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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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van der Eijk Y, Tan GPP, Teo O. Systems and policies to reduce secondhand smoke in multiunit housing in Singapore: a qualitative study. Tob Control 2023; 33:52-58. [PMID: 35715172 DOI: 10.1136/tobaccocontrol-2022-057301] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/02/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUND Multiunit housing residents are often exposed to neighbours' secondhand smoke (SHS). Little is known on the current systems available to protect residents in places not covered by a residential smoking ban, or what constitutes an appropriate policy approach. This study explores relevant systems and policies in Singapore, a densely populated city-state where the vast majority live in multiunit housing and discussions on regulating smoking in homes are ongoing. METHODS In-depth interviews with 18 key informants involved in thought leadership, advocacy, policy or handling SHS complaints, and 14 smokers and 16 non-smokers exposed to SHS at home. RESULTS The current system to address neighbours' SHS comprises three steps: moral suasion, mediation and legal dispute. Moral suasion and mediation are often ineffective as they depend on smokers to willingly restrict their smoking habits. Legal dispute can yield a court order to stop smoking inside the home, but the process places a high evidence burden on complainants. While setting up designated smoking points or running social responsibility campaigns may help to create no-smoking norms, more intractable cases will likely require regulation, a polarising approach which raises concerns about privacy. CONCLUSIONS Without regulations to limit SHS in multiunit housing, current systems are limited in their enforceability as they treat SHS as a neighbourly nuisance rather than a public health threat.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Grace Ping Ping Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Odelia Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Hernandez D, Khan F, Albert D, Giovenco D, Branas C, Valeri L, Navas-Acien A. A randomized control trial to support smoke-free policy compliance in public housing. Trials 2023; 24:551. [PMID: 37608390 PMCID: PMC10463922 DOI: 10.1186/s13063-023-07339-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 04/29/2023] [Indexed: 08/24/2023] Open
Abstract
BACKGROUND Smoke-free housing policies in multiunit housing are increasingly widespread interventions to reduce smoking and secondhand smoke exposure. Little research has identified factors that impede compliance with smoke-free housing policies in low-income multiunit housing and test corresponding solutions. METHODS We are using an experimental design to test two compliance support interventions: (A) a "compliance through reduction (via relocation and reduction in personal smoking) and cessation" intervention targets households with smokers and involves support to shift smoking practices to areas beyond the apartment or building setting, reduce personal smoking, and deliver in-residence smoking cessation support services via trained peer educators and (B) a "compliance through resident endorsement" intervention involving voluntary adoption of smoke-free living environments through personal pledges, visible door markers, and/or via social media. We will compare randomly sampled participants in buildings that receive A or B or A plus B to the NYCHA standard approach. DISCUSSION This RCT addresses key gaps in knowledge and capitalizes on key scientific opportunities by (1) leveraging the federal mandate to ban smoking in a public housing system of more than sufficient size to conduct an adequately powered RCT; (2) expanding our understanding of smoke-free policy compliance beyond policy implementation by testing two novel treatments: (a) in-residence smoking cessation and (b) resident endorsement, while (3) addressing population and location-specific tobacco-related disparities. At the conclusion of the study, this RCT will have leveraged a monumental policy shift affecting nearly half a million NYC public housing residents, many of whom disproportionately experience chronic illness and are more likely to smoke and be exposed to secondhand smoke than other city residents. This first-ever RCT will test the effects of much-needed compliance strategies on resident smoking behavior and secondhand smoke exposure in multiunit housing. TRIAL REGISTRATION Clinical Trials Registered, NCT05016505. Registered on August 23, 2021.
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Affiliation(s)
- Diana Hernandez
- Sociomedical Sciences, Columbia Mailman School of Public Health, New York, USA.
