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Dearfield CT, Ulfers M, Horn K, Bernat DH. Resident Support for the Federally Mandated Smoke-Free Rule in Public Housing: 2018-2022. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:102. [PMID: 38248565 PMCID: PMC10815862 DOI: 10.3390/ijerph21010102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/05/2024] [Accepted: 01/09/2024] [Indexed: 01/23/2024]
Abstract
This study examines support for the Department of Housing and Urban Development's (HUD) mandatory smoke-free rule up to four years post-rule among smokers and non-smokers. A repeated cross-sectional design was used where District of Columbia public housing residents aged 18+ (n = 529) completed surveys during three time points: July 2018 (pre-rule), November 2018-March 2020 (post-rule), and September 2020-December 2022 (post-rule + COVID-19). Full support for the rule was indicated by agreeing that smoking should not be allowed in all indoor locations and within 25 feet of buildings. Descriptive statistics showed significant differences in support across time for smokers (5.3%, 30.7%, and 22.5%, respectively) and similar support across time for nonsmokers (48.2%, 52.2%, and 40.0%, respectively). In unstratified regression analysis, pre-rule support was lower than when the rule was in effect (aOR = 0.47, 95% CI = 0.25, 0.90), and tobacco users were less likely to support the rule (aOR = 0.34, 95% CI = 0.23, 0.50). Stratified logistic regression results showed that pre-rule support was lower among smokers compared to post-rule support (aOR = 0.14, 95% CI = 0.03, 0.59); support among nonsmokers did not vary by time. Findings overall indicate low support for the smoke-free rule up to 4 years post-implementation. Engaging residents with the rule and promoting health and well-being may further enhance policy effectiveness and acceptance.
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Affiliation(s)
- Craig T. Dearfield
- Department of Epidemiology, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (M.U.); (D.H.B.)
| | - Margaret Ulfers
- Department of Epidemiology, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (M.U.); (D.H.B.)
| | - Kimberly Horn
- Department of Population Health Sciences, Virginia Tech-Carilion Fralin Biomedical Research Institute, Roanoke, VA 24016, USA;
| | - Debra H. Bernat
- Department of Epidemiology, The Milken Institute School of Public Health, The George Washington University, Washington, DC 20052, USA; (M.U.); (D.H.B.)
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van der Eijk Y, Tan GPP, Teo O. Systems and policies to reduce secondhand smoke in multiunit housing in Singapore: a qualitative study. Tob Control 2023; 33:52-58. [PMID: 35715172 DOI: 10.1136/tobaccocontrol-2022-057301] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/02/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Multiunit housing residents are often exposed to neighbours' secondhand smoke (SHS). Little is known on the current systems available to protect residents in places not covered by a residential smoking ban, or what constitutes an appropriate policy approach. This study explores relevant systems and policies in Singapore, a densely populated city-state where the vast majority live in multiunit housing and discussions on regulating smoking in homes are ongoing. METHODS In-depth interviews with 18 key informants involved in thought leadership, advocacy, policy or handling SHS complaints, and 14 smokers and 16 non-smokers exposed to SHS at home. RESULTS The current system to address neighbours' SHS comprises three steps: moral suasion, mediation and legal dispute. Moral suasion and mediation are often ineffective as they depend on smokers to willingly restrict their smoking habits. Legal dispute can yield a court order to stop smoking inside the home, but the process places a high evidence burden on complainants. While setting up designated smoking points or running social responsibility campaigns may help to create no-smoking norms, more intractable cases will likely require regulation, a polarising approach which raises concerns about privacy. CONCLUSIONS Without regulations to limit SHS in multiunit housing, current systems are limited in their enforceability as they treat SHS as a neighbourly nuisance rather than a public health threat.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Grace Ping Ping Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Odelia Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Hernandez D, Khan F, Albert D, Giovenco D, Branas C, Valeri L, Navas-Acien A. A randomized control trial to support smoke-free policy compliance in public housing. Trials 2023; 24:551. [PMID: 37608390 PMCID: PMC10463922 DOI: 10.1186/s13063-023-07339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/29/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Smoke-free housing policies in multiunit housing are increasingly widespread interventions to reduce smoking and secondhand smoke exposure. Little research has identified factors that impede compliance with smoke-free housing policies in low-income multiunit housing and test corresponding solutions. METHODS We are using an experimental design to test two compliance support interventions: (A) a "compliance through