Smoke-free Air Coalitions in Georgia and Armenia: A Community Randomized Trial

总结/摘要 低收入和中等收入国家的公共卫生工作可以通过加强以下方式来促进： 最佳地利用当地人才和资源，如民间社会。建立有效的协调模式 中低收入国家地方一级的民间社会和政府公共卫生有可能影响一系列 慢性疾病和风险因素，包括烟草。地方联盟一直是烟草业的主导战略 在美国，控制吸烟是一个成功的例子，具体来说，在建立无烟政策方面取得了成功。但这 这种方法在中低收入国家或那些民主传统较弱的国家没有得到广泛利用或充分研究， 美方相反，在许多中低收入国家，无烟政策的进展主要是在国家一级开始的。平行 可能需要地方一级的民间社会运动来建立对政策的支持和遵守。 考虑到他们的社会政治历史和高烟草使用率和二手烟暴露率， 格鲁吉亚（GE）和亚美尼亚（AM）是拟议工作的两个战略背景。吸烟率是 男性分别为57.7%和52.3%（世界第6和第11高），女性分别为5.7%和1.5%。 此外，我们的研究结果表明，极高的SHSe率。然而，我们也记录了高接受性 尽管吸烟率很高，但公共无烟政策仍然受到限制，特别是在工作场所和餐馆。这项建议是 这是对文献和我们先前工作的合理扩展。我们将建设通用电气和AM的能力 研究人员进行高质量的混合方法烟草研究和测试的社区联盟行动 理论作为影响当地社区驱动的政策变化的框架。GE National的研究人员 疾病控制中心（NCDC）和AM国家卫生研究所（NIH）将与埃默里大学合作， 执行拟议的研究，在其组织内培训烟草控制研究人员， 在这方面，联合国烟草控制规划署将继续与各大学合作，并培训当地社区的从业人员，以建立地方烟草控制政策联盟。 我们的目标是：1）在GE和AM的28个城市进行配对社区随机对照试验 审查促进在工作场所采取无烟政策的地方联盟的影响， 餐馆，主要结果是SHSe随时间的变化; 2）评估社区环境和 联合因素影响组织和市政无烟政策的采用，以提供证据- 公共卫生实践的基础; 3）传播关于有效性和 建立和维持联盟的进程，从而增加无烟政策， 减少对GE和AM的关键利益相关者的SHSe;以及4）利用拟议的研究， 在GE NCDC、AM NIH内部建立烟草控制研究能力的传播机会， 合作大学，以及当地公共卫生中心及其民间社会的实践能力 伙伴最后，本建议中概述的活动将促进今后面向行动的 以科学和循证实践为基础，更广泛地支持该地区的烟草控制进展。

SUMMARY/ABSTRACT Public health efforts in low- and middle-income countries (LMICs) could be catalyzed by bolstering ways to optimally leverage local talents and resources, such as civil society. Developing effective models for aligning civil society and governmental public health at the local level in LMICs has the potential to impact a range of chronic diseases and risk factors, including tobacco. Local coalitions have been a dominant strategy in tobacco control in the US, with well-documented success in establishing smoke-free policies specifically. However, this approach has not been widely leveraged or well-studied in LMICs or those with less democratic traditions than the US. Instead, in many LMICs, smoke-free policy progress is largely initiated at the national level. Parallel civil society movements at the local level may be needed to build support for and compliance with policies. Given their sociopolitical histories and high tobacco use and secondhand smoke exposure (SHSe) rates, Georgia (GE) and Armenia (AM) are two strategic settings for the proposed work. The smoking prevalence is 57.7% and 52.3% in men (6th and 11th highest in the world) and 5.7% and 1.5% in women, respectively. Moreover, our findings indicate extremely high rates of SHSe. However, we also documented high receptivity to public smoke-free policies despite high use rates, particularly in worksites and restaurants. This proposal is a well-justified extension of the literature and our prior work. We will build the capacity of GE and AM researchers to conduct high-quality mixed methods tobacco research and test the Community Coalition Action Theory as a framework for impacting local community-driven policy change. Researchers from the GE National Center for Disease Control (NCDC) and AM National Institute of Health (NIH) will collaborate with Emory to execute the proposed research, train tobacco control researchers within their organizations and partnering universities, and train practitioners within local communities to build local coalitions for tobacco control policy. We aim to: 1) conduct a matched-pair community randomized controlled trial in 28 municipalities in GE and AM to examine the impact of local coalitions promoting the adoption of smoke-free policies in worksites and restaurants, with the primary outcome of changes in SHSe over time; 2) assess how community context and coalition factors influence adoption of organizational and municipal smoke-free policies to provide an evidence- base for public health practice; 3) disseminate research findings regarding both the effectiveness and the process of establishing and maintaining coalitions, and consequently increasing smoke-free policies and reducing SHSe, to key stakeholders in GE and AM; and 4) capitalize on the proposed research and dissemination opportunities to build tobacco control research capacity within the GE NCDC, AM NIH, and partnering universities, as well as practice capacity within local public health centers and their civil society partners. Ultimately, the activities outlined in this proposal will serve as a catalyst for future action-oriented science and evidence-based practice to support tobacco control progress in this region more broadly.