PROJECT SUMMARY
The smoke-free home intervention study aims to reduce racial/ethnic disparities in tobacco use and exposure
by increasing access to smoke-free homes and cessation resources among racially/ethnically- and
linguistically-diverse populations in federally subsidized housing (“subsidized housing”). Black/African
American, Hispanic/Latino, and Asian populations with limited English proficiency are over-represented in
subsidized housing; these populations have higher rates of tobacco use and exposure than the general
population. Tobacco-related cancer and cardiovascular disease contribute disproportionately to the excess
morbidity and mortality in these populations. Comprehensive smoke-free policies have the potential to
substantially reduce tobacco-related disparities among populations in subsidized housing. In 2018, the
Department of Housing and Urban Development implemented a smoke-free policy in a minority of public
housing, presenting a unique opportunity to expand the reach of such policies to all types of subsidized
housing. This study fills this gap by identifying approaches to increase the implementation of smoke-free
policies in all types of subsidized housing by increasing the voluntary adoption of smoke-free homes and
promoting access to smoking cessation services. We will build on our pilot work, where we developed and
evaluated the feasibility of a smoke-free home intervention to increase voluntary adoption of smoke-free
homes in permanent supportive housing for formerly homeless adults. We adapted our previously-developed
smoke-free home intervention to federally subsidized housing by incorporating new intervention components
that align with racially-ethnically and linguistically-diverse populations in three geographically-diverse California
Counties. The multi-faceted intervention, delivered by bilingual study staff in Chinese (Mandarin and
Cantonese), English, or Spanish includes: 1) one-on-one counseling to residents who are smokers on how to
adopt a smoke-free home, and 2) training housing staff as lay health workers to deliver monthly brief cessation
coaching to residents. We propose to conduct a wait-list cluster randomized controlled trial of the adapted
smoke-free home intervention compared to usual care among N=544 residents from 24 subsidized housing
sites in Contra Costa, Oakland and San Francisco. Our specific aims are: Aim 1: To estimate the effect of our
adapted smoke-free home intervention on the primary outcome of residents' voluntary adoption of smoke-free
homes and the secondary outcome of biochemically-verified tobacco abstinence at 6-months follow-up. Aim 2:
To determine the cost of our adapted smoke-free home intervention and determine whether it is a cost-
effective use of health care resources. Aim 3: To evaluate variation in stakeholders’ perspectives on the
adapted smoke-free home intervention’s adaptability, scalability and sustainability. The proposed intervention
can expand access to smoke-free policies and smoking cessation services in subsidized housing, thereby
reducing racial/ethnic disparities in tobacco use, tobacco exposure and chronic disease in these populations.