A community-based trial of a voluntary smoke-free home intervention in permanent supportive housing for formerly homeless adults

一项基于社区的试验，对以前无家可归的成年人进行永久支持性住房的自愿无烟家庭干预

• 批准号: 10608959
• 负责人: Maya Vijayaraghavan
• 金额: $ 65.68万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-03 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10608959
• 关键词: Abstinence; Adopted; Adoption; Adult; Age; Alcohol consumption; Area; Authorization documentation; Behavior; Cancer Etiology; Cardiovascular Diseases; Characteristics; Chronic; Chronic Disease; Cities; Cluster randomized trial; Communities; Conflict (Psychology); Counseling; Disparity; Equity; Financial Hardship; Food; General Population; Goals; Harm Reduction; Health; Home; Homeless persons; Homelessness; Housing; Income; Individual; Intervention; Intervention Trial; Left; Link; Low income; Malignant Neoplasms; Medical; Mental Health; Pathway interactions; Personal Satisfaction; Persons; Pilot Projects; Policies; Population; Poverty; Property; Provider; Public Health; Public Housing; Randomized; Recording of previous events; Reporting; Research; Resources; Risk; Risk Factors; San Francisco; Services; Site; Smoke; Smoke-free home; Smoker; Smoking; Social Work; Substance Use Disorder; Testing; Time; Tobacco; Tobacco use; Training; Treatment Efficacy; U.S. Department of Housing and Urban Development; Vulnerable Populations; Waiting Lists; Work; alcohol abstinence; arm; authority; brief intervention; cancer health disparity; cost effective; cost effectiveness; cost-effectiveness evaluation; disability; disparity reduction; environmental tobacco smoke exposure; evidence base; experience; food insecurity; health disparity; marginalization; mortality; multi-component intervention; smoke-free policy; smoking cessation; smoking restriction; social; social health determinants; substance use; supported housing; tobacco control; tobacco products

PROJECT SUMMARY The focus of this proposal is on expanding access to voluntary smoke-free homes to formerly homeless residents residing in permanent supportive housing, and examining the impact of this intervention on reducing tobacco-caused disparities. Permanent supportive housing is subsidized housing with closely linked or on-site medical and/or social services for individuals with a history of chronic homelessness, and who are living with disabilities, mental health and/or substance use disorders. Permanent supportive housing uses a harm reduction framework, prioritizing housing stability over any pre-conditions of abstinence. In 2017, over 370,000 formerly homeless individuals lived in permanent supportive housing in the US. Tobacco use is highest among many of the same populations that live in permanent supportive housing, including people living with disabilities, mental health and substance use disorders, and who live below the federal poverty line. Approximately 50% of people living in permanent supportive housing report current smoking, yet there are no mandated smoke-free policies in permanent supportive housing. One of the concerns is that such policies may contradict permanent supportive housing’s harm reduction framework if it had the unintended consequence of increasing evictions related to policy violations. One strategy that we developed and tested in a pilot study is an intervention to increase voluntary adoption of smoke-free homes. The multi-faceted intervention, delivered by study staff includes: 1) one-on-one counseling to permanent supportive housing residents who are smokers on how to adopt a smoke-free home, and 2) training for permanent supportive housing staff on how to provide referrals to cessation services. In this study, we will conduct a multi-site, community-based cluster-randomized wait-list controlled trial of our multi-faceted smoke-free home intervention among 400 permanent supportive housing residents residing in 20 permanent supportive housing sites across the San Francisco Bay Area with the goal of increasing voluntary adoption of smoke-free homes. Our specific aims are: Aim 1: Conduct a cluster randomized trial to estimate the effect of our smoke-free home intervention on residents' voluntary adoption of smoke-free homes. Aim 2: Evaluate the cost-effectiveness of the smoke-free home intervention. Aim 3: Determine characteristics of high and low adopters at the individual level, and social and environmental barriers and enablers of adoption, scalability and sustainability of the intervention. The long-term goal is to develop evidence-based strategies that can be brought to scale in permanent supportive housing in order to reduce tobacco-caused cancer disparities among vulnerable populations disproportionately impacted by tobacco use.

项目概要 该提案的重点是扩大以前无家可归者进入自愿无烟之家的机会 居住在永久支持性住房中的居民，并研究这种干预措施对减少 烟草造成的差异。永久性保障性住房是指与住房紧密相连或就地的保障性住房。 为有长期无家可归史以及与他人同住的个人提供医疗和/或社会服务 残疾、心理健康和/或药物滥用障碍。永久性支持性住房使用有危害 减少框架，将住房稳定置于禁欲的任何先决条件之上。 2017年，超过37万 以前无家可归的人住在美国的永久支持性住房中。烟草使用率最高的是 许多同样居住在永久支持性住房中的人口，包括居住在 残疾、心理健康和药物滥用障碍，以及生活在联邦贫困线以下的人。 大约 50% 居住在永久支持性住房中的人报告目前吸烟，但没有 永久支持性住房强制实施无烟政策。担忧之一是此类政策可能会 如果永久支持性住房产生以下意想不到的后果，则与永久支持性住房的减害框架相矛盾 与违反政策有关的驱逐事件不断增加。我们在试点研究中开发和测试的一项策略是 旨在增加自愿采用无烟家庭的干预措施。多方位介入， 研究人员提供的服务包括： 1) 为吸烟的永久支持性住房居民提供一对一的咨询 关于如何采用无烟住宅，以及 2) 对永久支持性住房工作人员进行关于如何提供无烟住宅的培训 转介戒烟服务。在这项研究中，我们将进行多地点、基于社区的整群随机研究 我们在 400 名永久支持者中进行多方面无烟家庭干预的等候名单对照试验 居住在旧金山湾区 20 个永久支持性住房地点的居民 增加自愿采用无烟家庭的目标。我们的具体目标是： 目标 1：开展 整群随机试验来评估无烟家庭干预对居民自愿的影响 采用无烟家庭。目标 2：评估无烟家庭干预的成本效益。 目标 3：确定个人、社会和环境层面的高采用者和低采用者的特征 干预措施的采用、可扩展性和可持续性的障碍和推动因素。长期目标是 制定可在永久性支持性住房中推广的基于证据的战略，以便 减少受烟草影响较大的弱势群体中因烟草引起的癌症的差异 烟草的使用。