Community-Partnered Tobacco Control in Underserved Dominican Republic Communities

说明(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。为了有效应对这一全球公共卫生危机，来自高收入国家、拥有完善的烟草控制研究项目的研究人员与中低收入国家的研究人员之间需要建立研究伙伴关系。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家，烟草使用量大，二手烟暴露水平高，而且它正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线知识、态度、暴露和行为，提供社区合作的二手烟和戒烟干预措施的随机对照试验，并制定和实施国家和区域影响的传播计划，并酌情将方法和结果翻译给其他服务不足的群体。将使用多方法评估方法，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医疗保健提供者调查)，以及二手烟暴露的生物标记物评估。在滞后的治疗设计中，8个经济困难社区将被随机分配到干预或对照条件下；干预措施将基于来自其他国家和当前DR试验的证据基础，以及使用社区合作方法的国家和地方DR工作组的投入来制定和实施。这项干预的假设是降低烟草使用率，增加无烟家庭的数量，使吸烟非正常化，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的干预--相对于对照社区，需要检查地理和人口特征的差异。该项目还将让国际、国家和地方的DR工作组与主要合作伙伴保持研究结果的沟通，主办具有区域代表性的全国DR烟草控制会议，并为地方和区域传播研究结果和基于证据的干预措施、资源和基础设施制定其他行动步骤。最后，该项目将与罗切斯特大学临床和翻译科学研究所协调，将当前基于证据的方法和方法转化为DR中的实施，并探索拟议的DR试验中的任何方法或干预措施是否可以翻译到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，对于减少全球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：在全球发展中国家，烟草使用和烟草引起的疾病和死亡正在增加，因此研究这些国家对于有效应对烟草流行至关重要。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。该项目还将与社区以及国家和国际团体合作，以确定多米尼加共和国的这项研究的方法和干预措施是否也可以用于帮助该区域的其他国家和美国未得到充分服务的群体。

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.