A Randomized Controlled Trial to Support Smoke-Free Policy Compliance in Public Housing
Overview
- Phase
- Not Applicable
- Intervention
- Reduction (relocation and reduction of personal smoking) and cessation
- Conditions
- Smoking
- Sponsor
- Columbia University
- Enrollment
- 405
- Locations
- 1
- Primary Endpoint
- Change in number of cigarettes smoked per day
- Status
- Completed
- Last Updated
- 3 months ago
Overview
Brief Summary
This project seeks to determine the effectiveness of two types of interventions to reduce exposure to secondhand smoke in residential buildings. One intervention is geared toward all building residents (resident endorsement) and the other targets smokers (smoking reduction via relocation and reduction in personal smoking/cessation) with the goal of reducing personal smoking and secondhand smoke exposure.
Detailed Description
Smoke-free housing policies in multi-unit housing are promising and increasingly widespread interventions to reduce smoking and secondhand smoke exposure. Little research has identified factors that improve compliance with smoke-free housing policies in low-income multi-unit housing and test corresponding solutions. The proposed randomized controlled trial (RCT) addresses key gaps in knowledge and capitalizes on key scientific opportunities by: 1) leveraging the federal mandate to ban smoking in a public housing system of more than sufficient size to conduct an adequately powered RCT; 2) expanding our understanding of smoke-free policy compliance beyond policy implementation by testing two novel treatments: a) in-residence smoking cessation and b) resident endorsement, while 3) addressing population and location-specific tobacco-related disparities. The investigators hypothesize that the relocation/cessation plus resident endorsement intervention will yield significantly larger reductions in personal smoking and secondhand smoke exposure, compared to standalone interventions and the standard approach.
Investigators
Diana Hernandez, PhD
Associate Professor of Sociomedical Sciences
Columbia University
Eligibility Criteria
Inclusion Criteria
- •Building Inclusion Criteria:
- •NYCHA buildings in Manhattan \& the Bronx (stratified evenly by borough) with more than 50 units, not undergoing major renovations.
Exclusion Criteria
- •Buildings in a borough that is not in Manhattan or the Bronx
- •Buildings smaller than 50 units
- •Buildings undergoing major renovations
- •Buildings that are or will be part of Rental Assistance Demonstration (RAD) or Permanent Affordability Commitment Together (PACT)
- •Buildings that are mixed finance
- •Buildings that are exclusively for elderly
- •Buildings that are privately managed
- •Buildings that have other research studies ongoing
- •Participant Inclusion Criteria:
- •Recruit NYCHA residents via door knocking and lobby intercepts until we reach our targeted number per group (4 smokers, 4 non-smokers in each building).
Arms & Interventions
Compliance through reduction (relocation and reduction of personal smoking) and cessation
Smokers will be referred by the survey team to peer educators from a community-based organization trained to provide peer to peer health education including tobacco cessation support. The peer educator will coordinate smoking cessation support, including serving as a liaison between participant and research team, providing information regarding the smoke-free policy and opportunities for relocation, and connecting participant to access to tobacco replacement therapy and/or physician support if deemed appropriate.
Intervention: Reduction (relocation and reduction of personal smoking) and cessation
Compliance through resident endorsement
Buildings assigned will be targeted for a series of 2 in-residence programs that involve community forums and the creative arts to garner resident endorsements of smoke-free living environments. Premised on resident engagement, this arm seeks to impact social and physical dimensions of the residential environment to achieve compliance. The sessions will: 1) inform residents of risks associated with smoking and secondhand smoke; 2) identify reasons to have a smoke-free home, 3) ask residents to sign a pledge on paper and/or virtually; 4) display smoke-free signage on doors and/or social media pages with an original hashtag (#Smokefree\[building address\]); and 5) refer residents to the Smoke-free NYCHA website for information on the policy and existing cessation resources.
Intervention: Resident Endorsement
Compliance through reduction/cessation plus resident endorsement (combined)
The combined intervention will be carried out in the buildings assigned to this RCT arm, which will provide in-residence programs based on the resident endorsement treatment and the smoking relocation/cessation treatment. Both will occur simultaneously with one geared toward all building residents (resident endorsement) and the other targeting smokers (smoking relocation/cessation) with the goal of reducing both personal smoking and secondhand smoke exposure.
Intervention: Reduction (relocation and reduction of personal smoking) and cessation
Compliance through reduction/cessation plus resident endorsement (combined)
The combined intervention will be carried out in the buildings assigned to this RCT arm, which will provide in-residence programs based on the resident endorsement treatment and the smoking relocation/cessation treatment. Both will occur simultaneously with one geared toward all building residents (resident endorsement) and the other targeting smokers (smoking relocation/cessation) with the goal of reducing both personal smoking and secondhand smoke exposure.
Intervention: Resident Endorsement
Standard NYCHA approach (control)
Buildings and study participants assigned to this arm will be recruited and followed over a 12-month period to assess outcomes. No additional programs or services will be delivered to the buildings or residents assigned to this arm beyond standard programs that NYCHA may provide to support the smoke-free mandate. Field staff will document any policy-related signage, activities or information to which these participants are exposed.
Outcomes
Primary Outcomes
Change in number of cigarettes smoked per day
Time Frame: Measured at baseline (in person interview), 3 months (phone interview) and 12 months (in person interview)
Self-reported average number of cigarettes smoked per day among smokers
Change in salivary cotinine
Time Frame: At baseline and at the 12-month follow-up
Salivary cotinine (saliva collected as passive drool) will be measured for 25% of the sample among smokers and non-smokers alike
Change in secondhand smoke exposure
Time Frame: Measured at baseline (in person interview), 3 months (phone interview) and 12 months (in person interview)
Self-reported secondhand smoking exposure (hours of secondhand smoke exposure in the building in the past 7 days); among smokers \& non-smokers
Secondary Outcomes
- Change in number of hours of secondhand smoke exposure(Number of hours observed someone smoking indoors within the past 7 days measured at baseline (in person interview), 3 months (phone interview) and 12 months (in person interview))
- Change in number of quit attempts(Measured at baseline (in person interview), 3 months (phone interview) and 12 months (in person interview))
- Change in number of participants with secondhand smoke observations(Ever observing someone smoking indoors within the past 7 days measured at baseline (in person interview), 3 months (phone interview) and 12 months (in person interview))
- Change in number of participants with successful quit attempts(Measured at baseline (in person interview), 3 months (phone interview) and 12 months (in person interview))
- Change in number of smokers(At each building visit at baseline and 12 months)
- Change in number of cigarette butts(At each building visit at baseline and 12 months)