Implementing a Scalable Smoke-free Home Intervention in Armenia and Georgia - The number one cause of death in the US is tobacco use and related exposures, which are also major causes of mortality globally. Low- and middle-income countries (LMICs) represent low-resource settings with high rates of tobacco use and secondhand smoke exposure (SHSe). Two LMICs particularly impacted by tobacco use and SHSe are Armenia (AM) and Georgia (GE), which represent among the highest smoking rates in men globally (>50%). Notably, a primary source of SHSe among children and most nonsmoking adults in many countries, including LMICs like AM and GE, is the home. Smoke-free homes (SFHs) can reduce SHSe, promote cessation, and possibly disrupt initiation. Notably, 61% of households in AM and GE allow smoking in the home, thus providing a unique opportunity to assess efforts to promote SFHs, which could then be applied to other populations with high smoking rates and/or in low-resource settings. This proposal builds on our ongoing collaborations that have established: 1) a strong community-based infrastructure for implementing public health programs using local coalitions; and 2) an evidence-based intervention (EBI) to promote SFHs, designed to be brief and adaptable and shown to be effective, scalable, and cost-effective among low-income households in the US. This study will: (1) adapt our SFH intervention to be culturally appropriate for AM and GE and develop in-country capacity for intervention dissemination (via local coalitions) and delivery (via national quitlines); (2) examine effectiveness of the adapted intervention (vs. control) on SFH adoption (primary outcome) among households in AM and GE, using a type 1 hybrid effectiveness-implementation RCT, with follow-up assessments at 3 and 6 months; and (3) assess intervention reach, adoption, implementation, and maintenance potential, as well as related contextual influences, using a mixed-methods process evaluation. Impact: Implementing EBIs in high-risk populations and in low-resource settings, like AM and GE, provides unique scientific opportunities to study how to best address such populations and settings, which can translate into scientific findings that can be applied to improving and protecting the health of Americans. In particular, this work will elucidate key barriers and facilitators to the adoption, scale-up, and sustainment of EBIs in high-risk populations and low-resource settings, including those in the US. Furthermore, this research will provide the foundation for bidirectional flow of knowledge between these countries and the US that will bring novel insights regarding models for adapting and implementing EBIs targeting SFHs and other public health outcomes in the US and globally.
