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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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van der Eijk Y, Tan GPP, Teo O. Systems and policies to reduce secondhand smoke in multiunit housing in Singapore: a qualitative study. Tob Control 2023; 33:52-58. [PMID: 35715172 DOI: 10.1136/tobaccocontrol-2022-057301] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/02/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Multiunit housing residents are often exposed to neighbours' secondhand smoke (SHS). Little is known on the current systems available to protect residents in places not covered by a residential smoking ban, or what constitutes an appropriate policy approach. This study explores relevant systems and policies in Singapore, a densely populated city-state where the vast majority live in multiunit housing and discussions on regulating smoking in homes are ongoing. METHODS In-depth interviews with 18 key informants involved in thought leadership, advocacy, policy or handling SHS complaints, and 14 smokers and 16 non-smokers exposed to SHS at home. RESULTS The current system to address neighbours' SHS comprises three steps: moral suasion, mediation and legal dispute. Moral suasion and mediation are often ineffective as they depend on smokers to willingly restrict their smoking habits. Legal dispute can yield a court order to stop smoking inside the home, but the process places a high evidence burden on complainants. While setting up designated smoking points or running social responsibility campaigns may help to create no-smoking norms, more intractable cases will likely require regulation, a polarising approach which raises concerns about privacy. CONCLUSIONS Without regulations to limit SHS in multiunit housing, current systems are limited in their enforceability as they treat SHS as a neighbourly nuisance rather than a public health threat.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Grace Ping Ping Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Odelia Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Collins BN, Lepore SJ, Egleston BL. Eliminating children's tobacco smoke exposure: a pathway to bioverified abstinence among low-income maternal smokers in the Babies Living Safe and Smokefree (BLiSS) trial. J Behav Med 2023; 46:1042-1048. [PMID: 37285107 PMCID: PMC10591859 DOI: 10.1007/s10865-023-00423-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/19/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Identifying behavioral pathways to smoking cessation in high-risk populations, such as low-income maternal smokers, could reduce tobacco disparities. The previous "BLiSS" multilevel intervention trial demonstrated efficacy of the BLiSS intervention in facilitating low-income maternal smokers' bioverified abstinence. This present study examined four putative pathways measured at 3-month end of treatment (Time 2) that could account for the observed intervention effect on smoking abstinence through 12 months (Time 2 - Time 3). METHODS Nutritionists in community clinics delivering safety net nutrition promotion programs across Philadelphia, Pennsylvania, USA, were trained by trial principal investigators to deliver a brief tobacco intervention informed by the American Academy of Pediatrics best practice guidelines ("Ask, Advise, Refer [AAR]"). After referral, 396 eligible participants were randomized to either a multimodal behavioral intervention (AAR + MBI) or a parallel attention control (AAR + control). Random effects regression analysis tested mediation. RESULTS Elimination of children's tobacco smoke exposure (TSE) at Time 2 was the only significant mediator of longitudinal smoking abstinence through Time 3. AAR + MBI mothers were more likely to eliminate their children's TSE by Time 2 (OR = 2.11, 95%CI 1.30, 3.42), which was significantly associated with Time 3 abstinence (OR = 6.72, CI 2.28, 19.80). Modeling showed a significant total effect of AAR + MBI on abstinence (OR = 6.21, CI 1.86, 20.71), a direct effect of AAR + MBI on abstinence (OR = 4.80, CI 1.45, 15.94) and an indirect effect through TSE elimination (OR = 1.29, CI 1.06, 1.57). CONCLUSIONS Integrating smoking cessation interventions with counseling prior to the quit attempt that is designed to facilitate adoption of smokefree home policies and efforts to eliminate children's TSE could enhance the likelihood of long-term abstinence in populations of smokers with elevated challenges quitting smoking.
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Affiliation(s)
- Bradley N Collins
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex 954, Philadelphia, PA, USA.
| | - Stephen J Lepore
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, 1301 Cecil B. Moore Ave, Ritter Annex 954, Philadelphia, PA, USA
| | - Brian L Egleston
- Biostatistics and Bioinformatics Facility, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
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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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Hernandez D, Khan F, Albert D, Giovenco D, Branas C, Valeri L, Navas-Acien A. A randomized control trial to support smoke-free policy compliance in public housing. Trials 2023; 24:551. [PMID: 37608390 PMCID: PMC10463922 DOI: 10.1186/s13063-023-07339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/29/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Smoke-free housing policies in multiunit housing are increasingly widespread interventions to reduce smoking and secondhand smoke exposure. Little research has identified factors that impede compliance with smoke-free housing policies in low-income multiunit housing and test corresponding solutions. METHODS We are using an experimental design to test two compliance support interventions: (A) a "compliance through reduction (via relocation and reduction in personal smoking) and cessation" intervention targets households with smokers and involves support to shift smoking practices to areas beyond the apartment or building setting, reduce personal smoking, and deliver in-residence smoking cessation support services via trained peer educators and (B) a "compliance through resident endorsement" intervention involving voluntary adoption of smoke-free living environments through personal pledges, visible door markers, and/or via social media. We will compare randomly sampled participants in buildings that receive A or B or A plus B to the NYCHA standard approach. DISCUSSION This RCT addresses key gaps in knowledge and capitalizes on key scientific opportunities by (1) leveraging the federal mandate to ban smoking in a public housing system of more than sufficient size to conduct an adequately powered RCT; (2) expanding our understanding of smoke-free policy compliance beyond policy implementation by testing two novel treatments: (a) in-residence smoking cessation and (b) resident endorsement, while (3) addressing population and location-specific tobacco-related disparities. At the conclusion of the study, this RCT will have leveraged a monumental policy shift affecting nearly half a million NYC public housing residents, many of whom disproportionately experience chronic illness and are more likely to smoke and be exposed to secondhand smoke than other city residents. This first-ever RCT will test the effects of much-needed compliance strategies on resident smoking behavior and secondhand smoke exposure in multiunit housing. TRIAL REGISTRATION Clinical Trials Registered, NCT05016505. Registered on August 23, 2021.
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Affiliation(s)
- Diana Hernandez
- Sociomedical Sciences, Columbia Mailman School of Public Health, New York, USA.
| | - Farzana Khan
- Sociomedical Sciences, Columbia Mailman School of Public Health, New York, USA
| | - David Albert
- Health Policy and Management, Columbia Mailman School of Public Health, New York, USA
| | - Daniel Giovenco
- Sociomedical Sciences, Columbia Mailman School of Public Health, New York, USA
| | - Charles Branas
- Epidemiology, Columbia Mailman School of Public Health, New York, USA
| | - Linda Valeri
- Biostatistics, Columbia Mailman School of Public Health, New York, USA
| | - Ana Navas-Acien
- Environmental Health Sciences, Columbia Mailman School of Public Health, New York, USA
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Cheng D, Fung V, Shah R, Goldberg S, Lee B, Song G, Doane J, Kingsley M, Henley P, Banthin C, Winickoff JP, Rigotti NA, Levy DE. Smoke-Free Policies and Resident Turnover: An Evaluation in Massachusetts Public Housing From 2009‒2018. Am J Prev Med 2023; 64:503-511. [PMID: 36635198 PMCID: PMC10033366 DOI: 10.1016/j.amepre.2022.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/07/2022] [Accepted: 10/27/2022] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Smoke-free policies (SFP) in multi-unit housing are a promising tool for reducing exposure to tobacco smoke among residents. Concerns about increased housing instability due to voluntary or involuntary transitions induced by SFPs have been a primary barrier to greater widespread adoption. The impact of SFP implementation on transitions out of public housing in federally funded public housing authorities in Massachusetts was evaluated. METHODS Tenancy data from the Department of Housing and Urban Development were used to determine the time from admission to transitioning out of public housing based on a cohort study design. Periods of exposure to SFPs were defined based on dates of SFP implementation at each PHA. Multi-level Cox regression models were fit to estimate the effects of SFPs on the hazard of transitioning, adjusting for household- and PHA-level characteristics. Analyses were conducted in 2021‒2022. RESULTS There were 44,705 households with a record of residence in Massachusetts PHAs over 2009‒2018. Over this period, despite increasing adoption of SFPs among the PHAs, rates of transition remained steady at around 5‒8 transitions per 1,000 household-months. There was no overall association between exposure to SFPs and transitions among the full sample (adjusted HR=0.99, 95% CI=0.95, 1.04, p=0.794). However, the association varied significantly by age group, race/ethnicity, timing of SFP adoption, and era of admission. CONCLUSIONS Adoption of SFPs in public housing had a minimal overall impact on turnover for households in Massachusetts, though disparities in the impact were observed between different demographic and PHA-level subgroups.
