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Kibria MG, Islam T, Badiuzzaman M, Mamun AA, Sultana P, Hawlader MDH. Assessing the choice of smoke-free policies for multiunit housing and its associated determinants in Bangladesh: a cross-sectional study. BMJ Open 2024; 14:e074928. [PMID: 38642999 PMCID: PMC11033630 DOI: 10.1136/bmjopen-2023-074928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 09/11/2023] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVES This study aimed to assess the desire for smoke-free housing, determine the choice of smoke-free policies for multiunit housing (MUH), and identify the factors associated with policy choice among MUH residents in Bangladesh. DESIGN We conducted a cross-sectional study from April to November 2019 using a semi-structured survey questionnaire. SETTING This study was conducted in seven divisional cities of Bangladesh: Dhaka, Chattogram, Rajshahi, Khulna, Sylhet, Barishal, and Rangpur. PARTICIPANTS A total of 616 adult individuals living in MUH for at least 2 years participated in the study. PRIMARY OUTCOME MEASURE Multinomial logistic regression was used to identify the determinants of the choice of smoke-free policies for MUH. RESULTS Overall, 94.8% of the respondents wanted smoke-free housing. Among those who wanted smoke-free housing, 44.9% preferred a smoke-free building policy, 28.3% preferred a smoke-free common area policy, 20.2% favoured a smoke-free unit policy, and 6.7% did not know what policy they should choose. Three factors were found to be significantly associated with the choice of a smoke-free building policy: staying at home for more than 12 hours (adjusted OR (aOR): 2.6; 95% CI 1.035 to 6.493), being a non-smoker (aOR: 3.2; 95% CI 1.317 to 7.582), and having at least one family member who smoked (aOR: 3.0; 95% CI 1.058 to 8.422). Results also showed that residents having at least one child under 15 in the family (aOR: 0.3; 95% CI 0.152 to 0.778) were less likely to choose a smoke-free common area policy and that women (aOR: 3.7; 95% CI 1.024 to 13.188) were more likely to choose a smoke-free unit policy. CONCLUSIONS MUH residents in urban Bangladesh highly demanded smoke-free housing. Most residents favoured a smoke-free building policy for MUH. Those who stayed at home for a longer time, were non-smokers, and had smoking family members were more likely to choose this policy.
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Affiliation(s)
- Md Golam Kibria
- Department of Research, Centre for Development Action, Dhaka, Bangladesh
| | - Taslima Islam
- Department of Monitoring, Evaluation and Learning, Social Development Foundation, Dhaka, Bangladesh
- Centre for Development Action, Dhaka, Bangladesh
| | - Muhammad Badiuzzaman
- Centre for Development Action, Dhaka, Bangladesh
- Department of Research and Policy, Transparency International Bangladesh, Dhaka, Bangladesh
| | - Abdullah Al Mamun
- Centre for Development Action, Dhaka, Bangladesh
- High Court Division, Supreme Court of Bangladesh, Dhaka, Bangladesh
| | - Papia Sultana
- Centre for Development Action, Dhaka, Bangladesh
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
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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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Kibria MG, Hossain A, Islam T, Islam KR, Mahmud HMM, Nabi MH, Hawlader MDH. Secondhand smoke exposure and associated factors among city residents living in multiunit housing in Bangladesh. PLoS One 2023; 18:e0291746. [PMID: 37733729 PMCID: PMC10513191 DOI: 10.1371/journal.pone.0291746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 09/05/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Secondhand smoke (SHS) poses a high health risk to those living in multiunit housing (MUH) since it can easily spread from unit to unit and throughout the building's communal areas. MUH residents in Bangladesh are particularly vulnerable to SHS due to the absence of smoking restrictions within a housing complex. Therefore, this study aimed to assess the prevalence of SHS exposure and its associated factors among MUH residents living in seven divisional cities of Bangladesh- Dhaka, Chattogram, Rajshahi, Khulna, Sylhet, Barishal, and Rangpur. METHODS From April 2019 to November 2019, a cross-sectional survey was conducted with 616 MUH residents aged 18 or older who had been residing in MUH for at least two years in the seven divisional cities of Bangladesh. A multivariable logistic regression model was performed to determine the associated factors of SHS exposure. RESULTS In MUH complexes, more than half (54.9%) of the 616 respondents were exposed to SHS. The key factors positively associated with SHS exposure were females (aOR: 1.8, 95% CI:1.236-2.681), residents with a low monthly family income (aOR: 1.9, 95% CI: 1.162-3.220), those whose family members smoked (aOR: 2.4, 95% CI: 1.537-3.746), and Dhaka city residents (aOR: 1.9, 95% CI: 1.013-3.440). CONCLUSIONS This study revealed a high prevalence of SHS exposure among Bangladeshi MUH residents. Therefore, a smoking ban is needed in and around MUH complexes to protect non-smoking residents from SHS exposure.
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Affiliation(s)
- Md. Golam Kibria
- Department of Research, Centre for Development Action, Dhaka, Bangladesh
| | - Ahmed Hossain
- Health Services Administrations, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Taslima Islam
- Department of Research, Centre for Development Action, Dhaka, Bangladesh
- Department of Monitoring, Evaluation and Learning, Social Development Foundation, Dhaka, Bangladesh
| | - Kazi Rakibul Islam
- Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh
| | - H. M. Miraz Mahmud
- Department of Research & Evaluation, Bangladesh Center for Communication Programs, Dhaka, Bangladesh
| | | | - Mohammad Delwer Hossain Hawlader
- Department of Research, Centre for Development Action, Dhaka, Bangladesh
- Department of Public Health, North South University, Dhaka, Bangladesh
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Boderie NW, Sheikh A, Lo E, Sheikh A, Burdorf A, van Lenthe FJ, Mölenberg FJ, Been JV. Public support for smoke-free policies in outdoor areas and (semi-)private places: a systematic review and meta-analysis. EClinicalMedicine 2023; 59:101982. [PMID: 37256097 PMCID: PMC10225670 DOI: 10.1016/j.eclinm.2023.101982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 06/01/2023] Open
Abstract
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.
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Affiliation(s)
- Nienke W. Boderie
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Asiyah Sheikh
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Erika Lo
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Alex Burdorf
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Frank J. van Lenthe
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Famke J.M. Mölenberg
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Jasper V. Been
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Division of Neonatology, Department of Neonatal and Paediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
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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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Shearston JA, Eazor J, Lee L, Vilcassim MJR, Reed TA, Ort D, Weitzman M, Gordon T. Effects of electronic cigarettes and hookah (waterpipe) use on home air quality. Tob Control 2023; 32:36-41. [PMID: 34021062 PMCID: PMC10787574 DOI: 10.1136/tobaccocontrol-2020-056437] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/30/2021] [Accepted: 04/06/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION A major site of secondhand smoke exposure for children and adults is the home. Few studies have evaluated the impact of e-cigarette or hookah use on home air quality, despite evidence finding toxic chemicals in secondhand e-cigarette aerosols and hookah smoke. We assessed the effect of e-cigarette and hookah use on home air quality and compared it with air quality in homes where cigarettes were smoked and where no smoking or e-cigarette use occurred. METHODS Non-smoking homes and homes where e-cigarettes, hookah or cigarettes were used were recruited in the New York City area (n=57) from 2015 to 2019. Particulate matter with diameter less than 2.5 µm (PM2.5), black carbon and carbon monoxide (CO) were measured during a smoking or vaping session, both in a 'primary' smoking room and in an adjacent 'secondary' room where no smoking or vaping occurred. Log transformed data were compared with postanalysis of variance Tukey simultaneous tests. RESULTS Use of hookah significantly increased PM2.5 levels compared with non-smoking homes, in both the primary and secondary rooms, while use of e-cigarettes increased PM2.5 levels only in primary rooms. Additionally, in-home use of hookah resulted in greater CO concentrations than the use of cigarettes in primary rooms. CONCLUSIONS Use of e-cigarettes or hookah increases air pollution in homes. For hookah, increases in PM2.5 penetrated even into rooms adjacent to where smoking occurs. Extending smoke-free rules inside homes to include e-cigarette and hookah products is needed to protect household members and visitors from passive exposure to harmful aerosols and gases.
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Affiliation(s)
- Jenni A Shearston
- Department of Environmental Health Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - James Eazor
- Department of Pediatrics, New York University School of Medicine, New York, New York, USA
- Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA
| | - Lily Lee
- State University of New York Downstate Medical Center, New York, New York, USA
| | - M J Ruzmyn Vilcassim
- Department of Environmental Health Sciences, The University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA
| | - Taylor A Reed
- Department of Social Welfare, University of California Los Angeles, Los Angeles, California, USA
| | - Deborah Ort
- Nemours Children's Urgent Care, Orlando, Florida, USA
| | - Michael Weitzman
- Department of Pediatrics, New York University School of Medicine, New York, New York, USA
- New York University College of Global Public Health, New York, New York, USA
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, New York, New York, USA
- New York University College of Global Public Health, New York, New York, USA
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Farley SM, Jasek J, Debchoudhury I, Van Beck K, Talati A, Perlman SE, Thorpe LE. Housing type and secondhand tobacco smoke exposure among non-smoking New York City adults, 2004 and 2013–14. Prev Med Rep 2022; 27:101805. [PMID: 35656213 PMCID: PMC9152802 DOI: 10.1016/j.pmedr.2022.101805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 03/09/2022] [Accepted: 04/18/2022] [Indexed: 11/27/2022] Open
Abstract
Assessed association between housing type and cotinine level among non-smokers. Secondhand smoke exposure among New York City non-smokers has declined overtime. Odds of elevated cotinine doubled when living in multiunit housing in 2013/14.
Secondhand tobacco smoke (SHS) exposure has declined due to smoking reductions, expanding workplace and public smoke-free air laws, and smoke-free housing policy promotion. Population-based studies examining objective SHS exposure biomarkers have documented reductions over time, however non-smoking urban adults are more likely to have elevated cotinine (a metabolite of nicotine) compared with national averages. Evidence suggests residential housing type may impact urban SHS exposure risk. Direct associations between multiunit housing (MUH) and elevated cotinine have been identified among children but not yet examined among adults. We used data from the cross-sectional 2004 and 2013/14 New York City Health and Nutrition Examination Surveys to investigate associations between MUH (single-family versus 2; 3–99; and 100 + units) and likelihood of elevated serum cotinine among nonsmoking adults (2004: n = 1324; 2013/14: n = 946), adjusting for socio-demographics (sex, age, race/ethnicity, education, income) and self-reported SHS exposure variables. Combined and single-year adjusted multivariable regressions were conducted. Elevated cotinine was defined as a serum level of ≥ 0.05 ng/ml. Combined year adjusted multivariable regression analyses found no difference in elevated cotinine by housing type among non-smoking adults. By survey year, elevated cotinine did not vary by housing type in 2004, while non-smoking adults in 3–99 unit buildings were twice as likely to have elevated cotinine compared with single family residents in 2013/14 (adjusted Odds Ratio = 2.55 (1.13, 5.79)). While SHS exposure has declined, relative burden may be increasing among MUH residents. In urban settings with extensive MUH, attention to housing-based policies and programmatic interventions is critical to reducing SHS exposure.
