Social Ecological Based Smoking Cessation Intervention in Public Housing Neighborhoods
Phase: NA
Conditions: Cigarette Smoking
Sponsor: Medical University of South Carolina

 
 
Study Title: 
Social Ecological Based Smoking Cessation Intervention in Public Housing 
Neighborhoods 
 
 
#  R01HL090951 
 
 
Date:  8/09/2018 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Study Protocol 
 
Design.  A matched-pair cluster-randomized design will be used. We will form 7 matched pairs 
of 14 public housing neighborhoods, based on neighborhood size within geographic location, 
and randomly assign one neighborhood in each pair to either a bundled, multi-level smoking 
cessation intervention (TX) or control condition (C) (7 per condition). Eight (8) public housing 
neighborhoods in Augusta, GA and 6 in Charleston, SC that range in size from 100 units to 272 
units will be used. The trial will be conducted in 7 overlapping waves of recruitment and 
intervention delivery over 4 years as shown in Table 1. Staggering the participants allows ease 
of operational feasibility as shown in Table 1. 
Table 1: Timeline for Implementation of Community Trial (N=406) 
Wave 
Condition 
Neighborhood 
Data Collection 
Recruitment/ 
Individual  data 
collection 
Treatment 
Intervention 
6 month 
data 
collection 
12 month 
data 
collection 
1 
TX NBH #1-Aug (n=29) 
TX NBH #2-Chs (n=29) 
Mo 9 
Mo 9 
Mo 10 
Mo 10 
Mo 11-16 
Mo 11-16 
Mo 17 
Mo 17 
Mo 23 
Mo 23 
2 
C   NBH  #1-Aug (n=29) 
C  NBH  #2-Chs  (n=29) 
Mo 12 
Mo 12 
Mo 13 
Mo 13 
------- 
------- 
Mo 20 
Mo 20 
Mo 26* 
Mo 26* 
3 
TX NBH  #3-Aug (n=29) 
TX NBH #4-Chs  (n=29) 
Mo 15 
Mo 15 
Mo 16 
Mo 16 
Mo 17-22 
Mo 17-22 
Mo 23 
Mo 23 
Mo 29 
Mo 29 
4 
C   NBH #3-Aug  (n=29) 
C   NBH #4-Chs  (n=29) 
Mo 18 
Mo 18 
Mo 19 
Mo 19 
------ 
------ 
Mo 26 
Mo 26 
Mo 32* 
Mo 32* 
5 
TX NBH #5-Aug  (n=29) 
TX NBH #6-Chs (n=29) 
Mo 21 
Mo 21 
Mo 22 
Mo 22 
Mo 23-28 
Mo 23-28 
Mo 29 
Mo 29 
Mo 35 
Mo 35 
6 
C  NBH #5-Aug   (n=29) 
C   NBH #6-Chs  (n=29) 
Mo 24 
Mo 24 
Mo 25 
Mo 25 
------ 
------ 
Mo 32 
Mo 32 
Mo 38* 
Mo 38* 
7 
TX NBH #7-Aug (n=29) 
C   NBH #7-Aug (n=29) 
Mo 27 
Mo 30 
Mo 28 
Mo 31 
Mo 29-34 
----- 
Mo 35 
Mo 38 
Mo 41 
Mo 44* 
    TX = Treatment    C = Control    NBH= Neighborhood        Aug= Augusta       Chs = Charleston   Mo = Month 
   *Following the final data collection at 12 months in the C neighborhoods, a delayed intervention will be offered to C participants. 
 