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Affiliation(s)
- David Cheng
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts.
| | - Vicki Fung
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Radhika Shah
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Sydney Goldberg
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Boram Lee
- Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Glory Song
- Office of Statistics and Evaluation, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Jacqueline Doane
- Massachusetts Tobacco Cessation and Prevention Program, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Melody Kingsley
- Office of Statistics and Evaluation, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Patricia Henley
- Massachusetts Tobacco Cessation and Prevention Program, Massachusetts Department of Public Health, Boston, Massachusetts
| | - Christopher Banthin
- Public Health Advocacy Institute, Northeastern University School of Law, Boston, Massachusetts
| | - Jonathan P Winickoff
- Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Nancy A Rigotti
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts; Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts
| | - Douglas E Levy
- Department of Medicine, Harvard Medical School, Boston, Massachusetts; Mongan Institute Health Policy Research Center, Massachusetts General Hospital, Boston, Massachusetts; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts
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Titus AR, Mijanovich TN, Terlizzi K, Ellen IG, Anastasiou E, Shelley D, Wyka K, Elbel B, Thorpe LE. A Matched Analysis of the Association Between Federally Mandated Smoke-Free Housing Policies and Health Outcomes Among Medicaid-Enrolled Children in Subsidized Housing, New York City, 2015-2019. Am J Epidemiol 2023; 192:25-33. [PMID: 35551590 PMCID: PMC10175658 DOI: 10.1093/aje/kwac089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 01/11/2023] Open
Abstract
Smoke-free housing policies are intended to reduce the deleterious health effects of secondhand smoke exposure, but there is limited evidence regarding their health impacts. We examined associations between implementation of a federal smoke-free housing rule by the New York City Housing Authority (NYCHA) and pediatric Medicaid claims for asthma, lower respiratory tract infections, and upper respiratory tract infections in the early post-policy intervention period. We used geocoded address data to match children living in tax lots with NYCHA buildings (exposed to the policy) to children living in lots with other subsidized housing (unexposed to the policy). We constructed longitudinal difference-in-differences models to assess relative changes in monthly rates of claims between November 1, 2015, and December 31, 2019 (the policy was introduced on July 30, 2018). We also examined effect modification by baseline age group (≤2, 3-6, or 7-15 years). In New York City, introduction of a smoke-free policy was not associated with lower rates of Medicaid claims for any outcomes in the early postpolicy period. Exposure to the smoke-free policy was associated with slightly higher than expected rates of outpatient upper respiratory tract infection claims (incidence rate ratio = 1.05, 95% confidence interval: 1.01, 1.08), a result most pronounced among children aged 3-6 years. Ongoing monitoring is essential to understanding long-term health impacts of smoke-free housing policies.
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Mohindra M, Hernández D. "I think everybody will have to get together for it to work": NYCHA Tenant Perspectives on HUD's 2018 Smoke-Free Mandate Captured Prior to Policy Implementation. Nicotine Tob Res 2022; 24:1654-1660. [PMID: 35325238 PMCID: PMC9575971 DOI: 10.1093/ntr/ntac076] [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: 07/06/2021] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION In July 2018, a new federal mandate by the Department of Housing and Urban Development went into effect requiring all US public housing authorities to implement policies banning smoking in living units, indoor common areas, administrative buildings, and outdoor areas within 25 feet of these buildings. Although some housing authorities had smoke-free policies in place for decades, others had to implement them for the first time. Housing authorities continue to face challenges in ensuring compliance with these policies, and resident perspectives can greatly inform measures to promote adherence. AIMS AND METHODS We conducted in-person interviews with 20 New York City Housing Authority tenants in April 2018. Our thematic analysis examined resident opinions on the upcoming smoke-free housing policy. RESULTS Although 65% of residents supported the policy, 50% anticipated poor adherence due to expected lack of enforcement, safety issues with smoking outdoors, and general discontent with the housing authority and living conditions. However, many participants felt adherence could be improved if the housing authority optimized resource-provision and communication with tenants. CONCLUSIONS Our study adds to existing literature examining tenant views on the controversial topic of mandatory smoke-free housing policies, and our interviews were conducted at a unique time prior to policy implementation in the country's largest public housing authority. Based on our results, we provide recommendations for housing authorities including: (1) information and resource-provision, (2) safety enhancement, and (3) relationship building with tenants in order to maximize policy adherence. IMPLICATIONS Our study is unique because we captured resident views prior to policy implementation in a housing authority without a preexisting smoke-free policy in place. In comparison, most recent research on this topic has focused on the postimplementation period or used survey research methods in the preimplementation phase. Our findings add to extant research about tenant perspectives on smoke-free housing policies and offer suggestions to address barriers to compliance.
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Affiliation(s)
- Mandakini Mohindra
- Department of Medicine, University of California, San Diego, La Jolla, CA, USA
- General Public Health Track, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Diana Hernández
- Sociomedical Sciences Department, Columbia University Mailman School of Public Health, New York, NY, USA
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Bhattacharya M, Ojo-Fati O, Everson-Rose SA, Thomas JL, Miller JM, Ogedegbe G, Jean-Louis G, Joseph AM, Okuyemi KS. Smoking reduction among homeless smokers in a randomized controlled trial targeting cessation. Addict Behav 2022; 133:107373. [PMID: 35689905 DOI: 10.1016/j.addbeh.2022.107373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Homeless populations have high rates of smoking and unique barriers to quitting. General cessation strategies have been unsuccessful in this population. Smoking reduction may be a good intermediate goal. We conducted a secondary analysis to identify predictors of smoking reduction in a cohort of homeless smokers enrolled in a 26-week randomized clinical trial (RCT) targeting smoking cessation. METHODS Data are from an RCT comparing motivational interviewing counseling plus nicotine replacement therapy (NRT) to brief advice to quit (standard care) plus NRT among homeless smokers. Using bivariate analyses and multinomial logistic regression, we compared demographics, health and psychosocial variables, tobacco use, substance use, and NRT adherence among those who reported: quitting; reducing smoking by 50-99%; and not reducing smoking by 50%. RESULTS Of 324 participants who completed 26-week follow-up, 18.8% and 63.9% self-reported quitting and reducing, respectively. Compared to those who did not reduce smoking, participants reporting reducing indicated higher baseline cigarette use (OR=1.08; CI:1.04-1.12) and menthol use (OR=2.24; CI:1.05-4.77). Compared to participants who reduced, participants reporting quitting were more likely to be male (OR=1.998; CI:1.00-3.98), experience more housing instability (OR=1.97; CI:1.08-3.59), indicate higher importance of quitting (OR=1.27; CI:1.041.55), have higher NRT adherence (OR=1.75; CI:1.00-3.06), and lower odds of reported illicit drug use (OR=0.48; CI:0.24-0.95). CONCLUSIONS Over half of participants reduced smoking by at least 50%, indicating reduction is feasible among homeless smokers. Further research is required to understand the impact of reduction on future cessation attempts in homeless smokers. This study shows that reduction is achievable and may be a valid intermediate goal.
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Affiliation(s)
- Manami Bhattacharya
- University of Minnesota, Department of Health Policy and Management, Minneapolis, MN 55455, USA.
| | - Olamide Ojo-Fati
- California Department of Public Health, Sacramento, CA, United States
| | | | - Janet L Thomas
- University of Minnesota, Department of Medicine, Minneapolis, MN, United States
| | - Jonathan M Miller
- University of Minnesota, Department of Health Policy and Management, Minneapolis, MN 55455, USA
| | - Gbenga Ogedegbe
- New York University, Department of Population Health, New York, NY, United States
| | - Girardin Jean-Louis
- New York University, Department of Population Health, New York, NY, United States
| | - Anne M Joseph
- University of Minnesota, Department of Medicine, Minneapolis, MN, United States
| | - Kolawole S Okuyemi
- University of Utah, Department of Family & Preventive Medicine, Salt Lake City, UT, United States.
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Childs E, Geller AC, Brooks DR, Davine J, Kane J, Keske R, Anthony J, Rees VW. Assessing Smoke-Free Housing Implementation Approaches to Inform Best Practices: A National Survey of Early-Adopting Public Housing Authorities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3854. [PMID: 35409538 PMCID: PMC8997519 DOI: 10.3390/ijerph19073854] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 11/26/2022]
Abstract
Secondhand smoke (SHS) exposure causes chronic illness and occurs at a higher prevalence in low-income communities than the general public. In 2018, the U.S. Department of Housing and Urban Development (HUD) instituted a smoke-free housing rule for Public Housing Authorities (PHAs) to address persistent health inequities. However, the success of smoke-free housing requires evidence to inform effective implementation approaches. A mixed-methods, cross-sectional survey was conducted in a national sample of PHAs. Questions focused on housing officials' use of specific implementation strategies. Adjusted odds ratios were used to assess associations between implementation approaches and variations among PHAs (i.e., region, size, or recency of policy adoption). Qualitative analyses were conducted to assess the perceived effectiveness of implementation strategies. Resident engagement, staff training, and smoking cessation support were the most frequently used implementation strategies. Engagement with local stakeholders was cited less frequently. Enforcement actions were limited with no violations referred to housing court. Support for policy adherence was identified as a sixth implementation strategy. While most PHAs used at least some evidence-informed implementation strategies, a lack of a systematic approach may limit overall effectiveness. Further research is required to resolve implementation barriers experienced disproportionately by a subset of PHAs, and to inform a best practice implementation framework that meets the needs of a heterogeneous population.