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Affiliation(s)
- Shannon M. Farley
- New York City Department of Health and Mental Hygiene, New York, NY, USA
- Corresponding author at: Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, 42-09 28th St, Long Island City, NY 11101, USA.
| | - John Jasek
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | | | - Kellie Van Beck
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Achala Talati
- New York City Department of Health and Mental Hygiene, New York, NY, USA
| | - Sharon E. Perlman
- New York City Department of Health and Mental Hygiene, New York, NY, USA
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Wray JA, Sheehan BE, Rees VW, Cooper D, Morgan E, Plunk AD. A Qualitative Study of Unfairness and Distrust in Smoke-free Housing. Am J Health Behav 2021; 45:798-809. [PMID: 34702428 DOI: 10.5993/ajhb.45.5.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: Whereas smoke-free housing (SFH) has the potential to protect residents from tobacco smoke, evidence suggests that SFH could lead to increased indoor smoking. In this study, we examine how perceptions of a residential smoking ban could be related to non-compliance. Methods: We conducted 8 focus group interviews of low-income housing residents living in Norfolk, Virginia (N=53). Interviews were semi-structured and based on a list of guided questions related to SFH compliance, developed in partnership with a standing community advisory board comprised of low-income housing residents. Results: Several themes emerged, including pervasive non-compliance, perceived unfairness and shame, barriers to compliance, and distrust of the housing authority. Smokers reported behavior primarily motivated by punishment avoidance, rather than out of any perceived obligation to comply with the ban. Conclusions: Results led us to consider Procedural Justice Theory as a conceptual framework, in which compliance is directly related to perceptions about the legitimacy of a rule or authority. When compliance is low due to a lack of perceived legitimacy, SFH should be adapted to promote changes in smoking behavior. We offer specific theory-supported adaptations to SFH focused on trust-building and improving perceived fairness.
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Affiliation(s)
- Jasilyn A. Wray
- Jasilyn A. Wray, Research Coordinator, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Brynn E. Sheehan
- Brynn E. Sheehan, Assistant Professor, Healthcare Analytics and Delivery Science Institute, Eastern Virginia Medical School, Norfolk, VA, United States
| | - Vaughan W. Rees
- Vaughan W. Rees, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA, United States
| | - Diane Cooper
- Diane Cooper, Community Advisory Board, Norfolk, VA, United States
| | - Emma Morgan
- Emma Morgan, Community Advisory Board, Norfolk, VA, United States
| | - Andrew D. Plunk
- Andrew D. Plunk, Associate Professor, Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, United States;,
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Horn K, Johnson SB, Patiño SRG, Krost K, Gray T, Dearfield C, Du C, Bernat D. Implementation of the Department of Housing and Urban Development's Smoke-Free Rule: A Socio-Ecological Qualitative Assessment of Administrator and Resident Perceptions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8908. [PMID: 34501498 PMCID: PMC8431491 DOI: 10.3390/ijerph18178908] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/26/2022]
Abstract
In July 2018, the United States Department of Housing and Urban Development (HUD) implemented a mandatory smoke-free rule in public housing. This study assessed administrator and resident perceptions of rule implementation during its initial year in the District of Columbia Housing Authority (DCHA). Assessment included nine focus groups (n = 69) with residents and in-depth interviews with administrators (n = 7) and residents (n = 26) from 14 DCHA communities (family = 7 and senior/disabled = 7). Semi-structured discussion guides based on the multi-level socio-ecological framework captured dialogue that was recorded, transcribed verbatim, and coded inductively. Emerging major themes for each socio-ecological framework level included: (1) Individual: the rule was supported due to perceived health benefits, with stronger support among non-smokers; (2) Interpersonal: limiting secondhand smoke exposure was perceived as a positive for vulnerable residents; (3) Organizational: communication, signage, and cessation support was perceived as a need; (4) Community: residents perceived mobility, disability, weather, and safety-related issues as barriers; and (5) Public Policy: lease amendments were perceived as enablers of rule implementation but expressed confusion about violations and enforcement. A majority of administrators and residents reported favorable implications of the mandated HUD rule. The novel application of a socio-ecological framework, however, detected implementation nuances that required improvements on multiple levels, including more signage, cessation support, clarification of enforcement roles, and addressing safety concerns.
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Affiliation(s)
- Kimberly Horn
- Department of Population Health Sciences, Virginia Tech Carilion Research Institute, Riverside Circle, Roanoke, VA 24016, USA
| | - Sallie Beth Johnson
- Department of Public Health and Healthcare Leadership, Radford University Carilion, 101 Elm Avenue, SE, Roanoke, VA 24013, USA;
| | | | - Kevin Krost
- Department of Leadership, Counseling, and Research, Virginia Tech, Blacksburg, VA 24060, USA; (K.K.); (C.D.)
| | - Tiffany Gray
- Department of Epidemiology, The Milken Institute School of Public Health, The George Washington University, 905 New Hampshire Avenue, Northwest, Washington, DC 20052, USA; (T.G.); (C.D.); (D.B.)
| | - Craig Dearfield
- Department of Epidemiology, The Milken Institute School of Public Health, The George Washington University, 905 New Hampshire Avenue, Northwest, Washington, DC 20052, USA; (T.G.); (C.D.); (D.B.)
| | - Chenguang Du
- Department of Leadership, Counseling, and Research, Virginia Tech, Blacksburg, VA 24060, USA; (K.K.); (C.D.)
| | - Debra Bernat
- Department of Epidemiology, The Milken Institute School of Public Health, The George Washington University, 905 New Hampshire Avenue, Northwest, Washington, DC 20052, USA; (T.G.); (C.D.); (D.B.)
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Holmes LM, Llamas JD, Smith D, Ling PM. Drifting Tobacco Smoke Exposure among Young Adults in Multiunit Housing. J Community Health 2021; 45:319-328. [PMID: 31535264 DOI: 10.1007/s10900-019-00743-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study evaluated young adults' exposure to drifting secondhand smoke in San Francisco County housing units using the 2014 Bay Area Young Adult Health Survey (N = 1363). Logistic and geographically weighted regression models were used to determine whether residing in multiunit housing or in areas with greater neighborhood disorder were risk factors for exposure, and how drifting smoke exposure varied spatially within San Francisco County. Residing in buildings with five or more units significantly increased the odds of reporting drifting smoke exposure [OR (3.5 1.3, 9.9)], but neighborhood disorder did not have a significant association in the fully adjusted logistic regression model. At the local level, however, neighborhood disorder was significantly associated with exposure in lower income residential and downtown areas. Multiunit housing was significantly associated with exposure across all neighborhoods.
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Affiliation(s)
- Louisa M Holmes
- Department of Geography, State University of New York at Binghamton, 4400 Vestal Parkway E, Binghamton, NY, 13850, USA.
| | - Jasmin D Llamas
- School of Education and Counseling, Santa Clara University, Santa Clara, CA, USA
| | - Derek Smith
- Tobacco Free Project, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Pamela M Ling
- Center for Tobacco Control Research & Education, Department of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
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11
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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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12
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Proposal for smoke-free public housing: a systematic review of attitudes and preferences from residents of multi-unit housing. J Public Health Policy 2020; 41:496-514. [PMID: 32620837 DOI: 10.1057/s41271-020-00236-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A policy proposal to ban public housing smoking indoors has received support, but it is unclear how certain affected groups, specifically smokers in housing units, perceive such a policy. To review the literature on attitudes and perceptions of housing unit tenants towards an indoor smoke-free housing policy, using various databases, we searched articles for attitudes towards smoking ban enforcement in housing units. We identified fourteen articles. Non-smokers heavily favored indoor policies and current smokers heavily opposed them. Current smokers represented a substantial minority in the reviewed articles, resulting in overall outcomes of the surveys driven by non-smokers. Studies investigating attitudes about housing smoking bans largely represent the views of non-smokers and lack data about barriers and concerns of tenants who do not support a smoke-free policy. Future studies should investigate if such a discrepancy impacts the efficacy of smoke-free housing policies.
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Matt GE, Quintana PJE, Hoh E, Zakarian JM, Dodder NG, Record RA, Hovell MF, Mahabee-Gittens EM, Padilla S, Markman L, Watanabe K, Novotny TE. Persistent tobacco smoke residue in multiunit housing: Legacy of permissive indoor smoking policies and challenges in the implementation of smoking bans. Prev Med Rep 2020; 18:101088. [PMID: 32368436 PMCID: PMC7186560 DOI: 10.1016/j.pmedr.2020.101088] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/13/2020] [Accepted: 03/29/2020] [Indexed: 01/04/2023] Open
Abstract
Secondhand smoke (SHS) is a common indoor pollutant in multiunit housing (MUH). It is also the precursor of thirdhand smoke (THS), the toxic mixture of tobacco smoke residue that accumulates in indoor environments where tobacco has been used. This study examined the levels, distribution, and factors associated with THS pollution in low-income MUH. Interviews were conducted 2016-2018 in a cross-sectional study of N = 220 MUH homes in San Diego, California. Two surface wipe samples were collected per home and analyzed for nicotine, a THS marker, using liquid chromatography-triple quadrupole mass spectrometry. Nicotine was detected in all homes of nonsmokers with indoor smoking bans (Geo Mean = 1.67 µg/m2; 95% CI = [1.23;2.30]) and smokers regardless of an indoor ban (Geo Mean = 4.80 µg/m2; 95% CI = [1.89;12.19]). Approximately 10% of nonsmokers' homes with smoking bans showed nicotine levels higher than the average level in homes of smokers without smoking bans from previous studies (≥30 µg/m2). Housing for seniors, smoking bans on balconies, indoor tobacco use, difficult to reach surfaces, and self-reported African-American race/ethnicity were independently associated with higher THS levels. Individual cases demonstrated that high levels of surface nicotine may persist in nonsmoker homes for years after tobacco use even in the presence of indoor smoking bans. To achieve MUH free of tobacco smoke pollutants, attention must be given to identifying and remediating highly polluted units and to implementing smoking policies that prevent new accumulation of THS. As THS is a form of toxic tobacco product waste, responsibility for preventing and mitigating harmful impacts should include manufacturers, suppliers, and retailers.