| | - Farzana Khan
- Sociomedical Sciences, Columbia Mailman School of Public Health, New York, USA
| | - David Albert
- Health Policy and Management, Columbia Mailman School of Public Health, New York, USA
| | - Daniel Giovenco
- Sociomedical Sciences, Columbia Mailman School of Public Health, New York, USA
| | - Charles Branas
- Epidemiology, Columbia Mailman School of Public Health, New York, USA
| | - Linda Valeri
- Biostatistics, Columbia Mailman School of Public Health, New York, USA
| | - Ana Navas-Acien
- Environmental Health Sciences, Columbia Mailman School of Public Health, New York, USA
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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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Do EK, Bradley KC, Fugate-Laus K, Kaur K, Halquist MS, Ray L, Pope MA, Hayes RB, Wheeler DC, Fuemmeler BF. An examination of social and environmental determinants of secondhand smoke exposure among non-smoking adolescents. Tob Prev Cessat 2021; 7:20. [PMID: 33728387 PMCID: PMC7954078 DOI: 10.18332/tpc/131875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Adolescents are at increased risk of secondhand smoke exposure (SHS) due to the limited control that they have over social and physical environments. Yet, knowledge regarding determinants of SHS among non-smoking adolescents is limited. This study identifies social and environmental factors associated with SHS among non-smoking adolescents. METHODS To be included, parents and adolescents (aged 11–17 years) of the Adolescents, Place, and Behavior Study had to have completed surveys between March 2019 and May 2020. Adolescents had to have not reported smoking within the past 30 days and provided a saliva sample assayed for cotinine (≤3 ng/mL). A series of stepwise linear regression models were fit to the data to identify social and environmental determinants of SHS, using log-transformed salivary cotinine. RESULTS Of the 105 adolescent and parent dyads included, 90.3% were African American, 26.9% of parents reported smoking, 33.3% resided in multi-unit housing, and 67.7% lived in homes where smoking was not permitted. Significant associations were found between parent tobacco use (β=2.56, SE=0.98, p=0.0082) and residing in multi-unit housing (β=1.72, SE=0.86, p=0.0460) with increased log-transformed cotinine levels among non-smoking adolescents. Adolescent age, gender, and race/ ethnicity, parental education, peer tobacco use, the number of adults and children in the home, average number of days of self-reported SHS within public spaces outside of the home, and home smoking policies were not significantly associated with cotinine. CONCLUSIONS Results emphasize the importance of reducing secondhand smoke exposure by reducing parental smoking and altering exposures within social and home environments. Parental tobacco use and residential setting should be considered when developing interventions to reduce secondhand smoke exposure among non-smoking adolescents.
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Affiliation(s)
- Elizabeth K Do
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, United States.,Massey Cancer Center, Virginia Commonwealth University, Richmond, United States
| | - Kennedy C Bradley
- Department of Family Medicine and Population Health, Virginia Commonwealth University, Richmond, United States
| | - Kendall Fugate-Laus
- Department of Psychology, Virginia Commonwealth University, Richmond, United States
| | - Kiranpreet Kaur
- School of Medicine, Virginia Commonwealth University, Richmond, United States
| | - Matthew S Halquist
- School of Pharmacy, Virginia Commonwealth University, Richmond, United States
| | - Laure Ray
- School of Pharmacy, Virginia Commonwealth University, Richmond, United States
| | | | - Rashelle B Hayes
- Department of Psychiatry, Virginia Commonwealth University, Richmond, United States
| | - David C Wheeler
- Department of Biostatistics, Virginia Commonwealth University, Richmond, United States
| | - Bernard F Fuemmeler
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, United States.,Massey Cancer Center, Virginia Commonwealth University, Richmond, United States
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Proposal for smoke-free public housing: a systematic review of attitudes and preferences from residents of multi-unit housing. J Public Health Policy 2020; 41:496-514. [PMID: 32620837 DOI: 10.1057/s41271-020-00236-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
A policy proposal to ban public housing smoking indoors has received support, but it is unclear how certain affected groups, specifically smokers in housing units, perceive such a policy. To review the literature on attitudes and perceptions of housing unit tenants towards an indoor smoke-free housing policy, using various databases, we searched articles for attitudes towards smoking ban enforcement in housing units. We identified fourteen articles. Non-smokers heavily favored indoor policies and current smokers heavily opposed them. Current smokers represented a substantial minority in the reviewed articles, resulting in overall outcomes of the surveys driven by non-smokers. Studies investigating attitudes about housing smoking bans largely represent the views of non-smokers and lack data about barriers and concerns of tenants who do not support a smoke-free policy. Future studies should investigate if such a discrepancy impacts the efficacy of smoke-free housing policies.
