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

无烟住房政策对烟草烟雾暴露和健康结果影响的评估

• 批准号: 9471147
• 负责人: Donna R Shelley
• 金额: $ 71.27万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2017
• 资助国家: 美国
• 起止时间: 2017-12-15 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9471147
• 关键词: Acute; Adult; Affect; Air; Area; Asthma; Attention; Censuses; Cessation of life; Characteristics; Child; Data; Data Set; Data Sources; Development; Education; Emergency department visit; Environment; Environmental Monitoring; Environmental Risk Factor; Environmental Tobacco Smoke; Ethnic Origin; Evaluation; Focus Groups; General Population; Health; Home environment; Hospitalization; Household; Housing; Income; Intervention; Interview; Laws; Low Income Population; Low income; Mathematics; Measures; Mental Health; Methods; Minority; Monitor; Municipal Government; Municipalities; Myocardial Infarction; Natural experiment; Neighborhoods; New York; New York City; Nicotine; Outcome; Patient Self-Report; Policies; Population; Private Sector; Privatization; Process; Public Housing; Race; Research Personnel; Risk; Section 8; Smell Perception; Smoke; Smoking; Stroke; Surveys; Time; Tobacco smoke; Tobacco use; U.S. Department of Housing and Urban Development; United States; Universities; Workplace; aged; authority; base; cigarette smoke; development policy; environmental tobacco smoke exposure; federal policy; fine particles; follow-up; improved; longitudinal design; mathematical model; medical schools; multilevel analysis; non-smoker; non-smoking; preventable death; programs; smoke-free policy; voucher

ABSTRACT. Tobacco use remains the leading cause of preventable death in the U.S., responsible for more than 440,000 deaths annually, of which 41,000 are attributable to environmental tobacco smoke (ETS). The federal Department of Housing and Urban Development (HUD) recently passed a rule that will require all public housing agencies (PHAs) to implement smoke free policies in their developments. There is a strong rationale for the new housing policy. Compared to the general public, residents in public housing are at excess risk for ETS exposure for two reasons: (1) Despite overall declines in smoking over time, major disparities persist by income level, education and race/ethnicity. Thus smoking rates among residents living in public housing, a predominantly minority, lower income population, tend to be higher than in the general population. (2) Most public housing residents live in multiunit housing (MUH), an environment that places all residents at elevated risk for involuntary ETS exposure due to smoke accumulation compared to residents living in detached housing. While prohibition of smoking in homes has promising implications for improving health, initiatives to mandate smoke-free housing are still nascent. No empirical studies have objectively evaluated the impact on health outcomes among residents. Estimated health consequences of such policies are currently based on mathematical models, and only a few studies have measured change in resident ETS exposure before and after implementation of housing-wide bans. These studies have mostly been small, with short follow-up periods, and they have given only limited attention to studying the implementation process. To fill this gap, we propose a large-scale natural experiment to examine the impact of the HUD policy on reducing ETS exposure and improving health outcomes. The New York City Housing Authority (NYCHA) is the largest housing authority in the United States, with more than 400,000 residents. Using a quasi-experimental longitudinal design, we plan to monitor ETS before and after policy implementation (tracking every 6 months for 2.5 years post-policy) in 200 apartments of non-smokers and common areas of 10 select high-rise NYCHA buildings, and compare to ETS changes in 200 apartments in 10 demographically matched high-rise buildings in another housing program, not subject to the smoke-free policy. Using geocoded administrative data, citywide NYCHA resident health outcomes will be compared to residents in matched low-income census blocks. Finally we will use survey data, qualitative interviews and focus groups to explore multilevel factors that influence the implementation process and outcomes. This study leverages a strong, ongoing partnership of academic and municipal government investigators, including experts at New York University School of Medicine, senior staff at NYCHA, and leaders from the NYC Department of Health and Mental Hygiene. Findings will be used to develop guidance for implementing SFH policies in public or private MUH settings nationally.

抽象的。在美国，烟草使用仍然是可预防的死亡的主要原因，导致更多 每年超过44万人死亡，其中41000人可归因于环境烟草烟雾(ETS)。这个 联邦住房和城市发展部(HUD)最近通过了一项规定，将要求所有公众 住房机构(PHA)在其开发项目中实施无烟政策。这有一个强有力的理由 对于新的住房政策。与一般市民相比，公屋居民患上 ETS暴露有两个原因：(1)尽管吸烟人数随着时间的推移而总体下降，但主要差距仍然存在 收入水平、教育程度和种族/民族。因此，居住在公共房屋的居民的吸烟率 以少数民族为主，收入较低的人口往往高于一般人口。(2)最多 公共住房居民居住在多单元住房(Muh)中，这是一种将所有居民置于高架状态的环境。 与居住在独立居民区的居民相比，吸烟导致非自愿接触ETS的风险 住房。虽然禁止在家中吸烟对改善健康有很好的影响，但倡议 强制无烟住房仍处于萌芽状态。还没有实证研究客观地评估这一影响 居民的健康后果。这类政策的估计健康后果目前是基于 数学模型，只有几项研究测量了居民ETS暴露的变化 在全住房禁令实施后。这些研究大多规模较小，随访时间较短。 他们只对研究执行进程给予了有限的关注。为了填补这一空白，我们 提出一项大规模的自然实验，以检验HUD政策对减少ETS暴露的影响 以及改善健康状况。纽约市住房管理局(NYCHA)是美国最大的住房 美国当局，有40多万居民。使用准实验纵向 在设计上，我们计划在政策实施之前和之后监测ETS(每隔6个月跟踪一次，为期2.5年 政策出台后)在200套非吸烟者公寓和10栋精选的NYCHA高层建筑的公共区域， 与另一栋高层建筑中10栋人口统计相匹配的高层建筑中200套公寓的ETS变化进行比较 住房计划，不受无烟政策的影响。使用地理编码的管理数据，全市范围的NYCHA 居民的健康结果将与匹配的低收入人口普查区的居民进行比较。最后我们会 使用调查数据、定性访谈和焦点小组来探索影响 实施过程和结果。这项研究充分利用了学术界和学术界之间强大而持续的合作关系 市政府调查人员，包括纽约大学医学院的专家，高级工作人员 在NYCHA，以及纽约市卫生和精神卫生部门的领导。调查结果将用于 制定在全国公共或私人MUH环境中实施SFH政策的指导方针。