reduction (via relocation and reduction in personal smoking) and cessation" intervention targets households with smokers and involves support to shift smoking practices to areas beyond the apartment or building setting, reduce personal smoking, and deliver in-residence smoking cessation support services via trained peer educators and (B) a "compliance through resident endorsement" intervention involving voluntary adoption of smoke-free living environments through personal pledges, visible door markers, and/or via social media. We will compare randomly sampled participants in buildings that receive A or B or A plus B to the NYCHA standard approach. DISCUSSION This RCT addresses key gaps in knowledge and capitalizes on key scientific opportunities by (1) leveraging the federal mandate to ban smoking in a public housing system of more than sufficient size to conduct an adequately powered RCT; (2) expanding our understanding of smoke-free policy compliance beyond policy implementation by testing two novel treatments: (a) in-residence smoking cessation and (b) resident endorsement, while (3) addressing population and location-specific tobacco-related disparities. At the conclusion of the study, this RCT will have leveraged a monumental policy shift affecting nearly half a million NYC public housing residents, many of whom disproportionately experience chronic illness and are more likely to smoke and be exposed to secondhand smoke than other city residents. This first-ever RCT will test the effects of much-needed compliance strategies on resident smoking behavior and secondhand smoke exposure in multiunit housing. TRIAL REGISTRATION Clinical Trials Registered, NCT05016505. Registered on August 23, 2021.
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Affiliation(s)
- Diana Hernandez
- Sociomedical Sciences, Columbia Mailman School of Public Health, New York, USA.
| | - Farzana Khan
- Sociomedical Sciences, Columbia Mailman School of Public Health, New York, USA
| | - David Albert
- Health Policy and Management, Columbia Mailman School of Public Health, New York, USA
| | - Daniel Giovenco
- Sociomedical Sciences, Columbia Mailman School of Public Health, New York, USA
| | - Charles Branas
- Epidemiology, Columbia Mailman School of Public Health, New York, USA
| | - Linda Valeri
- Biostatistics, Columbia Mailman School of Public Health, New York, USA
| | - Ana Navas-Acien
- Environmental Health Sciences, Columbia Mailman School of Public Health, New York, USA
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Anastasiou E, Gordon T, Wyka K, Tovar A, Gill E, Rule AM, Elbel B, Kaplan JDS, Shelley D, Thorpe LE. Long-Term Trends in Secondhand Smoke Exposure in High-Rise Housing Serving Low-Income Residents in New York City: Three-Year Evaluation of a Federal Smoking Ban in Public Housing, 2018-2021. Nicotine Tob Res 2023; 25:164-169. [PMID: 36041039 PMCID: PMC9717387 DOI: 10.1093/ntr/ntac202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/10/2022] [Accepted: 08/29/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION In July 2018, the U.S. Department of Housing and Urban Development passed a rule requiring public housing authorities to implement smoke-free housing (SFH) policies. We measured secondhand smoke (SHS) exposure immediately before, and repeatedly up to 36 months post-SFH policy implementation in a purposeful sample of 21 New York City (NYC) high-rise buildings (>15 floors): 10 NYC Housing Authority (NYCHA) buildings subject to the policy and 11 privately managed buildings in which most residents received housing vouchers (herein "Section 8"). AIMS AND METHODS We invited participants from nonsmoking households (NYCHA n = 157, Section-8 n = 118) to enroll in a longitudinal air monitoring study, measuring (1) nicotine concentration with passive, bisulfate-coated filters, and (2) particulate matter (PM2.5) with low-cost particle sensors. We also measured nicotine concentrations and counted cigarette butts in common areas (n = 91 stairwells and hallways). We repeated air monitoring sessions in households and common areas every 6 months, totaling six post-policy sessions. RESULTS After 3 years, we observed larger declines in nicotine concentration in NYCHA hallways than in Section-8, [difference-in-difference (DID) = -1.92 µg/m3 (95% CI -2.98, -0.87), p = .001]. In stairwells, nicotine concentration declines were larger in NYCHA buildings, but the differences were not statistically significant [DID= -1.10 µg/m3 (95% CI -2.40, 0.18), p = .089]. In households, there was no differential change in nicotine concentration (p = .093) or in PM2.5 levels (p = .385). CONCLUSIONS Nicotine concentration reductions in NYCHA common areas over 3 years may be attributable to the SFH policy, reflecting its gradual implementation over this time. IMPLICATIONS Continued air monitoring over multiple years has demonstrated that SHS exposure may be declining more rapidly in NYCHA common areas as a result of SFH policy adherence. This may have positive implications for improved health outcomes among those living in public housing, but additional tracking of air quality and studies of health outcomes are needed. Ongoing efforts by NYCHA to integrate the SFH policy into wider healthier-homes initiatives may increase policy compliance.
