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Vijayaraghavan M, Hartman-Filson M, Vyas P, Katyal T, Nguyen T, Handley MA. Multi-Level Influences of Smoke-Free Policies in Subsidized Housing: Applying the COM-B Model and Neighborhood Assessments to Inform Smoke-Free Policies. Health Promot Pract 2023:15248399231174925. [PMID: 37209138 DOI: 10.1177/15248399231174925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Smoke-free policies in multi-unit housing are associated with reduced exposure to secondhand smoke (SHS); however, attitudes toward comprehensive smoke-free policies among residents in subsidized multi-unit housing are unknown. In this mixed-methods study, we explored the socio-ecological context for tobacco and cannabis use and attitudes toward policies restricting indoor use of these products through interviews with residents (N = 134) and staff (N = 22) in 15 federally subsidized multi-unit housing in San Francisco, California. We conducted a geo-spatial and ethnographic environmental assessment by mapping alcohol, cannabis, and tobacco retail density using ArcGIS, and conducted systematic social observations of the neighborhood around each site for environmental cues to tobacco use. We used the Capability, Opportunity, and Motivation behavior (COM-B) model to identify factors that might influence implementation of smoke-free policies in multi-unit housing. Knowledge and attitudes toward tobacco and cannabis use, social norms around smoking, neighborhood violence, and cannabis legalization were some of the social-ecological factors that influenced tobacco use. There was spatial variation in the availability of alcohol, cannabis, and tobacco stores around sites, which may have influenced residents' ability to maintain smoke-free homes. Lack of skill on how to moderate indoor smoking (psychological capability), lack of safe neighborhoods (physical opportunity), and the stigma of smoking outdoors in multi-unit housing (motivation) were some of the barriers to adopting a smoke-free home. Interventions to increase adoption of smoke-free policies in multi-unit housing need to address the co-use of tobacco and cannabis and commercial and environmental determinants of tobacco use to facilitate smoke-free living.
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Affiliation(s)
| | | | - Priyanka Vyas
- California State University, East Bay, Hayward, CA, USA
| | - Toshali Katyal
- University of California, San Francisco, San Francisco, CA, USA
| | - Tram Nguyen
- University of California, San Francisco, San Francisco, CA, USA
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Melamed OC, Zawertailo L, Schwartz R, Buckley L, Selby P. Protecting vulnerable groups from tobacco-related harm during and following the COVID-19 pandemic. Health Promot Chronic Dis Prev Can 2021; 41:282-287. [PMID: 34164973 PMCID: PMC8565858 DOI: 10.24095/hpcdp.41.10.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Marginalized populations are being disproportionally affected by the current pandemic. Direct effects include higher infection rates with greater morbidity and mortality; indirect effects stem from the societal response to limit the spread of the virus. These same groups also have smoking rates that are significantly higher than the general population. In this commentary, we discuss how the pandemic has been acting to further increase the harm from tobacco endured by these groups by applying the syndemic framework. Using this approach, we elaborate on the factors that promote clustering of harms from tobacco with harms from COVID-19. These include the worsening of psychological distress, a potential increase in smoking behaviour, greater exposure to second-hand smoke and less access to smoking cessation services. Then, we offer mitigation strategies to protect disadvantaged groups from tobacco-related harm during and following the COVID-19 pandemic. These strategies include affordable smoking cessation services, a proactive approach for smoking treatment using information technology, opportunistic screening and treatment of tobacco dependence among individuals presenting for COVID-19 vaccination, policy interventions for universal coverage of cessation pharmacotherapy, comprehensive smoke-free policies and regulation of tobacco retail density. Now more than ever, coordinated action between clinicians, health care systems, public health organizations and health policy makers is needed to protect vulnerable groups from the harm of tobacco.
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Affiliation(s)
- Osnat C Melamed
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Laurie Zawertailo
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Pharmacology and Toxicology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Robert Schwartz
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada
| | - Leslie Buckley
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Peter Selby
- Addictions Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Sangmo L, Liu B, Elaiho C, Boguski L, Yaker M, Resnick M, Malbari A, Wilson KM. Reported Marijuana and Tobacco Smoke Incursions Among Families Living in Multiunit Housing in New York City. Acad Pediatr 2021; 21:670-676. [PMID: 33460815 DOI: 10.1016/j.acap.2021.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND While public knowledge on the prevalence and adverse health effects of secondhand tobacco smoke exposure is well established, information on the prevalence of secondhand marijuana smoke (SHMS) exposure is limited. METHODS A convenience sample of parents of children attending 1 of 4 pediatric practices in the Mount Sinai Health System completed an anonymous questionnaire assessing demographics, housing characteristics, and the child's health status, as well as smoke incursions and household smoking behaviors. RESULTS About 450 parents completed the survey between 2018 and 2019; those with incomplete data were excluded, and 382 surveys were included in the analysis. Approximately 40% of the children were white; the median age was 15 months (interquartile range: 5-40 months). About 30.9% (n = 118) of participants reported marijuana incursions in their home while with their child, while 33.5% (n = 122) reported tobacco smoke incursions. SHMS exposure differed by race (P = .0043); and by housing types (P < .0001). Participants in New York City Housing Authority (NYCHA) developments were more likely to report smelling SHMS (adjusted odds ratio = 3.45, 95% confidence interval = 1.18, 10.10], P = .02). Those in Section 8 housing were also more likely to report smelling SHMS, but the association was not significant (adjusted odds ratio = 3.29, 95% confidence interval = 0.94, 11.55, P = .06). Approximately two thirds of the participants reported viewing marijuana smoke as being harmful to their child. CONCLUSIONS About one third of the families enrolled in the study reported smelling SHMS while at home with their child. Reported marijuana smoke exposure was associated with living in NYCHA housing. Policies that limit all smoke in multiunit housing should be supported.
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Affiliation(s)
- Lodoe Sangmo
- Icahn School of Medicine at Mount Sinai (L Sangmo), New York City, NY
| | - Bian Liu
- Department of Population Health Science and Policy, Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai (B Liu), New York City, NY
| | - Cordelia Elaiho
- Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai (C Elaiho, L Boguski, M Yaker, M Resnick, A Malbari, and KM Wilson), New York City, NY
| | - Lisa Boguski
- Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai (C Elaiho, L Boguski, M Yaker, M Resnick, A Malbari, and KM Wilson), New York City, NY
| | - Michael Yaker
- Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai (C Elaiho, L Boguski, M Yaker, M Resnick, A Malbari, and KM Wilson), New York City, NY
| | - Micah Resnick
- Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai (C Elaiho, L Boguski, M Yaker, M Resnick, A Malbari, and KM Wilson), New York City, NY
| | - Alefiyah Malbari
- Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai (C Elaiho, L Boguski, M Yaker, M Resnick, A Malbari, and KM Wilson), New York City, NY
| | - Karen M Wilson
- Department of Pediatrics, Kravis Children's Hospital, Icahn School of Medicine at Mount Sinai (C Elaiho, L Boguski, M Yaker, M Resnick, A Malbari, and KM Wilson), New York City, NY.
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