A smoke-free home intervention in federally subsidized housing

PROJECT SUMMARY The smoke-free home intervention study aims to reduce racial/ethnic disparities in tobacco use and exposure by increasing access to smoke-free homes and cessation resources among racially/ethnically- and linguistically-diverse populations in federally subsidized housing (“subsidized housing”). Black/African American, Hispanic/Latino, and Asian populations with limited English proficiency are over-represented in subsidized housing; these populations have higher rates of tobacco use and exposure than the general population. Tobacco-related cancer and cardiovascular disease contribute disproportionately to the excess morbidity and mortality in these populations. Comprehensive smoke-free policies have the potential to substantially reduce tobacco-related disparities among populations in subsidized housing. In 2018, the Department of Housing and Urban Development implemented a smoke-free policy in a minority of public housing, presenting a unique opportunity to expand the reach of such policies to all types of subsidized housing. This study fills this gap by identifying approaches to increase the implementation of smoke-free policies in all types of subsidized housing by increasing the voluntary adoption of smoke-free homes and promoting access to smoking cessation services. We will build on our pilot work, where we developed and evaluated the feasibility of a smoke-free home intervention to increase voluntary adoption of smoke-free homes in permanent supportive housing for formerly homeless adults. We adapted our previously-developed smoke-free home intervention to federally subsidized housing by incorporating new intervention components that align with racially-ethnically and linguistically-diverse populations in three geographically-diverse California Counties. The multi-faceted intervention, delivered by bilingual study staff in Chinese (Mandarin and Cantonese), English, or Spanish includes: 1) one-on-one counseling to residents who are smokers on how to adopt a smoke-free home, and 2) training housing staff as lay health workers to deliver monthly brief cessation coaching to residents. We propose to conduct a wait-list cluster randomized controlled trial of the adapted smoke-free home intervention compared to usual care among N=544 residents from 24 subsidized housing sites in Contra Costa, Oakland and San Francisco. Our specific aims are: Aim 1: To estimate the effect of our adapted smoke-free home intervention on the primary outcome of residents' voluntary adoption of smoke-free homes and the secondary outcome of biochemically-verified tobacco abstinence at 6-months follow-up. Aim 2: To determine the cost of our adapted smoke-free home intervention and determine whether it is a cost- effective use of health care resources. Aim 3: To evaluate variation in stakeholders’ perspectives on the adapted smoke-free home intervention’s adaptability, scalability and sustainability. The proposed intervention can expand access to smoke-free policies and smoking cessation services in subsidized housing, thereby reducing racial/ethnic disparities in tobacco use, tobacco exposure and chronic disease in these populations.