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Affiliation(s)
- Elle Anastasiou
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, 341 East 25th Street, New York, NY 10010, USA
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, Graduate School of Public Health and Health Policy, City University of New York, City University of New York, New York, NY 10027, USA
| | - Albert Tovar
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Emily Gill
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, 21205, USA
| | - Brian Elbel
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
- Wagner Graduate School of Public Service, New York University, 295 Lafayette Street, New York, NY 10012, USA
| | - J D Sue Kaplan
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Donna Shelley
- Department of Public Health Policy and Management, New York University School of Global Public Health, NY, NY 10012, USA
| | - Lorna E Thorpe
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
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Anastasiou E, Vilcassim MJR, Adragna J, Gill E, Tovar A, Thorpe LE, Gordon T. Feasibility of low-cost particle sensor types in long-term indoor air pollution health studies after repeated calibration, 2019-2021. Sci Rep 2022; 12:14571. [PMID: 36028517 PMCID: PMC9411839 DOI: 10.1038/s41598-022-18200-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 08/08/2022] [Indexed: 11/09/2022] Open
Abstract
Previous studies have explored using calibrated low-cost particulate matter (PM) sensors, but important research gaps remain regarding long-term performance and reliability. Evaluate longitudinal performance of low-cost particle sensors by measuring sensor performance changes over 2 years of use. 51 low-cost particle sensors (Airbeam 1 N = 29; Airbeam 2 N = 22) were calibrated four times over a 2-year timeframe between 2019 and 2021. Cigarette smoke-specific calibration curves for Airbeam 1 and 2 PM sensors were created by directly comparing simultaneous 1-min readings of a Thermo Scientific Personal DataRAM PDR-1500 unit with a 2.5 µm inlet. Inter-sensor variability in calibration coefficient was high, particularly in Airbeam 1 sensors at study initiation. Calibration coefficients for both sensor types trended downwards over time to < 1 at final calibration timepoint [Airbeam 1 Mean (SD) = 0.87 (0.20); Airbeam 2 Mean (SD) = 0.96 (0.27)]. We lost more Airbeam 1 sensors (N = 27 out of 56, failure rate 48.2%) than Airbeam 2 (N = 2 out of 24, failure rate 8.3%) due to electronics, battery, or data output issues. Evidence suggests degradation over time might depend more on particle sensor type, rather than individual usage. Repeated calibrations of low-cost particle sensors may increase confidence in reported PM levels in longitudinal indoor air pollution studies.
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Affiliation(s)
- Elle Anastasiou
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - M J Ruzmyn Vilcassim
- Department of Environmental Health Sciences, University of Alabama at Birmingham School of Public Health, Birmingham, AL, 205-934-8927, USA
| | - John Adragna
- Department of Environmental Science, New York University Grossman School of Medicine, 341 East 25th Street, New York, NY, 10010, USA
| | - Emily Gill
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Albert Tovar
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Lorna E Thorpe
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, USA
| | - Terry Gordon
- Department of Environmental Science, New York University Grossman School of Medicine, 341 East 25th Street, New York, NY, 10010, USA.