The intervention components for each condition are listed below: 
Multi-level Smoking Cessation Intervention 
(TX): 
Control Condition (C): 
 1:1 contact by CHW weekly for 12 weeks, 
every other week for 4 weeks, every 4 weeks 
for 8 weeks (24 weeks total) 
 Weekly peer group behavioral counseling 
sessions by cessation specialist for 6 weeks    
 Neighborhood level strategies 
(countermarketing and policy 
implementation) by neighborhood advisory 
board over 24 weeks 
 8-week supply of nicotine patches 
 Study specific written cessation materials 
(Sister to  
     Sister Handbook)    
 Written cessation materials (Pathways 
to                      
    Freedom) at enrollment/baseline data   
    collection 
 Mailed written materials 
- Week 6: State Sponsored, Toll-Free     
  Quit- Line 
- Week 12: You Can Quit Smoking  
(AHRQ)* 
- Week 18: When Smokers Quit 
(ACS)** 
 
*Agency for Research on Healthcare Research and Quality           **American Cancer Society 
 
Subjects.  A total of 406 participants will be recruited from 14 public housing neighborhoods (29 
women from each neighborhood) in the Augusta, GA and Charleston, SC areas. With 
consultation of our community advisory board and housing authority partners, we have chosen 
not to exclude non-AA women.  
 

 
Inclusion Criteria: 
Exclusion Criteria: 
 Females age 18 years or older  
 Current daily smoker 
 Resides in the respective neighborhood   
 Thinking about quitting in next 6 months 
 Willingness to follow through with protocol 
requirements 
 Able to provide names and phone numbers of 
3 contacts 
 Able to speak English       
 Acute serious medical illness 
 Pregnancy or breast feeding 
 Acute psychiatric disorder 
 Myocardial infarction in past month, 
unstable angina or serious 
arrhythmias 
 Plan to move in next 12 months 
 
 
Neighborhood and Subject Recruitment.  We have received permission from the respective 
housing authorities to conduct the interventions in the 14 eligible neighborhoods. Our team has 
worked with public housing neighborhoods and residents for the past 8 years. The respective 
universities (Medical University of South Carolina and Medical College of Georgia) both have 
long-standing relationships with the housing authorities and residents. The PI, Co-I, and/or 
project managers will meet with neighborhood leaders (i.e., tenant association) prior to data 
collection to explain the overall purpose of the study. Following, ethnic minority graduate 
students will complete the neighborhood level data collection. During this neighborhood data 
collection process and interaction, the graduate students will elicit assistance from 
neighborhood liaisons to distribute flyers (dates and times of neighborhood information 
sessions, inclusion/exclusion criteria, and toll-free lines for further information) and “word of 
mouth” to recruit individual participants for the study. They will also place flyers in the 
community center, mailbox center, housing authority office, and other key sites in the 
neighborhoods.  
 
The study information sessions will be held in the neighborhood activity center and 
include a neighborhood bingo game, cookout, or preferred activity of that neighborhood (as 
identified by the tenant association) based on our pilot work. During these sessions, the PI or 
Co-I and project manager will provide a brief overview of the study. Women who are interested 
will be screened for eligibility and consented by the PI or Co-PI, enrolled, and baseline data 
collected.  
Based on our preliminary studies, we expect to schedule two introductory/baseline data 
collection sessions in each neighborhood to enroll 29 eligible participants. We are anticipating 
one month to complete the neighborhood data collection and one month to enroll eligible 
individual participants in each neighborhood. 
  
Subject Retention. Several previously used strategies will be continued to maintain high 
retention rates. These include: 1) using indigenous CHWs with expertise in navigating the social 
environment;  2) providing telephone messages where participants can leave voice mail; 3) 
scheduling evening and weekend group meetings and data collection schedules; 4) scheduling 
all meetings and data collection in the neighborhood (i.e., community center); 5) use of 
incentives (i.e., door prizes such as candles, lotions, kitchen supplies) for all group counseling 
meetings; 6) graduated remuneration at the end of each data collection ($25 gift card at 
baseline; $50 gift card at 6 months; $100 gift card at 12 months); 7) collecting three contact 
names, addresses, and phone numbers from participants with specific emphasis on obtaining 
older contacts (i.e., mothers, aunts, grandmothers) since these contacts are less mobile; 8) 
sending periodic postcards to participants as well as birthday and holiday cards; and, 9) 
providing stress balls, t-shirts, and other gifts with study logo and phone number.  
 

