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Triangulum (Tobacco, E-Cigarettes, Marijuana) SHS exposure in Low SES MUH

Institution: University of Southern California
Investigator(s): Lourdes Baezconde-Garbanati, Ph.D., M.P.H.
Award Cycle: 2017 (Cycle 26) Grant #: 26IR-0022 Award: $495,000
Subject Area: State and Local Tobacco Control Policy Research
Award Type: High Impact Research Project Award

Initial Award Abstract

BACKGROUND: The U.S. Surgeon General said in 2006 that secondhand smoke (the smoke breathed in by a non-smoker when someone around them smokes tobacco), is not safe. Secondhand (SHS) and thirdhand smoke (THS), which is the leftover nicotine and cancer-causing chemicals that stay in rooms or closed spaces after someone smokes, can stay in the air, carpets, curtains and other places. People who have not finished high-school and who are poor are forced to breathe these toxic chemicals, because most of them live in rental multi-unit housing (MUH) where smoke comes in through the air vents. MUHs are apartments or condos that share the same walls and air vents, where smoke drifts from next-door neighbors. The poor and those with low education, that are Black, Hispanic and White makeup the most renters in MUH in Los Angeles. They often deal with health problems caused by tobacco because of their low income, low levels of education, and low ability to read, and speak English. Because electronic cigarettes have become so popular, these people at high risk already, face new risks of breathing in toxic chemicals from smoke/vape in MUH. To make this worse electronic delivery systems (EDS) like e-cigarettes, hookah pens, e-cigars, vape pens, e-pipes, and e-hookahs are being used to smoke marijuana. Because marijuana just became legal in the state, all this together has caused a trend called the “Triangulum” that can affect tobacco use and smoke/vape-free policies in MUH. The Triangulum is the use of tobacco, marijuana and e-cigarettes together by mixing them up, with EDS used to vape marijuana. Tenants in MUH say that marijuana smokers cause more problems than cigarette users when asked to not smoke in common outdoor areas, and are worried about being exposed to marijuana’s SHS (Rodriguez et al., 2016 (Rendon et al., 2015).

METHODS: This study will go door-to-door to get completed surveys from 360 tenants among poor, low education Blacks, Hispanics and Whites. We will include those who speak Spanish as well as speak English, and are 21 years of age or older and live in the Greater Los Angeles area. We will select at random MUH buildings with more than 20 units in the zip codes with the highest percent of people from these communities. Buildings will be identified from the Los Angeles County Assessor’s Apartment House Listing, that gives us information on all rentals in Los Angeles. We will combined with listings from Smoke-free Apartments Los Angeles (SAFE and SALA) that tell us which buildings have and which ones don’t have MUH SHS policies. The goal is to study the knowledge, attitudes, beliefs and behaviors, compliance, and best ways to communicate (traditional media, social media, mobile devices, in person, written materials) with tenants regarding Triangulum smoke/vape-free policies in MUH. To obtain in-depth data, we will also run eight focus groups with 8-10 people per group (total participants=80), lasting 90 minutes. Participants will be MUH managers/owners, key opinion leaders, and tenants selected from the general door-to-door survey sample. Focus groups will tell us about compliance with current policies, how likely it is that they will get new policies or expand them, and what are the best ways to communicate with people who have low levels of education and low ability to read, and speak English. Our goal is to help create and increase Triangulum (tobacco, e-cigarettes, marijuana) smoke/vape-free policies in MUH. An anchoring survey will be given to focus group participants so we can collect basic data about them before starting the focus group.

ANALYSIS: Statistical analysis (Analysis of Variance and Chi-Square tests) will be used to compare variables across racial/ethnic groups. We will analyze many important variables together. Qualitative data will be analyzed using Atlas.Ti software. Dissemination: Information will be spread widely by our Community Advisory Committee and partner organizations, including agencies from the government and non-government agencies, and policy and advocacy groups to make current policies strong and make new more complete MUH Triangulum smoke/vape-free policies.