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Tan GPP, Teo O, van der Eijk Y. Residential secondhand smoke in a densely populated urban setting: a qualitative exploration of psychosocial impacts, views and experiences. BMC Public Health 2022; 22:1168. [PMID: 35690740 PMCID: PMC9187883 DOI: 10.1186/s12889-022-13561-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/30/2022] [Indexed: 11/23/2022] Open
Abstract
Background People remain exposed to secondhand smoke, a serious health hazard, inside their home as households face challenges in setting no-smoking rules or are exposed to secondhand smoke drifting in from neighbouring homes. This study explores the psychosocial impacts, views, and experiences with residential secondhand smoke in a densely populated urban setting. Methods In-depth online or face to face interviews with 18 key informants who had been involved in public discourse, policy, advocacy or handling complaints related to residential secondhand smoke, 14 smokers, and 16 non-smokers exposed to secondhand smoke inside their home. All participants were residents of Singapore, a densely populated, multi-ethnic city-state. Interview transcripts were coded in NVivo using a deductive and inductive coding process. Findings Secondhand smoke has wide-reaching impacts on physical and psychosocial wellbeing, even if smokers tried to minimise secondhand smoke. Feelings of anxiety and stress are generally tied to feeling discomfort in one’s personal space, a perceived lack of control over the situation, resentment towards smokers, and concerns over the health effects. Family, community, and cultural dynamics add complexities to tackling the issue, especially in patriarchal households. Secondhand smoke exposure from neighbours is considered a widespread issue, exacerbated by structural factors such as building layout and the COVID-19 pandemic. Resolving the issue amicably is considered challenging due to the absence of regulations and a reluctance to stir up conflict with neighbours. While smokers took measures to reduce secondhand smoke, these were described as ineffective by other participants. Smokers appeared to have contrasting views from other participants on what it means to smoke in a socially responsible manner. Conclusion Given the wide-reaching psychosocial impacts of residential secondhand smoke, there is a case for stronger interventions, especially in densely populated urban settings where it is more difficult to avoid. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13561-7.
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Affiliation(s)
- Grace Ping Ping Tan
- Saw Swee Hock School of Public Health, National University of Singapore, MD1 Tahir Foundation Building 12 Science Drive 2 #09-01C, 117549, Singapore, Singapore
| | - Odelia Teo
- Saw Swee Hock School of Public Health, National University of Singapore, MD1 Tahir Foundation Building 12 Science Drive 2 #09-01C, 117549, Singapore, Singapore
| | - Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, MD1 Tahir Foundation Building 12 Science Drive 2 #09-01C, 117549, Singapore, Singapore.
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Boey CPH, Quaye SED, Cook AR, Seow WJ, van der Eijk Y. Secondhand smoke in the densely populated urban setting: A cross-sectional survey of exposure, knowledge, attitudes, and respiratory symptoms. INDOOR AIR 2022; 32:e13069. [PMID: 35762238 DOI: 10.1111/ina.13069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 04/10/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
Secondhand smoke (SHS) remains a common health threat in densely populated, urban settings. We estimated the prevalence of exposure and associated respiratory symptoms, knowledge, attitudes, and behaviors in a multi-ethnic, weighted sample of Singapore residents using a cross-sectional survey of 1806 adults. We weighted data to match the national population in terms of gender, ethnicity, and education level and analyzed data using descriptive statistics, bivariate analyses, multiple linear and logistic regressions, and a multinomial logistic regression model. About 88% of respondents reported regular SHS exposure. Nearly 57% reported exposure to neighbors' SHS at home. Respiratory symptoms were reported by 32.5% and significantly associated with exposure to daily (AOR = 2.63, 95% CI = 1.62-4.36), non-daily (AOR = 1.75, 95% CI = 1.14-2.77), and neighbors' (AOR = 1.37, 95% CI = 1.07-1.76) SHS. More knowledge of SHS was associated with male gender (β = 0.28, p = 0.0009) and higher household income (linear trend; p = 0.0400). More negative attitudes to SHS were associated with older age (linear trend; p < 0.0001). Engaging in behaviors to avoid SHS was associated with a more negative attitude to SHS (AOR = 1.09-1.23). SHS exposure is common in Singapore's densely populated setting and associated with respiratory symptoms, even if exposure is non-daily or from neighboring homes.
