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: 10039272
• 负责人: Diana Hernandez
• 金额: $ 67.22万
• 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 2025-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10039272
• 关键词: Address; Adopted; Adoption; Adult; Affect; Air; Area; Biological Markers; Biological Monitoring; Cessation of life; Cigarette; Communities; Cotinine; Data; Development; Disadvantaged; Economics; Effectiveness; Environment; Environmental Health; Experimental Designs; Exposure to; Focus Groups; Health Benefit; Home environment; Household; Housing; Interdisciplinary Study; Intervention; Interview; Knowledge; Location; Low Income Population; Low income; Measures; Methods; Movement; Neighborhoods; New York City; Outcome; Participant; Passive Smoking; Patient Education; Patient Self-Report; Policies; Policy Compliance; Population; Process; Property; Provider; Public Housing; 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; density; design; disparity reduction; environmental tobacco smoke; environmental tobacco smoke exposure; ethnic minority population; experience; frontier; hazard; high risk; high risk population; informant; non-smoker; non-smoking; novel; post intervention; premature; preventable death; racial and ethnic; 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.

项目概要 烟草使用仍然是美国可预防的过早死亡的主要原因，尤其是对于 少数种族/族裔和低收入人群。公共住房和多单元住房与烟草密切相关 相关差异，因为弱势群体最有可能居住在多单元住房中，其比例最高 吸烟和接触二手烟，同时也是最不可能进入无烟家庭的人 环境。例如，报告称，纽约市住房管理局 (NYCHA) 居民吸烟率较高 来自外部来源的二手烟暴露量较高，且周围有高密度烟草零售店 与其他纽约人相比的环境。公共住房处于无烟政策的最前沿 移动。 2016 年，HUD 要求所有住房当局采取无烟政策，这影响了所有人 全国 3,300 个住房部门和 120 万户家庭。 NYCHA 是最大的公共住房提供商 在国家； 326 个公共住房开发项目覆盖 2,400 多个街区，可容纳超过 400,000 人 全市的建筑物。截至 2018 年 7 月，所有 NYCHA 住房单元都采用了无烟政策，影响到所有 特性。这项政策的实施是同类政策中最大规模的，也是审查这一问题的重要机会。 减少与公共住房相关的烟草危害。迄今为止，尚无随机对照试验（RCT） 旨在测试合规策略对居民吸烟行为和二手烟的影响 接触。拟议的设计将是一个行政区分层、四臂、因子设计、集群随机对照试验， 针对不同 NYCHA 开发项目中随机选择的 128 座建筑物（每支 32 座建筑物）。我们将 招募并跟踪 8 名随机选择的居民，按吸烟状况分层 - 4 名吸烟者和 4 名不吸烟者 - 每栋建筑（n=1024）分为四个部分：（1）搬迁/停止，（2）居民认可，（3）搬迁/ 戒烟加居民认可和（4）标准方法（每组 256 名参与者）。结果 将使用唾液可替宁和居民调查进行纵向评估，以衡量吸烟行为和 4 个时间点的二手烟暴露：基线、干预后 2、6 和 12 个月。定性 还将通过主要知情人访谈、焦点小组和对建筑物的感官观察来收集数据。 这种混合方法、事前比较 RCT 设计由经验丰富的跨学科人士监督 该团队与 NYCHA 和利益相关者顾问委员会合作。目的包括通过实验测试政策是否有效 合规干预措施减少个人吸烟行为（目标 1）；减少二手烟暴露 （目标 2），并确定每栋建筑周围的烟草零售环境是否调节了这种关系 依从性干预措施与吸烟相关结果之间的关系（目标 3）。这个综合性的社区 参与和社会生态知情的随机对照试验支持干预措施的设计和实施 优化烟草相关差异负担较重的人群的无烟住房合规性。