Attitudes Toward Smoke-Free Public Housing Among U.S. Adults, 2016

Public support for smoke-free policies in outdoor areas and (semi-)private places: a systematic review and meta-analysis

Background

Smoke-free policies are essential to protect people against tobacco smoke exposure. To successfully implement smoke-free policies that go beyond enclosed public places and workplaces, public support is important. We undertook a comprehensive systematic review of levels and determinants of public support for indoor (semi-)private and outdoor smoke-free policies.

Methods

In this systematic review and meta-analysis, six electronic databases were searched for studies (published between 1 January 2004 and 19 January 2022) reporting support for (semi-)private and outdoor smoke-free policies in representative samples of at least 400 respondents aged 16 years and above. Two reviewers independently extracted data and assessed risk of bias of individual reports using the Mixed Methods Appraisal Tool. The primary outcome was proportion support for smoke-free policies, grouped according to location covered. Three-level meta-analyses, subgroup analyses and meta-regression were performed.

Findings

14,749 records were screened, of which 107 were included; 42 had low risk of bias and 65 were at moderate risk. 99 studies were included in the meta-analyses, reporting 326 measures of support from 896,016 individuals across 33 different countries. Support was pooled for indoor private areas (e.g., private cars, homes: 73%, 95% confidence interval (CI): 66-79), indoor semi-private areas (e.g., multi-unit housing: 70%, 95% CI: 48-86), outdoor hospitality areas (e.g., café and restaurant terraces: 50%, 95% CI: 43-56), outdoor non-hospitality areas (e.g., school grounds, playgrounds, parks, beaches: 69%, 95% CI: 64-73), outdoor semi-private areas (e.g., shared gardens: 67%, 95% CI: 53-79) and outdoor private areas (e.g., private balconies: 41%, 95% CI: 18-69). Subcategories showed highest support for smoke-free cars with children (86%, 95% CI: 81-89), playgrounds (80%, 95% CI: 74-86) and school grounds (76%, 95% CI: 69-83). Non-smokers and ex-smokers were more in favour of smoke-free policies compared to smokers. Support generally increased over time, and following implementation of each smoke-free policy.

Interpretation

Our findings suggested that public support for novel smoke-free policies is high, especially in places frequented by children. Governments should be reassured about public support for implementation of novel smoke-free policies.

Funding

Dutch Heart Foundation, Lung Foundation Netherlands, Dutch Cancer Society, Dutch Diabetes Research Foundation and Netherlands Thrombosis Foundation.

Tobacco treatment clinics in urban public housing: feasibility and outcomes of a hands-on tobacco dependence service in the community

BACKGROUND

As a further extension of smoke-free laws in indoor public places and workplaces, the Department of Housing and Urban Development's declaration to propose a regulation that would make housing units smoke-free was inevitable. Of note is the challenge this regulation poses to current tenants of housing units who are active smokers. We aimed to assess the efficacy of a tobacco treatment clinic in public housing. The utilization of the clinic by tenants and tenants' respective outcomes regarding smoking status were used to determine the intervention's effectiveness.

METHODS

Tobacco treatment clinics were held in two urban-based housing units for 1-year. The clinics provided on-site motivational interviewing and prescriptions for pharmacological agents if warranted. Outcomes collected include the tenants' clinic attendance and 3- and 6-month self-reported smoking status.

RESULTS

Twenty-nine tobacco treatment clinic sessions were implemented, recruiting 47 tenants to participate in smoking cessation. The mean age of the cohort was 53 ± 12.3 years old. Of the 47 tenants who participated, 21 (44.7%) attended three or more clinic sessions. At the 3-month mark, five (10.6%) tenants were identified to have quit smoking; at 6-months, 13 (27.7%) tenants had quit smoking. All 13 of the tenants who quit smoking at the end of 6-months attended three or more sessions.

CONCLUSION

An on-site tobacco treatment clinic to provide strategies on smoking cessation was feasible. Efforts are warranted to ensure more frequent follow-ups for tenants aiming to quit smoking. While further resources should be allocated to help tenants comply with smoke-free housing units' regulations, we believe an on-site tobacco treatment clinic is impactful.

Policy Support for Smoke-Free and E-Cigarette Free Multiunit Housing

PURPOSE

Estimate public support for prohibiting multiunit housing (MUH) e-cigarette and cigarette use.

DESIGN

Cross-sectional study.

SETTING

Data from an online panel survey.

SAMPLE

A Fall 2018 nationally representative sample of 3,415 (99.3% response rate) United States (US) adults 18-64 years old.

MEASURES

Policy support for prohibiting MUH smoking and e-cigarette use, sociodemographics, and tobacco perceptions and behaviors.

ANALYSIS

Weighted multivariate logistic regression examined predictors of support for prohibiting 1) cigarette use and 2) e-cigarette use in MUH.