Setting.  
This study will be conducted in two similar metropolitan settings: Augusta, GA and 
Charleston, SC. The Augusta metropolitan area has a population of 193,316, with 46% African 
Americans. The median income in Augusta is $32,972 and an estimated 20% of the population 
lives below the poverty level. The Charleston metropolitan area has a population of 217,070, 
with 38% African Americans.  The median income in Charleston is $35,295, and 19.7% of the 
population lives below the poverty level.  Both communities have Housing Authorities that were 
established in the 1930’s and sponsor traditional public housing programs. 
     There are a total of 14 traditional public housing neighborhoods in the Augusta metropolitan 
community. Eight of these 14 have at least 100 adult women residents, are family residential 
neighborhoods (vs. high rise senior complexes), and have not been previously used in our pilot 
studies. There are a total of 12 public traditional public housing neighborhoods in the Charleston 
metropolitan community. Six of these 12 have at least 100 adult women residents, are family 
residential neighborhoods, and have not been previously used in our pilot studies.  In total, we 
have permission to use all 8 eligible in Augusta and 6 eligible in Charleston for a total of 14 
neighborhoods for this study. We will pair-match the neighborhoods based on location and size. 
(See Section D3a). An estimated 40% of adult women in each neighborhood are current 
smokers based on our pilot data [19,52]. Approximately 98% of the women are AA. Table 4 
displays demographic information for each neighborhood and estimated number of female 
smokers. 
The 14 neighborhoods (8 in Augusta and 6 in Charleston) are not contiguous and are all 
located in separate school zones, which limit the risk of contamination across neighborhoods. 
Each neighborhood has its own tenant association and residential manager. Further, most 
women do not own cars, do not actively participate in organized community social groups (i.e., 
church groups) and are isolated to the neighborhood, except for public transportation. The 
residents typically do not move to other neighborhoods (average length of residency  is 6-8 
years), with many living in the same neighborhood their entire lifetime. These neighborhoods 
provide ideal settings for multi-level interventions randomized by clusters due to the 
circumscribed geographical space, isolation of residents, and density of the population.  
Table 4:  Study Sites                                     
 
 
Pair 
Name 
#  
Households 
Adult 
Women 
 > 18 yrs 
Estimate
d # of 
women 
smokers 
(40%) 
 
 
Name 
 
# 
Household
s 
 
Adult 
Wome
n > 18 
yrs 
Estimate
d # of 
women 
smokers 
(40%) 
Augusta Public Housing Neighborhoods 
#1 
Hahn Village 
100 
102 
  41 
Barton Homes 
143 
152 
61 
#2 
Allen Homes 
146 
135 
54 
Jennings Place   
148 
165 
66 
#3 
Cherry Tree 
219 
230 
92 
Oak Pointe  
246 
190 
76 
#4 
Dogwood 
Terrace 
266 
305 
122 
Gilbert Manor 
272 
285 
114 
Charleston Public Housing Neighborhoods 
#5 
Wraggborough 
178 
185 
74 
Horizon Village 
200 
210 
84 
#6 
Meeting St. 
Manor 
201 
210 
84 
Cooper River  
216 
235 
94 
#7 
Robert Mills 
257 
270 
      108 
Gasden Green 
  264 
  280 
112 
 
Bundled, Multi-level Treatment Intervention (Sister to Sister) Overview.  The Sister to 
Sister intervention has been developed using CBPR methods and incorporates the preferred 
socio-cultural dimensions of the targeted population as described in our recent publication in 
Ethnicity & Disease. The intervention was named by the women in the feasibility study, which 

reflects a sisterhood of women helping other women. This social-ecological intervention bundles 
multi-level strategies (i.e., individual, interpersonal, neighborhood) in addition to nicotine 
replacement therapy and study specific written materials.  
 
