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The Tobacco Related Disease Research Program has prioritized the homeless population as one of the disproportionately impacted populations in California. Of the 3.5 million individuals experiencing homelessness yearly in the United States, approximately 70% are smokers. Interventions to address tobacco use in the homeless population have focused on the delivery of cessation services, but few have addressed policy-level interventions. Smoke-free policies are an integral component of current population-wide tobacco control efforts, however these policies are not implemented in housing for homeless adults. Permanent Supportive Housing is a highly successful housing program designed to end chronic homelessness for persons with a history of mental illness, substance use, and other disabilities. Most supportive housing programs utilize a harm reduction framework, recognizing the need for rapid housing without requiring abstinence from drugs or alcohol prior to being housed. Supportive Housing presents a promising venue to introduce tobacco control interventions because it provides a stable environment to engage in behavior change. Interventions to treat tobacco dependence are most efficacious when combined with smoke-free policies. In California, few supportive housing agencies offer smoke-free policies on their properties despite preliminary data suggesting that homeless adults are supportive of such policies. Thus, research is needed to identify ways to increase the prevalence of smoke-free, supportive housing for homeless adults. To address this gap, we have partnered with 6 large Supportive Housing Agencies in the San Francisco Bay Area to develop and implement a brief intervention to increase adoption of smoke-free homes among tenants of supportive housing. We will conduct a formative needs assessment by interviewing key stakeholders including property managers, directors of supportive housing services, and tenants of supportive housing on the barriers to and facilitators of implementing smoke-free policies and cessation services in supportive housing. We will use this formative research to develop a smoke-free home intervention that will consist of a tool kit to implement smoke-free homes and training for supportive housing staff to provide smoking cessation and smoke-free home counseling. We will pilot test the feasibility and preliminary efficacy of the intervention among 56 tenants in 8 supportive housing programs in the San Francisco Bay Area. We will assess smoke-free home adoption, exposure to secondhand smoke, and smoking behaviors before the intervention and 3 months and 6 months after the intervention. This pilot research grant proposal has the potential for short-term community impact by developing partnerships with homeless services providers to increase access to resources that reduce tobacco use and exposure to secondhand smoke among tenants in supportive housing. The proposal has the potential for long-term policy impact by identifying best practices to increase the prevalence of smoke-free, multi-unit low-income housing. In doing so, the proposal may lead to the development of programmatic or policy changes on the treatment of tobacco dependence that is integrated into the service delivery model of supportive housing. |
