazard; high risk; high risk population; implementation intervention; informant; non-smoker; non-smoking; novel; patient navigator; post intervention; premature; preventable death; racial minority; recruit; residence; smoke-free policy; smoking cessation; social; social media; tobacco products; trial design; ventilation

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.

项目摘要 烟草使用仍然是美国可预防过早死亡的主要原因，特别是 种族/族裔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 相关的差异作为弱势群体最有可能生活在多单元住房中 吸烟和二手烟暴露，同时也最不可能进入无烟的家 环境。例如，纽约市住房管理局（NYCHA）居民以较高的速度吸烟，报告 外部来源的高二手烟雾暴露，并被高密度的烟草零售包围 与其他纽约人相比，环境。公共住房处于无烟政策的最前沿 移动。 2016年，HUD规定所有住房当局采用无烟政策，这影响了所有政策 全国3,300个住房当局和120万家庭。 NYCHA是最大的公共住房提供商 在国家它在326个公共住房开发中拥有超过40万人，超过2,400 全市建筑物。截至2018年7月，所有NYCHA住房单位都采用了无烟政策，影响了所有人 特性。这项政策的实施，是同类最大的，这是检查的关键机会 并减少与公共住房有关的烟草危害。迄今为止，尚无随机对照试验（RCT） 进行测试合规策略对居民吸烟行为和二手烟的影响 接触。拟议的设计将是自治市镇分层的，四臂，阶乘设计，群集RCT 在单独的NYCHA开发项目中，目标128个随机选择的建筑物（每臂32个建筑物）。我们将 招募并关注8个随机选择的居民，通过吸烟状态分层-4个吸烟者和4名非吸烟者 - 每个建筑物（n = 1024）分为四个武器：（1）搬迁/停止，（2）居民认可，（3）搬迁/ 戒烟加居民的认可和（4）标准方法（每臂256名参与者）。结果 将使用唾液可替宁和常驻调查来纵向评估，以衡量吸烟行为和 二手烟雾在4个时间点：干预后基线2、6和12个月。定性 数据还将通过关键的线人访谈，焦点小组和建筑物的感官观察收集。 这种混合的方法，预先与经验丰富，跨学科的RCT设计进行了比较的RCT设计 与NYCHA和利益相关者顾问委员会合作团队。目的包括实验测试是否政策 合规干预措施降低了个人吸烟行为（AIM 1）；减少二手烟暴露 （AIM 2），并确定每座建筑物周围的烟草零售环境是否使关系缓和 在合规干预和与吸烟有关的结果之间（AIM 3）。这个全面的社区 参与和社会知识的RCT支持设计和实施干预措施 优化对烟草相关差异高的人群的无烟住房符合性。