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Affiliation(s)
- Georg E Matt
- San Diego State University Department of Psychology, San Diego, CA, USA
| | | | - Eunha Hoh
- San Diego State University School of Public Health, San Diego, CA, USA
| | - Joy M Zakarian
- San Diego State University Research Foundation, San Diego, CA, USA
| | - Nathan G Dodder
- San Diego State University Research Foundation, San Diego, CA, USA
| | - Rachael A Record
- San Diego State University School of Communication, San Diego, CA, USA
| | | | - E Melinda Mahabee-Gittens
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Samuel Padilla
- San Diego State University Research Foundation, San Diego, CA, USA
| | - Laura Markman
- San Diego State University School of Public Health, San Diego, CA, USA
| | - Kayo Watanabe
- San Diego State University School of Public Health, San Diego, CA, USA
| | - Thomas E Novotny
- San Diego State University School of Public Health, San Diego, CA, USA
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Anastasiou E, Feinberg A, Tovar A, Gill E, Ruzmyn Vilcassim MJ, Wyka K, Gordon T, Rule AM, Kaplan S, Elbel B, Shelley D, Thorpe LE. Secondhand smoke exposure in public and private high-rise multiunit housing serving low-income residents in New York City prior to federal smoking ban in public housing, 2018. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 704:135322. [PMID: 31787288 PMCID: PMC6939143 DOI: 10.1016/j.scitotenv.2019.135322] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/08/2019] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Tobacco remains the leading cause of preventable death in the United States, with 41,000 deaths attributable to secondhand smoke (SHS) exposure. On July 30, 2018, the U.S. Department of Housing and Urban Development passed a rule requiring public housing authorities to implement smoke-free housing (SFH) policies. OBJECTIVES Prior to SFH policy implementation, we measured self-reported and objective SHS incursions in a purposeful sample of 21 high-rise buildings (>15 floors) in New York City (NYC): 10 public housing and 11 private sector buildings where most residents receive federal housing subsidies (herein 'Section 8' buildings). METHODS We conducted a baseline telephone survey targeting all residents living on the 3rd floor or higher of selected buildings: NYC Housing Authority (NYCHA) residents were surveyed in April-July 2018 (n = 559), and residents in 'Section 8' buildings in August-November 2018 (n = 471). We invited non-smoking household participants to enroll into a longitudinal air monitoring study to track SHS exposure using: (1) nicotine concentration from passive, bisulfate-coated nicotine filters and (2) particulate matter (PM2.5) from low-cost particle monitors. SHS was measured for 7-days in non-smoking households (NYCHA n = 157, Section 8 n = 118 households) and in building common areas (n = 91 hallways and stairwells). RESULTS Smoking prevalence among residents in the 21 buildings was 15.5%. Two-thirds of residents reported seeing people smoke in common areas in the past year (67%) and 60% reported smelling smoke in their apartments coming from elsewhere. Most stairwells (88%) and hallways (74%) had detectable nicotine levels, but nicotine was detected in only 9.9% of non-smoking apartments. Substantial variation in nicotine and PM2.5 was observed between and within buildings; on average nicotine concentrations were higher in NYCHA apartments and hallways than in Section 8 buildings (p < 0.05), and NYCHA residents reported seeing smokers in common areas more frequently. CONCLUSIONS SFH policies may help in successfully reducing SHS exposure in public housing, but widespread pre-policy incursions suggest achieving SFH will be challenging.
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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; Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10027, USA.
| | - Alexis Feinberg
- Graduate School of Public Health and Health Policy, 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.
| | - M J Ruzmyn Vilcassim
- Department of Environmental Medicine, New York University School of Medicine, 341 East 25th Street, New York, NY 10010, USA.
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10027, USA.
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, 341 East 25th Street, New York, NY 10010, USA.
| | - Ana M Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe Street, Baltimore, MD 21205, USA.
| | - Sue Kaplan
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016, 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 St, New York, NY 10012, USA.
| | - Donna Shelley
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016, 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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15
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Phetphum C, Noosorn N. Prevalence of secondhand smoke exposure at home and associated factors among middle school students in Northern Thailand. Tob Induc Dis 2020; 18:11. [PMID: 32165877 PMCID: PMC7057047 DOI: 10.18332/tid/117733] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/30/2020] [Accepted: 02/01/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION One-third of youths in Thailand will be exposed to secondhand smoke (SHS) from family members who are smokers. This research aims to study the prevalence of and factors associated with SHS exposure at home among middle school students in Northern Thailand. METHODS This study used a cross-sectional survey. The sample was 780 middle school students in Northern Thailand. A self-administered questionnaire was used for data collection and analyses were performed using a chi-squared test and multiple logistic regression. RESULTS Of the respondents, 46.8% reported that they had been exposed to SHS at home. The main SHS sources were from fathers (45.4%), relatives (24.1%), siblings (12.4%), mothers (3.3%), and neighbours and guests (14.8%). The factors associated with SHS exposure at home included: household members who were smokers (OR=7.43; 95% CI: 5.17–10.68; p<0.001), home without a smoke-free rule (OR=3.40; 95% CI: 1.85–6.24; p<0.001), household members who were alcohol drinkers (OR=2.29; 95% CI: 1.59–3.30; p<0.001), and living in homes with ≤3 rooms (OR=1.79; 95% CI: 1.21–2.63; p=0.003). CONCLUSIONS Thai student’s exposure to SHS at home is high, especially when household members smoke and they live in a home without a smoke-free rule. Our findings highlight the need for policies and interventions to establish smoke-free homes.
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Affiliation(s)
- Chakkraphan Phetphum
- Department of Community Health, Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
| | - Narongsak Noosorn
- Department of Community Health, Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
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Debchoudhury I, Farley SM. Implementing Smoke-Free Housing Policies Among Multiunit Housing Owners in New York City Between 2012 and 2015. Tob Use Insights 2019; 12:1179173X19859355. [PMID: 31320807 PMCID: PMC6610436 DOI: 10.1177/1179173x19859355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/23/2019] [Indexed: 11/16/2022] Open
Abstract
Smoke-free regulations are the norm in workplaces and public outdoor areas across New York City (NYC), and smoke-free apartment building regulations are less widespread. In 2017, more than one-third (37.6%) of NYC multiunit housing (MUH) residents reported breathing secondhand smoke (SHS) from neighboring units. In 2015, the NYC Health Department conducted a cross-sectional phone survey among a random sample of NYC low-income and market-rate MUH property owners/managers as a follow-up to a 2012 study. The study compared owners' experiences and attitudes regarding smoke-free policies. Bivariate and multivariable logistic regression analyses were used. Overall, the proportion of owners who have a policy prohibiting smoking in individual units (33% vs 37%) increased between 2012 and 2015. In both waves, owners without low-income units (wave 1: 36%, wave 2: 40%) were more likely to have smoke-free housing policies than those with low-income units (wave 1: 26%, wave 2: 30%). The models adjusted for factors such as current smoking, size and nature of housing units, and several beliefs. Owners in 2015 were more likely to have a smoke-free policy (adjusted odds ratio [AOR]: 1.25, 95% confidence interval (CI): 1.003, 1.564) and, among those without a current smoke-free policy, to have future interest in smoke-free unit policies (AOR: 1.68, 95% CI: 1.17, 2.39) than in 2012. An increasing proportion of NYC MUH owners are reducing tenant exposure to SHS and providing them with a healthier environment. We expect to see further expansion of smoke-free housing in NYC as positive norms grow.
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Affiliation(s)
- Indira Debchoudhury
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Shannon M Farley
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
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17
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Cardozo RA, Feinberg A, Tovar A, Vilcassim MJR, Shelley D, Elbel B, Kaplan S, Wyka K, Rule AM, Gordon T, Thorpe LE. A protocol for measuring the impact of a smoke-free housing policy on indoor tobacco smoke exposure. BMC Public Health 2019; 19:666. [PMID: 31146711 PMCID: PMC6543633 DOI: 10.1186/s12889-019-7043-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 05/23/2019] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Tobacco remains a leading cause of preventable death in the U.S., responsible for more than 440,000 deaths each year. Approximately 10% of these deaths are attributable to exposure of non-smokers to secondhand smoke (SHS). Residents living in public multi-unit housing (MUH) are at excess risk for SHS exposure compared to the general population. On November 30, 2016, the U.S. Department of Housing and Urban Development (HUD) passed a rule requiring all public housing agencies to implement smoke-free housing (SFH) policies in their housing developments by July 30, 2018. METHODS As part of a larger natural experiment study, we designed a protocol to evaluate indoor SHS levels before and after policy implementation through collection of repeat indoor air samples in non-smoking apartments and common areas of select high-rise NYCHA buildings subject to the HUD SFH rule, and also from socio-demographically matched private-sector high-rise control buildings not subject to the rule. A baseline telephone survey was conducted in all selected buildings to facilitate rapid recruitment into the longitudinal study and assess smoking prevalence, behaviors, and attitudes regarding the SFH policy prior to implementation. Data collection began in early 2018 and will continue through 2021. DISCUSSION The baseline survey was completed by 559 NYCHA residents and 471 comparison building residents (response rates, 35, and 32%, respectively). Smoking prevalence was comparable between study arms (15.7% among NYCHA residents and 15.2% among comparison residents). The majority of residents reported supporting a building-wide smoke-free policy (63.0 and 59.9%, respectively). We enrolled 157 NYCHA and 118 comparison non-smoking households into the longitudinal air monitoring study and performed air monitoring in common areas. Follow up surveys and air monitoring in participant households occur every 6 months for 2.5 years. Capitalizing on the opportunity of this federal policy rollout, the large and diverse public housing population in NYC, and robust municipal data sources, this study offers a unique opportunity to evaluate the policy's direct impacts on SHS exposure. Methods in this protocol can inform similar SFH policy evaluations elsewhere.
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Affiliation(s)
- Rodrigo Arce Cardozo
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Alexis Feinberg
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Albert Tovar
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - M. J. Ruzmyn Vilcassim
- Department of Environmental Medicine, New York University School of Medicine, 341 East 25th Street, New York, NY 10010 USA
| | - Donna Shelley
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Brian Elbel
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Sue Kaplan
- Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY 10016 USA
| | - Katarzyna Wyka
- Graduate School of Public Health and Health Policy, City University of New York, New York, NY 10027 USA
| | - Ana M. Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, 615N Wolfe Street, Baltimore, MD 21205 USA
| | - Terry Gordon
- Department of Environmental Medicine, New York University School of Medicine, 341 East 25th Street, New York, NY 10010 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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18
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Kegler MC, Lea J, Lebow-Skelley E, Lefevre AM, Diggs P, Haard�rfer R. Implementation and enforcement of smoke-free policies in public housing. HEALTH EDUCATION RESEARCH 2019; 34:234-246. [PMID: 30624678 PMCID: PMC7526794 DOI: 10.1093/her/cyy053] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 12/19/2018] [Indexed: 06/09/2023]
Abstract
Smoke-free policies such as those required by the US Department of Housing and Urban Development have the potential to reduce persistent income-related disparities in secondhand smoke exposure. To understand the implementation and enforcement process, as well as barriers and facilitators to compliance and enforcement, we conducted semi-structured interviews (n=37) with representatives from 23 Public Housing Authorities (PHAs) with some level of smoking restriction in place, along with residents from 14 of these PHAs, from January to August 2016. Residents were typically notified of the new policy through group meetings, new resident orientations and/or one-on-one discussions during lease renewal or annual recertification. Timing of implementation varied, with advanced notice of 6 months or a year most common. Enforcement typically involved a series of verbal and/or written warnings, followed by written notice of lease violation, and eventual notice of lease termination and/or eviction. Challenges in enforcement were generally classified as monitoring difficulties or legal concerns. Characterizing current practices (e.g. advance notice, clear communication of escalating consequences, cessation support and concrete evidence of violation) from early adopters sets the stage for identifying best practices and helps to ensure successful and fair implementation of smoke-free policies in subsidized housing.