Individual Level Strategies. The individual level strategies will be led by CHWs (i.e., AA 
women who are from the community, former smokers, and credible leaders). The 1:1 CHW 
interventions will be initiated in the TX neighborhoods within the first week of the 24-week 
intervention period. There will be 2 CHWs assigned to the TX neighborhood, with 14-15 
participants assigned to each CHW (i.e., total of 29 participants). The CHWs will make pro-
active personal contact (e.g., face-to-face, or phone) with participants using semi-structured 
guides to assist women in quitting smoking by assisting to build their confidence in quitting (self-
efficacy) and the use of spiritual resources as a coping strategy. These semi-structured guides 
will incorporate the use of the CHWs own language and cultural style, and the opportunity to 
share testimonials and personal experiences. The CHWs will encourage the participant to set a 
quit date within the first 2 weeks of the intervention. To enhance smoking cessation self-
efficacy, the CHWs encourage the participants’ success with comments such as: “I know you 
can quit smoking….if I can quit smoking, so can you.” The CHWs will provide recommendations 
to avoid trigger situations and motivational strategies to encourage positive smoking behaviors. 
To enhance spiritual well-being, the CHWs will offer prayer and share favorite biblical scriptures, 
poems, and inspirational meditations. The CHW will encourage participants to maintain their 
personal diaries as directed in the group sessions (described below). Based on our experiences 
and feedback from our pilot studies, the protocols for proactive CHW contacts include weekly 
contacts for 12 weeks, every other week for 4 weeks, and every 4 weeks for 8 weeks (24 weeks 
total). This schedule is preferred to allow time for the CHW and participant to facilitate 
successful closure of the structured relationship. Each CHW contact with participants will be 
face-to-face or by telephone and will last approximately 10–15 minutes. Reactive contacts (i.e., 
from participants) can occur at any time, with participants being able to reach our research staff 
through the toll-free lines. All CHWs will be paid.  
 
Interpersonal (Peer Group) Strategies.  Behavioral, peer group counseling sessions will be 
conducted by a certified smoking cessation counselor, who has a minimum of masters degree in 
health professions and experience with group counseling. The group sessions will be initiated in 
the TX neighborhoods within the first week of the 24-week intervention period. The behavioral 
group sessions will be offered weekly for 6 weeks and are based on recommendations from 
PHS Treating Tobacco Dependence Guideline, with adaptations based on the community’s 
input during our formative work. The adaptations reflect this population’s socio-cultural 
preferences including group meetings with food, ethnically appropriate graphics and content, 
emphasis on stress reduction, spiritual themes and prayers, and opportunities for storytelling.  
Each participant will be encouraged to set a quit date within the first two weeks of the 
intervention period. A major aspect of the group sessions is to enhance positive social support 
systems, both intra-treatment-and extra-treatment social support among peers, as 
recommended by the PHS Treating Tobacco Dependence Guideline. To promote social 
support, the group leader will facilitate the delivery of emotional support (i.e., empathetic 
listening, displaying trust and concern) among peers in the group and assist them to identify 
other positive support systems in the family and/or neighborhood. The major content of the 
group sessions include:  
Week 1: Making the Decision to Quit Smoking includes introductions and establishing group 
norms and rules; introductory discussions on addiction, self assessment of tobacco addiction, 
readiness to quit, pros and cons of quitting smoking, self evaluation, opportunities for sharing 
experiences (storytelling), inspirational and spiritual tools, goals and action plan, journal 