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Affiliation(s)
- Ellen Childs
- Division of Health and Environment, Abt Associates, Rockville, MD 20852, USA;
| | - Alan C. Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (A.C.G.); (J.D.)
| | - Daniel R. Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA;
| | - Jessica Davine
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (A.C.G.); (J.D.)
| | - John Kane
- Boston Housing Authority, Boston, MA 02111, USA;
| | - Robyn Keske
- Football Players Health Study, Harvard Medical School, Boston, MA 02215, USA;
| | | | - Vaughan W. Rees
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA; (A.C.G.); (J.D.)
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Changes in Reported Secondhand Smoke Incursions and Smoking Behavior after Implementation of a Federal Smoke-Free Rule in New York State Federally Subsidized Public Housing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063513. [PMID: 35329199 PMCID: PMC8949517 DOI: 10.3390/ijerph19063513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 03/03/2022] [Accepted: 03/04/2022] [Indexed: 12/10/2022]
Abstract
This study assessed changes in smoking behavior and secondhand smoke (SHS) exposure after implementation of the U.S. Department of Housing and Urban Development (HUD) rule prohibiting the use of cigarettes, cigars, pipes, and waterpipes in all federally subsidized public housing, including within residential units (apartments). Using quantitative data from a repeated cross-sectional mail survey of New York State residents of five public housing authorities (N = 761 at Wave 1, N = 649 at Wave 2), we found evidence of policy compliance (99% decrease in odds of self-reported smoking in units, OR = 0.01, p < 0.01, CI: 0.00−0.16), reduced SHS incursions (77% decrease in odds of smelling smoke within developments, OR = 0.23, p < 0.01, CI: 0.13−0.44), and lower reported smoking rates in July 2018 (9.5%, down from 16.8%), 10 months after implementation of the rule. Despite evident success, one-fifth of residents reported smelling smoke inside their apartment at least a few times per week. This study provides insights into how the policy was implemented in selected New York public housing authorities, offers evidence of policy-intended effects, and highlights challenges to consistent and impactful policy implementation.
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Foster B, Ledgerwood DM, Struble CA, Fodor MC, Jordan P, Krishnan AC, Turner B, Pearson C, Twiner MJ, Levy PD. Public Housing Resident Perspectives on Smoking, Barriers for Smoking Cessation, and Changes in Smoking Mandates. INQUIRY: THE JOURNAL OF HEALTH CARE ORGANIZATION, PROVISION, AND FINANCING 2022; 59:469580221092814. [PMID: 35403482 PMCID: PMC9006371 DOI: 10.1177/00469580221092814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Individuals from low-income groups report disproportionate rates of cigarette use, secondhand smoke (SHS) exposure with increased morbidity and mortality. Smoking bans in public housing have been enacted in attempt to reduce tobacco use and SHS exposure among lower income individuals. This study investigated the support needs of tobacco users living in two public housing complexes in Detroit, Michigan (USA), including their perspectives on smoking, resources and barriers for smoking cessation, and the impact of policy changes. Methods This is a mixed-methods study, using a qualitative focus groups approach and a short survey, public housing residents interview data was analyzed to explore themes related to smoking-related issues. Specifically, six themes were assessed across four focus groups: (1) Quitting Smoking, (2) Current Smoking Cessation Resources, (3) Legal Mandates, (4) Education and Perceptions of Smoking, (5) Community Needs and Barriers, and (6) Medical Experiences. Results There were 59 participants; the majority (39/42, 93%) of smokers reported at least one quit attempt. During the focus groups, several participants indicated a desire to quit smoking but reported barriers to smoking cessation, such as lack of access to medications, social triggers to continue smoking, and socioeconomic stressors. A number of suggestions were provided to improve smoking cessation resources, including support groups, graphic images of smoking-related diseased tissue, and better communication with health care providers. Conclusions These findings demonstrate smoking bans in two public housing complexes can be effective yet are dependent upon a complex set of issues, including numerous barriers to care.
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Affiliation(s)
- Bethany Foster
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
- Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
| | - David M. Ledgerwood
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Cara A. Struble
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Marina C. Fodor
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
- Department of Psychology, Wayne State University, Detroit, MI, USA
| | - Parada Jordan
- Office of Community Engaged Research, Wayne State University, Detroit, MI, USA
| | - Abhinav C. Krishnan
- Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
- Department of Physiology, Wayne State University, Detroit, MI, USA
| | - Beverly Turner
- Office of Community Engaged Research, Wayne State University, Detroit, MI, USA
| | | | - Michael J. Twiner
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
- Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
| | - Phillip D Levy
- Department of Emergency Medicine, Wayne State University, Detroit, MI, USA
- Integrative Biosciences Center, Wayne State University, Detroit, MI, USA
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Horn K, Dearfield CT, Beth Johnson S, Krost K, Rincon Gallardo Patino S, Gray T, Crandell I, Bernat DH. Smoking cessation intentions and attempts one year after the federally mandated smoke-free housing rule. Prev Med Rep 2021; 24:101600. [PMID: 34976657 PMCID: PMC8683937 DOI: 10.1016/j.pmedr.2021.101600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 10/06/2021] [Accepted: 10/09/2021] [Indexed: 12/15/2022] Open
Abstract
The present study examines public housing residents' smoking cessation intentions, expectancies, and attempts one year after implementation of the Department of Housing and Urban Development's mandatory smoke-free rule in public housing. The sample includes 233 cigarette smokers, ages 18-80, who reside in the District of Columbia Housing Authority. Data collection occurred between March and August 2019. Descriptive statistics, chi-square, and Wilcoxon two-sample test analyses assessed smoking cessation intentions, expectancies, and attempts across resident demographics and characteristics. Findings showed 17.2% of residents reported not thinking about quitting, 39.1% reported thinking about quitting, and 48.6% reported thinking about quitting specifically because of the rule. Residents ages 60-80 were more likely to consider quitting because of the rule, compared to residents ages 18-59. Of those thinking of quitting, 58.6% were sure they could quit if they tried. Those thinking of quitting due to the rule (62.0%) were more likely to have made at least one quit attempt in the past 3 months than those i not attributinging thinking of quitting to the rule. Res Residents trying to quit reported an average of 2.7 attempts in the last 3 months;; most perceived evidence-based cessation supports as not helpful. A A majority reported thinking about quitting and attempting to quit but continuing to smoke, indicating a significant gap between intent to quit and successfully quitting. Results suggest that the rule positively influenced smoking behaviors. However, additional interventions are needed to assist public housing residents with successfully quitting smoking.
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Affiliation(s)
- Kimberly Horn
- Virginia Tech-Carilion Fralin Biomedical Research Institute, Blacksburg, VA, USA
| | - Craig T. Dearfield
- The George Washington University Milken Institute School of Public Health, Department of Epidemiology, Washington, DC, USA
| | - Sallie Beth Johnson
- Radford University Carilion, Department of Public Health and Healthcare Leadership, Roanoke, VA, USA
- Virginia Tech Carilion, Department of Family and Community Medicine, Roanoke, VA, USA
| | - Kevin Krost
- Virginia Tech-Carilion Fralin Biomedical Research Institute, Blacksburg, VA, USA
| | | | - Tiffany Gray
- Virginia Tech-Carilion Fralin Biomedical Research Institute, Blacksburg, VA, USA
| | - Ian Crandell
- Virginia Tech-Center for Biostatistics and Health Data Sciences, Roanoke, VA, USA
| | - Debra H. Bernat
- The George Washington University Milken Institute School of Public Health, Department of Epidemiology, Washington, DC, USA
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Pebley K, Krukowski RA, Mallawaarachchi I, Wayne Talcott G, Klesges RC, Little MA. Dual and polytobacco use after a period of enforced tobacco cessation. Addict Behav 2021; 123:107077. [PMID: 34391132 DOI: 10.1016/j.addbeh.2021.107077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 07/07/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
The current study aimed to assess single product, dual, and polytobacco use in a young adult military population and how an enforced tobacco ban during training impacts these behaviors. Participants were 810 U.S. Airmen who reported tobacco use as civilians. Participants completed baseline and one-year follow-up surveys about their tobacco use from 2016 to 2019. Each product used by a participant was assigned a score based on their frequency of use, which were summed to create a total score. Change scores were calculated by determining the difference between baseline and follow-up frequency scores. Tobacco frequency score and the categorical change (e.g., increased, decreased) were compared between groups using t-tests and Chi-squared tests, respectively, adjusting for clustering effects by squadron and base. Among single product users, 44.58% quit using tobacco products, 47.1% remained single product users, and 8.32% became dual or polytobacco users. Among dual users, 39.1% quit, 43.1% became single product users, 14.2% remained dual users, and 3.7% became polytobacco users. Among polytobacco users, 29.9% quit, 43.4% became single product users, 17.9% became dual users, and 8.8% continued poly-tobacco use. Most participants reduced the number and frequency of tobacco products used. Implementing stringent policies that further restrict tobacco use may decrease tobacco product use or frequency of use.