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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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Anthony J, Goldman R, Rees VW, Frounfelker RL, Davine J, Keske RR, Brooks DR, Geller AC. Qualitative Assessment of Smoke-Free Policy Implementation in Low-Income Housing: Enhancing Resident Compliance. Am J Health Promot 2019; 33:107-117. [PMID: 29772910 PMCID: PMC10623451 DOI: 10.1177/0890117118776090] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE As public housing agencies and other low-income housing providers adopt smoke-free policies, data are needed to inform implementation approaches that support compliance. DESIGN Focused ethnography used including qualitative interviews with staff, focus groups with residents, and property observations. SETTING Four low-income housing properties in Massachusetts, 12 months postpolicy adoption. PARTICIPANTS Individual interviews (n = 17) with property staff (managers, resident service coordinators, maintenance, security, and administrators) and focus groups with resident smokers (n = 28) and nonsmokers (n = 47). MEASURES Informed by the social-ecological model: intrapersonal, interpersonal, organizational, and community factors relating to compliance were assessed. ANALYSIS Utilized MAXQDA in a theory-driven immersion/crystallization analytic process with cycles of raw data examination and pattern identification until no new themes emerged. RESULTS Self-reported secondhand smoke exposure (SHSe) was reduced but not eliminated. Challenges included relying on ambivalent maintenance staff and residents to report violations, staff serving as both enforcers and smoking cessation counsellors, and inability to enforce on nights and weekends. Erroneous knowledge of the policy, perception that SHSe is not harmful to neighbors, as well as believing that smokers were losing their autonomy and being unfairly singled out when other resident violations were being unaddressed, hindered policy acceptance among resident smokers. The greatest challenge to compliance was the lack of allowable outdoor smoking areas that may have reduced the burden of the policy on smokers. CONCLUSION Smoke-free policy implementation to support compliance could be enhanced with information about SHSe for smokers and nonsmokers, cessation support from external community partners, discussion forums for maintenance staff, resident inclusion in decision-making, and framing the policy as part of a broader wellness initiative.
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Affiliation(s)
- Jodi Anthony
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Roberta Goldman
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Vaughan W. Rees
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Rochelle L. Frounfelker
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Jessica Davine
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Robyn R. Keske
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Daniel R. Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Alan C. Geller
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
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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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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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Butler KM, Rayens MK, Wiggins AT, Rademacher KB, Hahn EJ. Association of Smoking in the Home With Lung Cancer Worry, Perceived Risk, and Synergistic Risk. Oncol Nurs Forum 2018; 44:E55-E63. [PMID: 28222077 DOI: 10.1188/17.onf.e55-e63] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the association of smoking in the home with lung cancer worry, perceived risk, and synergistic risk, controlling for sociodemographics, family history of lung cancer, and health-related self-concept. The hypothesis is that participants with smoking in the home would have higher scores for lung cancer worry, perceived risk, and synergistic risk.
. DESIGN Cross-sectional baseline survey.
. SETTING Participants recruited from an outpatient clinic and pharmacy at University of Kentucky HealthCare, an academic medical center.
. SAMPLE 515 homeowners from a larger randomized, controlled trial aimed at reducing exposure to radon and secondhand smoke (SHS).
. METHODS Homeowners were selected via quota sampling so that about half would have a smoker or smokers in the home.
. MAIN RESEARCH VARIABLES Lung cancer worry and perceived risk; perception of synergistic risk of radon and SHS exposure; demographics.
. FINDINGS Participants with smoking in the home had higher rates of lung cancer worry and perceived risk. In addition, those with less education and a family history of lung cancer and who were current smokers had higher lung cancer worry and perceived lung cancer risk scores. Predictors of perception of synergistic risk were marital status and health-related self-concept.
. CONCLUSIONS Homeowners with smoking in the home, less education, and a family history of lung cancer had greater lung cancer worry and perceived lung cancer risk. Lung cancer risk reduction interventions with vulnerable populations are needed.
. IMPLICATIONS FOR NURSING Nurses are in a unique position to target high-risk populations and identify opportunities to create teachable moments to reduce environmental risks of radon and tobacco smoke exposure.
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Orazine CI, Arias WA, Magee SR, King E. Non-smoking pregnant women and their fetuses are exposed to environmental tobacco smoke as a result of living in multiunit housing. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2017; 27:465-470. [PMID: 27485991 DOI: 10.1038/jes.2016.34] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 05/03/2016] [Accepted: 05/23/2016] [Indexed: 05/07/2023]
Abstract
This study investigates whether pregnant women and their fetuses are exposed to environmental tobacco smoke (ETS) as a result of living in apartments. We measured cotinine concentrations in serum, a biomarker of exposure to ETS, in non-smoking women's umbilical cord blood collected at delivery and in maternal blood drawn shortly after delivering a baby. Concurrently, information was collected regarding the women's housing situation, whether family members or co-workers smoked, and other potential exposure factors. Newborns whose non-smoking mothers lived in an apartment during pregnancy were more than three times (OR 3.17, 95% CI 1.62-6.21) more likely to have detectable levels of cotinine in their cord blood serum than babies whose mothers lived in a detached house. There is a strong association between detectable concentrations of cotinine in cord blood serum and living in an apartment, even after adjusting for confounders, such as exposure at home or at work. A similar association was observed between the detectable levels of cotinine in maternal serum and living in an apartment (OR 1.95, 95% CI 1.03-3.71).
