Evaluation of Smoke-Free Housing Policy Impacts on Tobacco Smoke Exposure and Health Outcomes

ABSTRACT. By mid-June, 2020, COVID-19 associated hospitalization rates among Hispanic/Latino and African-American/Black persons in the United States were 4 and 5 times greater than that of non-HispanicWhite persons. New York City (NYC) became the epicenter of COVID-19 early in the epidemic and disturbing patterns of COVID-related disparities rapidly emerged. The Rapid Acceleration of Diagnostics for Underserved Populations (RADx-UP) initiative supports supplements to individual NIH awards to increase COVID-19 testing among underserved populations. For this proposal, we leverage the infrastructure of a current project in NYC(NCI R01CA220591 "Evaluation of Smoke-Free Housing Policy Impacts on Tobacco Smoke Exposure") and longstanding partnerships between the NYC Housing Authority (NYCHA), the NYC Health Department. The NYC public hospital system responsible for contact tracing (NYC Health + Hospitals) and a robust set of community partners to execute a data-informed, community-engaged research to develop and test strategiesto increase adoption of COVID-19 testing among NYC public housing residents. NYCHA is the largest public housing authority in North America, with more than 400,000 official residents living in 15% of the nation's public housing units. Median family income is $20,000, and approximately 90% of NYCHA residents are either black or Hispanic. Our aims are to: 1) Develop a sustainable community engagement infrastructure to guide current and future deployment of evidence-based COVID-19 testing and vaccination options for NYC Public Housingresidents; 2) Quantify inequities in COVID testing and SARS CoV-2 infection among Public Housing residents; 3) Engage NYCHA residents and community based organization partners in primary data collection and analysis to understand barriers to testing, isolation and follow-up care; and 4) Test community-informed strategies to increase testing uptake. Specifically, we aim to conduct a cluster randomized controlled trial totest the added value of adding navigation services to teams of community health worker (CHWs) and residentnavigators offering a menu of COVID-19 testing referral options. We will compare impacts on reach,acceptability and adoption of COVID-19 diagnostic testing. By capitalizing on strong partnerships, robustmunicipal data sources that support real-time prospective surveillance, and a rapidly expanding array of testing initiatives, this implementation study offers an unparalleled opportunity to identify effective strategies to reduce disparities in COVID risk and health outcomes in a large, high-need population. Findings will be used to develop guidance for implementing testing strategies in multi-unit and public housing settings nationally.