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Principal Investigator: Carla J Berg
Organization: GEORGE WASHINGTON UNIVERSITY
Fiscal Year: 2024
Award: $515,131
Funding agency: National Cancer Institute
SUMMARY/ABSTRACT
Among the disparities faced by populations in low- and middle-income countries (LMICs) are those related to tobacco use
and secondhand smoke exposure (SHSe). Two countries particularly impacted by tobacco use and SHSe are Armenia
(AM) and Georgia (GE), which represent the 11th and 6th highest smoking rates in men globally (51.5% and 55.5%,
respectively). However, smoking prevalence is much lower among women (1.8% and 7.8%). Notably, a primary source of
SHSe among children and most nonsmoking adults in many LMICs, including AM and GE, is the home. Smoke-free
homes (SFHs) can reduce SHSe, promote cessation, and possibly disrupt initiation; however, 61.4% of households in AM
and GE allow smoking in the home. Thus, promoting SFHs may be an innovative and relatively untapped strategy for
chronic disease prevention in these countries – and in other LMICs with high smoking rates. Research focused on
implementing evidence-based interventions (EBIs) offers unique opportunities to address the pressing needs in LMICs
and to examine key barriers in the adoption, scale-up, and sustainment of EBIs in low-resource settings. This proposal
builds on ongoing collaborations among MPIs Berg and Kegler, the GE National Center for Disease Control (NCDC), the
AM National Institute of Health (NIH), and the American University of Armenia (AUA), dating back to 2013. These
collaborations have established: 1) a strong community-based infrastructure for implementing public health programs
using local coalitions in 14 communities, developed in our current Fogarty-funded R01; and 2) a theory-based SFHs
intervention, designed to be brief and adaptable and shown to be effective, generalizable, scalable, and cost-effective
among low-income households in the US. The current proposal will strategically capitalize on our strong partnerships
with national public health agencies, local community mobilization infrastructure, and SFH EBI to address our specific
aims. Aim 1: We will adapt our SFH intervention to be culturally appropriate for the AM and GE populations, using a
community-engaged approach and robust adaptation frameworks and methods, and develop in-country capacity for
intervention dissemination (via local coalitions) and delivery (via national quitlines). Aim 2: We will examine the
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 (n=550 participants; 275/country), with follow-up
assessments at 3 and 6 months. Aim 3: We will assess intervention reach, adoption, implementation, and maintenance
potential, as well as related contextual influences, using a mixed-methods process evaluation guided by RE-AIM. Our
team (including national public health agencies) will use these findings to develop a sustainability and dissemination plan
(e.g., intervention packaging for scale-up). This work will provide a robust model for adapting and implementing this EBI
for AM and GE, which could then be used for this intervention in other countries and/or for other behavioral targets and
EBIs in AM, GE, and elsewhere. This work will advance our long-term goals of building the knowledge base informing
strategies to reduce tobacco-related disparities globally and the implementation and scale-out of EBIs in LMICs.
Terms: <0-11 years old><21+ years old><Active Follow-up><Address><Adoption><Adult><Adult Human><American><Armenia><Back><Behavioral><Cancer Control><Cancer Control Science><Centers for Disease Control><Centers for Disease Control and Prevention><Centers for Disease Control and Prevention (U.S.)><Child><Child Youth><Children (0-21)><Chronic Disease><Chronic Illness><Collaborations><Communities><Counselor><Country><Data><Disparities><Disparity><Dorsum><Effectiveness><Ensure><Evidence based intervention><Focus Groups><Funding><Goals><Health><Home><Household><Human Resources><Imagery><Individual><Infrastructure><Intervention><Intervention Strategies><Interview><LMIC><Low income><Low-resource area><Low-resource community><Low-resource environment><Low-resource region><Low-resource setting><Maintenance><Manpower><Methods><Modeling><Motivation><NCI Organization><NIH><National Cancer Institute><National Institutes of Health><Participant><Passive Smoke Exposure><Patient Recruitments><Population><Preparedness><Primary Care><Professional counselor><Public Health><RE-AIM><Randomized, Controlled Trials><Reach, Effectiveness, Adoption, Implementation, and Maintenance><Readiness><Research><Resource-constrained area><Resource-constrained community><Resource-constrained environment><Resource-constrained region><Resource-constrained setting><Resource-limited area><Resource-limited community><Resource-limited environment><Resource-limited region><Resource-limited setting><Resource-poor area><Resource-poor community><Resource-poor environment><Resource-poor region><Resource-poor setting><Schools><Science><Self Efficacy><Smoke><Smoke-free home><Smoker><Smoking><Smoking Behavior><Source><System><Testing><Tobacco><Tobacco Consumption><Tobacco use><Training><Translating><United States Centers for Disease Control><United States Centers for Disease Control and Prevention><United States National Institutes of Health><Universities><Woman><Work><active followup><adulthood><assess effectiveness><brief intervention><brief therapy><brief treatment><cancer prevention><cease smoking><chronic disorder><cigarette smoke><clean indoor air law><community based organizations><community engaged approach><community engaged approaches><community engaged strategies><community engaged strategy><community organizations><community partnered approach><community partnered strategy><community partners><community setting><community-based partners><cost effective><cost effectiveness><design><designing><determine effectiveness><disease prevention><disorder prevention><disparity in health><effectiveness assessment><effectiveness evaluation><effectiveness-implementation RCT><effectiveness-implementation randomized control trial><effectiveness-implementation randomized controlled trial><effectiveness/implementation hybrid><environmental tobacco smoke exposure><evaluate effectiveness><evidence base><examine effectiveness><exposure to ETS><exposure to SHS><exposure to environmental tobacco smoke><exposure to secondhand smoke><exposure to tobacco smoke><follow up><follow up assessment><follow-up><followed up><followup><followup assessment><global health><health disparity><health organization><homes><innovate><innovation><innovative><intervention delivery><intervention refinement><interventional strategy><kids><knowledge base><low and middle-income countries><member><men><non-smoker><non-smoking><nonsmoker><nonsmoking><participant recruitment><personnel><primary outcome><process evaluation><programs><quit line><quit smoking><quitline><randomized control trial><reach, efficacy, adoption, implementation, and maintenance><scale up><second hand smoke exposure><secondary outcome><secondhand smoke exposure><secondhand tobacco smoke exposure><smoke-free air law><smoke-free air policy><smoke-free housing><smoke-free indoor policy><smoke-free law><smoke-free policy><smokefree air law><smokefree home><smokefree housing><smokefree policy><smoking cessation><smoking prevalence><stop smoking><theories><tobacco product use><web site><website><youngster>