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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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Durazo A, Hartman-Filson M, Perez K, Alizaga NM, Petersen AB, Vijayaraghavan M. Smoke-Free Home Intervention in Permanent Supportive Housing: A Multifaceted Intervention Pilot. Nicotine Tob Res 2021; 23:63-70. [PMID: 32123908 DOI: 10.1093/ntr/ntaa043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/26/2020] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Smoke-free homes (SFHs), the voluntary adoption of home smoking restrictions, are associated with reduced secondhand smoke exposure. However, SFHs are uncommon in permanent supportive housing (PSH) for formerly homeless adults, who have fivefold higher smoking rates than the general population. We pilot-tested a brief intervention to increase voluntary adoption of SFHs among PSH residents in the San Francisco Bay Area. AIMS AND METHODS We pilot-tested a brief intervention to increase voluntary adoption of SFHs among PSH residents in the San Francisco Bay Area. Rest of the methods, PSH residents (n = 100) and staff (n = 62) from 15 PSH sites participated in the intervention between October 2017 and February 2018. Research staff provided counseling to PSH residents on how to adopt an SFH and trained PSH staff on how to counsel residents on smoking cessation. The primary outcome was self-reported voluntary adoption of an SFH for ≥90 days, and the secondary outcome was carbon monoxide-verified PPA at 6-month follow-up. PSH staff completed the Smoking Knowledge, Attitudes, and Practices survey at baseline and 3-month follow-up. RESULTS At 6 months, 31.3% of PSH residents had adopted an SFH (vs. 13.0% at baseline) and 16.9% reported carbon monoxide-verified PPA. A positive attitude toward an SFH policy was associated with increased odds of SFH adoption (adjusted odds ratio = 8.68, 95% confidence interval: 2.42, 31.17). Voluntary SFH adoption was associated with increased PPA (adjusted odds ratio = 26.27, 95% confidence interval: 3.43, 201.30). PSH staff reported improved attitudes toward and self-efficacy in delivering cessation care, and decreased barriers to discussing smoking cessation among PSH residents between baseline and 3-month follow-up. CONCLUSIONS In this single-arm study, a brief intervention increased SFH adoption and PPA among PSH residents. IMPLICATIONS To date, few interventions have addressed SFHs and their association with tobacco use among PSH residents. A "ground-up" approach that relies on buy-in from residents and that promotes voluntary SFHs is an innovative way to increase smoke-free living environments in PSH. This approach could pave a pathway for smoke-free policy implementation in these sites. PSH can play a role in reducing the burden of tobacco use by empowering its residents to adopt voluntary SFHs, which could increase smoking cessation among residents.
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Affiliation(s)
- Arturo Durazo
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA
| | | | - Kenneth Perez
- School of Public Health, University of California, Berkeley, CA
| | | | | | - Maya Vijayaraghavan
- Center for Tobacco Control Research and Education, University of California, San Francisco, CA.,Division of General Internal Medicine, University of California, San Francisco, CA
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Alizaga NM, Nguyen T, Petersen AB, Elser H, Vijayaraghavan M. Developing Tobacco Control Interventions in Permanent Supportive Housing for Formerly Homeless Adults. Health Promot Pract 2020; 21:972-982. [PMID: 30971139 PMCID: PMC6788936 DOI: 10.1177/1524839919839358] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Smoke-free policies are effective population-based strategies to reduce tobacco use yet are uncommon in permanent supportive housing (PSH) for formerly homeless individuals who have high rates of smoking. In this study, we partnered with six supportive housing agencies in the San Francisco Bay Area to examine the implementation of smoke-free policies and cessation services. We administered a questionnaire and conducted in-depth, semistructured interviews with agency directors (n = 6), property management staff (n = 23), and services staff (n = 24) from 23 PSH sites on the barriers to implementing tobacco control interventions. All properties restricted smoking in indoor shared areas, but only two had policies restricting smoking in living areas. While there was staff consensus that smoke-free policies were important to reduce tobacco-related harm, participants disagreed on whether smoke-free policies were aligned with PSH's harm reduction framework. Residents' comorbid mental illness and substance use and the lack of appropriate enforcement tools were barriers to implementation. Using these formative findings, we present a framework for a toolkit of strategies to increase implementation of smoke-free policies and cessation interventions in PSH. Successful implementation of indoor smoke-free policies in PSH will require concurrent cessation services to support smoking cessation efforts and address the mental health and substance use needs of residents.
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Affiliation(s)
| | - Tram Nguyen
- University of California, San Francisco, CA, USA
| | | | - Holly Elser
- University of California, Berkeley, CA, USA
- Stanford University, Stanford, CA, USA
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19
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Kim B, Lee Y, Kwon YD, Kim TH, Noh JW. Factors associated with indoor smoking at home by adults across Korea: a focus on socioeconomic status. Epidemiol Health 2020; 42:e2020067. [PMID: 33147900 PMCID: PMC8137374 DOI: 10.4178/epih.e2020067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 10/28/2020] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES Secondhand smoke is an issue that cannot be ignored due to its various negative effects. Especially, secondhand smoke inside the household is an area where health policy must pay attention as it can affect all age groups. This study aims to identify the factors associated with smoking inside the household focusing on socioeconomic status in Korea. METHODS We used data from the Community Health Survey of 2017 and a total of 33,462 participated in the study. Data were analyzed through IBM SPSS version 25.0 to conduct binary logistic regression analysis. RESULTS Results indicated that indoor smoking had a significant association with socioeconomic status. This association was more marked in those participants who had low household income or those with elementary school education level or less. Furthermore, the study indicates that when the smoker is a woman, older, has higher stress, and is a heavier smoker, the probability of her smoking inside the house is higher. CONCLUSIONS Based on the results, it is meaningful that this study has found the factors of smoking inside household. The result identify the factors associated with indoor smoking at home, and it can be used as baseline data for developing new smoking cessation policies.
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Affiliation(s)
- Bomgyeol Kim
- Department of Public Health, Yonsei University, Seoul, Korea
| | - Yejin Lee
- Department of Healthcare Management, Eulji University, Seongnam, Korea
| | - Young Dae Kwon
- Department of Humanities and Social Medicine, College of Medicine and Catholic Institute for Healthcare Management, The Catholic University of Korea, Seoul, Korea
| | - Tae Hyun Kim
- Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Korea
| | - Jin Won Noh
- Department of Health Administration, Dankook University, Cheonan, Korea
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20
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Lathen LS, Plears ML, Shartle EL, Conner KL, Fiore MC, Christiansen BA. The HUD smoke-free rule: Perceptions of residents post-implementation. Prev Med Rep 2020; 19:101159. [PMID: 32728524 PMCID: PMC7381686 DOI: 10.1016/j.pmedr.2020.101159] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 05/27/2020] [Accepted: 07/04/2020] [Indexed: 11/03/2022] Open
Abstract
The new HUD no smoking policy has had a favorable impact on smokers. The new HUD no smoking policy has reduced second hand smoke exposure. There remain needs for education, policy enforcement and on-site cessation help.
In July 2018, the U.S. Department of Housing and Urban Development (HUD) implemented a new Public health Agency rule prohibiting the use of tobacco in and within 25 feet of HUD housing. A convenience sample of 574 residents living in Milwaukee, Wisconsin multi-unit HUD complexes completed a survey from May through July 2019, designed to assess their perceptions of the new policy and its impact. Knowledge of the policy was strong, although continued educational efforts are needed. Attitudes about the policy were generally positive, although smokers held more negative attitudes than non-smokers. Some residents desired more and fairer policy enforcement. Most residents reported that smoke incursions were reduced post policy compared to pre policy, although such incursions still occurred. The policy has had a favorable health impact on smokers; over 80% made at least one positive change in their smoking, including 6.4% who said the policy motivated them to quit. There was no evidence that residents with mobility challenges were differentially affected by the policy. Overall, the HUD smoke-free policy was well received, reduced self-reported exposure to smoke and led most smokers to make positive changes in their smoking. Additional education on the policy, improved enforcement, and cessation services are needed.