assignment, and group prayer. Participants are encouraged to set a quit date within the first 2 
weeks of the intervention period. 
Week 2: Understanding the Risks of Smoking and Benefits of Quitting includes health risks of 
smoking, reasons to quit, benefits of quitting, establishing a quit date, opportunities for sharing 
experiences (storytelling), inspirational and spiritual tools, goals and action plan, and journal 
assignment. 
Week 3: Tools for Quitting Smoking includes review of progress, behavioral and coping 
strategies, medications to assist with quitting smoking, opportunities for sharing experiences 
(storytelling), inspirational and spiritual tools, goals and action plan, journal assignment, and 
group prayer. 
Week 4:  Staying Quit includes review of progress, relapse prevention, opportunities for sharing 
experiences (storytelling), inspirational and spiritual tools, goals and action plan, journal 
assignment, and prayer. 
Week 5:  Staying a Nonsmoker includes a review of progress, long-term relapse prevention 
strategies, opportunities for sharing experiences (storytelling), inspirational and spiritual tools, 
goals and action plan, journal assignment, and prayer. 
Week 6: Overcoming Other Hurdles includes a review of progress, weight management, 
nutrition, physical activity, opportunities of sharing experiences (storytelling), inspirational and 
spiritual tools, goals and action plan, journal assignment, and prayer. 
       To promote individual and group interaction, each group will be limited to 8-12 participants. 
We will offer three groups in each TX neighborhood to accommodate the 29 enrolled women. 
Each participant will have a choice of attending an afternoon or evening session (based on our 
formative work) and will be given the schedule at study enrollment. CHWs will deliver a 
reminder (phone call, postcard, visit) 24 hours prior to each scheduled session. Each group 
session will last approximately one hour. Socio-culturally preferred food and door prizes (i.e., 
candles, lotions) will be available at each meeting.  
 
Neighborhood Level Strategies.  Neighborhood level strategies will be led by a 5-member 
neighborhood advisory board. Within each TX neighborhood, the project directors and PI/Co-I will 
work with neighborhood and housing authority leaders to identify, screen, and recruit adult 
residents for the appropriate composition of the board (both informal and formal resident leaders, 
smokers and nonsmokers, men and women, and representative of varying ages) as we have 
done in our pilot studies. Board members must be a resident of the neighborhood, be influential 
and credible among peers, and have interest in collective neighborhood efforts. We will hold the 
first neighborhood advisory board meeting in the TX neighborhoods within the first two weeks of 
the 24-week intervention period. At the first meeting, the research staff will make a brief 
presentation on the unique health risks of smoking for AAs, an overview of our study protocols, 
and the objectives of the advisory board.  They will be told that 29 women in the neighborhood 
have enrolled in a cessation study, but the identification of enrolled participants will not be shared. 
The project directors, PI or Co-I, and CHWs will attend each neighborhood advisory board 
meeting.  
    The objectives of the neighborhood advisory board are to implement tobacco-related policy and 
counter-marketing strategies that will foster the success of the women attempting to quit smoking 
and any other resident who wishes to quit smoking. A set of “core” events and activities for each 
neighborhood will include a neighborhood “kick-off event,” at least two neighborhood anti-smoking 
events, and at least one policy change.  Neighborhood advisory boards will receive a program 
implementation manual that describes how to implement the program and suggested potential 
events and activities.  Examples of neighborhood counter-marketing activities include: having a 
Smoke-Out Day, messages from community leaders, community food events with testimonials 
from former smokers, distribution of pamphlets on passive smoke exposure and risks to children, 
and message boards at the entrance to the community. Examples of policy activities include 

setting guidelines about smoking at the community center, prohibiting smoking during 
children/family events, and allowing “public service credit” for women enrolled in study. In addition, 
neighborhoods will be encouraged to promote the project through strategies such as 
announcements on display boards and newsletters. Board members will receive training, project 
manuals, and technical assistance as needed.  
Timelines and strategies will be developed during the first month, with implementation of 
planned events activities during the 24-week time frame. The research team will negotiate with the 
board to have a minimum of monthly meetings during the 24-week intervention period to 
adequately plan activities, assess progress, and establish feedback mechanisms. Each 
neighborhood advisory board will be provided a $750 budget for the intervention period, and each 
advisory board member will receive a $100 honorarium. 
 
