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

一项基于社区的试验，对以前无家可归的成年人进行永久支持性住房的自愿无烟家庭干预

• 批准号: 10608959
• 负责人: Maya Vijayaraghavan
• 金额: $ 65.68万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-03-03 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10608959
• 关键词: Abstinence; Adopted; Adoption; Adult; Age; Alcohol consumption; Area; Authorization documentation; Behavior; Cancer Etiology; Cardiovascular Diseases; Characteristics; Chronic; Chronic Disease; Cities; Cluster randomized trial; Communities; Conflict (Psychology); Counseling; Disparity; Equity; Financial Hardship; Food; General Population; Goals; Harm Reduction; Health; Home; Homeless persons; Homelessness; Housing; Income; Individual; Intervention; Intervention Trial; Left; Link; Low income; Malignant Neoplasms; Medical; Mental Health; Pathway interactions; Personal Satisfaction; Persons; Pilot Projects; Policies; Population; Poverty; Property; Provider; Public Health; Public Housing; Randomized; Recording of previous events; Reporting; Research; Resources; Risk; Risk Factors; San Francisco; Services; Site; Smoke; Smoke-free home; Smoker; Smoking; Social Work; Substance Use Disorder; Testing; Time; Tobacco; Tobacco use; Training; Treatment Efficacy; U.S. Department of Housing and Urban Development; Vulnerable Populations; Waiting Lists; Work; alcohol abstinence; arm; authority; brief intervention; cancer health disparity; cost effective; cost effectiveness; cost-effectiveness evaluation; disability; disparity reduction; environmental tobacco smoke exposure; evidence base; experience; food insecurity; health disparity; marginalization; mortality; multi-component intervention; smoke-free policy; smoking cessation; smoking restriction; social; social health determinants; substance use; supported housing; tobacco control; tobacco products

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.

项目摘要 该提案的重点是扩大获得自愿无烟的房屋的机会 居住在永久支持住房中的居民，并检查了这种干预对减少的影响 烟草引起的分布。永久支撑的住房是有紧密连接或现场的补贴住房 具有慢性无家可归历史的个人的医疗和/或社会服务，与之同住的人 残疾，心理健康和/或药物使用障碍。永久支持住房使用危害 减少框架，优先考虑住房稳定性，而不是禁欲的任何前提条件。 2017年，超过370,000 以前无家可归的人居住在美国的永久支持住房中。烟草使用最高 许多生活在永久支持住房中的人群，包括与之相处的人 残疾，心理健康和药物使用障碍以及生活在联邦贫困线以下的人。 约有50％的人居住在永久支持住房报告当前吸烟，但没有 永久支持住房中的无烟政策。问题之一是这样的政策可能 如果有意外的后果 越来越多的驱逐与违反政策有关。我们在试点研究中制定和测试的一种策略是 一种干预措施，以增加自愿采用无烟房屋。多面干预措施，交付 由学习人员包括：1）对吸烟者的永久支持住房居民一对一的咨询 关于如何采用无烟房屋，以及2）对永久支持住房人员的培训 转介到戒烟服务。在这项研究中，我们将进行多站点，基于社区的集群随机化 我们多面无烟家庭干预的等待名单对照试验400个永久性支持 住房居民居住在旧金山湾地区的20个永久性支持住房中 增加自愿采用无烟房屋的目的。我们的具体目的是：目标1：进行 聚类随机试验以估计我们无烟家庭干预对居民自愿的影响 采用无烟房屋。目标2：评估无烟家庭干预的成本效益。 目标3：确定个人层面和社会和环境的高和低采用者的特征 干预的采用，可伸缩性和可持续性的障碍和推动者。长期目标是 制定基于循证的策略，可以将其扩展为永久的支持住房，以便 减少烟草引起的癌症差异 烟草使用。