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Affiliation(s)
| | | | - Emile L Shartle
- Wisconsin Department of Health Service's Tobacco Prevention and Control Program, United States
| | - Karen L Conner
- Wisconsin Department of Health Service's Tobacco Prevention and Control Program, United States
| | - Michael C Fiore
- University of Wisconsin, Center for Tobacco Research and Intervention, United States
| | - Bruce A Christiansen
- University of Wisconsin, Center for Tobacco Research and Intervention, United States
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21
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Ellison-Barnes A, Pollack CE, Levine D, Latkin C, Clark JM, Gudzune KA. Potential for unintended consequences: The association between smoking and body mass index among public housing residents in Baltimore, MD. Prev Med Rep 2020; 18:101081. [PMID: 32368434 PMCID: PMC7186554 DOI: 10.1016/j.pmedr.2020.101081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 02/26/2020] [Accepted: 03/13/2020] [Indexed: 11/30/2022] Open
Abstract
The U.S. Department of Housing and Urban Development (HUD) smokefree rule for public housing may prompt smokers to quit. Cessation, while desirable, can be associated with weight gain, and an excess burden of obesity already exists among public housing residents. Our objectives were to characterize the association between smoking and weight status prior to the policy implementation and to explore eating patterns. We conducted a cross-sectional analysis of survey data collected in 2014–2015 from randomly selected households in two public housing developments in Baltimore, MD. Our independent variable was self-reported smoking status, and dependent variables were measured body mass index (BMI) and uncontrolled/emotional eating scores. We used multivariable linear regression to examine the associations. Respondents included 266 heads of household with mean age 44.5 (SD 12.4). A majority (63.2%) were current smokers. Seventy-five percent were overweight or obese, with mean BMI 32.6 kg/m2 (SD 10.1). In the adjusted regression models, the mean BMI of smokers was significantly lower than that of former/never smokers (31.7 kg/m2 vs. 34.2 kg/m2), and the mean uncontrolled eating score of smokers was significantly higher (24.4 vs 18.7). These results suggest that the new HUD smokefree rule has the potential to promote further weight gain among smokers prompted to quit, highlighting the need to simultaneously consider these two prevalent risk factors in the setting of policy changes.
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Affiliation(s)
- Alejandra Ellison-Barnes
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Corresponding author at: 2024 East Monument Street, Room 2-300, Baltimore, MD 21287, United States.
| | - Craig E. Pollack
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - David Levine
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Carl Latkin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Jeanne M. Clark
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Division of Cardiovascular and Clinical Epidemiology, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kimberly A. Gudzune
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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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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Hwang JE, Cho SI, Park E. Changes in smokers’ behavior following the implementation
of a smoke-free apartment-building legislation. Tob Induc Dis 2019. [DOI: 10.18332/tid/114228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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24
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Petersen AB, Elser H, Nguyen T, Alizaga NM, Vijayaraghavan M. Smoke-Free or Not: Attitudes Toward Indoor Smoke-Free Policies Among Permanent Supportive Housing Residents. Am J Health Promot 2019; 34:32-41. [DOI: 10.1177/0890117119876763] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: Interventions for tobacco dependence are most effective when combined with smoke-free policies, yet such policies are rare in permanent supportive housing (PSH) for formerly homeless adults. We aimed to provide in-depth analysis of attitudes and barriers to and facilitators of implementing smoke-free policies in PSH. Approach: Current smokers living in PSH completed a questionnaire and participated in in-depth, semistructured interviews on smoking history, attitudes toward smoke-free policies, and perceived barriers to cessation. Setting: We collaborated with 6 San Francisco Bay Area PSH agencies. Participants: Thirty-six residents in PSH. Methods: Interviews, conducted by trained interviewers, were digitally recorded, transcribed, and analyzed using content analysis methods. Participants were recruited until we reached thematic saturation, or no new themes emerged from the interviews. Results: Over half of participants (52.8%, n = 19) reported depression, and 97.2% (n = 35) reported current substance use. Support for indoor smoking bans in living areas was modest (33.1%), although most residents anticipated cutting down (61%) and reported they would not move because of a smoking ban (77.8%). There was interest in quitting smoking, although co-use of tobacco with other substances was a major barrier. Conclusion: This study is the first to explore attitudes toward smoke-free policies in PSH. We found that residents in PSH support smoke-free policies and consider them feasible if implementation processes are sound. Our findings underscore the need to address barriers to adopting smoke-free policies and accessing smoking cessation services. In particular, interventions must address the co-use of tobacco with other substances and the impact of smoking on financial and housing stability.
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Affiliation(s)
| | - Holly Elser
- University of California, Berkeley, Berkeley, CA, USA
| | - Tram Nguyen
- University of California, Berkeley, Berkeley, CA, USA
| | | | - Maya Vijayaraghavan
- Division of General Internal Medicine, Center for Tobacco Control Research and Education, Zuckerberg San Francisco General Hospital, University of California, San Francisco, CA, USA
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Kegler MC, Lebow-Skelley E, Lea J, Haardörfer R, Lefevre A, Diggs P, Herndon S. A qualitative study of the process of adoption, implementation and enforcement of smoke-free policies in privately-owned affordable housing. BMC Public Health 2019; 19:1071. [PMID: 31395051 PMCID: PMC6686249 DOI: 10.1186/s12889-019-7404-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 07/30/2019] [Indexed: 11/23/2022] Open
Abstract
Background Household smoke-free home rules cannot fully protect nonsmokers from secondhand smoke (SHS) if they live in multi-unit housing (MUH). Instead, property-level smoke-free policies are needed to prevent SHS incursion into apartment units and to keep common areas smoke-free. Smoke-free policies are usually at the discretion of property management companies and owners within the context of market-rate and privately-owned affordable housing in the U.S. Methods Semi-structured interviews on the policy development, implementation and enforcement experiences of 21 different privately-owned affordable housing management companies were conducted with representatives from properties in North Carolina and Georgia who had established smoke-free policies before 2016. Results The decision to adopt was typically made by corporate leadership, board members, owners or property managers, with relatively little resident input. Policy details were influenced by property layout, perceptions of how best to facilitate compliance and enforcement, and cost of creating a designated smoking area. Policies were implemented through inclusion in leases, lease addenda or house rules with 6 months’ notice most common. Participants thought having a written policy, the norms and culture of the housing community, public norms for smoke-free environments, and resident awareness of the rules and their consequences, aided with compliance. Violations were identified through routine inspections of units and resident reporting. Resident denial and efforts to hide smoking were shared as challenges to enforcement, along with a perception that concrete evidence would be needed in eviction court and that simply the smell of SHS was insufficient evidence of violation. Over half had terminated leases or evicted residents due to violations of the smoke-free policy. The most common benefits cited were reduced turnover cost and time, and lower vacancy rates. Conclusions Understanding the smoke-free policy process in privately-owned affordable housing can help practitioners encourage policies within subsidized housing contexts. The study identified salient benefits (e.g., reduced cost, time, and vacancies) that can be highlighted when encouraging MUH partners to adopt policies. Additionally, study findings provide guidance on what to consider when designing smoke-free policies (e.g., layout, costs), and provide insights into how to enhance compliance (e.g., resident awareness) and manage enforcement (e.g., routine inspections). Electronic supplementary material The online version of this article (10.1186/s12889-019-7404-y) contains supplementary material, which is available to authorized users.