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Affiliation(s)
- Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA
| | - Jaimie Lea
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA
| | - Erin Lebow-Skelley
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA
| | - Adrienne M Lefevre
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA
| | - Pam Diggs
- Youth Empowered Solutions, 4021 Carya Dr., Raleigh, NC, USA
| | - Regine Haard�rfer
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, USA
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19
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Kim J, Lee E, Lee K, Kim K. Relationships Between Secondhand Smoke Incursion and Wheeze, Rhinitis, and Eczema Symptoms in Children Living in Homes Without Smokers in Multi-Unit Housing. Nicotine Tob Res 2019. [PMID: 29518241 DOI: 10.1093/ntr/nty027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Secondhand smoke (SHS) incursion can occur in units of multi-unit housing (MUH). The purpose of this study was to determine the relationship between SHS incursion and allergic symptoms in children living in MUH without smokers. METHODS We conducted a cross-sectional study from May to September 2015 in Seoul, Korea. Children were recruited from elementary schools, kindergartens, and daycare centers. In total, 16676 children between 1 and 13 years of age living in MUH without smokers were included in the analysis. Allergic symptoms during the previous 12 months (current wheeze, rhinitis, and eczema) and home environmental factors, including the frequency of SHS incursion during the previous 12 months, were examined using a questionnaire filled out by the parents or guardians of the children. RESULTS The prevalence of current allergic symptoms in children was 4.9% for wheeze, 42.0% for rhinitis, and 28.1% for eczema. The prevalence of SHS incursion into the children's homes was 61.6%. In a multivariable logistic regression analysis adjusted for demographic and home environmental factors, children living in homes with SHS incursion (either no more than once a month or more than once a month) were more likely to have current wheeze, rhinitis, and eczema than those with no SHS incursion. CONCLUSIONS More than half of the children's homes in MUH without smokers had SHS incursion. SHS incursion into homes was associated with wheeze, rhinitis, and eczema symptoms in children. IMPLICATIONS Children living in multi-unit housing (MUH) can be exposed to secondhand smoke (SHS) from smoke transferred from neighboring units with smokers. This study found that more than half of the children's homes without smokers in MUH had SHS incursion. Children living in homes with SHS incursion (either no more than once a month or more than once a month) were more likely to have current wheeze, rhinitis, and eczema than those with no SHS incursion. We confirmed that SHS incursion was associated with allergic symptoms in children.
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Affiliation(s)
- Jeonghoon Kim
- Department of Environmental Health Research, Seoul Medical Center, Seoul, South Korea.,Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Eunsun Lee
- Department of Environmental Health Research, Seoul Medical Center, Seoul, South Korea
| | - Kiyoung Lee
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, South Korea.,Institute of Health and Environment, Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - KyooSang Kim
- Department of Environmental Health Research, Seoul Medical Center, Seoul, South Korea
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20
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Anthony J, Goldman R, Rees VW, Frounfelker RL, Davine J, Keske RR, Brooks DR, Geller AC. Qualitative Assessment of Smoke-Free Policy Implementation in Low-Income Housing: Enhancing Resident Compliance. Am J Health Promot 2019; 33:107-117. [PMID: 29772910 PMCID: PMC10623451 DOI: 10.1177/0890117118776090] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE As public housing agencies and other low-income housing providers adopt smoke-free policies, data are needed to inform implementation approaches that support compliance. DESIGN Focused ethnography used including qualitative interviews with staff, focus groups with residents, and property observations. SETTING Four low-income housing properties in Massachusetts, 12 months postpolicy adoption. PARTICIPANTS Individual interviews (n = 17) with property staff (managers, resident service coordinators, maintenance, security, and administrators) and focus groups with resident smokers (n = 28) and nonsmokers (n = 47). MEASURES Informed by the social-ecological model: intrapersonal, interpersonal, organizational, and community factors relating to compliance were assessed. ANALYSIS Utilized MAXQDA in a theory-driven immersion/crystallization analytic process with cycles of raw data examination and pattern identification until no new themes emerged. RESULTS Self-reported secondhand smoke exposure (SHSe) was reduced but not eliminated. Challenges included relying on ambivalent maintenance staff and residents to report violations, staff serving as both enforcers and smoking cessation counsellors, and inability to enforce on nights and weekends. Erroneous knowledge of the policy, perception that SHSe is not harmful to neighbors, as well as believing that smokers were losing their autonomy and being unfairly singled out when other resident violations were being unaddressed, hindered policy acceptance among resident smokers. The greatest challenge to compliance was the lack of allowable outdoor smoking areas that may have reduced the burden of the policy on smokers. CONCLUSION Smoke-free policy implementation to support compliance could be enhanced with information about SHSe for smokers and nonsmokers, cessation support from external community partners, discussion forums for maintenance staff, resident inclusion in decision-making, and framing the policy as part of a broader wellness initiative.
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Affiliation(s)
- Jodi Anthony
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Roberta Goldman
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Vaughan W. Rees
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Rochelle L. Frounfelker
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Jessica Davine
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Robyn R. Keske
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Daniel R. Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Alan C. Geller
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
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Jiang N, Thorpe L, Kaplan S, Shelley D. Perceptions about the Federally Mandated Smoke-Free Housing Policy among Residents Living in Public Housing in New York City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102062. [PMID: 30241291 PMCID: PMC6210957 DOI: 10.3390/ijerph15102062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 09/12/2018] [Accepted: 09/18/2018] [Indexed: 11/20/2022]
Abstract
Background: To assess residents’ attitudes towards the United States (U.S.) Department of Housing and Urban Development’s new smoke-free public housing policy, perceptions about barriers to policy implementation, and suggestions for optimizing implementation. Methods: In 2017, we conducted 10 focus groups among 91 residents (smokers and nonsmokers) living in New York City public housing. Results: Smokers and nonsmokers expressed skepticism about the public housing authority’s capacity to enforce the policy due to widespread violations of the current smoke-free policy in common areas and pervasive use of marijuana in buildings. Most believed that resident engagement in the roll-out and providing smoking cessation services was important for compliance. Resident expressed concerns about evictions and worried that other building priorities (i.e., repairs, drug use) would be ignored with the focus now on smoke-free housing. Conclusions: Resident-endorsed strategies to optimize implementation effectiveness include improving the access to cessation services, ongoing resident engagement, education and communication to address misconceptions and concerns about enforcement, and placing smoke-free homes in a larger public housing authority healthy housing agenda.
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Affiliation(s)
- Nan Jiang
- Department of Population Health, School of Medicine, New York University, New York, NY 10016, USA.
| | - Lorna Thorpe
- Department of Population Health, School of Medicine, New York University, New York, NY 10016, USA.
| | - Sue Kaplan
- Department of Population Health, School of Medicine, New York University, New York, NY 10016, USA.
| | - Donna Shelley
- Department of Population Health, School of Medicine, New York University, New York, NY 10016, USA.
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22
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Hollar TL, Cook N, Quinn D, Phillips T, DeLucca M. Smoke-Free Multi-unit Housing Policies Show Promise in Reducing Secondhand Smoke Exposure Among Racially and Ethnically Diverse, Low-Income Seniors. J Immigr Minor Health 2018; 19:1281-1289. [PMID: 27189486 DOI: 10.1007/s10903-016-0430-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Secondhand smoke (SHS) exposure is a public health issue for residents of multi-unit housing (MUH) properties. We evaluated the impact of smoke-free policy implementation on reported SHS exposure among racially, ethnically diverse seniors living in low-income MUH properties. In Spring 2013 and Summer 2014, we surveyed residents (n = 960) at 15 MUH properties in Broward and Miami-Dade Counties, Florida. The percentage of residents reporting SHS exposure within their apartments from elsewhere in or around their building decreased from 31.1 %, before policy implementation, to 23.6 % at follow-up (p = 0.02). In multivariate analysis of non-smoking residents after policy implementation, residents who reported having one or more comorbidities were two times more likely to report SHS exposure (aOR 2.23, 95 % CI 1.12-4.40). Considering the vulnerability of low-income seniors to SHS exposure, our findings are relevant to residents, property owners/managers, and public health professionals making decisions about smoke-free policies for MUH properties in which seniors reside.
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Affiliation(s)
- T Lucas Hollar
- Master of Public Health Program, College of Osteopathic Medicine, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL, 33328, USA.
| | - Nicole Cook
- Master of Public Health Program, College of Osteopathic Medicine, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL, 33328, USA
| | - David Quinn
- Area Health Education Center, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Teina Phillips
- Broward Regional Health Planning Council, Hollywood, FL, USA
| | - Michael DeLucca
- Broward Regional Health Planning Council, Hollywood, FL, USA
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23
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Kegler MC, Lebow-Skelley E, Lea J, Lefevre AM, Diggs P, Herndon S, Haardörfer R. Developing Smoke-Free Policies in Public Housing: Perspectives From Early Adopters in 2 Southern States. Prev Chronic Dis 2018; 15:E83. [PMID: 29935078 PMCID: PMC6016427 DOI: 10.5888/pcd15.170427] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE AND OBJECTIVES In 2016, the US Department of Housing and Urban Development (HUD) issued a new rule requiring smoke-free policies in conventional public housing by July 2018 (HUD, 2016). This process evaluation describes the policy development experiences of conventional and nonconventional public housing authorities (PHAs) in North Carolina and Georgia that had established smoke-free policies before the HUD rule. INTERVENTION APPROACH HUD began to issue guidance that encouraged smoke-free policies in public housing in 2009, and most early adopters were outside of the Southeast. Documenting the process early adopters in the Southeast used to develop their policies provides useful lessons for conventional PHAs and those with properties not covered by the rule. EVALUATION METHODS Semi-structured interviews were conducted with PHA representatives from 23 PHAs with some level of smoking restriction, along with residents from 14 of these PHAs, from January to August 2016. RESULTS Organizational leaders and board members were usually the primary players in making the decision to adopt a policy, with approval processes consistent with any type of policy adoption. Common reasons for establishing the policy included costs of turning a unit; health of children, nonsmokers, and staff; HUD guidance; and concerns or experience with fire caused by cigarettes. Levels of restriction were influenced by layout of the property, perceptions of compliance and enforcement challenges, concerns about smokers congregating, resident mobility, weather concerns, consistency with HUD guidance, and availability of funds for designated smoking areas. Resident input was obtained through general meetings, resident advisory boards or councils, surveys, and formal comment periods. IMPLICATIONS FOR PUBLIC HEALTH Understanding the process of policy development and adoption enables public health practitioners to be more effective partners in advising on the flexible components of the HUD smoke-free rule and accelerating the adoption of comprehensive policies within nonconventional PHAs.
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Affiliation(s)
- Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322.
| | - Erin Lebow-Skelley
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jaimie Lea
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Tobacco Prevention and Control Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Adrienne M Lefevre
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Pam Diggs
- Youth Empowered Solutions, Raleigh, North Carolina
| | - Sally Herndon
- Tobacco Prevention and Control Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
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24
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Gentzke AS, Hyland A, Kiviniemi M, Travers MJ. Attitudes and experiences with secondhand smoke and smoke-free policies among subsidised and market-rate multiunit housing residents living in six diverse communities in the USA. Tob Control 2018; 27:194-202. [PMID: 28302920 PMCID: PMC5844180 DOI: 10.1136/tobaccocontrol-2016-053374] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 01/16/2017] [Accepted: 02/14/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Given that higher smoking rates persist among lower socioeconomic populations, multiunit housing (MUH) environments may result in higher secondhand smoke (SHS) exposures among subsidised MUH residents. This cross-sectional assessment compares experiences with SHS and smoke-free policies among subsidised and market-rate MUH residents living in six US communities. METHODS MUH residents (n=1565) were surveyed regarding their smoke-free rules (home and building), SHS exposures and preferences towards smoke-free policies. Binary logistic regression identified predictors of each outcome, focusing on differences by subsidised housing status (subsidised vs market rate). RESULTS Among residents enforcing smoke-free home rules (76%, overall), 50% reported SHS incursions into their unit. Only 23% reported living in a smoke-free building; 56% of those living in smoking-allowable buildings reported preferences towards smoke-free building policies. Among market-rate housing residents, smoke-free home (OR=4.18) and building (OR=2.26) rules were significantly higher when children were present. Smoke-free building rules reduced the odds of SHS incursions among market-rate housing residents (OR=0.50), but no association was observed among subsidised housing residents. Non-smoking subsidised housing residents exhibited stronger preferences for smoke-free policies compared with those in market-rate housing. DISCUSSION Smoke-free home rules may not protect MUH residents from SHS exposures, particularly in subsidised MUH. Although strong preferences towards smoke-free policies were present overall, subsidised MUH residents may have fewer alternative smoke-free housing options available. Therefore, all publicly funded housing should be smoke free to protect these vulnerable populations. However, continued efforts to encourage privately owned MUH operators to adopt smoke-free policies are also necessary.
