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

ABSTRACT. By December, 2020, COVID-19 associated hospitalization rates among Hispanic/Latino and African-American/Black persons in the United States were twice as large as non-Hispanic White persons. New York City (NYC) became the epicenter of COVID-19 early in the epidemic and disturbing patterns of COVID- related disparities rapidly emerged. In October 2020, we launched a Rapid Acceleration of Diagnostics for Underserved Populations (RADx-UP) targeting NYC public housing residents, leveraging longstanding partnerships with 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 project to develop and test strategies to 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. Through the RADx-Phase I project, we developed a strong community engagement structure to guide our work, designed and launched weekly surveillance of COVID -19 infections and testing rates at all 374 developments across NYC, facilitated COVID-19 testing sites on public housing grounds, and launched an intervention trial using NYCHA resident community health workers. Now, to address the facts that transmission is predominantly occurring among younger age groups, we are introducing point-of-contact saliva testing and on-the-spot vaccine scheduling, as well as testing methods to extend reach. Our new aims are to: 1) Expand and sustain our community engagement infrastructure; 2) Apply near-real time surveillance to direct mobile testing and popup vaccination clinics to public housing developments citywide; 3) Discover facilitators and barriers to testing and vaccination in two new priority groups (teens/young adults and homebound older adults); and 4) Test supervised point-of-care saliva testing and vaccine scheduling modalities. By building on our early successes, strong partnerships, robust municipal data sources, and a rapidly expanding array of testing initiatives, this implementation study offers the opportunity to tailor strategies to address real barriers in extending testing and vaccination services to a large, high-need population. Findings will be used to develop guidance for implementing testing strategies in multi-unit and public housing settings nationally.