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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, 30033, 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, 30033, USA
| | - Jaimie Lea
- Center for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30033, USA
| | - Adrienne 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, 30033, USA
| | - Pam Diggs
- Director of Programs and Racial Equity, Youth Empowered Solutions [YES!], 4021 Carya Drive, Suite 160, Raleigh, NC, 27610, USA
| | - Sally Herndon
- North Carolina Department of Health and Human Services, Tobacco Prevention and Control Branch, Division of Public Health, 1932 Mail Service Center, Raleigh, NC, 27699, USA
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26
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Leung LT, Ho SY, Wang MP, Lam TH. Secondhand Smoke From Multiple Sources, Thirdhand Smoke and Respiratory Symptoms in Hong Kong Adolescents. Nicotine Tob Res 2019; 20:192-198. [PMID: 27807126 DOI: 10.1093/ntr/ntw302] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/01/2016] [Indexed: 12/28/2022]
Abstract
Introduction Reports on involuntary tobacco smoke exposure in children have focused mostly on secondhand smoke (SHS) from smoking inside the home. We studied the separate and combined prevalence of SHS exposure from multiple sources and thirdhand smoke (THS) and the associations with respiratory symptoms in Hong Kong adolescents. Methods In 2010-2011, 61 810 Secondary 1 (US Grade 7) to seven students reported their smoking status, respiratory symptoms, and exposure to four sources of tobacco smoke in the past 7 days. Weighted prevalence of exposure was calculated. Associations with respiratory symptoms were analyzed in 50 762 never smokers using logistic regression. Results Tobacco smoke exposure at home was 23.2% considering SHS exposure from inside the home, but increased to 33.2% including SHS from neighbors and 36.2% further including THS. Including SHS outside home (55.3%), 63.3% of adolescents were exposed to SHS anywhere or THS at home. In never smokers, SHS from each source and THS at home were linearly associated with respiratory symptoms. Exposure to more sources yielded stronger associations with respiratory symptoms (p for trend<.001). The adjusted odds ratios (95% CI) were 1.04 (0.97-1.11), 1.12 (1.03-1.22), 1.40 (1.26-1.56) and 1.99 (1.74-2.28) for 1, 2, 3, and 4 sources, respectively. Conclusions Although Hong Kong's smoking prevalence is among the lowest in the developed world, over 60% of its adolescents were involuntarily exposed to tobacco smoke from one or more sources with a linear association with respiratory symptoms in never smokers. More stringent policies are needed to protect adolescents from tobacco smoke. Implications In a high-density urban setting, involuntary exposure to tobacco smoke in adolescents can be much higher than the smoking prevalence of the general population, especially if SHS exposure from multiple sources and THS are also considered. Such exposures have important health implications as demonstrated by their linear associations with respiratory symptoms. Tobacco control measures effective in reducing smoking prevalence may have little effect in reducing adolescent exposure to tobacco smoke, especially in the private home, in which other public health strategies are urgently needed.
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Affiliation(s)
- Lok Tung Leung
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
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27
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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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28
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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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29
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Petersen AB, Stewart HC, Walters J, Vijayaraghavan M. Smoking Policy Change Within Permanent Supportive Housing. J Community Health 2019; 43:312-320. [PMID: 28884243 DOI: 10.1007/s10900-017-0423-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Smoke-free policies effectively reduce secondhand smoke (SHS) exposure among non-smokers, and reduce consumption, encourage quit attempts, and minimize relapse to smoking among smokers. Such policies are uncommon in permanent supportive housing (PSH) for formerly homeless individuals. In this study, we collaborated with a PSH provider in San Diego, California to assess a smoke-free policy that restricted indoor smoking. Between August and November 2015, residents completed a pre-policy questionnaire on attitudes toward smoke-free policies and exposure to secondhand smoke, and then 7-9 months after policy implementation residents were re-surveyed. At follow-up, there was a 59.7% reduction in indoor smoking. The proportion of residents who identified as current smokers reduced by 13% (95% CI: -38, 10.2). The proportion of residents who reported never smelling SHS indoors (apartment 24.2%, 95% CI: 4.2, 44.1; shared areas 17.2%, 95% CI: 1.7, 32.7); in outdoor areas next to the living unit (porches or patio 56.7%, 95% CI: 40.7, 72.8); and in other outdoor areas (parking lot 28.6%, 95% CI: 8.3, 48.9) was lower post-policy compared with pre-policy. Overall, resident support increased by 18.7%; however, the greatest increase in support occurred among current smokers (from 14.8 to 37.5%). Fewer current smokers reported that the policy would enable cessation at post-policy compared to pre-policy. Our findings demonstrate the feasibility of implementing smoke-free policies in PSH for formerly homeless adults. However, policy alone appears insufficient to trigger change in smoking behavior, highlighting the need for additional cessation resources to facilitate quitting.
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Affiliation(s)
| | | | - Jon Walters
- Housing Innovation Partners, San Diego, CA, USA
| | - Maya Vijayaraghavan
- Division of General Internal Medicine/Zuckerberg San Francisco General Hospital, School of Medicine, University of California San Francisco, 1001 Potrero Ave, Box 1364, San Francisco, CA, 94110, USA.
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'If I pay rent, I'm gonna smoke': Insights on the social contract of smokefree housing policy in affordable housing settings. Health Place 2019; 56:106-117. [PMID: 30716667 DOI: 10.1016/j.healthplace.2019.01.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 12/27/2018] [Accepted: 01/10/2019] [Indexed: 11/24/2022]
Abstract
Smoke-free housing policy in multi-unit housing has emerged as a promising tobacco control initiative, yet full compliance remains elusive and is a critical impediment to policy effectiveness. There is a gap in existing research on potential factors preventing optimal smoke-free policy adoption and corresponding solutions. Using qualitative and quantitative data from resident surveys (N = 115) as well as key informant interviews, a focus group, and observational fieldwork, this study 1) assesses smoking behaviors and experience with secondhand smoke in buildings after adoption of a smoke-free policy; 2) examines resident and property management perceptions of the policy; and 3) identifies socioecological factors that influence the policy's effectiveness in affordable housing settings in New York City. Findings indicate that residents view smoking regulations within the context of broader relationships with the housing provider and other residents. We argue that these "social contracts" strongly influence the effectiveness of smoke-free housing policies and must be acknowledged to maximize compliance.
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31
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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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32
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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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Khavjou OA, Honeycutt AA, Yarnoff B, Bradley C, Soler R, Orenstein D. Costs of community-based interventions from the Community Transformation Grants. Prev Med 2018; 112:138-144. [PMID: 29678616 DOI: 10.1016/j.ypmed.2018.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/03/2018] [Accepted: 04/16/2018] [Indexed: 11/29/2022]
Abstract
Limited data are available on the costs of evidence-based community-wide prevention programs. The objective of this study was to estimate the per-person costs of strategies that support policy, systems, and environmental changes implemented under the Community Transformation Grants (CTG) program. We collected cost data from 29 CTG awardees and estimated program costs as spending on labor; consultants; materials, travel, and services; overhead activities; partners; and the value of in-kind contributions. We estimated costs per person reached for 20 strategies. We assessed how per-person costs varied with the number of people reached. Data were collected in 2012-2015, and the analysis was conducted in 2015-2016. Two of the tobacco-free living strategies cost less than $1.20 per person and reached over 6 million people each. Four of the healthy eating strategies cost less than $1.00 per person, and one of them reached over 6.5 million people. One of the active living strategies cost $2.20 per person and reached over 7 million people. Three of the clinical and community preventive services strategies cost less than $2.30 per person, and one of them reached almost 2 million people. Across all 20 strategies combined, an increase of 10,000 people in the number of people reached was associated with a $0.22 reduction in the per-person cost. Results demonstrate that interventions, such as tobacco-free indoor policies, which have been shown to improve health outcomes have relatively low per-person costs and are able to reach a large number of people.
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Affiliation(s)
- Olga A Khavjou
- RTI International, Research Triangle Park, NC, United States.
| | | | | | | | - Robin Soler
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Diane Orenstein
- Centers for Disease Control and Prevention, Atlanta, GA, United States
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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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Kaufman P, Kang J, Kennedy RD, Beck P, Ferrence R. Impact of smoke-free housing policy lease exemptions on compliance, enforcement and smoking behavior: A qualitative study. Prev Med Rep 2018; 10:29-36. [PMID: 29552455 PMCID: PMC5852412 DOI: 10.1016/j.pmedr.2018.01.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/02/2018] [Accepted: 01/20/2018] [Indexed: 11/30/2022] Open
Abstract
This paper investigates the impacts of smoke-free housing policies on compliance, enforcement and smoking behavior. From 2012 to 2014, we studied two affordable housing providers in Canada with comprehensive smoke-free policies: Waterloo Regional Housing that required new leases to be non-smoking and exempted existing leases, and Yukon Housing Corporation that required all leases (existing and new) to be non-smoking. Focus groups and key informant interviews were conducted with 31 housing and public health staff involved in policy development and implementation, and qualitative interviews with 56 tenants. Both types of smoke-free policies helped tenants to reduce and quit smoking. However, exempting existing tenants from the policy created challenges for monitoring compliance and enforcing the policy, and resulted in ongoing tobacco smoke exposure. Moreover, some new tenants were smoking in exempted units, which undermined the policy and maintained smoking behavior. Our findings support the implementation of complete smoke-free housing policies that do not exempt existing leases to avoid many of the problems experienced by staff and tenants. In jurisdictions where exempting existing leases is still required by law, adequate staff resources for monitoring and enforcement, along with consistent and clear communication (particularly regarding balconies, patios and outdoor spaces) will encourage compliance. Smoke-free housing policy exemptions contribute to continued tobacco smoke exposure. Smoke-free housing policy exemptions contribute to compliance/enforcement issues. Resources for proactive policy enforcement will help to encourage compliance.
