Division of Health and Environment, Abt Associates, Rockville, MD 20852, USA.
Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA.
Int J Environ Res Public Health. 2022 Mar 24;19(7):3854. doi: 10.3390/ijerph19073854.
Secondhand smoke (SHS) exposure causes chronic illness and occurs at a higher prevalence in low-income communities than the general public. In 2018, the U.S. Department of Housing and Urban Development (HUD) instituted a smoke-free housing rule for Public Housing Authorities (PHAs) to address persistent health inequities. However, the success of smoke-free housing requires evidence to inform effective implementation approaches. A mixed-methods, cross-sectional survey was conducted in a national sample of PHAs. Questions focused on housing officials' use of specific implementation strategies. Adjusted odds ratios were used to assess associations between implementation approaches and variations among PHAs (i.e., region, size, or recency of policy adoption). Qualitative analyses were conducted to assess the perceived effectiveness of implementation strategies. Resident engagement, staff training, and smoking cessation support were the most frequently used implementation strategies. Engagement with local stakeholders was cited less frequently. Enforcement actions were limited with no violations referred to housing court. Support for policy adherence was identified as a sixth implementation strategy. While most PHAs used at least some evidence-informed implementation strategies, a lack of a systematic approach may limit overall effectiveness. Further research is required to resolve implementation barriers experienced disproportionately by a subset of PHAs, and to inform a best practice implementation framework that meets the needs of a heterogeneous population.
二手烟（SHS）暴露会导致慢性病，在低收入社区的流行程度高于普通公众。2018 年，美国住房和城市发展部（HUD）为公共住房管理局（PHA）制定了一项无烟住房规定，以解决持续存在的健康不平等问题。然而，无烟住房的成功需要有证据来为有效的实施方法提供信息。在全国范围内的 PHA 样本中进行了一项混合方法、横断面调查。问题集中在住房官员使用特定实施策略上。使用调整后的优势比来评估实施方法与 PHA 之间的差异（即区域、规模或政策采用的时间）之间的关联。进行了定性分析，以评估实施策略的有效性。居民参与、员工培训和戒烟支持是最常使用的实施策略。与当地利益相关者的接触较少。没有违法行为被提交给住房法院，因此执法行动受到限制。支持政策遵守被确定为第六个实施策略。虽然大多数 PHA 至少使用了一些基于证据的实施策略，但缺乏系统的方法可能会限制整体效果。需要进一步研究，以解决一部分 PHA 面临的实施障碍，并为满足异质人群需求的最佳实践实施框架提供信息。
