Smoke-free Air Coalitions in Georgia and Armenia: A Community Randomized Trial

摘要/摘要 低收入和中等收入国家(LMIC)的公共卫生努力可以通过支持以下方法来促进 以最佳方式利用当地人才和资源，如民间社会。开发有效的对齐模型 小岛屿发展中国家地方一级的民间社会和政府公共卫生有可能影响一系列 慢性病和风险因素，包括烟草。地方联盟一直是烟草行业的主导战略 美国的无烟控制，特别是在制定无烟政策方面取得了很好的成功。不过，这个 这种方法在LMIC或那些民主传统不如 美国。相反，在许多小岛屿发展中国家，无烟政策的进展在很大程度上是在国家一级发起的。平行 可能需要在地方一级开展民间社会运动，以争取对政策的支持和遵守。 鉴于他们的社会政治历史以及高烟草使用率和二手烟暴露(SHSE)率， 格鲁吉亚(GE)和亚美尼亚(AM)是拟议工作的两个战略背景。吸烟率为 男性分别为57.7%和52.3%(世界排名第6和第11)，女性分别为5.7%和1.5%。 此外，我们的研究结果表明，SHSE的发生率极高。然而，我们也记录了高接受性 公共无烟政策，尽管使用率很高，特别是在工作场所和餐馆。这项建议是 这是对文献和我们先前工作的合理扩展。我们将建设GE和AM的能力 研究人员将进行高质量的混合方法烟草研究和测试社区联盟行动 作为影响当地社区主导的政策变化的框架的理论。来自GE National的研究人员 疾病控制中心(NCDC)和AM国家健康研究所(NIH)将与Emory合作 执行建议的研究，在其组织内培训烟草控制研究人员并与其合作 大学，并在当地社区内培训从业人员，以建立地方烟草控制政策联盟。 我们的目标是：1)在GE和AM的28个城市进行配对社区随机对照试验 审查地方联盟在工作场所和地方促进采用无烟政策的影响 餐馆，以及随着时间的推移SHSE变化的主要结果；2)评估社区背景和 联盟因素影响组织和市政无烟政策的采用，以提供证据- 公共卫生实践基地；3)传播关于有效性和 建立和维持联盟的过程，从而增加无烟政策和 向GE和AM的关键利益相关者降低SHSE；以及4)利用建议的研究和 在GE NCDC、AM NIH和 与大学结成伙伴关系，以及地方公共卫生中心及其民间社会的实践能力 合伙人。最终，本提案中概述的活动将成为未来面向行动的催化剂。 科学和循证实践，以更广泛地支持这一区域的烟草控制进展。

SUMMARY/ABSTRACT Public health efforts in low- and middle-income countries (LMICs) could be catalyzed by bolstering ways to optimally leverage local talents and resources, such as civil society. Developing effective models for aligning civil society and governmental public health at the local level in LMICs has the potential to impact a range of chronic diseases and risk factors, including tobacco. Local coalitions have been a dominant strategy in tobacco control in the US, with well-documented success in establishing smoke-free policies specifically. However, this approach has not been widely leveraged or well-studied in LMICs or those with less democratic traditions than the US. Instead, in many LMICs, smoke-free policy progress is largely initiated at the national level. Parallel civil society movements at the local level may be needed to build support for and compliance with policies. Given their sociopolitical histories and high tobacco use and secondhand smoke exposure (SHSe) rates, Georgia (GE) and Armenia (AM) are two strategic settings for the proposed work. The smoking prevalence is 57.7% and 52.3% in men (6th and 11th highest in the world) and 5.7% and 1.5% in women, respectively. Moreover, our findings indicate extremely high rates of SHSe. However, we also documented high receptivity to public smoke-free policies despite high use rates, particularly in worksites and restaurants. This proposal is a well-justified extension of the literature and our prior work. We will build the capacity of GE and AM researchers to conduct high-quality mixed methods tobacco research and test the Community Coalition Action Theory as a framework for impacting local community-driven policy change. Researchers from the GE National Center for Disease Control (NCDC) and AM National Institute of Health (NIH) will collaborate with Emory to execute the proposed research, train tobacco control researchers within their organizations and partnering universities, and train practitioners within local communities to build local coalitions for tobacco control policy. We aim to: 1) conduct a matched-pair community randomized controlled trial in 28 municipalities in GE and AM to examine the impact of local coalitions promoting the adoption of smoke-free policies in worksites and restaurants, with the primary outcome of changes in SHSe over time; 2) assess how community context and coalition factors influence adoption of organizational and municipal smoke-free policies to provide an evidence- base for public health practice; 3) disseminate research findings regarding both the effectiveness and the process of establishing and maintaining coalitions, and consequently increasing smoke-free policies and reducing SHSe, to key stakeholders in GE and AM; and 4) capitalize on the proposed research and dissemination opportunities to build tobacco control research capacity within the GE NCDC, AM NIH, and partnering universities, as well as practice capacity within local public health centers and their civil society partners. Ultimately, the activities outlined in this proposal will serve as a catalyst for future action-oriented science and evidence-based practice to support tobacco control progress in this region more broadly.