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Affiliation(s)
- Pamela Kaufman
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 3M7, Canada
| | - Julie Kang
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 3M7, Canada
| | - Ryan David Kennedy
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Pippa Beck
- Smoking and Health Action Foundation, Toronto, ON, Canada
| | - Roberta Ferrence
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, 155 College St., Toronto, ON M5T 3M7, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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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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Thorpe LE, Feinberg AM, Elbel B, Gordon T, Kaplan SA, Wyka K, Athens J, Shelley D. Time to Track Health Outcomes of Smoke-Free Multiunit Housing. Am J Prev Med 2018; 54:320-322. [PMID: 29246676 PMCID: PMC6214453 DOI: 10.1016/j.amepre.2017.09.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 08/28/2017] [Accepted: 09/26/2017] [Indexed: 11/16/2022]
Affiliation(s)
- Lorna E Thorpe
- Department of Population Health, New York University School of Medicine, New York, New York.
| | - Alexis M Feinberg
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Brian Elbel
- Department of Population Health, New York University School of Medicine, New York, New York; NYU Wagner Graduate School of Public Service, New York, New York
| | - Terry Gordon
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Sue A Kaplan
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Katarzyna Wyka
- City University of New York Graduate School of Public Health and Health Policy, New York, New York
| | - Jessica Athens
- Department of Population Health, New York University School of Medicine, New York, New York
| | - Donna Shelley
- Department of Population Health, New York University School of Medicine, New York, New York
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Schmidt LM, Reidmohr AA, Helgerson SD, Harwell TS. Secondhand Smoke Exposure and Smoke-Free Policy Support Among Public Housing Authority Residents in Rural and Tribal Settings. J Community Health 2018; 41:1116-1121. [PMID: 27197971 DOI: 10.1007/s10900-016-0204-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Previous research has shown that multi-unit housing (MUH) residents are at risk of secondhand smoke (SHS) exposure, which can transfer between units. The purpose of this study was to determine SHS exposure and examine attitudes towards smoking policies among public housing authority (PHA) residents in rural and tribal settings. A self-administered questionnaire was completed by 895 adult tenants (41 % response rate) living in PHA multiunit buildings in Montana in 2013. Our primary outcome was tenant support of smoke-free policies; our secondary outcome was exacerbation of child asthma symptoms due to SHS exposure. In 2014, we used multiple logistic regression models to test associations between independent variables and outcomes of interest. The majority (80.6 %) of respondents supported having a smoke-free policy in their building, with support being significantly higher among nonsmokers [adjusted odds ratio (aOR) 4.2, 95 % confidence interval (CI) 1.5-11.6] and among residents living with children (aOR 2.9, 95 % CI 1.3-6.2). Tribal residents were as likely to support smoke-free policies as non-tribal residents (aOR 1.4; 95 % CI 0.5-4.0). Over half (56.5 %) of respondents reported SHS exposure in their home; residents in a building with no smoke-free policy in place were significantly more likely to report exposure (aOR 3.5, 95 % CI 2.2-5.5). SHS exposure was not significantly associated with asthma symptoms. There is a significant reduction in exposure to SHS in facilities with smoke-free policies and there is strong support for such policies by both tribal and non-tribal MUH residents. Opportunities exist for smoke-free policy initiatives in rural and tribal settings.
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Affiliation(s)
- Lisa M Schmidt
- Montana Department of Public Health and Human Services, 1400 Broadway Street, Helena, MT, 59620, USA.
| | - Alison A Reidmohr
- Montana Department of Public Health and Human Services, 1400 Broadway Street, Helena, MT, 59620, USA
| | - Steven D Helgerson
- Montana Department of Public Health and Human Services, 1400 Broadway Street, Helena, MT, 59620, USA
| | - Todd S Harwell
- Montana Department of Public Health and Human Services, 1400 Broadway Street, Helena, MT, 59620, USA
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Stein AH, Baker LE, Agans RP, Xue W, Collins NM, Suttie JL. The Experience With Smoke-Free Policies in Affordable Multiunit Housing in North Carolina: A Statewide Survey. Am J Health Promot 2018; 30:382-9. [PMID: 27404647 DOI: 10.1177/0890117116646346] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Previous surveys of housing operators have identified concerns about enforcement, legal issues, and loss of market share as the main barriers to implementing smoke-free policies in multiunit housing. The purpose of this study was to examine enforcement practices as well as economic and legal outcomes in smoke-free affordable multiunit housing. DESIGN Cross-sectional. SETTING Affordable multiunit housing in North Carolina. SUBJECTS Affordable multiunit housing properties (n = 1063, 57% response rate). MEASURES Property representatives completed a written survey with questions regarding the existence of smoke-free policies, smoke-free policy implementation and enforcement practices, and smoking-related costs. ANALYSIS Descriptive statistics, χ(2) goodness-of-fit test, and t-test. RESULTS A total of 16.5% of properties had policies that prohibited smoking in all residential units. Half (49.8%) of smoke-free properties reported no violations to their policies in the past 12 months. Legal actions to enforce policies were rarely needed and were successful when they did occur. Compared to smoking-allowed properties, smoke-free properties did not experience a loss of market share in terms of occupancy rate (t = .09; p = .93) or residents moving away (χ(2) =. 5; p = .48). CONCLUSION Housing operators' concerns about enforcement, legal issues, and loss of market share associated with smoke-free policies are largely unfounded among affordable housing properties in North Carolina. Public health professionals should use messaging strategies that refute these concerns to encourage more properties to adopt smoke-free policies.
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Affiliation(s)
- Anna H Stein
- North Carolina Division of Public Health, Raleigh, NC, USA
| | - Laura E Baker
- North Carolina Division of Public Health, Raleigh, NC, USA
| | - Robert P Agans
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Wei Xue
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Nina M Collins
- North Carolina Division of Public Health, Raleigh, NC, USA
| | - Janet L Suttie
- North Carolina Division of Public Health, Raleigh, NC, USA
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Levy DE, Adams IF, Adamkiewicz G. Delivering on the Promise of Smoke-Free Public Housing. Am J Public Health 2017; 107:380-383. [PMID: 28103063 PMCID: PMC5296692 DOI: 10.2105/ajph.2016.303606] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2016] [Indexed: 11/04/2022]
Abstract
On November 30, 2016, the US Department of Housing and Urban Development (HUD) published a final rule mandating that public housing authorities it supports prohibit all smoking on their residential premises, including within residents' apartments. The primary rationale for this action was to protect nonsmoking residents from the harms of tobacco smoke exposure. Although the harms of secondhand smoke are clear and the potential for reducing nonsmoking residents' exposure is real, it will be no simple matter to successfully implement the policy requirements set down by HUD. Some challenges to policy implementation will apply to all public housing authorities, and others will be unique to specific settings. By being aware of the benefits of smoke-free public housing as well as the challenges inherent in complying with HUD's rule, public housing authorities stand the best chance of fulfilling the potential of this major policy initiative to significantly improve public health in a vulnerable population.
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Affiliation(s)
- Douglas E Levy
- Douglas E. Levy is with the Mongan Institute Health Policy Center and the Tobacco Research and Treatment Center, Massachusetts General Hospital and Harvard Medical School, Boston. Inez F. Adams is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Gary Adamkiewicz is with the Department of Environmental Health, Harvard T. H. Chan School of Public Health
| | - Inez F Adams
- Douglas E. Levy is with the Mongan Institute Health Policy Center and the Tobacco Research and Treatment Center, Massachusetts General Hospital and Harvard Medical School, Boston. Inez F. Adams is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Gary Adamkiewicz is with the Department of Environmental Health, Harvard T. H. Chan School of Public Health
| | - Gary Adamkiewicz
- Douglas E. Levy is with the Mongan Institute Health Policy Center and the Tobacco Research and Treatment Center, Massachusetts General Hospital and Harvard Medical School, Boston. Inez F. Adams is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston. Gary Adamkiewicz is with the Department of Environmental Health, Harvard T. H. Chan School of Public Health
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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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Cherng ST, Tam J, Christine P, Meza R. Modeling the Effects of E-cigarettes on Smoking Behavior: Implications for Future Adult Smoking Prevalence. Epidemiology 2016; 27:819-26. [PMID: 27093020 PMCID: PMC5039081 DOI: 10.1097/ede.0000000000000497] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Electronic cigarette (e-cigarette) use has increased rapidly in recent years. Given the unknown effects of e-cigarette use on cigarette smoking behaviors, e-cigarette regulation has become the subject of considerable controversy. In the absence of longitudinal data documenting the long-term effects of e-cigarette use on smoking behavior and population smoking outcomes, computational models can guide future empirical research and provide insights into the possible effects of e-cigarette use on smoking prevalence over time. METHODS Agent-based model examining hypothetical scenarios of e-cigarette use by smoking status and e-cigarette effects on smoking initiation and smoking cessation. RESULTS If e-cigarettes increase individual-level smoking cessation probabilities by 20%, the model estimates a 6% reduction in smoking prevalence by 2060 compared with baseline model (no effects) outcomes. In contrast, e-cigarette use prevalence among never smokers would have to rise dramatically from current estimates, with e-cigarettes increasing smoking initiation by more than 200% relative to baseline model estimates to achieve a corresponding 6% increase in smoking prevalence by 2060. CONCLUSIONS Based on current knowledge of the patterns of e-cigarette use by smoking status and the heavy concentration of e-cigarette use among current smokers, the simulated effects of e-cigarettes on smoking cessation generate substantially larger changes to smoking prevalence compared with their effects on smoking initiation.
