Reducing Environmental Tobacco Smoke Exposure in Public Housing

描述(申请人提供)：环境烟草烟雾(ETS)，也被称为二手烟或二手烟，对不吸烟者的健康构成威胁，导致和加剧哮喘，以及上呼吸道和下呼吸道感染、心血管疾病(CVD)和肺癌。ETS暴露没有安全水平。人类ETS暴露在低收入群体中最高，多单元住房(包括公共住房)中的非吸烟家庭ETS水平较高。公屋居民更易受到ETS的影响，因为他们住在最后的住房里，没有办法通过改变住所来避免暴露。工作场所禁烟等公共政策明显改善了人口健康，降低了非吸烟者接触ETS的水平，降低了心血管和呼吸系统不良后果的发生率。2009年6月，住房和城市发展部呼吁地方住房当局实施无烟政策。由于卫生部是吸烟监管的最后前沿之一，目前尚不清楚无烟住房规则是否会有效地减少非吸烟者接触ETS，特别是在公共住房中，而且到目前为止还没有全面的研究。2010年，马萨诸塞州波士顿宣布，波士顿住房管理局(BHA)的物业，包括住宅，将在2012年秋季完全无烟，使波士顿成为全国最大的公共住房管理局，有这样的计划。我们建议的研究抓住了这一独特的时刻，使用准实验、纵向设计来检验公共住房无烟政策减少居民暴露于ETS的假设。钻塔是我们的干预点。我们的控制地点是位于马萨诸塞州剑桥市的剑桥住房管理局(CHA)，那里将不会实施无烟住房政策。我们将进行差异分析，以测试从2012年夏季(BHA之前的无烟住房政策)到2013年夏季(BHA后的无烟政策)，干预地点(BHA)的ETS水平和暴露水平是否比对照地点(CHA)的变化更大。从每个地点随机选择的至少150个不吸烟家庭将接受事前和事后评估，每个家庭中的一名居民将包括在研究中。将通过测量参与者的唾液可替宁、家庭和公共区域的空气质量(空气中尼古丁和颗粒物-PM2.5)以及参与者的自我报告来评估ETS的暴露情况。此外，暴露于ETS的来源将通过空气中尼古丁、空气流量和PM2.5测量以及居民的自我报告来确定。此外，还将调查居民对ETS和无烟政策的知识、态度、信念和行为。了解波士顿实施该政策的经验，并了解该政策对公共健康的影响，将为政策制定者和其他住房当局提供至关重要的信息，因为这些政策变得越来越常见。

DESCRIPTION (provided by applicant): Environmental tobacco smoke (ETS), also known as secondhand smoke or passive smoking, is a threat to non-smokers' health, causing and exacerbating asthma, as well as upper and lower respiratory infections, cardiovascular disease (CVD), and lung cancer. There is no safe level of ETS exposure. Human ETS exposure is highest among low-income groups and non-smoking households in multiunit housing (MUH), including public housing, have elevated levels of ETS. Public housing residents' vulnerability to ETS exposure is heightened because they are in housing of last resort without the means to avoid exposure by changing residences. Public policies such as workplace smoking bans have resulted in demonstrated improvements in population health, leading to lower levels of ETS exposure for non-smokers and lower rates of adverse cardiovascular and respiratory outcomes. In June of 2009, the Department of Housing and Urban Development called on local housing authorities to implement smoke-free policies. Because MUH is one of the last frontiers of smoking regulation, it is not clear whether smoke-free housing rules will be effective at reducing non-smokers' exposure to ETS, particularly in public housing, and to date there have been no comprehensive studies. In 2010, the city of Boston, MA declared that the properties of the Boston Housing Authority (BHA), including residences, will become entirely smoke-free in the fall of 2012, making Boston's the largest public housing authority in the country with such plans. Our proposed study seizes on this unique moment in time, using a quasi- experimental, longitudinal design to test the hypothesis that smoke-free policies in public housing reduce residents' exposures to ETS. The BHA is our intervention site. Our control site is the Cambridge Housing Authority (CHA) in Cambridge, MA where no smoke-free housing policy will be implemented. We will conduct difference-in-differences analyses to test whether changes in ETS levels and exposure from summer 2012 (pre-BHA smoke-free housing policy) to summer 2013 (post-BHA smoke-free policy) are greater for the intervention site (BHA) than for the control site (CHA). At least 150 randomly selected non-smoking households from each site will undergo pre and post assessments, and one resident from each household will be included in the study. ETS exposure will be assessed by measuring participants' saliva cotinine; air quality in households and common areas (airborne nicotine and particulate matter - PM2.5); and participants' self- reports. In addition, the sources of exposure to ETS will be determined by airborne nicotine, air flow, and PM2.5 measurements, as well as residents' self-report. Additionally, residents will be surveyed on their knowledge, attitudes, beliefs, and behaviors towards ETS and smoke-free policies. Understanding Boston's experience implementing the policy, and understanding the impact the policy's effect on public health will provide crucial information to policy makers and other housing authorities as these policies become more commonplace.