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Affiliation(s)
- Andrea S. Gentzke
- Department of Health Behavior, Roswell Park Cancer Institute. Buffalo, NY, USA
- Department of Epidemiology and Environmental Health, State University of New York at Buffalo. Buffalo, NY, USA
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Cancer Institute. Buffalo, NY, USA
| | - Marc Kiviniemi
- Department of Community Health and Health Behavior, State University of New York at Buffalo. Buffalo, NY USA
| | - Mark J. Travers
- Department of Health Behavior, Roswell Park Cancer Institute. Buffalo, NY, USA
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25
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Wang TW, Lemos PR, McNabb S, King BA. Attitudes Toward Smoke-Free Public Housing Among U.S. Adults, 2016. Am J Prev Med 2018; 54:113-118. [PMID: 29153476 PMCID: PMC5957281 DOI: 10.1016/j.amepre.2017.08.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/28/2017] [Accepted: 08/22/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Effective February 2017, the U.S. Department of Housing and Urban Development published a rule requiring each public housing agency to implement a smoke-free policy within 18 months. This study assessed the prevalence and determinants of favorability toward smoke-free public housing among U.S. adults. METHODS Data from 2016 Summer Styles, a nationally representative web-based survey conducted among adults (N=4,203) were analyzed in 2017. Participants were asked: Do you favor or oppose prohibiting smoking in public housing, including all indoor areas of living units, common areas, and office buildings, as well as in all outdoor areas within 25 feet of buildings? Multivariate Poisson regression was used to calculate adjusted prevalence ratios of favorability (strongly or somewhat). RESULTS Overall, 73.7% of respondents favored smoke-free public housing. Favorability was 44.3% among current cigarette smokers, 73.2% among former smokers, and 80.4% among never smokers. The adjusted likelihood of favorability was greater among non-Hispanic, non-black racial/ethnic minorities than whites, and among those in the West than the Northeast (p<0.05). Favorability was lower among adults with a high school education or less compared with those with a college degree, adults with annual household income <$15,000 than those with income ≥$60,000, multiunit housing residents than non-multiunit housing residents, current cigarette smokers than never smokers, and current non-cigarette tobacco product users than never users (p<0.05). CONCLUSIONS Most U.S. adults favor prohibiting smoking in public housing. These data can inform the implementation and sustainment of smoke-free policies to reduce the public health burden of tobacco smoking in public housing.
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Affiliation(s)
- Teresa W Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia; Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Pamela R Lemos
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Simon McNabb
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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26
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Wilson KM, Torok MR, McMillen RC, Klein JD, Levy DE, Winickoff JP. Tobacco-Smoke Incursions and Satisfaction Among Residents With Children in Multiunit Housing, United States, 2013. Public Health Rep 2017; 132:637-645. [PMID: 28977766 PMCID: PMC5692161 DOI: 10.1177/0033354917732767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Residents of multiunit housing can be exposed to tobacco smoke even if they do not permit smoking in their homes. Although even low levels of tobacco smoke exposure can cause health problems for children and adults, some landlords are reluctant to ban smoking for fear of decreased occupancy rates or tenant satisfaction. The objective of this study was to assess the impact of tobacco smoke-free policies and tobacco-smoke incursions on housing satisfaction in multiunit housing residences with children. METHODS In 2013, 3696 randomly sampled US adult multiunit housing dwellers were invited to participate in a survey, and 3253 (88%) participated. Of these, 3128 responded to the question about having a child in the home, and 835 (27%) reported having a child in the home. We collected data on demographic characteristics, tobacco-smoke incursions, knowledge and attitudes about smoking policies, and housing satisfaction for this sample of 835 residents. RESULTS Of the 827 residents who responded to the question, 755 (91.3%) agreed that tenants have a right to live in a tobacco smoke-free building. Although 672 of 835 (80.5%) residents were not cigarette smokers, most lived where smoking was permitted in the units (n = 463, 56.9%) or on the property (n = 571, 70.5%). Of 580 non-cigarette smoking residents who lived where no one had smoked cigarettes in the home for the past 3 months, 144 (25.2%) reported a recent tobacco-smoke incursion. Of these 144 residents, 143 (99%) were bothered. Few (36/143, 25.2%) complained to the landlord. Reasons for not complaining were reluctance to upset neighbors or concern about retaliation. Tobacco-smoke incursions and housing/landlord satisfaction were inversely related ( P < .05). CONCLUSION Multiunit housing residents living with children in the United States strongly support smoke-free multiunit housing.
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Affiliation(s)
- Karen M. Wilson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- American Academy of Pediatrics Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
| | - Michelle R. Torok
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Denver, CO, USA
| | - Robert C. McMillen
- American Academy of Pediatrics Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
- Department of Psychology, Mississippi State University, Starkville, MS, USA
| | - Jonathan D. Klein
- American Academy of Pediatrics Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
| | - Douglas E. Levy
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan P. Winickoff
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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27
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Kim J, Lee K, Kim K. Factors associated with secondhand smoke incursion into the homes of non-smoking residents in a multi-unit housing complex: a cross-sectional study in Seoul, Korea. BMC Public Health 2017; 17:739. [PMID: 28946863 PMCID: PMC5613333 DOI: 10.1186/s12889-017-4774-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 09/19/2017] [Indexed: 11/30/2022] Open
Abstract
Background In a multi-unit housing (MUH) complex, secondhand smoke (SHS) can pass from one living space to another. The aim of this study was to determine the prevalence of SHS incursion, and to establish the relationship between SHS incursion and socio-demographic and built environmental factors in MUH in Korea. Methods A population-based sample of 2600 residents (aged ≥19 years) living in MUH from across the city of Seoul, Korea, was obtained through a web-based selection panel. The residents completed a questionnaire detailing socio-demographic factors, smoking status, frequency of SHS incursion, and built environmental factors. The presence of a personal smoke-free home rule was determined by residents declaring that no one smoked inside the home. Results Of the 2600 participants, non-smoking residents who lived in homes with a personal smoke-free rule were selected for further analysis (n = 1784). In the previous 12 months, 74.7% of residents had experienced SHS incursion ≥1 times. A multivariate ordinal logistic regression analysis indicated that residents who spent more time at home, lived with children, supported the implementation of smoke-free regulations in MUH, lived in small homes, lived in homes with natural ventilation provided by opening a front door or the windows and front door, and lived in homes with more frequent natural ventilation were more likely to report SHS incursion into their homes. Conclusions The majority of the non-smoking residents experienced SHS incursion, even with a personal smoke-free rule in their homes. A smoke-free policy in MUH is needed to protect residents from SHS exposure when they are at home. Electronic supplementary material The online version of this article (10.1186/s12889-017-4774-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeonghoon Kim
- Department of Environmental Health Research, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul, 02053, Republic of Korea.,Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Kiyoung Lee
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.,Institute of Health and Environment, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - KyooSang Kim
- Department of Environmental Health Research, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul, 02053, Republic of Korea.
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Jenssen BP, Wilson KM. Tobacco Control and Treatment for the Pediatric Clinician: Practice, Policy, and Research Updates. Acad Pediatr 2017; 17:233-242. [PMID: 28069410 DOI: 10.1016/j.acap.2016.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 11/30/2016] [Accepted: 12/17/2016] [Indexed: 12/15/2022]
Abstract
Tobacco use is the leading cause of preventable death in the United States, and exposure to tobacco smoke harms children from conception forward. There is no safe level of tobacco exposure. Although overall smoking rates have declined, the advent of new products, such as electronic cigarettes, threatens to perpetuate nicotine addiction without clear health benefits. In addition to reviewing traditional and new tobacco products, we discuss the unique role that pediatricians should play in tobacco treatment and control efforts. New policies and technologies can empower pediatric clinicians and pediatric health care systems to help parent smokers quit, and new policies outside of the health care setting might help prevent smoking initiation as well as improve cessation treatments. Future research is needed to continue to study the consequences of tobacco use exposure as well as the best ways to help patients and parents stop tobacco use.
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Affiliation(s)
- Brian P Jenssen
- Department of Pediatrics, University of Pennsylvania School of Medicine and PolicyLab, The Children's Hospital of Philadelphia.
| | - Karen M Wilson
- Division of General Pediatrics, Kravis Children's Hospital at Mount Sinai, New York, NY
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29
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Nguyen KH, Gomez Y, Homa DM, King BA. Tobacco Use, Secondhand Smoke, and Smoke-Free Home Rules in Multiunit Housing. Am J Prev Med 2016; 51:682-692. [PMID: 27423656 PMCID: PMC5821129 DOI: 10.1016/j.amepre.2016.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/03/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Multiunit housing (MUH) residents are particularly susceptible to involuntary secondhand smoke (SHS) exposure in their home, which can enter their living units from nearby units and shared areas where smoking occurs. To date, no study has assessed non-cigarette tobacco use among MUH residents. This study assessed the prevalence and sociodemographic correlates of tobacco use (combustible, noncombustible, any tobacco use including electronic cigarettes), smoke-free home rules, and SHS incursions among U.S. MUH residents. METHODS Data came from the 2013-2014 National Adult Tobacco Survey, a telephone survey of U.S. adults aged ≥18 years. Analyses were conducted in 2015. Prevalence of current tobacco use and smoke-free home rules were assessed overall and by sociodemographics, stratified by housing type (single family versus MUH). Prevalence and adjusted odds of SHS incursions among MUH residents with smoke-free home rules were assessed. RESULTS Tobacco use was higher among adults living in MUH (24.7%) than those in single-family housing (18.9%, p<0.05). Smoke-free home rules were higher among adults living in single-family housing (86.7%) than those in MUH (80.9%, p<0.05). Among MUH residents with smoke-free homes, 34.4% experienced SHS incursions. Adjusted odds of SHS incursions were greater among women, younger adults, non-Hispanic blacks, Hispanics, and those with lower income. CONCLUSIONS One quarter of MUH residents use tobacco, and one third of MUH residents with smoke-free rules experience SHS incursions. Interventions are warranted to promote tobacco cessation and smoke-free building policies to protect all MUH residents, employees, and visitors from the dangers of tobacco use and SHS.