Nicotine Replacement Therapy. In accordance with the PHS Treating Tobacco Dependence 
Guideline, an 8-week supply of transdermal nicotine patches will be offered to each participant 
at no cost. The patches will be administered and monitored weekly following the group sessions 
by the certified smoking cessation counselor. Participants will initiate the nicotine patch on their 
established quit date (usually set within 2 weeks of the intervention period). Participants who 
smoke 10 or more cigarettes per day will receive the 21 mg patch for 2-4 weeks, 14 mg patch 
for 2 -4 weeks, and the 7 mg patch for 2 weeks. Individuals who smoke less than 10 cigarettes 
per day will receive the 14 mg patch for 2-4 weeks and the 7 mg patch for 2-4 weeks.  In 
addition to the receptiveness of using the nicotine patch in our pilot studies, research findings 
have repeatedly demonstrated effective smoking cessation outcomes with the use of over-the-
counter (OTC)  nicotine patch and behavioral interventions with low-income, inner-city AAs 
[65,72,109]. The use of an OTC product in clinical studies may allow sustainability of translating 
the intervention in a “real world” setting in this population.  
 
Study Specific Written Cessation Materials.  Written cessation materials (Sister handbook) 
will be given to each participant at enrollment. This 96-page, 8 1/2 x 11 inch handbook is 
designed to accompany each group session (described above). The materials are organized 
into the 6 thematic group sessions. The materials contain information on principles of addiction, 
pros and cons of quitting smoking, health risks of smoking, benefits of quitting, behavioral and 
coping strategies, stress reduction, pharmacotherapeutics for cessation, relapse prevention, 
weight management, nutrition, and physical activity. There are prompts and space available to 
record personal diaries and goal setting, and selected inspirational scripture and poems 
throughout the handbook. This handbook has been developed by our initial neighborhood 
advisory board and CHW staff, with multiple revisions during the preliminary and pilot work 
based on focus group and process evaluation measures. A CHW developed the chosen logo for 
the locally developed handbook which reflects a figure of two AA women supporting each other 
with the preferred ethnic body image and style of the neighborhood women. Based on 
recommendations from the literature [110,111] and from the study partners, the Sister handbook 
has been developed at a 3rd – 4th grade reading level. The handbook contains colorful ethnic 
graphics and photos of “ordinary women;” uses easy-to-read, monosyllabic words printed in 
large font; contains graphics and photos that provide meaning to the text; uses a simplistic and 
concise formatting design with simple page layouts and adequate white space; and is printed on 
glossy paper and bound in a 3-ring binder. (A copy of the handbook is provided in the 
Appendix). The handbook is distributed to participants at the first group session. Our preliminary 
studies show that women bring the handbook to each group session, and report using the 
handbook for up to one year post cessation [19]. 
 
Summary of Protocol for Treatment Condition. In each TX neighborhood, the 24-week 
intervention will occur after the neighborhood data collection and recruitment/enrollment of 

eligible participants. During the recruitment period, we will recruit and enroll 29 eligible women 
who smoke and collect the baseline data. During the 24-week intervention period, we will 
concurrently deliver strategies at the individual, peer groups, and the neighborhood level for the 
29 women participants who have enrolled. In the first week of the intervention period, the CHWs 
will begin their 1:1 contacts with the 29 enrolled women, and the cessation counselor will initiate 
the peer group counseling sessions. Within the first two weeks of the intervention period, the 
neighborhood advisory board will meet to develop a timeline and strategies to promote 
neighborhood level smoking policies and counter-marketing campaigns. The CHWs will interact 
(face-to-face or phone) with the 29 enrolled participants weekly for 12 weeks, every other week 
for 4 weeks, and every 4 weeks for 8 weeks to enhance smoking cessation self-efficacy and 
spiritual well-being. The smoking cessation counselor will lead peer group meetings for the 29 
enrolled participants as a means for social support (8-12 participants per group) weekly for 6 
weeks, and administer the nicotine patch and the Sister to Sister handbook. The 5-member 
neighborhood advisory board will identify and implement neighborhood level strategies (policies 
and counter-marketing campaigns) over this 24-week period to enhance participants’ cessation 
success. 
 
