Community-Partnered Tobacco Control in Underserved Dominican Republic Communities

烟草流行的全球化造成了重大的发病率和死亡负担，其中首当其冲。 低收入和中等收入国家所承受的影响越来越大。研究人员之间的研究伙伴关系 来自高收入国家，拥有完善的烟草控制研究项目及其同行 在中低收入国家，需要有效解决这一全球公共卫生危机。这个 多米尼加共和国(DR)是一个反映拉丁美洲趋势的关键地点：它是中低收入者 烟草种植国，烟草使用量大，二手烟暴露水平高，而且 正处于烟草控制的非常早期阶段。拟议的项目将评估基线知识、态度、 暴露以及与烟草使用和二手烟有关的行为提供了一种随机对照 关于二手烟和戒烟的社区合作干预试验，并制定 执行国家和区域影响的传播计划以及方法和成果的翻译 适当地向其他服务不足的群体提供援助。将使用多方法评估方法，以包括 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 接触二手烟。八个经济困难社区将被随机分配到 在滞后的治疗设计中的干预或控制条件；将制定干预措施并 根据来自其他国家和当前DR试验的证据基础并根据投入实施 来自国家和地方灾难恢复工作组，使用社区合作方式。干预措施是 假设是为了降低烟草使用率，增加无烟家庭的数量，使非正常化 吸烟，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，增加卫生保健提供者干预干预- 相对于对照社区，根据地理和人口特征的不同 检查过了。该项目还将参与国际、国家和地方灾难恢复工作组，以维护 向主要合作伙伴传达调查结果，与区域组织共同主办全国DR烟草控制会议 代表，并制定其他行动步骤，以便在当地和区域传播调查结果和证据 基于干预措施、资源和基础设施。最后，该项目将与加州大学进行协调。 罗切斯特临床和翻译科学研究所当前基于证据的方法的翻译 和在灾难恢复中实施的方法，并探索是否有任何方法或 来自DR拟议试验的干预措施可以转化为美国服务不足的群体 各州。将有效地让早期中低收入国家参与烟草控制研究 在全球范围内减少烟草使用和烟草引起的疾病负担至关重要。

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.