Community-Partnered Dominican Republic Tobacco Control
Condition: Tobacco Use Cessation; Second Hand Tobacco Smoke
Study type: Interventional

Summary: 
      Tobacco use and tobacco-caused illnesses and death are increasing in developing countries
      globally, so it is critical to study these countries in order to effectively address the
      tobacco epidemic. The proposed project will test the effectiveness of community-based
      interventions for secondhand smoke and quitting smoking in eight underserved communities in
      the Dominican Republic. The project will also partner with communities and national and
      international groups to determine whether the methods and interventions from this study in
      the Dominican Republic can also be used to help other countries in the region and underserved
      groups in the United States.
    

Detailed description: 
      The globalization of the tobacco epidemic poses significant morbidity and mortality burdens,
      with the brunt of impact increasingly borne by low-middle income countries. Research
      partnerships between investigators from high-income countries with well developed tobacco
      control research programs and their counterparts in low-middle income countries are needed to
      effectively address this global public health crisis. The Dominican Republic (DR) is a key
      site that mirrors the trends in Latin America: it is a low-middle income tobacco growing
      country with significant tobacco use and high levels of secondhand smoke exposure, and it is
      at a very early stage of tobacco control. The proposed project will assess baseline
      knowledge, attitudes, exposures, and behaviors regarding tobacco use and secondhand smoke,
      provide a randomized controlled trial of community-partnered interventions around secondhand
      smoke and tobacco cessation, and develop and implement a dissemination plan for national and
      regional impact and translation of methods and results to other underserved groups as
      appropriate. A multimethod assessment approach will be used, to include qualitative community
      assessments (RAPs), a series of quantitative surveys (household surveillances, community and
      smoker cohort surveys, and health care provider surveys), and a biomarker assessment of
      secondhand smoke exposure. Eight economically disadvantaged communities will be randomized to
      intervention or control conditions in a lagged treatment design; interventions will be
      developed and implemented based on the evidence base from other countries and from a current
      DR trial, and on input from national and local DR workgroups using a community partnered
      approach. The intervention is hypothesized to decrease tobacco use rates, increase the number
      of smokefree homes, denormalize smoking, increase awareness of and change attitudes regarding
      tobacco use and secondhand smoke risks, decrease exposure to secondhand smoke, and increase
      health care provider intervention in intervention- relative to control communities, with
      differences by geographic and demographic characteristics to be examined. The project will
      also engage international, national, and local DR workgroups to maintain communication of
      findings to key partners, host a national DR tobacco control conference with regional
      representation, and develop other action steps for local and regional dissemination of
      findings and evidence based interventions, resources, and infrastructures. Finally, the
      project will coordinate with the University of Rochester Clinical and Translational Sciences
      Institute for translation of current evidence based approaches and methodologies for
      implementation in the DR, and to explore whether any methodologies or interventions from the
      proposed trial in the DR can be translated to underserved groups in the United States.
      Effectively engaging early stage low-middle income countries in tobacco control research will
      be critical to reducing tobacco use and the burden of tobacco-caused illnesses globally.
    

Intervention name(s): Tobacco Cessation and Secondhand Smoke Reduction
Intervention type(s): Behavioral
Intervention description(s): Awareness raising and resources for cessation and secondhand smoke reduction
Other intervention name(s): tobacco cessation; secondhand smoke; smokefree homes
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: tobacco; smoking; secondhand smoke