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Affiliation(s)
- Kimberly H Nguyen
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Yessica Gomez
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David M Homa
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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MacNaughton P, Adamkiewicz G, Arku RE, Vallarino J, Levy DE. The impact of a smoke-free policy on environmental tobacco smoke exposure in public housing developments. THE SCIENCE OF THE TOTAL ENVIRONMENT 2016; 557-558:676-680. [PMID: 27037889 PMCID: PMC4856038 DOI: 10.1016/j.scitotenv.2016.03.110] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/11/2016] [Accepted: 03/16/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Smoke-free housing policies have the potential to reduce secondhand smoke (SHS) exposures for residents of multi-unit housing. Since common areas represent a pathway of SHS movement between units, smoke-free policies would be expected to reduce SHS in these microenvironments. METHODS Week-long air nicotine and PM2.5 (particulate matter below 2.5μm in aerodynamic diameter) samples were collected in the common areas of 10 Boston Housing Authority (BHA) and 6 Cambridge Housing Authority (CHA) buildings from January 2012 to October 2013. We also measured one outdoor PM level at each study building. Samples from BHA included pre and post- smoke-free policy measurements. Each development was visited three times over the course of the study period. The effect of the smoking ban on indoor PM2.5 was examined using generalized mixed effect models to accommodate repeated measurement at each site. Changes in nicotine concentrations were modeled using quantile mixed regression to reduce the impact of outliers. RESULTS After controlling for season, site, and background PM2.5 concentrations, PM2.5 levels were 4.05μg/m(3) (p-value=0.09) lower in BHA after the smoke-free policy was implemented in the summer of 2012, compared with CHA developments, which had no smoking policy in place. Similarly, nicotine levels decreased by 57% (p-value=0.08) in Boston relative to Cambridge after the ban. CONCLUSIONS Our findings support the use of smoke-free policies as an effective tool to reduce SHS exposure and protect non-smokers, especially residents of multi-unit housing.
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Affiliation(s)
- Piers MacNaughton
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Raphael E Arku
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jose Vallarino
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Douglas E Levy
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA; Department of Medicine, Harvard Medical School, Boston, MA, USA
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Fang SC, Chen S, Trachtenberg F, Rokicki S, Adamkiewicz G, Levy DE. Validity of Self-Reported Tobacco Smoke Exposure among Non-Smoking Adult Public Housing Residents. PLoS One 2016; 11:e0155024. [PMID: 27171392 PMCID: PMC4865127 DOI: 10.1371/journal.pone.0155024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/22/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Tobacco smoke exposure (TSE) in public multi-unit housing (MUH) is of concern. However, the validity of self-reports for determining TSE among non-smoking residents in such housing is unclear. METHODS We analyzed data from 285 non-smoking public MUH residents living in non-smoking households in the Boston area. Participants were interviewed about personal TSE in various locations in the past 7 days and completed a diary of home TSE for 7 days. Self-reported TSE was validated against measurable saliva cotinine (lower limit of detection (LOD) 0.02 ng/ml) and airborne apartment nicotine (LOD 5 ng). Correlations, estimates of inter-measure agreement, and logistic regression assessed associations between self-reported TSE items and measurable cotinine and nicotine. RESULTS Cotinine and nicotine levels were low in this sample (median = 0.026 ng/ml and 0.022 μg/m(3), respectively). Prevalence of detectable personal TSE was 66.3% via self-report and 57.0% via measurable cotinine (median concentration among those with cotinine>LOD: 0.057 ng/ml), with poor agreement (kappa = 0.06; sensitivity = 68.9%; specificity = 37.1%). TSE in the home, car, and other peoples' homes was weakly associated with cotinine levels (Spearman correlations rs = 0.15-0.25), while TSE in public places was not associated with cotinine. Among those with airborne nicotine and daily diary data (n = 161), a smaller proportion had household TSE via self-report (41.6%) compared with measurable airborne nicotine (53.4%) (median concentration among those with nicotine>LOD: 0.04 μg/m(3)) (kappa = 0.09, sensitivity = 46.5%, specificity = 62.7%). CONCLUSIONS Self-report alone was not adequate to identify individuals with TSE, as 31% with measurable cotinine and 53% with measurable nicotine did not report TSE. Self-report of TSE in private indoor spaces outside the home was most associated with measurable cotinine in this low-income non-smoking population.
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Affiliation(s)
- Shona C. Fang
- New England Research Institutes, Inc., Watertown, MA, United States of America
| | - Shan Chen
- New England Research Institutes, Inc., Watertown, MA, United States of America
| | | | - Slawa Rokicki
- Interfaculty Initiative in Health Policy, Harvard University, Cambridge, MA, United States of America
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Douglas E. Levy
- Mongan Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States of America
- * E-mail:
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Rokicki S, Adamkiewicz G, Fang SC, Rigotti NA, Winickoff JP, Levy DE. Assessment of Residents' Attitudes and Satisfaction Before and After Implementation of a Smoke-Free Policy in Boston Multiunit Housing. Nicotine Tob Res 2016; 18:1282-1289. [PMID: 26508397 PMCID: PMC6407845 DOI: 10.1093/ntr/ntv239] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 10/18/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION In 2012, the Boston Housing Authority (BHA) in Massachusetts implemented a smoke-free policy prohibiting smoking within its residences. We sought to characterize BHA resident experiences before and after the smoke-free policy implementation, and compare them to that of nearby residents of the Cambridge Housing Authority, which had no such policy. METHODS We recruited a convenience sample of nonsmoking residents from the BHA and Cambridge Housing Authority. We measured residents' awareness and support of their local smoking policies before and 9-12 months after the BHA's policy implementation, as well as BHA respondents' attitudes towards the smoke-free policy. We assessed tobacco smoke exposure via saliva cotinine, airborne apartment nicotine, and self-reported number of days smelling smoke in the home. We evaluated predictors of general satisfaction at follow-up using linear regression. RESULTS At follow-up, 91% of BHA respondents knew that smoking was not allowed in apartments and 82% were supportive of such a policy in their building. BHA residents believed enforcement of the smoke-free policy was low. Fifty-one percent of BHA respondents indicated that other residents "never" or "rarely" followed the new smoke-free rule and 41% of respondents were dissatisfied with policy enforcement. Dissatisfaction with enforcement was the strongest predictor of general housing satisfaction, while objective and self-reported measures of tobacco smoke exposure were not predictive of satisfaction. At follow-up, 24% of BHA participants had complained to someone in charge about policy violations. CONCLUSIONS Resident support for smoke-free policies is high. However, lack of enforcement of smoke-free policies may cause frustration and resentment among residents, potentially leading to a decrease in housing satisfaction. IMPLICATIONS Smoke-free housing laws are becoming increasingly prevalent, yet little is known about satisfaction and compliance with such policies post-implementation. We evaluated nonsmoking residents' attitudes about smoke-free rules and their satisfaction with enforcement 1 year after the BHA implemented its comprehensive smoke-free policy. We found that while residents were supportive of the policy, they believed enforcement was low, a perception that was associated with a drop in housing satisfaction. Our findings point to a desire for smoke-free housing among public housing residents, and the importance of establishing systems and guidelines to help landlords monitor and enforce these policies effectively.
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Affiliation(s)
- Slawa Rokicki
- Interfaculty Initiative in Health Policy, Harvard University
,
Cambridge, MA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health
,
Boston, MA
| | - Shona C. Fang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health
,
Boston, MA
- New England Research Institutes, Inc
,
Watertown, MA
| | - Nancy A. Rigotti
- Mongan Institute for Health Policy, Massachusetts General Hospital
,
Boston, MA
- Tobacco Research and Treatment Center, Massachusetts General Hospital
,
Boston, MA
- Department of Medicine, Harvard Medical School
,
Boston, MA
| | - Jonathan P. Winickoff
- Tobacco Research and Treatment Center, Massachusetts General Hospital
,
Boston, MA
- Department of Medicine, Harvard Medical School
,
Boston, MA
- Division of General Academic Pediatrics and Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital
,
Boston, MA
| | - Douglas E. Levy
- Mongan Institute for Health Policy, Massachusetts General Hospital
,
Boston, MA
- Tobacco Research and Treatment Center, Massachusetts General Hospital
,
Boston, MA
- Department of Medicine, Harvard Medical School
,
Boston, MA
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Farley SM, Schroth KRJ, Curtis CJ, Angell S. Evidence of Support for Smoke-Free Public Housing Among New York City Residents. Public Health Rep 2016; 131:2-3. [PMID: 26843660 DOI: 10.1177/003335491613100102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
| | | | | | - Sonia Angell
- New York City Department of Health and Mental Hygiene
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Leung LT, Ho SY, Wang MP, Lo WS, Lam TH. Exposure to secondhand smoke from neighbours and respiratory symptoms in never-smoking adolescents in Hong Kong: a cross-sectional study. BMJ Open 2015; 5:e008607. [PMID: 26537497 PMCID: PMC4636600 DOI: 10.1136/bmjopen-2015-008607] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/04/2015] [Accepted: 07/31/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To investigate secondhand smoke (SHS) exposure at home from neighbours in Hong Kong adolescents and its association with respiratory symptoms in never-smokers. DESIGN A cross-sectional study. SETTING 79 randomly selected secondary schools in Hong Kong. PARTICIPANTS 61,810 secondary 1 (USA grade 7) to 7 students, in which 50,762 never-smokers were identified and included in the analysis of the association between SHS exposure at home from neighbours and respiratory symptoms. MAIN OUTCOME MEASURES Smoking status, family smoking status, SHS exposure at home from inside the home and from neighbours in the past 7 days, respiratory symptoms and sociodemographic characteristics were reported. Adjusted ORs (AORs) of respiratory symptoms for SHS exposure from the 2 sources in never-smokers were calculated using logistic regression. RESULTS In all students, 33.2% were exposed to SHS at home, including 16.2% from inside the home only, 10.0% from neighbours only and 7.0% from both. The prevalence of SHS exposure from neighbours was 17.1%, including 13.5% for 1-4 days/week and 3.6% for 5-7 days/week. In never-smokers (n=50,762), respiratory symptoms were significantly associated with SHS exposure from neighbours with AORs (95% CI) of 1.29 (1.20 to 1.39) for any exposure (p<0.001), 1.21 (1.12 to 1.31) for 1-4 days/week (p<0.001) and 1.63 (1.44 to 1.86) for 5-7 days/week (p<0.001) (P for trend <0.001). Compared with no SHS exposure at home from any source, the AORs were 1.16 (1.07 to 1.25) for SHS from inside the home only (p<0.001), 1.20 (1.11 to 1.31) from neighbours only (p<0.001), and 1.74 (1.56 to 1.94) from both (p<0.001). CONCLUSIONS SHS exposure at home from neighbours was prevalent in Hong Kong adolescents, and was associated with respiratory symptoms in never-smokers. SHS exposure at home may be underestimated by ignoring the neighbouring source. Smoke-free housing policy is needed to protect children and adolescents from harms of SHS.
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Affiliation(s)
- Lok Tung Leung
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Wing Sze Lo
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong
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Farber HJ, Nelson KE, Groner JA, Walley SC. Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke. Pediatrics 2015; 136:998-1007. [PMID: 26504133 DOI: 10.1542/peds.2015-3109] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Tobacco use and tobacco smoke exposure are among the most important health threats to children, adolescents, and adults. There is no safe level of tobacco smoke exposure. The developing brains of children and adolescents are particularly vulnerable to the development of tobacco and nicotine dependence. Tobacco is unique among consumer products in that it causes disease and death when used exactly as intended. Tobacco continues to be heavily promoted to children and young adults. Flavored and alternative tobacco products, including little cigars, chewing tobacco, and electronic nicotine delivery systems are gaining popularity among youth. This statement describes important evidence-based public policy actions that, when implemented, will reduce tobacco product use and tobacco smoke exposure among youth and, by doing so, improve the health of children and young adults.