RESULTS

Most respondents expressed support for prohibiting smoking (76.9%) and e-cigarette use (74.0%) in MUH. About 17% (n = 588) of the sample lived in MUH, and living in MUH was not predictive of support for either policy. For both cigarette and e-cigarette policies, current smokers (n = 630; OR = 0.44, p < 0.001; OR = 0.59, p < 0.01) and current e-cigarette users (n = 305; OR = 0.42, p < 0.001; OR = 0.22, p < 0.001) had lower odds of support. Notably, while most smokers supported prohibiting cigarette (51.4%) and e-cigarette use in MUH (51.1%), there was less support among current e-cigarette users for prohibiting cigarette (48.1%) and e-cigarette use in MUH (34.5%).

CONCLUSION

Majority support for prohibiting smoking and e-cigarette use in MUH is promising for policy adoption; however, lower support of both policies among e-cigarette users needs to be examined, as increasing use of e-cigarettes may be shifting social norms away from support for smoke free housing policies.

Second-Hand Smoke Exposure at Home in the United States; Minorities' Diminished Returns

Introduction

Educational attainment and poverty status are two strong socioeconomic status (SES) indicators that protect individuals against exposure to second-hand smoke. Minorities' Diminished Returns (MDRs), however, refer to smaller protective effects of SES indicators among ethnic minority groups such as Hispanics and Blacks, compared to non-Hispanic Whites. This study explored ethnic differences in the effects of educational attainment and poverty status on second-hand smoke exposure in the homes of American adults.

Methods

This cross-sectional study included 18,274 non-smoking adults who had participated in the Population Assessment of Tobacco and Health (PATH; 2013). The independent variables were educational attainment and poverty status. The dependent variable was second-hand smoke exposure at home. Age and region of residence were the covariates. Ethnicity was the moderator.

Results

Overall, individuals with a higher educational attainment (odds ratio [OR] = 0.76, 95% CI = 0.74-0.79) and those who lived out of poverty (OR = 0.56, 95% CI =0.51-0.62) had lower odds of second-hand smoke exposure at home. Hispanic ethnicity showed significant interactions with both SES indicators, suggesting that the protective effects of education and poverty on second-hand smoke exposure at home are smaller for Hispanics (ORs for interaction with education and poverty status = 1.30 and 1.26, P < 0.05) than for Non-Hispanics.

Conclusion

In the US, high SES Hispanics remain at high risk of exposure to second-hand smoke at home despite a high education and income. High SES better reduces environmental exposures for non-Hispanic than for Hispanic individuals.

Uneven Access to Smoke-Free Laws and Policies and Its Effect on Health Equity in the United States: 2000-2019

Tobacco control measures have played an important role in the reduction of the cigarette smoking prevalence among US adults.However, although overall smoking prevalence has declined, it remains high among many subpopulations that are disproportionately burdened by tobacco use, resulting in tobacco-related health disparities. Slow diffusion of smoke-free laws to rural regions, particularly in the South and Southeast, and uneven adoption of voluntary policies in single-family homes and multiunit housing are key policy variables associated with the disproportionate burden of tobacco-related health disparities in these subpopulations.Developing policies that expand the reach of comprehensive smoke-free laws not only will facilitate the decline in smoking prevalence among subpopulations disproportionately burdened by tobacco use but will also decrease exposure to secondhand smoke and further reduce tobacco-caused health disparities in the United States.

Public Support for Smoke-Free Section 8 Public Housing

The U.S. Department of Housing and Urban Development (HUD) recently issued rules requiring that federally funded authorities administering public housing must have smoke-free policies. Importantly, this requirement does not extend to Section 8 housing. Under the Section 8 program, public housing vouchers provide subsidies for private rental housing to low-income residents. This study examines support for smoke-free policy options in Section 8 housing. Using a nationally representative survey of adults, we asked 3,070 respondents to agree or disagree with two potential policies. The majority (71%) supported prohibiting indoor smoking everywhere inside buildings that have Section 8 housing units. Alternatively, respondents were less supportive (38%) of a policy to prohibit smoking only inside units with Section 8 subsidies, and allowing smoking in nonsubsidized units. Prohibiting smoking in all units in multiunit housing (MUH) buildings would help protect the health of both the 2.2 million households who receive Section 8 subsidies and their neighbors.

[Behavioral changes in smokers after implementation of anti-smoking legislation in ArgentinaMudança de comportamento nos fumantes após a implementação da legislação antifumo na Argentina]

OBJECTIVE

Identify factors related to behavioral changes in smokers over 18 years of age following implementation of provincial policies for 100% smoke-free spaces in Argentina.

METHODS

A cross-sectional analytical study was conducted. The multilevel technique was used with data from different hierarchies. Secondary data sources were used: National Risk Factor Surveys 2005, 2009, and 2013.

RESULTS

The individual analysis of explanatory variables revealed that residents of provinces that do not have smoke-free legislation were 40% less likely to consider quitting smoking than people who live in provinces with such legislation. In provinces without smoke-free spaces, males over 65 years old are even less likely to think about quitting smoking.

CONCLUSIONS

The results suggest that legislation based on Article 8 of the Framework Convention would be effective in promoting tobacco cessation in Argentina.