Implementing a Scalable Smoke-free Home Intervention in Armenia and Georgia

在亚美尼亚和格鲁吉亚实施可扩展的无烟家庭干预措施

• 批准号: 10607033
• 负责人: Carla J Berg
• 金额: $ 61.55万
• 依托单位: GEORGE WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2028-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10607033
• 关键词: Address; Adoption; Adult; American; Armenia; Back; Behavioral; Cancer Control; Centers for Disease Control and Prevention (U.S.); Child; Chronic Disease; Collaborations; Communities; Country; Data; Disparity; Effectiveness; Ensure; Evidence based intervention; Focus Groups; Funding; Goals; Health; Home; Household; Human Resources; Imagery; Individual; Infrastructure; Intervention; Interview; Low income; Maintenance; Methods; Modeling; Motivation; National Cancer Institute; Participant; Patient Recruitments; Population; Primary Care; Professional counselor; Public Health; Randomized, Controlled Trials; Reach, Effectiveness, Adoption, Implementation, and Maintenance; Readiness; Research; Resource-limited setting; Schools; Science; Self Efficacy; Smoke; Smoke-free home; Smoker; Smoking; Smoking Behavior; Source; System; Testing; Tobacco; Tobacco use; Training; Translating; United States National Institutes of Health; Universities; Woman; Work; brief intervention; cancer prevention; cigarette smoke; community organizations; community setting; cost effective; cost effectiveness; design; disorder prevention; effectiveness evaluation; effectiveness-implementation RCT; effectiveness/implementation hybrid; environmental tobacco smoke exposure; evidence base; follow up assessment; follow-up; global health; health disparity; health organization; innovation; intervention delivery; intervention refinement; knowledge base; low and middle-income countries; member; men; non-smoker; non-smoking; primary outcome; process evaluation; programs; quitline; scale up; secondary outcome; smoke-free policy; smoking cessation; smoking prevalence; theories; web site

SUMMARY/ABSTRACT Among the disparities faced by populations in low- and middle-income countries (LMICs) are those related to tobacco use and secondhand smoke exposure (SHSe). Two countries particularly impacted by tobacco use and SHSe are Armenia (AM) and Georgia (GE), which represent the 11th and 6th highest smoking rates in men globally (51.5% and 55.5%, respectively). However, smoking prevalence is much lower among women (1.8% and 7.8%). Notably, a primary source of SHSe among children and most nonsmoking adults in many LMICs, including AM and GE, is the home. Smoke-free homes (SFHs) can reduce SHSe, promote cessation, and possibly disrupt initiation; however, 61.4% of households in AM and GE allow smoking in the home. Thus, promoting SFHs may be an innovative and relatively untapped strategy for chronic disease prevention in these countries – and in other LMICs with high smoking rates. Research focused on implementing evidence-based interventions (EBIs) offers unique opportunities to address the pressing needs in LMICs and to examine key barriers in the adoption, scale-up, and sustainment of EBIs in low-resource settings. This proposal builds on ongoing collaborations among MPIs Berg and Kegler, the GE National Center for Disease Control (NCDC), the AM National Institute of Health (NIH), and the American University of Armenia (AUA), dating back to 2013. These collaborations have established: 1) a strong community-based infrastructure for implementing public health programs using local coalitions in 14 communities, developed in our current Fogarty-funded R01; and 2) a theory-based SFHs intervention, designed to be brief and adaptable and shown to be effective, generalizable, scalable, and cost-effective among low-income households in the US. The current proposal will strategically capitalize on our strong partnerships with national public health agencies, local community mobilization infrastructure, and SFH EBI to address our specific aims. Aim 1: We will adapt our SFH intervention to be culturally appropriate for the AM and GE populations, using a community-engaged approach and robust adaptation frameworks and methods, and develop in-country capacity for intervention dissemination (via local coalitions) and delivery (via national quitlines). Aim 2: We will examine the effectiveness of the adapted intervention (vs. control) on SFH adoption (primary outcome) among households in AM and GE, using a type 1 hybrid effectiveness-implementation RCT (n=550 participants; 275/country), with follow-up assessments at 3 and 6 months. Aim 3: We will assess intervention reach, adoption, implementation, and maintenance potential, as well as related contextual influences, using a mixed-methods process evaluation guided by RE-AIM. Our team (including national public health agencies) will use these findings to develop a sustainability and dissemination plan (e.g., intervention packaging for scale-up). This work will provide a robust model for adapting and implementing this EBI for AM and GE, which could then be used for this intervention in other countries and/or for other behavioral targets and EBIs in AM, GE, and elsewhere. This work will advance our long-term goals of building the knowledge base informing strategies to reduce tobacco-related disparities globally and the implementation and scale-out of EBIs in LMICs.

摘要/摘要 在低收入和中等收入国家（LMIC）的人口所面临的分布中，与烟草使用有关 和二手烟暴露（S​​HSE）。两个国家特别受烟草使用和SHSE影响的国家是亚美尼亚 （AM）和佐治亚州（GE），代表全球男性吸烟率第11和第六（51.5％和55.5％） 分别）。但是，女性的吸烟患病率要低得多（1.8％和7.8％）。值得注意的是，主要来源 在包括AM和GE在内的许多LMIC中，儿童和大多数不吸烟的成年人都是家。无烟 房屋（SFHS）可以减少档案，促进停止并可能破坏主动性；但是，AM中有61.4％的家庭 GE允许在家中吸烟。这是促进SFHS可能是一种创新且相对尚未开发的策略 这些国家的慢性疾病预防以及其他吸烟率高的LMIC。研究的重点是 实施基于证据的干预措施（EBIS）为满足LMIC的紧迫需求提供了独特的机会 并检查在低资源环境中EBI的采用，扩大和维持中的关键障碍。这个建议 建立了GE国家疾病控制中心（NCDC）的MPIS Berg和Kegler之间的持续合作 美国国家卫生研究院（NIH）和亚美尼亚大学（AUA），可追溯到2013年。 合作建立了：1）一个基于社区的强大基础架构，用于实施公共卫生计划 在我们目前由Fogarty资助的R01中开发的14个社区中使用当地联盟； 2）基于理论的SFHS 干预措施，旨在简短和适应性，显示为有效，可概括，可扩展性和成本效益 在美国的低收入家庭中。当前的提案将在战略上利用我们的强大合作伙伴关系 与国家公共卫生机构，当地社区动员基础设施和SFH EBI有关我们的特定 目标。目的1：我们将适应我们的SFH干预措施在文化上适合于AM和GE种群，并使用A 社区参与的方法和强大的适应框架和方法，并发展国内能力 干预传播（通过当地联盟）和交付（通过国家戒烟）。目标2：我们将检查 改编干预措施（与控制）对AM家庭中SFH采用（主要结果）的有效性 GE，使用1型混合有效性 - 实现RCT（n = 550名参与者； 275/country），随访 3个月和6个月的评估。目标3：我们将评估干预措施，采用，实施和维护 潜在的以及相关的上下文影响，使用由Re-Aim指导的混合方法评估。我们的 团队（包括国家公共卫生机构）将使用这些发现来制定可持续性和传播计划 （例如，干预包装以进行扩展）。这项工作将为适应和实施此EBI提供强大的模型 对于AM和GE，可以在其他国家和/或其他行为目标和/或 EBIS在AM，GE和其他地方。这项工作将促进我们建立知识库的长期目标，以告知知识库 在全球范围内减少与烟草相关的差距以及LMIC中EBIS的实施和扩展的策略。