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Abstract
This technical report serves to provide the evidence base for the American Academy of Pediatrics' policy statements "Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke" and "Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke." Tobacco use and involuntary exposure are major preventable causes of morbidity and premature mortality in adults and children. Tobacco dependence almost always starts in childhood or adolescence. Electronic nicotine delivery systems are rapidly gaining popularity among youth, and their significant harms are being documented. In utero tobacco smoke exposure, in addition to increasing the risk of preterm birth, low birth weight, stillbirth, placental abruption, and sudden infant death, has been found to increase the risk of obesity and neurodevelopmental disorders. Actions by pediatricians can help to reduce children's risk of developing tobacco dependence and reduce children's involuntary tobacco smoke exposure. Public policy actions to protect children from tobacco are essential to reduce the toll that the tobacco epidemic takes on our children.
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Cook NJ, Hollar L, Chavez S, Quinn DL, Phillips T, DeLucca M, Corrales L. Support for smoke-free multi-unit housing policies among racially and ethnically diverse, low-income seniors in South Florida. J Cross Cult Gerontol 2015; 29:405-15. [PMID: 25349018 PMCID: PMC4228194 DOI: 10.1007/s10823-014-9247-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Previous studies have gauged support for implementing smoke-free multi-unit housing (MUH) policies in the United States, but none have specifically examined attitudes among racially and ethnically diverse elders living in low-income MUH. We surveyed a convenience sample of elders 62 years of age and older (n = 807) across 24 low-income housing properties in Broward County, Florida in order to assess residents' smoking behaviors, exposure to second-hand smoke, and support for smoke-free policies. The study sample was ethnically and racially diverse with Hispanics comprising more than 61 % of the population, and 22 % identifying as Black or other races. Although close to 22 % of the sample were former smokers, only 9 % of residents reported being current smokers. The majority of residents surveyed supported no-smoking policies: 75 % support no-smoking policies for individual units; 77 % supported no-smoking policies in common areas; and, 68 % supported no-smoking policies in outdoor areas. Over 29 % of residents surveyed reported being exposed to secondhand smoke entering their units from elsewhere in their building. Residents who reported having a home smoking rule were more than twice as likely to support an indoor policy compared to residents who allowed smoking anywhere in their home (OR = 2.36; 95%CI 1.25-4.43; p ≤ 0.01), and nonsmoking residents were nearly three times as likely to support an indoor policy compared to smokers (OR = 2.89; 95%CI 1.44-5.79; p ≤ 0.01). Support for an indoor policy was not modified by age, gender, ethnicity or race. . This study demonstrates that elders living in low-income MUH properties overwhelmingly supported the implementation of smoke-free policies.
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Affiliation(s)
- Nicole J Cook
- Master of Public Health Program, College of Osteopathic Medicine, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL, 33328, USA,
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Berg CJ, Haardörfer R, Windle M, Solomon M, Kegler MC. Smoke-Free Policies in Multiunit Housing: Smoking Behavior and Reactions to Messaging Strategies in Support or in Opposition. Prev Chronic Dis 2015; 12:E98. [PMID: 26111158 PMCID: PMC4492220 DOI: 10.5888/pcd12.140479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Given the high proportion of US adults living in multiunit housing (MUH) and the related risks of secondhand smoke, we examined correlates of having smoke-free MUH policies, level of support for such policies, and reactions to related messaging among a quota-based nonprobability sample of US adults. METHODS In 2013, 752 adult MUH residents were recruited through an online survey panel to complete a cross-sectional survey assessing tobacco use, personal smoke-free policies in homes and cars, smoke-free MUH policies, and reactions to messaging on smoke-free MUH policies. We sought sufficient representation of smokers, racial/ethnic minorities, and residents of the Southeast. RESULTS Overall, 56.3% had no smoke-free MUH policies and 16.2% had complete policies; 62.8% favored living in smoke-free MUH, and 28.9% said they would move if their building became smoke-free. Multivariate regression indicated that correlates of living in MUH with partial or no policies included younger age, less education, lower income, and current smoking (P's ≤ .01); more restrictive smoke-free MUH policies were associated with lower cigarette consumption and recent quit attempts among current smokers (P's < .05); and correlates of support for MUH policies included greater education, nonsmoker status, and having complete MUH policies (P's < .05). Of 9 messages opposing smoke-free MUH policies, the most persuasive was "People have the right to smoke in their own homes"; the most persuasive message of 11 in support was "You have the right to breathe clean air in your home." CONCLUSION Smoke-free MUH policies may reduce smoking. Messaging in favor of smoke-free MUH policies was more persuasive than messaging opposing such policies, indicating the potential for using these approaches.
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Affiliation(s)
- Carla J Berg
- Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Rd NE, Room 524, Atlanta, GA 30322.
| | | | - Michael Windle
- Emory University Rollins School of Public Health, Atlanta, Georgia
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Policy Options to Promote Smokefree Environments for Children and Adolescents. Curr Probl Pediatr Adolesc Health Care 2015; 45:146-81. [PMID: 26032229 DOI: 10.1016/j.cppeds.2015.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 04/14/2015] [Indexed: 11/22/2022]
Abstract
Secondhand smoke (SHS) exposure among children is associated with a wide variety of adverse health risks, including: asthma, otitis media, respiratory infections, impaired lung growth and function, decreased exercise tolerance, cognitive impairments, behavior problems, and sudden infant death syndrome. Unfortunately, over 40% of children aged 3-11 years-15.1 million children-are currently exposed to SHS, with nearly 70% of black children in this age group being exposed. Over the past three decades, great strides have been made in establishing smokefree environments for adults, ultimately reducing their SHS exposure. Regulations have been passed at the organizational, local, and state levels that increasingly ban smoking in the workplace and public places. Children's SHS exposure patterns, however, differ from adults' exposures, with greater time spent in the home and other potentially unregulated venues (school, child care, and car). This means that children have been afforded relatively less protection from SHS by these smokefree regulations. It is imperative, therefore, to seek alternative options for promoting smokefree environments for children throughout the United States. This article explores policy options that promote smokefree environments for children and adolescents: comprehensive smokefree/tobacco-free policies covering indoor/outdoor public places, housing, private vehicles, and child care, as well as Clinical Guidelines regarding patient/family interviews on smoking, SHS, cessation, and voluntary smokefree efforts. The policy section highlights the role of child and adolescent health practitioners in promoting these policies with the hope of fostering engagement of these key stakeholders in the policy process. Note, there are a wide range of important policy and regulatory strategies aimed at reducing tobacco initiation and use among children, adolescents, and young adults; while essential in tobacco prevention and control efforts, a discussion of these strategies is beyond the scope of this article.
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Stein A, Suttie J, Baker L, Agans R, Xue W, Bowling JM. Predictors of smoke-free policies in affordable multiunit housing, North Carolina, 2013. Prev Chronic Dis 2015; 12:E73. [PMID: 25974143 PMCID: PMC4438422 DOI: 10.5888/pcd12.140506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Smoke-free policies can effectively protect nonsmokers from secondhand smoke (SHS) exposure in multiunit housing. We surveyed all affordable multiunit housing properties in North Carolina to determine the statewide prevalence of smoke-free policies and to identify predictors of smoke-free policies. Methods Representatives of affordable housing properties in North Carolina completed a mailed or online survey during June through October 2013. The primary outcome measure was presence of a smoke-free policy, defined as prohibiting smoking in all residential units. We used χ2 analysis and multivariate logistic regression to identify correlates of smoke-free policies. Results Of 1,865 eligible properties, responses were received for 1,063 (57%). A total of 16.5% of properties had policies that prohibited smoking in all residential units, while 69.6% prohibited smoking in indoor common areas. In multivariate analysis, an increase in the number of children per unit was associated with a decrease in the odds of having a smoke-free policy at most properties. Newer properties across all company sizes were more likely to have smoke-free policies. Accessing units from interior hallways predicted smoke-free policies among medium-sized companies. Conclusion More smoke-free policies in affordable multiunit housing are needed to protect vulnerable populations, particularly children, from SHS exposure. Public health professionals should continue to educate housing operators about SHS and the benefits of smoke-free policies at all properties, including older ones and ones where units are accessed from outside rather than from an interior hallway.
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Affiliation(s)
- Anna Stein
- North Carolina Division of Public Health, Raleigh, North Carolina,1932 Mail Service Center, Raleigh, NC 27699-1932.
| | - Janet Suttie
- North Carolina Division of Public Health, Raleigh, North Carolina
| | - Laura Baker
- North Carolina Division of Public Health, Raleigh, North Carolina
| | - Robert Agans
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Wei Xue
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - J Michael Bowling
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Chambers C, Sung HY, Max W. Home exposure to secondhand smoke among people living in multiunit housing and single family housing: a study of California adults, 2003-2012. J Urban Health 2015; 92:279-90. [PMID: 25466438 PMCID: PMC4411315 DOI: 10.1007/s11524-014-9919-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Public health education efforts continue to encourage people to adopt voluntary smoking bans at home; nonetheless, the home remains a place where many people are exposed to secondhand smoke (SHS). Little is known about how SHS exposure in the home differs between adults residing in multiunit housing (MUH) and those residing in single family housing (SFH). This study (1) compared the socio-demographic characteristics, chronic disease conditions, and smoking status of adults living in MUH with those living in SFH, (2) assessed the correlates of living in MUH for adults, and (3) evaluated the association of residency in MUH and SFH with the odds of being exposed to SHS at home using population-based survey data of California adults. Smoking prevalence was significantly higher among MUH residents than SFH residents. The adjusted odds of exposure to SHS at home were 32 % higher for MUH smokers than SFH smokers but were not significantly different for non-smokers. This study presents evidence that there are significant socio-demographic differences between MUH residents and SFH residents and that MUH smokers have higher rates of exposure to SHS at home than SFH smokers after adjusting for other covariates. To reduce home exposure to SHS among MUH residents, it is important to adopt tobacco control policies that are aimed at reducing SHS exposure in and around MUH and at reducing cigarette smoking among current smokers in MUH.
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Snyder K, Vick JH, King BA. Smoke-free multiunit housing: a review of the scientific literature. Tob Control 2015; 25:9-20. [PMID: 25566811 DOI: 10.1136/tobaccocontrol-2014-051849] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 12/16/2014] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Multiunit housing (MUH) residents are susceptible to secondhand smoke (SHS) exposure, which can transfer between living units. This review summarises existing scientific literature relevant to smoke-free MUH, discusses knowledge gaps and provides recommendations for future research to inform public health action. DATA SOURCES We conducted a systematic search of peer-reviewed articles using three databases: EBSCOhost CINAHL, PubMed and Web of Science. STUDY SELECTION Article titles, abstracts and text were reviewed to ascertain three inclusion criteria: (1) English language; (2) conducted in the USA; (3) reported on baseline data, development, implementation or evaluation of smoke-free MUH. DATA EXTRACTION We used a multistep process to identify eligible articles: (1) two reviewers separately evaluated article titles; (2) two reviewers separately evaluated abstracts and (3) one reviewer read each article and determined inclusion eligibility. DATA SYNTHESIS We identified and included 35 articles published during 2001-2014, grouped based on broad themes: MUH resident (n=16); MUH operator (n=6); environmental monitoring and biomarkers (n=9); economic (n=2); legal (n=3); and implementation process and policy impact (n=8). Studies with multiple themes were included in all relevant groups. CONCLUSIONS Existing literature has focused on self-reported, cross-sectional studies of MUH residents and operators; some studies of environmental markers, biomarkers and economic indicators have also been conducted. Future research on smoke-free MUH policy compliance and enforcement, and on the impact of these policies on smoking behaviours and health outcomes, could further inform public health planning, policy and practice. Despite these gaps, the current literature provides sufficient evidence for action to eliminate SHS exposure in MUH.
