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Fotonovela to prevent SHS exposure in multiunit housing

Institution: University of Southern California
Investigator(s): Jennifer Unger, Ph.D.
Award Cycle: 2012 (Cycle 21) Grant #: 21RT-0119H Award: $785,104
Subject Area: Disparities /Prevention/ Cessation/ Nicotine Dependence
Award Type: Research Project Awards

Initial Award Abstract

Although smoking is banned in most indoor workplaces and many outdoor areas in California, residents of multi-unit housing continue to be exposed to secondhand smoke (SHS) from neighboring units, outdoor areas, and common areas in their apartment buildings, and residents can be exposed to thirdhand smoke (THS) on surfaces, carpet, or upholstery. In California, Hispanics are more likely to live in multi-unit housing than are Whites. Although California Hispanics have a lower smoking prevalence than Whites do, they face a greater risk of exposure to SHS and THS. This could create a significant disparity in tobacco-related disease among Hispanic residents of multi-unit housing, who are disproportionately affected by other people’s smoking. Effective and culturally appropriate interventions are needed to decrease exposure to SHS and THS among Hispanic residents of multi-unit housing. Until policies are implemented and enforced statewide to prohibit smoking in all multi-unit housing, prevention of exposure to SHS and THS will depend on informal communications, agreements, and policies among tenants, managers, and landlords. Our previous research has shown that most Hispanic residents of multi-unit housing dislike smoke exposure and would prefer smokefree apartment policies. Unfortunately, many residents are hesitant to talk to their neighbors about not smoking or talk to their landlords about smokefree policies because they worry about interpersonal conflict or eviction. Interventions are needed to help residents proactively protect their families from SHS and THS by asking their neighbors not to smoke in or near their units and advocating for smokefree policies. Previous research by our group and others has shown that fotonovelas—small booklets that tell a dramatic story with photographs—can be a powerful tool for health education. We have produced Spanish-language fotonovelas about various topics such as diabetes, depression, obesity, and asthma, and our evaluations have shown significant changes in knowledge, attitudes, and behavioral intentions among Hispanic adults who read the fotonovelas. Fotonovelas are well-suited for low-SES Hispanics because they are a popular entertainment medium in many Latin American countries, can increase self-efficacy by depicting role models handling challenging situations, and can convey information to low-literacy audiences. We propose to develop and evaluate a fotonovela about SHS and THS exposure in multi-unit housing. We will conduct focus groups of Hispanic residents of multi-unit housing and conduct key informant interviews of health and policy experts to generate a list of messages about SHS and THS that could help empower residents of multi-unit housing to take action to protect themselves and their families. Working with professional scriptwriters and photographers, we will produce a bilingual (Spanish/English) fotonovela to educate Hispanic multi-unit housing residents about SHS and THS and model effective communication strategies that they can emulate. We will conduct a randomized controlled trial to evaluate the effects of the fotonovela on residents’ knowledge, attitudes, self-efficacy, and communication with other tenants and landlords about SHS and THS, in comparison with a text pamphlet and a no-intervention control. The fotonovela will be disseminated to the state funded tobacco control projects engaged in tobacco advocacy and education on multi-unit housing in California, and we will submit it to the California Tobacco Education and Materials Lab (TEAM Lab) for inclusion in the Tobacco Education Clearinghouse of California for statewide and possible national dissemination. The fotonovela produced and evaluated in this project can be an important health education tool to reduce tobacco-related health disparities by helping Hispanic multi-unit housing residents avoid SHS and THS and advocate effectively for smokefree housing policies.