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Affiliation(s)
- Sarah T. Cherng
- Department of Epidemiology, University of Michigan School of Public Health
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health
| | - Jamie Tam
- Department of Health Management and Policy, University of Michigan School of Public Health
| | - Paul Christine
- Department of Epidemiology, University of Michigan School of Public Health
- Center for Social Epidemiology and Population Health, University of Michigan School of Public Health
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health
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Kingsbury JH, Reckinger D. Clearing the Air: Smoke-Free Housing Policies, Smoking, and Secondhand Smoke Exposure Among Affordable Housing Residents in Minnesota, 2014-2015. Prev Chronic Dis 2016; 13:E111. [PMID: 27536903 PMCID: PMC4993114 DOI: 10.5888/pcd13.160195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION During the past 30 years, local and state tobacco use control laws in the United States have helped reduce smoking prevalence and exposure to secondhand smoke, but progress among low socioeconomic populations has been slow. Implementing smoke-free housing policies in affordable housing may help address this issue. The purpose of our study was to assess how such policies affect smoking rates and exposure to secondhand smoke among residents of affordable housing. METHODS We conducted a pretest-posttest longitudinal study of 180 residents from 8 affordable housing properties in Minnesota. Participating properties agreed to adopt a smoke-free housing policy covering indoor grounds, and 3 of these properties also prohibited smoking on all outdoor grounds. Policies were implemented with assistance from local public health departments and the Statewide Health Improvement Program. Participants completed surveys one month before policy implementation and 6 months postimplementation. Surveys assessed smoking, quit attempts, and indoor and outdoor secondhand smoke exposure. RESULTS Results indicated a significant reduction in nonsmokers' indoor exposure to secondhand smoke (F1,144 = 22.69, P < .001) and no change in outdoor exposure to secondhand smoke from Time 1 (pretest) to Time 2 (posttest) (F1,140 = 2.17, P = .14). However, when examining sites that only prohibited smoking indoors, we observed an increase in outdoor secondhand smoke exposure that approached significance (F1,118 = 3.76, P = .055). Results showed no change in quit attempts over time, but 77% of residents who smoked at pretest reported reducing the amount that they smoked at posttest, and an additional 5% reported that they had quit. CONCLUSIONS Smoke-free housing policies may be an effective strategy to reduce exposure to indoor secondhand exposure and promote decreased cigarette smoking among residents of affordable housing.
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Affiliation(s)
- John H Kingsbury
- Minnesota Department of Health, 85 7th Place E, St. Paul, MN 55101.
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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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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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Alcalá HE, Sharif MZ, Albert SL. Social cohesion and the smoking behaviors of adults living with children. Addict Behav 2016; 53:201-5. [PMID: 26562680 DOI: 10.1016/j.addbeh.2015.10.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 10/29/2015] [Accepted: 10/30/2015] [Indexed: 11/11/2022]
Abstract
INTRODUCTION The smoking behavior of adults can negatively impact children through exposure to environmental tobacco smoke and by modeling this unhealthy behavior. Little research has examined the role of the social environment in smoking behaviors of adults living with children. The present study specifically analyzed the relationship between social cohesion and smoking behaviors of adults living with children. METHODS Data from the 2009 California Health Interview Survey, a random-digit dial cross-sectional survey of California Adults, were used. Adults living with children reported their levels of social cohesion and smoking behaviors (N=13,978). Logistic regression models were used to predict odds of being a current smoker or living in a household in which smoking was allowed, from social cohesion. RESULTS Overall, 13% of the sample was current smokers and 3.74% lived in households in which smoking was allowed. Logistic regression models showed that each one-unit increase in social cohesion is associated with reduced odds of being a current smoker (AOR=0.92; 95% CI=0.85-0.99) and reduced odds of living in a household in which smoking is allowed (AOR=0.84; 95% CI=0.75-0.93), after controlling for sociodemographic characteristics. CONCLUSIONS Among adults living with children, higher social cohesion is associated with a lower likelihood of both being and smoker and living in a home where smoking is allowed. Thus, future research is needed to better understand mechanisms that explain the relationship between social cohesion and smoking-related behavior in order to prevent smoking-related health consequences and smoking initiation among children and adults.
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Garrett BE, Dube SR, Babb S, McAfee T. Addressing the Social Determinants of Health to Reduce Tobacco-Related Disparities. Nicotine Tob Res 2015; 17:892-7. [PMID: 25516538 PMCID: PMC5104348 DOI: 10.1093/ntr/ntu266] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 12/01/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Comprehensive tobacco prevention and control efforts that include implementing smoke-free air laws, increasing tobacco prices, conducting hard-hitting mass media campaigns, and making evidence-based cessation treatments available are effective in reducing tobacco use in the general population. However, if these interventions are not implemented in an equitable manner, certain population groups may be left out causing or exacerbating disparities in tobacco use. Disparities in tobacco use have, in part, stemmed from inequities in the way tobacco control policies and programs have been adopted and implemented to reach and impact the most vulnerable segments of the population that have the highest rates of smokings (e.g., those with lower education and incomes). METHODS Education and income are the 2 main social determinants of health that negatively impact health. However, there are other social determinants of health that must be considered for tobacco control policies to be effective in reducing tobacco-related disparities. This article will provide an overview of how tobacco control policies and programs can address key social determinants of health in order to achieve equity and eliminate disparities in tobacco prevention and control. RESULTS Tobacco control policy interventions can be effective in addressing the social determinants of health in tobacco prevention and control to achieve equity and eliminate tobacco-related disparities when they are implemented consistently and equitably across all population groups. CONCLUSIONS Taking a social determinants of health approach in tobacco prevention and control will be necessary to achieve equity and eliminate tobacco-related disparities.
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Affiliation(s)
- Bridgette E Garrett
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA;
| | - Shanta R Dube
- Division of Epidemiology and Biostatistics, Georgia State University, Atlanta, GA
| | - Stephen Babb
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tim McAfee
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, GA
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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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Mason J, Wheeler W, Brown MJ. The economic burden of exposure to secondhand smoke for child and adult never smokers residing in U.S. public housing. Public Health Rep 2015; 130:230-44. [PMID: 25931627 DOI: 10.1177/003335491513000310] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The World Health Organization (WHO) reports that nonsmokers experience disease and death due to secondhand smoke (SHS) exposure in the home. We estimated the total excess burden and costs to society due to SHS exposure in U.S. public housing. METHODS We quantified the public health burden for outcomes causally related to SHS exposure for nationally representative never-smoking residents in U.S. public housing using (1) WHO-recommended health outcomes and methodology, (2) publicly available and other large databases, and (3) published estimates of morbidity and mortality rates. We used published estimates of direct medical and nonmedical care costs and the value of productivity losses to estimate SHS-related societal costs for disease and death. We estimated the public health and economic burden for two serum cotinine limits of detection (LODs): 0.05 nanograms per milliliter (ng/mL) and 0.015 ng/mL. RESULTS In 2011, an estimated 37,791 never-smoking child and adult U.S. public housing residents experienced illness and death due to SHS exposure at home based on an LOD=0.05 ng/mL (50,967 residents at LOD=0.015 ng/mL). Costs incurred by society for these illnesses and deaths totaled $183 million (LOD=0.05 ng/mL) and $267 million (LOD=0.015 ng/mL) annually. Of the total costs, direct costs (medical and nonmedical) accounted for $128 million and $176 million for LOD=0.05 ng/mL and LOD=0.015 ng/mL, respectively. Medical care accounted for the majority of direct costs-$110 million at LOD=0.05 ng/mL and $153 million at LOD=0.015 ng/mL. Adverse respiratory health outcomes accounted for approximately one-half (56% at LOD=0.05 ng/mL and 52% at LOD=0.015 ng/mL) of total societal costs. CONCLUSION Implementing smoke-free policies in all U.S. public housing could save lives and decrease SHS-related morbidity and mortality in never-smoking residents, resulting in annual societal savings of $183 million at LOD=0.05 ng/mL and $267 million at LOD=0.015 ng/mL.
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Affiliation(s)
- Jacquelyn Mason
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Emergency and Environmental Health Services, Atlanta, GA
| | - William Wheeler
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Emergency and Environmental Health Services, Atlanta, GA ; Current affiliation: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity, Atlanta, GA
| | - Mary Jean Brown
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Emergency and Environmental Health Services, Atlanta, GA
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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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