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Affiliation(s)
- Kimberly Snyder
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janice Hassett Vick
- Public Health and Survey Research Division, ICF International, Atlanta, Georgia, USA
| | - Brian A King
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Zhang X, Martinez-Donate AP, Cook J, Piper ME, Berg K, Jones NR. Battling tobacco use at home: an analysis of smoke-free home rules among U.S. veterans from 2001 to 2011. Am J Public Health 2014; 104 Suppl 4:S572-9. [PMID: 25100423 DOI: 10.2105/ajph.2014.301975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined national trends in smoke-free home rules among U.S. veterans and nonveterans. METHODS We used data from the 2001-2002 and 2010-2011 Tobacco Use Supplement to the Current Population Survey to estimate and compare the existence of smoke-free home rules among veterans and nonveterans for each survey period. RESULTS The prevalence of a complete smoke-free home rule among veterans increased from 64.0% to 79.7% between 2001 and 2011 (P < .01) but was consistently lower than were rates estimated for nonveterans (67.6% and 84.4%, respectively). Disparities between the 2 groups increased significantly over time (P < .05). CONCLUSIONS Despite the general increase in the adoption of smoke-free home rules, veterans lag behind the rest of the U.S. population. Interventions promoting the adoption of complete smoke-free home rules are necessary to protect veterans and their families and to reduce disparities.
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Affiliation(s)
- Xiao Zhang
- Xiao Zhang and Ana P. Martinez-Donate are with the Department of Population Health Sciences, University of Wisconsin, Madison. Jessica Cook, Megan E. Piper, and Kristin Berg are with the University of Wisconsin Center for Tobacco Research and Intervention. Nathan R. Jones is with the University of Wisconsin Survey Center
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Wilson KM, Torok M, McMillen R, Tanski S, Klein JD, Winickoff JP. Tobacco smoke incursions in multiunit housing. Am J Public Health 2014; 104:1445-53. [PMID: 24922124 DOI: 10.2105/ajph.2014.301878] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to describe the prevalence of secondhand tobacco smoke incursions reported by multiunit housing (MUH) residents, pinpoint factors associated with exposure, and determine whether smoke-free building policy was associated with prevalence of reported tobacco smoke incursions. METHODS Data are from a 2011 nationally representative dual-frame survey (random-digit-dial and Internet panels) of US adults aged 18 years and older. Individuals who lived in MUH and who reported no smoking in their homes for the past 3 months, whether or not they reported being smokers themselves, were included in this study. Incursions were defined as smelling tobacco smoke in their building or unit. RESULTS Of 562 respondents, 29.5% reported smoke incursions in their buildings. Of these, 16% reported incursions in their own unit, 36.2% of which occurred at least weekly. Government-subsidized housing and partial smoke-free policies were associated with a higher likelihood of reporting smoke incursions. CONCLUSIONS Many residents of multiunit housing are exposed to tobacco smoke in their units and buildings. Partial smoke-free policies do not appear to protect residents and might increase the likelihood of incursions in residents' individual units.
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Affiliation(s)
- Karen M Wilson
- Karen M. Wilson is with the Section of Hospital Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Denver. Michelle Torok is with the Children's Outcomes Research Program, University of Colorado School of Medicine. Robert McMillen is with the Department of Psychology and Social Science Research Center, Mississippi State University, Mississippi State. Susanne Tanski is with the Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, NH. Jonathan D. Klein is with the American Academy of Pediatrics Julius B. Richmond Center of Excellence, Elk Grove Village, IL. Jonathan P. Winickoff is with the Division of General Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA
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Chen YT, Chen PL. Perceptions of Parental Smoking and Sociodemographic Factors Associated With the Adoption of Home Smoking Bans Among Parents of School-Aged Children. Nicotine Tob Res 2014; 16:1112-20. [DOI: 10.1093/ntr/ntu043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Disparities and trends in indoor exposure to secondhand smoke among U.S. adolescents: 2000-2009. PLoS One 2013; 8:e83058. [PMID: 24358249 PMCID: PMC3866255 DOI: 10.1371/journal.pone.0083058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 10/30/2013] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Secondhand smoke (SHS) exposure causes disease and death among nonsmokers. With a plethora of smoke-free legislation implemented and a steady decrease in cigarette consumption noted over the past decade in the U.S., this study assessed trends in indoor SHS exposure among U.S. adolescents in grades 6-12 during 2000-2009. METHODS Data were obtained from the 2000-2009 National Youth Tobacco Survey - a national survey of U.S. middle and high school students. SHS exposure within an indoor area within the past seven days was self-reported. Trends in indoor SHS exposure during 2000-2009 were assessed overall and by socio-demographic characteristics, using the Wald's test in a binary logistic regression. Within-group comparisons were performed using chi-squared statistics (p<0.05). RESULTS The proportion of U.S. middle and high school students who were exposed to indoor SHS declined from 65.5% in 2000 to 40.5% in 2009 (p<0.05 for linear trend). Significant declines were also observed across all population subgroups. Between 2000 and 2009, prevalence of indoor SHS exposure declined significantly among both middle (58.5% to 34.3%) and high school (71.5% to 45.4%) students. Prevalence of indoor SHS exposure was significantly higher among girls (44.0% in 2009) compared to boys (37.2% in 2009) during each survey year. Similarly, prevalence of indoor SHS exposure during 2000-2009 was highest among non-Hispanic whites (44.2% in 2009) and lowest among non-Hispanic Asians (30.2% in 2009). During each survey year, prevalence was highest among the oldest age group (≥18 years) and lowest among the youngest (9-11 years). Also, prevalence was significantly higher among current cigarette smokers (83.8% in 2009) compared to nonsmokers (34.0% in 2009). CONCLUSION Significant declines in indoor SHS exposure among U.S. middle and high school students occurred during 2000-2009. While the results are encouraging, additional efforts are needed to further reduce youth indoor SHS exposure.
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Hood NE, Wewers ME, Ferketich AK, Klein EG, Pirie P. Predictors of Voluntary Home-Smoking Restrictions and Associations with an Objective Measure of In-Home Smoking among Subsidized Housing Tenants. Am J Health Promot 2013; 28:97-104. [DOI: 10.4278/ajhp.120816-quan-399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Examine predictors of voluntary home-smoking restrictions (HSRs) and associations with an objective measure of in-home smoking. Design. Cross-sectional. Setting. Publicly subsidized multiunit housing units managed by private company in Columbus, Ohio, without a smoke-free housing policy. Subjects. Probability sample of primary leaseholders (N = 301, 64% response rate). Measures. Self-reported knowledge, attitudes, and behaviors collected during face-to-face survey in fall 2011, including individual (e.g., knowledge of health effects), social (e.g., number of friends who smoke), and environmental (e.g., safety) factors hypothesized to be related to having HSRs. Surface nicotine concentration (μg/m2) based on samples collected from wood surface in respondents' living rooms (n = 279). Analysis. Multiple linear and logistic regression were used to identify factors associated with having HSRs and with indoor surface nicotine concentrations. Results. Fewer than one-third (29.2%) of tenants had complete HSRs, while more than half (55.8%) had partial restrictions. Several individual and social factors, but no environmental/community factors, were associated with having HSRs. Type of HSRs (p < .001) and smoking status (p < .001) were independently associated with mean surface nicotine concentrations. Conclusion. Few subsidized housing tenants voluntarily limit in-home smoking. Partial restrictions could be considered as a harm reduction strategy but may be less effective among smokers. Strategies to change social norms are also needed to modify in-home smoking behavior among subsidized housing tenants.
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Satterlund TD, Treiber J, Kipke R, Cassady D. A qualitative evaluation of 40 voluntary, smoke-free, multiunit, housing policy campaigns in California. Tob Control 2013; 23:491-5. [PMID: 23783509 PMCID: PMC4215349 DOI: 10.1136/tobaccocontrol-2012-050923] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Although it is legal for multiunit housing (MUH) property owners in all 50 states to prohibit smoking on their premises, including in individual units, MUH constitutes a relatively new setting to reduce exposure to secondhand smoke via voluntary smoke-free policy. This paper examines California state-funded smoke-free MUH policy campaigns between 2004 and 2010. Methods A cross-case analysis of 40 state-funded smoke-free MUH policy campaigns was conducted via an examination of final evaluation reports submitted to the California Tobacco Control Program. Results The most effective voluntary smoke-free MUH policy campaigns typically included: (1) learning the local [MUH] context, (2) finding and using a champion, (3) partnering with like-minded organisations, (4) building relationships with stakeholders, (5) collecting and using local data and (6) making a compelling case to decision makers. Discussions The aforementioned steps tended to be intertwined, and successfully securing voluntary smoke-free MUH policy required a strategic but flexible plan of implementation prior to entrance into the field. Campaigns designed to enhance voluntary smoke-free MUH policy adoption should underscore the economic viability of such policies during each strategic step.
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Affiliation(s)
- Travis D Satterlund
- Center for Program Design & Evaluation at Dartmouth, Lebanon, New Hampshire, USA
| | - Jeanette Treiber
- Center for Evaluation and Research, University of California, Davis; Davis, California, USA
| | - Robin Kipke
- Center for Evaluation and Research, University of California, Davis; Davis, California, USA
| | - Diana Cassady
- Center for Evaluation and Research, University of California, Davis; Davis, California, USA
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Support for No-Smoking Policies Among Residents of Public Multiunit Housing Differs by Smoking Status. J Community Health 2013; 38:1074-80. [DOI: 10.1007/s10900-013-9716-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Levy DE, Rigotti NA, Winickoff JP. Tobacco smoke exposure in a sample of Boston public housing residents. Am J Prev Med 2013; 44:63-6. [PMID: 23253651 DOI: 10.1016/j.amepre.2012.09.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/24/2012] [Accepted: 09/03/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is no safe level of tobacco smoke exposure. Nonsmoking residents of public housing are at particular risk of suffering the health consequences of tobacco smoke exposure. PURPOSE To compare levels of tobacco smoke exposure among nonsmoking residents of the Boston Housing Authority (BHA) to previously published data from the National Health and Nutrition Examination Survey and identify factors associated with such exposure in the BHA. METHODS Nonsmoking adults and children from two BHA housing developments were invited to participate in a tobacco smoke exposure screening in which they completed a short survey and provided a saliva sample for cotinine analysis. Data were collected in 2011 and analyzed in 2012. RESULTS Of 51 eligible study participants, 88% (95% CI=76%, 95%) had detectable cotinine levels (0.15 ng/mL lower limit of detection) compared to at most 56% of residents nationally (using a more sensitive 0.05 ng/mL lower limit of detection). Geometric mean cotinine levels among study participants were 0.52 ng/mL (95% CI=0.37 ng/mL, 0.74 ng/mL) compared to at most 0.10 ng/mL nationally. Residents living in homes with strict no-smoking rules had lower cotinine levels than those without such rules (0.40 ng/mL vs 1.07 ng/mL, p=0.006). CONCLUSIONS Tobacco smoke exposure is substantially higher in this sample of nonsmoking BHA residents than among nonsmoking Americans nationally. A comprehensive prohibition on smoking in BHA housing units enacted in October 2012 will help protect this highly exposed group of residents and serve as a model for other housing authorities.
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Affiliation(s)
- Douglas E Levy
- Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA 02114, USA.
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