Strengths
chronic illness, first-ever
CHRONIC ILLNESS
This RCT leverages a monumental policy shift that affects nearly half a million New York City (NYC) public housing residents, many of whom disproportionately experience chronic illness and are more likely to smoke and be exposed to secondhand smoke than other city residents. This first-ever RCT tests the effects of much-needed compliance strategies on resident smoking behavior and secondhand smoke exposure in multiunit housing. We are testing interventions at the building level that are framed by a broad, system-wide and national-level smoking ban in public housing, Medicaid-supported smoking cessation, and variations in the tobacco retail environment in neighborhoods throughout NYC. Within the scope of a changing policy landscape and differing community contexts, a series of public housing building clusters will receive different policy compliance interventions, focusing on either reduction/cessation or the resident endorsement of smoke-free homes that will be tested in terms of longitudinal pre-post outcomes among residents who smoke and those that do not smoke. These interventions seek to enhance policy compliance, have been previously piloted, are adaptable to public housing settings around the country given the national ban, and address tobacco disparities while producing lasting health benefits at relatively low costs.Further, this study has implications for the allocation of resources related to the smoke-free policy extending beyond NYCHA to other public housing located nationwide by providing evidence-based support for efficacious methods to reduce personal smoking and exposure to secondhand smoke. Our findings have the potential to affect comprehensive and interlinked tobacco control policies at federal, state, and local levels (i.e., nationwide smoke-free housing policy implementation in public housing, NY State Medicaid coverage for smoking cessation, and local legislation limiting licensing that will affect the tobacco retail environment). As such, the study has potential to drive better health outcomes overall for public housing residents.