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Affiliation(s)
- Clement Peng Hee Boey
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Sharon Esi Duoduwa Quaye
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Alex R Cook
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Wei Jie Seow
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
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Mahabee-Gittens EM, Vidourek RA, King KA, Merianos AL. Home Tobacco Smoke Exposure and Neighborhood Support and Safety among U.S. School-aged Children. HEALTH BEHAVIOR RESEARCH 2022; 5:6. [PMID: 38107160 PMCID: PMC10722861 DOI: 10.4148/2572-1836.1140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Children who are socioeconomically disadvantaged face a myriad of environmental hardships in the neighborhoods in which they live. This study examined the associations between home tobacco smoke exposure (TSE) and neighborhood support, neighborhood safety, and school safety among U.S. school-aged children. Children ages 6-11 years were included in this secondary analysis of 2018-2019 National Survey of Children's Health data (N = 17,300). Children's home TSE status was categorized into three levels: (1) no TSE: Child did not live with a smoker; (2) Outside TSE only: Child lived with a smoker who did not smoke inside the home; and (3) Inside TSE: Child lived with a smoker who smoked inside the home. Parent-reported measures of perceived neighborhood support, and neighborhood and school safety were examined; covariates included the child's age, sex, and race/ethnicity; the parent's education; the family's household structure, and federal poverty level. Weighted logistic and ordinal regression models were built adjusting for the covariates. In total, 13.2% of children had outside TSE and 1.7% of children had inside TSE. Multivariable logistic regression model results indicated that children with outside TSE were at decreased odds (AOR = 0.79, 95%CI = 0.65-0.96) of living in a supportive neighborhood compared to children with no TSE. Ordinal regression model results indicated that children with outside TSE (AOR = 0.77, 95%CI = 0.61-0.97) and children with inside TSE were at decreased odds (AOR = 0.62, 95%CI = 0.39-0.99) of going to a school that was perceived as safe. Community-level programs, policies, and funding are needed to improve neighborhood characteristics among children with TSE to improve their future health outcomes.
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Zajac L, Gallate X, Gu G, Liu B, Elaiho C, Lin E, Mogilner L, Oliver K, Vangeepuram N, Wilson K. Disparities in Marijuana and Tobacco Smoke Incursions Among New York City Families During Early Months of the COVID-19 Pandemic. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:248-257. [PMID: 34750327 PMCID: PMC8963431 DOI: 10.1097/phh.0000000000001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Once the COVID-19 pandemic arrived in New York City (NYC), stay-at-home orders led to more time spent indoors, potentially increasing exposure to secondhand marijuana and tobacco smoke via incursions from common areas or neighbors. The objective of this study was to characterize housing-based disparities in marijuana and tobacco incursions in NYC housing during the pandemic. DESIGN We surveyed a random sample of families from May to July 2020 and collected sociodemographic data, housing characteristics, and the presence, frequency, and pandemic-related change in incursions. SETTING Five pediatric practices affiliated with a large NYC health care system. PARTICIPANTS In total, 230 caregivers of children attending the practices. MAIN OUTCOME MEASURES Prevalence and change in tobacco and marijuana smoke incursions. RESULTS Tobacco and marijuana smoke incursions were reported by 22.9% and 30.7%, respectively. Twenty-two percent of families received financial housing support (public housing, Section-8). Compared with families in private housing, families with financial housing support had 3.8 times the odds of tobacco incursions (95% CI, 1.4-10.1) and 3.7 times the odds of worsening incursions during pandemic (95% CI, 1.1-12.5). Families with financially supported housing had 6.9 times the odds of marijuana incursions (95% CI, 2.4-19.5) and 5 times the odds of worsening incursions during pandemic (95% CI, 1.9-12.8). Children in financially supported housing spent more time inside the home during pandemic (median 24 hours vs 21.6 hours, P = .02) and were more likely to have asthma (37% vs 12.9%, P = .001) than children in private housing. CONCLUSIONS Incursions were higher among families with financially supported housing. Better enforcement of existing regulations (eg, Smoke-Free Public Housing Rule) and implementation of additional policies to limit secondhand tobacco and marijuana exposure in children are needed. Such actions should prioritize equitable access to cessation and mental health services and consider structural systems leading to poverty and health disparities.
