Community-Partnered Tobacco Control in Underserved Dominican Republic Communities

说明（由申请人提供）：烟草流行的全球化造成了严重的发病率和死亡率负担，中低收入国家日益首当其冲。需要来自具有发达烟草控制研究规划的高收入国家的研究人员与中低收入国家的研究人员建立研究伙伴关系，以有效应对这一全球公共卫生危机。多米尼加共和国是反映拉丁美洲趋势的一个关键地点：它是一个中低收入烟草种植国，烟草使用量大，二手烟暴露程度高，而且还处于烟草控制的非常早期阶段。拟议的项目将评估有关烟草使用和二手烟的基本知识、态度、接触和行为，提供一项与社区合作的二手烟和戒烟干预措施的随机对照试验，并制定和实施一项传播计划，以对国家和区域产生影响，并酌情向其他服务不足的群体推广方法和结果。将采用多方法评估方法，包括定性社区评估（rap）、一系列定量调查（家庭监测、社区和吸烟者队列调查以及卫生保健提供者调查）以及二手烟暴露的生物标志物评估。在滞后治疗设计中，将8个经济弱势社区随机分为干预组或对照组；干预措施的制定和实施将基于其他国家的证据基础和当前的DR试验，以及采用社区合作方法的国家和地方DR工作组的投入。假设干预措施降低烟草使用率，增加无烟家庭的数量，使吸烟不正常化，提高对烟草使用和二手烟风险的认识并改变态度，减少二手烟暴露，并增加卫生保健提供者对干预措施的干预-相对于对照社区，地理和人口特征的差异有待检查。该项目还将使国际、国家和地方预防吸烟工作组参与，保持与主要合作伙伴沟通调查结果，主办有区域代表参加的国家预防吸烟控制会议，并制定其他行动步骤，以便在地方和区域传播调查结果以及基于证据的干预措施、资源和基础设施。最后，该项目将与罗彻斯特大学临床和转化科学研究所协调，翻译当前基于证据的方法和方法，以便在DR中实施，并探索DR中拟议试验的任何方法或干预措施是否可以翻译为美国服务不足的群体。有效地让处于早期阶段的中低收入国家参与烟草控制研究，对于在全球减少烟草使用和烟草引起的疾病负担至关重要。公共卫生相关性：全球发展中国家的烟草使用和烟草引起的疾病和死亡正在增加，因此对这些国家进行研究至关重要，以便有效解决烟草流行问题。拟议的项目将在多米尼加共和国八个服务不足的社区测试以社区为基础的二手烟和戒烟干预措施的有效性。该项目还将与社区、国家和国际团体合作，以确定多米尼加共和国研究的方法和干预措施是否也可用于帮助该地区的其他国家和美国服务不足的群体。

DESCRIPTION (provided by applicant): The globalization of the tobacco epidemic poses significant morbidity and mortality burdens, with the brunt of impact increasingly borne by low-middle income countries. Research partnerships between investigators from high-income countries with well developed tobacco control research programs and their counterparts in low-middle income countries are needed to effectively address this global public health crisis. The Dominican Republic (DR) is a key site that mirrors the trends in Latin America: it is a low-middle income tobacco growing country with significant tobacco use and high levels of secondhand smoke exposure, and it is at a very early stage of tobacco control. The proposed project will assess baseline knowledge, attitudes, exposures, and behaviors regarding tobacco use and secondhand smoke, provide a randomized controlled trial of community-partnered interventions around secondhand smoke and tobacco cessation, and develop and implement a dissemination plan for national and regional impact and translation of methods and results to other underserved groups as appropriate. A multimethod assessment approach will be used, to include qualitative community assessments (RAPs), a series of quantitative surveys (household surveillances, community and smoker cohort surveys, and health care provider surveys), and a biomarker assessment of secondhand smoke exposure. Eight economically disadvantaged communities will be randomized to intervention or control conditions in a lagged treatment design; interventions will be developed and implemented based on the evidence base from other countries and from a current DR trial, and on input from national and local DR workgroups using a community partnered approach. The intervention is hypothesized to decrease tobacco use rates, increase the number of smokefree homes, denormalize smoking, increase awareness of and change attitudes regarding tobacco use and secondhand smoke risks, decrease exposure to secondhand smoke, and increase health care provider intervention in intervention- relative to control communities, with differences by geographic and demographic characteristics to be examined. The project will also engage international, national, and local DR workgroups to maintain communication of findings to key partners, host a national DR tobacco control conference with regional representation, and develop other action steps for local and regional dissemination of findings and evidence based interventions, resources, and infrastructures. Finally, the project will coordinate with the University of Rochester Clinical and Translational Sciences Institute for translation of current evidence based approaches and methodologies for implementation in the DR, and to explore whether any methodologies or interventions from the proposed trial in the DR can be translated to underserved groups in the United States. Effectively engaging early stage low-middle income countries in tobacco control research will be critical to reducing tobacco use and the burden of tobacco-caused illnesses globally. PUBLIC HEALTH RELEVANCE: Tobacco use and tobacco-caused illnesses and death are increasing in developing countries globally, so it is critical to study these countries in order to effectively address the tobacco epidemic. The proposed project will test the effectiveness of community- based interventions for secondhand smoke and quitting smoking in eight underserved communities in the Dominican Republic. The project will also partner with communities and national and international groups to determine whether the methods and interventions from this study in the Dominican Republic can also be used to help other countries in the region and underserved groups in the United States.