A community-based trial of a voluntary smoke-free home intervention in permanent supportive housing for formerly homeless adults

About This Grant

PROJECT SUMMARY The focus of this extension proposal is on expanding access to voluntary smoke-free homes to formerly homeless residents residing in permanent supportive housing and examining the role of the built environment and commercial determinants of tobacco use on smoke-free home adoption. Permanent supportive housing is subsidized housing with closely linked or on-site medical and/or social services for individuals with a history of chronic homelessness and who are living with disabilities, mental health, and/or substance use disorders. Approximately 50% of people living in permanent supportive housing report current smoking, yet there are no mandated smoke-free policies in permanent supportive housing. In the parent study, we conducted a multi-site, community-based cluster-randomized wait-list controlled trial of our multi-faceted smoke-free home intervention among 400 permanent supportive housing residents residing in 40 permanent supportive housing sites across the San Francisco Bay Area. The multi-faceted intervention, delivered by study staff includes: 1) one-on-one counseling to permanent supportive housing residents who are smokers on how to adopt a smoke- free home, and 2) training for permanent supportive housing staff on how to provide referrals to cessation services. We are in the process of completing efficacy and cost-effectiveness analyses and examining barriers to and facilitators of successful adoption of smoke-free homes from the parent RCT. In the qualitative evaluation of the parent proposal, we used the Consolidated Framework of Implementation Research to understand inner and outer setting factors linked with smoke-free home adoption. The aims of the extension proposal are to expand on these inner and outer setting factors from the Aim 3 analyses in our parent proposal to better understand the role of built environment factors and commercial determinants on smoke-free home adoption using environmental mapping and participatory action research methods. Our specific aims are: 1) Explore how self-reported perceptions of commercial determinants, the built environment, and treatment access shape smoke-free home adoption among smoke-free home RCT participants, 2) Identify commercial determinants of smoke-free home adoption using environmental mapping of tobacco, alcohol, and cannabis retailer density in neighborhoods where PSH are located, 3) Evaluate the influence of built environment factors such as neighborhood safety and walkability, housing quality, and environmental cues to tobacco use on smoke-free home adoption using participatory action research methods. The long-term impact of this work will be to create best practices and action-oriented implementation guidance for housing authorities, non-profit housing providers, and local, state, and federal authorities to increase smoke-free policy implementation and tobacco treatment in subsidized multi-unit housing.