 Control Condition. Participants in the control condition will receive Pathways to Freedom: 
Winning the Fight Against Tobacco at baseline. It is a 36-page self-help manual designed for 
AAs and written at the 6th-8th grade reading level [111]. The manual includes characteristics of 
smoking among AAs, health risks of smoking, how to quit smoking, coping strategies, and how 
to stay quit. Control participants will receive additional materials in the mail at week 6 (State-
Sponsored Toll-Free Tobacco Quit Line pamphlet), week 12 [PHS Guideline patient pamphlet 
(You Can Quit Smoking)], and week 18 [ACS pamphlet (When Smokers Quit)].  
      At the request of our CAB, the control participants will be offered a delayed intervention at 
the end of the study (i.e., the 12 month data collection has been completed). This intervention 
will include a 1-hour face-to-face counseling session with the cessation specialist, personal 
contact by a CHW every other week for 8 weeks, and an 8-week supply of nicotine patches. The 
cessation specialist will meet with the participant to discuss readiness to quit smoking, risks and 
benefits of quitting, strategies for cessation, and the use of the nicotine patch.  If the participant 
sets a quit date, an 8-week supply of nicotine patches will be offered to the participant. The 
CHW will have 4 personal follow-ups with the participant over an 8-week period to assess 
progress, share personal testimonials, and reward positive achievements. The treatment teams 
will have no contact with the control participants until after all 12-month data collection has been 
completed. 
 
 
Data Collection Procedures.  
D2d1. Neighborhood level: To assess neighborhood level moderators, baseline neighborhood-
level data will be collected by ethnic minority graduate students at each site. This neighborhood 
data will be collected from a 20% random sampling among female heads-of-households in each 
neighborhood. For example, in a neighborhood with 240 households, n=48 households will be 
sampled. There are a total of 2,856 households in these 14 neighborhoods, and the total sample 
size (20%) for this neighborhood data will consist of 571 female heads-of-households. A diagram 
of the layout of each housing neighborhood will be used to randomly assign the households for 
the respective neighborhood. A uniform random number will be generated using SAS 9.1.3 and 
assigned to each household. Households will then be sorted in ascending order by their 
corresponding random number. Randomization procedures will be done by the project statistician. 
Adult female heads-of-households will be approached (up to 3 visits) by the graduate students for 
participation in order of randomization until the number of households (i.e., 48) in each 
neighborhood has been surveyed. After providing an information sheet and obtaining verbal 

assent, the graduate student will read aloud the surveys (36-items; 3 instruments) as described in 
D2c3 and mark their responses on the data collection tool. Data collection will take place at the 
respective household. Each woman completing the survey will receive a $10 gift card, with choice 
of selection from local merchants (i.e., Wal-Mart, local grocery store). 
 
Individual level: Data collection procedures for eligible, consented participants will occur after 
the neighborhood level data have been completed. Neighborhood residents will be invited to 
attend an informational session at the respective community center in the housing complex. 
Immediately following this session, eligible participants will be screened, consented, enrolled, 
and baseline data will be collected. Data collection for individuals enrolled in the study will be 
conducted by trained research assistants and will take place in the neighborhood community 
center. The data collectors are independent from both the intervention and interventionists.  
The data collector (i.e., research assistant) will read aloud the instruments for each 
participant and mark their responses on the data collection tool. The entire data collection will 
take approximately 45 minutes for each participant at each time point. Ten days prior to 
scheduled 6- and 12-month data collection, a post-card will be mailed to each participant. 
Twenty-four to 48 hours prior to the 6- and 12-month data collection, the staff will make personal 
or phone contact with participants as a reminder. Separate toll-free phones lines will be 
established for participants at each site. Individual participants will receive a $25 gift card at 
baseline; $50 gift card at 6 months; and $100 gift card at 12 months.