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Affiliation(s)
- Lauren Zajac
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Xanthe Gallate
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Gregory Gu
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Bian Liu
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Cordelia Elaiho
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Elaine Lin
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Leora Mogilner
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Kristin Oliver
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Nita Vangeepuram
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Karen Wilson
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
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Okekunle AP, Asowata JO, Lee JE, Akpa OM. Association of Environmental tobacco smoke exposure with depression among non-smoking adults. BMC Public Health 2021; 21:1755. [PMID: 34565350 PMCID: PMC8474776 DOI: 10.1186/s12889-021-11780-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/13/2021] [Indexed: 11/29/2022] Open
Abstract
Background Depression is a psychological dysfunction that impairs health and quality of life. However, whether environmental tobacco smoke exposure (ETSE) is associated with depression is poorly understood. This study was designed to evaluate the association of ETSE with depression among non-smoking adults in the United States. Method Using the 2015–2016 United States National Health and Nutrition Examination Survey (NHANES), we identified 2623 adults (females – 64.2%, males – 35.8%) who had never smoked and applied multivariable adjusted-logistic regression to determine the adjusted odds ratio (aOR) and 95% confidence interval (CI) at P < 0.05 for the association of ETSE with depression adjusting for relevant confounders. Results Mean age of respondents was 46.5 ± 17.9 years, 23.5% reported ETSE, and 4.7% reported depression. Also, aORs for the association of ETSE with depression were 1.992 (1.987, 1.997) among females and 0.674 (0.670, 0.677) among males. When we examined the association by age groups, the aORs were 1.792 (1.787, 1.796) among young adults (< 60 years) and 1.146 (1.140, 1.152) among older adults (≥60 years). Conclusions We found that ETSE was associated with higher odds of depression among females but not among males.
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Affiliation(s)
- Akinkunmi Paul Okekunle
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Post Office200284 PMB, Ibadan, UI, 900001, Nigeria. .,The Postgraduate College, University of Ibadan, Ibadan, 200284, Nigeria. .,Department of Food and Nutrition, College of Human Ecology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, IL, 08826, South Korea. .,Research Institute of Human Ecology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, IL, 08826, South Korea.
| | - Jeffery Osahon Asowata
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Post Office200284 PMB, Ibadan, UI, 900001, Nigeria
| | - Jung Eun Lee
- Department of Food and Nutrition, College of Human Ecology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, IL, 08826, South Korea.,Research Institute of Human Ecology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, IL, 08826, South Korea
| | - Onoja Matthew Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, Post Office200284 PMB, Ibadan, UI, 900001, Nigeria. .,Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, 200284, Nigeria. .,Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, 200284, Nigeria.
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Akpa OM, Okekunle AP, Asowata JO, Adedokun B. Passive smoking exposure and the risk of hypertension among non-smoking adults: the 2015-2016 NHANES data. Clin Hypertens 2021; 27:1. [PMID: 33384019 PMCID: PMC7775627 DOI: 10.1186/s40885-020-00159-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 12/03/2020] [Indexed: 01/14/2023] Open
Abstract
Background Hypertension is a major public health problem and a prominent risk factor for cardiovascular diseases. However, whether passive smoking exposure (PSE) is associated with the risk of hypertension is scarcely understood. This study assessed the association between PSE and the risk of hypertension among adults (≥18 years) in the United States of America. Methods Three thousand and sixty-seven adults were identified from the 2015–2016 National Health and Nutrition Examination Survey and the association between PSE and hypertension (adjusting for relevant confounders) was examined using multivariable adjusted-logistic regression analysis at P < 0.05. Results Mean age of respondents was 46.5 ± 17.9 years. Overall, 23.7% of respondents reported PSE and 32.6% were hypertensives (of which only 14.3% were aware of their hypertensive state) Also, adjusted odds of hypertension for participants with PSE was 1.038 (1.037, 1.040), P < 0.0001, in the overall population. Also, PSE aggravated odds of hypertension among young adults – < 60 years (aOR: 1.095, 95CI%: 1.094 to 1.097), P < 0.0001, and old adults – ≥60 years (aOR: 1.110, 95% CI: 1.108 to 1.113), P < 0.0001. Similarly, PSE was associated with increased odds of hypertension among women (aOR: 1.240, 95% CI: 1.238 to 1.242), P < 0.0001 but not among men (aOR: 0.755, 95% CI: 0.754 to 0.757), P < 0.0001. Conclusions PSE was independently associated with the risk of hypertension particularly among women, young and old adults. A multi-ethnic longitudinal cohort may help ascertain causality and provide more evidence for appropriate interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s40885-020-00159-7.
