Smoke-free Home Study in Subsidized Housing

Study Overview
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Brief Summary
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Comprehensive smoke-free policies have the potential to substantially reduce tobacco-related disparities among populations in 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.

Detailed Description
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OBJECTIVES: The investigators will build on previous studies, where a smoke-free home intervention to increase voluntary adoption of smoke-free homes in permanent supportive housing for formerly homeless adults was developed and evaluated. 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. OUTLINE: A wait-list cluster randomized controlled trial of the adapted smoke-free home intervention compared to usual care among residents from subsidized housing sites in Contra Costa, Oakland and San Francisco. Participants from twenty-four subsidized housing sites will be randomized into intervention and waitlist control arms

Official Title
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A Smoke-free Home Intervention in Federally Subsidized Housing

Conditions
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Tobacco Dependence, Tobacco Smoking

Intervention / Treatment
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* Behavioral: Smoke-free home resident intervention
* Behavioral: Lay Health Worker coaching


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Eligible resident participants Current smokers defined as: Smoked at least 100 cigarettes in lifetime Smoked daily in the past 7 days, and at least 5 cigarettes per day, verified by expired CO ≥ 5 parts per million [ppm] Smokerlyzer CO+ monitor), Smoke in their home Expect to live in the subsidized housing site for at least 12 months Age ≥ 18 years Speak Chinese (Cantonese or Mandarin), English, or Spanish Able to provide informed consent. Exclusion Criteria: Contraindication to any study-related procedures or assessment

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: Parallel Assignment
Interventional Model Description: Cluster randomized controlled groups
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Intervention<br>The study's investigators will train bilingual study staff to deliver the intervention to residents using a script that matches the content in the smoke-free home intervention pamphlet. The in-person delivery of the intervention and pamphlet will be the primary modes of intervention delivery to residents. The pamphlet will include: (1) the harms of tobacco, e-cigarette use, cannabis use and exposure (secondhand and thirdhand), (2) an exercise to calculate personal cost of tobacco use, (3) benefits of a smoke-free home, (4) skill-building on how to adopt a smoke-free home, and (5) motivational language on smoke-free home adoption. The study staff will qualitatively assess participants' knowledge by prompting questions on the topics covered and will refer participants to lay-health workers (LHWs) for one-on-one coaching. Participants will receive a pledge to designate their homes smoke-free. | Behavioral: Smoke-free home resident intervention<br>* Study staff delivered intervention on how to adopt a smoke free home using a pamphlet<br>Behavioral: Lay Health Worker coaching<br>* Brief tobacco cessation coaching by lay health worker housing staff with residents within 2 weeks of the smoke-free home resident intervention, and on a monthly schedule as part of their routine encounters with residents (total 6 sessions).<br>|
| No Intervention: Waitlist Control Group<br>The current standard of care does not include any interventions for smoke-free home adoption or referrals to tobacco treatment resources. At the end of the primary endpoint (6 months), control participants will be offered the intervention. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of participants adopting a smoke-free home for ≥90 days | The percentage of participants who reported to adopt a smoke-free home in the past 90 days will be reported | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Percentage of participants with point prevalent abstinence (PPA) | The percentage of participants with carbon dioxide (CO)-verified tobacco abstinence will be reported at the 6 month follow-up visit. | 6 months |