A community-based trial of a voluntary smoke-free home intervention in permanent supportive housing for formerly homeless adults

项目总结 这项提案的重点是将自愿无烟之家的使用范围扩大到以前的无家可归者 居住在永久性支持性住房的居民，并检查这种干预措施对减少 烟草引起的差异。永久性支持性住房是指联系紧密或现场配套的保障性住房 为有长期无家可归史的个人提供医疗和/或社会服务，并与 残疾、精神健康和/或物质使用障碍。永久性支持性住房有害无益 减少框架，优先考虑住房稳定，而不是禁欲的任何先决条件。2017年，超过37万 以前无家可归的人住在美国的永久支持性住房中。烟草使用率最高的是 居住在永久支持性住房中的许多相同人口，包括与 残疾、精神健康和药物使用障碍，以及生活在联邦贫困线以下的人。 大约50%居住在永久支持性住房的人报告说他们现在吸烟，但没有 在永久性支持性住房中强制实施无烟政策。其中一个令人担忧的问题是，这些政策可能 与永久支持性住房的减少危害框架相矛盾，如果它具有意外的后果 与违反政策有关的驱逐事件不断增加。我们在一项试点研究中开发和测试的一种策略是 一项旨在增加自愿采用无烟住宅的干预措施。多方面的干预，提供 研究工作人员包括：1)对吸烟者的永久支持性住房居民进行一对一咨询 关于如何采用无烟家庭，以及2)培训永久支持性住房工作人员如何提供 转介到戒烟服务机构。在这项研究中，我们将进行多站点、基于社区的随机分组 我们在400名永久性支持者中进行的多方面无烟家庭干预的等待名单对照试验 居住在旧金山湾区20个永久性支持性住房地点的居民 增加自愿采用无烟住宅的目标。我们的具体目标是：目标1：开展 随机整群试验评估无烟家庭干预对居民自愿行为的影响 采用无烟住宅。目的2：评价无烟家庭干预的成本-效果。 目标3：在个人以及社会和环境层面确定高采用率和低采用率的特点 采用的障碍和推动因素、干预措施的可扩展性和可持续性。长期目标是 制定可在永久性支持性住房中规模化的循证战略，以便 减少烟草引起的癌症在易感人群中的差异 烟草使用。

PROJECT SUMMARY The focus of this proposal is on expanding access to voluntary smoke-free homes to formerly homeless residents residing in permanent supportive housing, and examining the impact of this intervention on reducing tobacco-caused disparities. Permanent supportive housing is subsidized housing with closely linked or on-site medical and/or social services for individuals with a history of chronic homelessness, and who are living with disabilities, mental health and/or substance use disorders. Permanent supportive housing uses a harm reduction framework, prioritizing housing stability over any pre-conditions of abstinence. In 2017, over 370,000 formerly homeless individuals lived in permanent supportive housing in the US. Tobacco use is highest among many of the same populations that live in permanent supportive housing, including people living with disabilities, mental health and substance use disorders, and who live below the federal poverty line. Approximately 50% of people living in permanent supportive housing report current smoking, yet there are no mandated smoke-free policies in permanent supportive housing. One of the concerns is that such policies may contradict permanent supportive housing’s harm reduction framework if it had the unintended consequence of increasing evictions related to policy violations. One strategy that we developed and tested in a pilot study is an intervention to increase voluntary adoption of smoke-free homes. The multi-faceted intervention, delivered by study staff includes: 1) one-on-one counseling to permanent supportive housing residents who are smokers on how to adopt a smoke-free home, and 2) training for permanent supportive housing staff on how to provide referrals to cessation services. In this study, we will conduct a multi-site, community-based cluster-randomized wait-list controlled trial of our multi-faceted smoke-free home intervention among 400 permanent supportive housing residents residing in 20 permanent supportive housing sites across the San Francisco Bay Area with the goal of increasing voluntary adoption of smoke-free homes. Our specific aims are: Aim 1: Conduct a cluster randomized trial to estimate the effect of our smoke-free home intervention on residents' voluntary adoption of smoke-free homes. Aim 2: Evaluate the cost-effectiveness of the smoke-free home intervention. Aim 3: Determine characteristics of high and low adopters at the individual level, and social and environmental barriers and enablers of adoption, scalability and sustainability of the intervention. The long-term goal is to develop evidence-based strategies that can be brought to scale in permanent supportive housing in order to reduce tobacco-caused cancer disparities among vulnerable populations disproportionately impacted by tobacco use.