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.

项目摘要 这项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 居住在永久性支持性住房的居民，并研究这种干预措施对减少 烟草造成的差异。永久性支助性住房是指补贴住房， 医疗和/或社会服务的个人与历史的长期无家可归，谁是生活在 残疾、精神健康和/或物质使用障碍。永久性支持性住房使用危害 减少框架，优先考虑住房稳定，而不是任何禁欲的先决条件。2017年，超过37万人 以前无家可归的人住在美国的永久性支持性住房中。烟草使用率最高的是 许多住在永久性支持性住房中的人口，包括与 残疾、精神健康和药物使用障碍以及生活在联邦贫困线以下的人。 大约50%居住在永久性支持性住房中的人报告目前吸烟，但没有 在永久性支持性住房中强制实行无烟政策。其中一个问题是，这些政策可能会 与永久性支持性住房的减少危害框架相矛盾，如果它有以下意外后果： 越来越多的驱逐与违反政策有关。我们在试点研究中开发和测试的一个策略是， 增加自愿采用无烟家庭的干预措施。多方面的干预， 包括：1）对吸烟的永久性支持性住房居民进行一对一咨询 如何采用无烟家庭，以及2）培训永久性支持性住房工作人员如何提供 转介戒烟服务。在这项研究中，我们将进行一个多中心，以社区为基础的随机分组， 在400名永久性支持者中进行的多方面无烟家庭干预的等待名单对照试验 居住在旧金山弗朗西斯科湾区20个永久性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： 评估我们的无烟家庭干预对居民自愿吸烟的影响的随机分组试验 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：确定高和低采用者在个人水平、社会和环境方面的特征 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 制定可在永久性支助性住房中推广的循证战略， 减少烟草造成的癌症在受烟草过度影响的弱势群体中的差异 烟草使用。