Supporting Smoke-Free Policy Compliance in Public Housing

Study Overview
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Brief Summary
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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
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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.

Official Title
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A Randomized Controlled Trial to Support Smoke-Free Policy Compliance in Public Housing

Conditions
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Smoking, Smoking Cessation, Smoking Reduction, Smoking Behaviors

Intervention / Treatment
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* Behavioral: Reduction (relocation and reduction of personal smoking) and cessation
* Behavioral: Resident Endorsement


Participation Criteria
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Eligibility Criteria
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Building Inclusion Criteria: NYCHA buildings in Manhattan & the Bronx (stratified evenly by borough) with more than 50 units, not undergoing major renovations. Building 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). Residents will be screened for smoking status. Both smokers and non-smokers to be recruited but only one participant- smoker or a non-smoker- will be recruited per apartment. Smoking will be defined as those that report using a cigarette or other combustible tobacco product (e.g., little cigar, cigarillo) at least 5 days in the past month. Non-smokers include never smokers and former smokers who had quit 12 months ago or earlier. Additional eligibility criteria include individuals above 18 years old living in the building at least 5 days/week and 9 months/year, not planning on moving in the next 2 years. Participant Exclusion Criteria: Individuals with severe physical or mental medical conditions (i.e. cognitive disability) or other factors that could limit participation or ability to give informed consent in the study at baseline or during follow-ups. Individuals who participated in the earlier focus groups. Individuals who only smoke non-tobacco products (e.g., marijuana).

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Factorial Assignment
Interventional Model Description: The proposed design will be a borough-stratified, four-arm, factorial-design, cluster RCT that will target 64 randomly selected buildings (16 buildings per arm) in separate New York City Housing Authority (NYCHA) developments. The investigators will recruit and follow 8 randomly selected residents stratified by smoking status- 4 smokers and 4 non-smokers- per building (n=512 residents) into four arms: (1) reduction (relocation and reduction in personal smoking)/cessation, (2) resident endorsement, (3) reduction (relocation and reduction in personal smoking)/cessation plus resident endorsement and (4) the standard approach (128 participants per arm).
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Compliance through reduction (relocation and reduction of personal smoking) and cessation<br>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. | Behavioral: Reduction (relocation and reduction of personal smoking) and cessation<br>* Individual-level. Peer educator to provide reduction/cessation and/or relocation support.<br>|
| Experimental: Compliance through resident endorsement<br>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. | Behavioral: Resident Endorsement<br>* Building-level. Peer educator to conduct building-level sessions.<br>|
| Experimental: Compliance through reduction/cessation plus resident endorsement (combined)<br>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. | Behavioral: Reduction (relocation and reduction of personal smoking) and cessation<br>* Individual-level. Peer educator to provide reduction/cessation and/or relocation support.<br>Behavioral: Resident Endorsement<br>* Building-level. Peer educator to conduct building-level sessions.<br>|
| No Intervention: Standard NYCHA approach (control)<br>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. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in number of cigarettes smoked per day | Self-reported average number of cigarettes smoked per day among smokers | Measured at baseline (in person interview), 3 months (phone interview) and 12 months (in person interview) | 
| Change in salivary cotinine | Salivary cotinine (saliva collected as passive drool) will be measured for 25% of the sample among smokers and non-smokers alike | At baseline and at the 12-month follow-up | 
| Change in secondhand smoke exposure | Self-reported secondhand smoking exposure (hours of secondhand smoke exposure in the building in the past 7 days); among smokers & non-smokers | Measured at baseline (in person interview), 3 months (phone interview) and 12 months (in person interview) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in number of participants with successful quit attempts | Binary; whether smokers have successfully quit | Measured at baseline (in person interview), 3 months (phone interview) and 12 months (in person interview) | 
| Change in number of quit attempts | Mean number of quitting attempts among smokers | 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 | Binary; whether participant has observed someone smoking indoors in the building; among smokers & non-smokers | 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 hours of secondhand smoke exposure | Counted number of hours of 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 smokers | Counted number of people observed smoking in common areas | At each building visit at baseline and 12 months | 
| Change in number of cigarette butts | Counted number of cigarette butts observed in common areas | At each building visit at baseline and 12 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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smoking, secondhand smoke