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Affiliation(s)
- Onoja Matthew Akpa
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, PMB 900001 UI Post Office, Ibadan, 200284, Nigeria. .,Center for Genomic and Precision Medicine, College of Medicine, University of Ibadan, Ibadan, 200284, Nigeria. .,Preventive Cardiology Research Unit, Institute of Cardiovascular Diseases, College of Medicine, University of Ibadan, Ibadan, 200284, Nigeria.
| | - Akinkunmi Paul Okekunle
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, PMB 900001 UI Post Office, Ibadan, 200284, Nigeria. .,The Postgraduate College, University of Ibadan, PMB 900001, Ibadan, Nigeria. .,Nutritional Epidemiology Lab, Department of Food and Nutrition, College of Human Ecology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, IL, 08826, Korea. .,Research Institute of Human Ecology, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, IL, 08826, Korea.
| | - Jeffery Osahon Asowata
- Department of Epidemiology and Medical Statistics, College of Medicine, University of Ibadan, PMB 900001 UI Post Office, Ibadan, 200284, Nigeria
| | - Babatunde Adedokun
- Center for Clinical Cancer Genetics and Global Health, Department of Medicine, University of Chicago, Chicago, IL, 60637, USA
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Abstract
Secondhand smoke (SHS) caused by smoking on apartment verandas is a severe social problem in Japan. If someone smokes on a veranda, SHS drifts into other residents' rooms through their windows. Most non-smoking residents are annoyed by this, but they do not confront the person responsible. To study this situation, we burned cigarettes and measured the spread of SHS in terms of fine particle (PM2.5) concentrations. Cigarette smoke generated on a lower veranda spread to upper and horizontal neighboring verandas and into rooms through windows, reaching a maximum concentration of 139 μg/m3. The Health Promotion Act that was revised in 2018 and enacted in 2019-2020 requires all smokers to avoid producing SHS, even outdoors and at home. It is expected that combining the measurement of SHS from verandas to other verandas and rooms with the revised Health Promotion Act could create a national consensus on "no smoking on apartment verandas."
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Thorpe LE, Anastasiou E, Wyka K, Tovar A, Gill E, Rule A, Elbel B, Kaplan SA, Jiang N, Gordon T, Shelley D. Evaluation of Secondhand Smoke Exposure in New York City Public Housing After Implementation of the 2018 Federal Smoke-Free Housing Policy. JAMA Netw Open 2020; 3:e2024385. [PMID: 33151318 PMCID: PMC7645700 DOI: 10.1001/jamanetworkopen.2020.24385] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE Secondhand smoke (SHS) exposure is associated with many health conditions in children and adults. Millions of individuals in the US are currently exposed to SHS in their homes. OBJECTIVE To investigate whether a federal ban on smoking in public housing settings was associated with a decrease in indoor SHS levels in New York City public housing developments 12 months after the policy's implementation. DESIGN, SETTING, AND PARTICIPANTS This cohort study tracked indoor air quality longitudinally from April 2018 to September 2019 and used difference-in-differences analysis to examine SHS exposure before vs after implementation of the 2018 federal smoke-free housing (SFH) policy in 10 New York City Housing Authority (NYCHA) buildings vs 11 matched low-income buildings not subject to the SFH policy (ie, Section 8 buildings). EXPOSURES Federal SFH policy implementation, beginning July 30, 2018. MAIN OUTCOMES AND MEASURES Comparison of nicotine concentration levels from passive, bisulfate-coated filters before vs 12 months after implementation of the federal SFH policy. Secondary outcomes included changes in particulate matter less than 2.5 μm in diameter, measured with low-cost particle monitors, and counts of cigarette butts in common areas. RESULTS Air quality was measured repeatedly in a total of 153 NYCHA and 110 Section 8 nonsmoking households as well as in 91 stairwells and hallways. Before the SFH policy implementation, air nicotine was detectable in 19 of 20 stairwells (95.0%) in NYCHA buildings and 15 of 19 stairwells (78.9%) in Section 8 buildings (P = .19) and in 17 of 19 hallways (89.5%) in NYCHA buildings and 14 of 23 hallways (60.9%) in Section 8 buildings (P = .004). Nicotine was detected less frequently inside nonsmoking apartments overall (26 of 263 [9.9%]) but more frequently in NYCHA apartments (20 of 153 [13.1%]) than in Section 8 apartments (6 of 110 [5.5%]) (P = .04). One year after policy implementation, there was no differential change over time in nicotine concentrations measured in stairwells (DID, 0.03 μg/m3; 95% CI, -0.99 to 1.06 μg/m3) or inside nonsmoking households (DID, -0.04 μg/m3; 95% CI, -0.24 to 0.15 μg/m3). Larger decreases in nicotine concentration were found in NYCHA hallways than in Section 8 hallways (DID, -0.43 μg/m3; 95% CI, -1.26 to 0.40 μg/m3). CONCLUSIONS AND RELEVANCE The findings suggest that there was no differential change in SHS in NYCHA buildings 12 months after SFH policy implementation. Additional support may be needed to ensure adherence to SFH policies.
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Affiliation(s)
- Lorna E. Thorpe
- Department of Population Health, NYU Grossman School of Medicine, New York
| | - Elle Anastasiou
- Department of Population Health, NYU Grossman School of Medicine, New York
| | - Katarzyna Wyka
- Department of Epidemiology and Biostatistics, The City University of New York Graduate School of Public Health and Health Policy, New York
| | - Albert Tovar
- Department of Population Health, NYU Grossman School of Medicine, New York
| | - Emily Gill
- Department of Population Health, NYU Grossman School of Medicine, New York
| | - Ana Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Brian Elbel
- Department of Population Health, NYU Grossman School of Medicine, New York
| | - Sue A. Kaplan
- Department of Population Health, NYU Grossman School of Medicine, New York
| | - Nan Jiang
- Department of Population Health, NYU Grossman School of Medicine, New York
| | - Terry Gordon
- Department of Environmental Medicine, NYU Grossman School of Medicine, New York
| | - Donna Shelley
- Department of Public Health Policy and Management, NYU School of Global Public Health, New York
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Amin HS, Alomair AN, Alhammad AH, Altwijri FA, Altaweel AA, Alandejani TA. Tobacco consumption and environmental exposure among healthcare students in King Saud University in Riyadh. J Family Med Prim Care 2020; 9:657-663. [PMID: 32318399 PMCID: PMC7114038 DOI: 10.4103/jfmpc.jfmpc_1217_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/21/2020] [Accepted: 01/31/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES The goal of this study was to determine the prevalence of tobacco smoking in healthcare students at a university in Riyadh, Saudi Arabia, along with environmental exposure and potential influential factors. METHODS This observational cross-sectional study was conducted at King Saud University from January-April 2019. It included 1,273 randomly selected male and female first- to fifth-year undergraduate healthcare students from all health colleges at the university. The study used a self-administrated questionnaire and descriptive data analysis. Associations between variables were tested using a Chi-square test with the statistical significance set at P value < 0.05. RESULTS Among the 1,273 respondents, the prevalence of tobacco product smoking was 13.7%. The prevalence was highest in the College of Applied Science (34.5%) and lowest in the College of Pharmacy (10.9%). Among those 18- to 21-year-olds, the prevalence was 43.1%, while it was 51.1% for the 22-25 age group and only 5.8% for those 26 or older. Common reasons for smoking cigarettes included having fun or passing time (45.2%) and relieving stress (33.3%). Among those who smoked a water-pipe (12.5%), the most common reason was to enjoy its flavors (42.1%). The prevalence of secondhand smoking at home was 31.7%, and environmental exposure was 42.5%. CONCLUSION Tobacco consumption is a common problem among healthcare students including cigarette as well as the increasing consumption of water-pipe in addition to secondhand smoking. Along with proven strategies to promote smoking cessation, including smoke-free laws, improved access to effective quitting treatments and media campaigns are needed to reduce tobacco consumption.
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Affiliation(s)
- Hussein S. Amin
- Assistant Professor, Consultant, Family and Community Medicine Department, Member of King Saud University Chair for Medical Education Research, College of Medicine, Saudi Arabia
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