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Affiliation(s)
- Christina I Orazine
- Rhode Island Department of Health, State Health Laboratories, 50 Orms Street, Providence, Rhode Island 02904, USA
| | - William A Arias
- Rhode Island Department of Health, 3 Capitol Hill, Providence, Rhode Island 02908, USA
| | - Suzanna R Magee
- Memorial Hospital of Rhode Island, 111 Brewster Street Pawtucket, Rhode Island 02860, USA
| | - Ewa King
- Rhode Island Department of Health, State Health Laboratories, 50 Orms Street, Providence, Rhode Island 02904, USA
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Young W, Karp S, Bialick P, Liverance C, Seder A, Berg E, Karp L. Health, Secondhand Smoke Exposure, and Smoking Behavior Impacts of No-Smoking Policies in Public Housing, Colorado, 2014-2015. Prev Chronic Dis 2016; 13:E148. [PMID: 27763830 PMCID: PMC5072752 DOI: 10.5888/pcd13.160008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Exposure to secondhand smoke is problematic for residents living in multiunit housing, as the smoke migrates through shared ventilation systems, unsealed cracks, and door spaces. The objective of our research was to assess resident exposure to secondhand smoke, support for no-smoking policies, and the health impacts of no-smoking policies in multiunit housing. METHODS Surveys of 312 heads of households who resided in 1 of 3 multiunit buildings managed by a Colorado public housing authority were administered before and after implementation of a no-smoking policy that prohibited smoking in all resident apartments and all indoor common areas. A matched-pairs analysis of initial surveys and 15-month post-policy implementation surveys for 115 respondents was conducted. RESULTS Decreases were found in the number and percentage of smokers who smoked every day and the number of cigarettes smoked per day, and 30% had quit smoking 15 months after policy implementation. The percentage of residents who smelled secondhand smoke indoors declined significantly. A significant decrease in breathing problems was found after policy implementation. Although decreases were found in the incidence of asthma attacks, emphysema/chronic obstructive pulmonary disease, eye irritation, colds, nasal congestion, and ear/sinus infections, these decreases were not significant. CONCLUSION Consistent findings across nearly all variables tested suggest that no-smoking policies reduce resident exposure to secondhand smoke, lower the incidence of secondhand smoke-associated breathing problems, decrease daily smoking and cigarette consumption, encourage smoking cessation, and increase quit attempts. If implemented in all multiunit housing, these policies could reduce exposure to secondhand smoke and health problems associated with secondhand smoke, promote smoking cessation, and reduce cigarette consumption.
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Affiliation(s)
- Walter Young
- Advanced Health Directions, 14945 Foothill Rd, Golden, CO 80401.
| | - Shelley Karp
- Abacus Statistical Consultants, Portland, Oregon
| | | | | | - Ashley Seder
- American Lung Association in Colorado, Centennial, Colorado
| | - Erica Berg
- Denver Health and Hospital Authority, Denver, Colorado
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14
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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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Fang SC, Chen S, Trachtenberg F, Rokicki S, Adamkiewicz G, Levy DE. Validity of Self-Reported Tobacco Smoke Exposure among Non-Smoking Adult Public Housing Residents. PLoS One 2016; 11:e0155024. [PMID: 27171392 PMCID: PMC4865127 DOI: 10.1371/journal.pone.0155024] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 04/22/2016] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Tobacco smoke exposure (TSE) in public multi-unit housing (MUH) is of concern. However, the validity of self-reports for determining TSE among non-smoking residents in such housing is unclear. METHODS We analyzed data from 285 non-smoking public MUH residents living in non-smoking households in the Boston area. Participants were interviewed about personal TSE in various locations in the past 7 days and completed a diary of home TSE for 7 days. Self-reported TSE was validated against measurable saliva cotinine (lower limit of detection (LOD) 0.02 ng/ml) and airborne apartment nicotine (LOD 5 ng). Correlations, estimates of inter-measure agreement, and logistic regression assessed associations between self-reported TSE items and measurable cotinine and nicotine. RESULTS Cotinine and nicotine levels were low in this sample (median = 0.026 ng/ml and 0.022 μg/m(3), respectively). Prevalence of detectable personal TSE was 66.3% via self-report and 57.0% via measurable cotinine (median concentration among those with cotinine>LOD: 0.057 ng/ml), with poor agreement (kappa = 0.06; sensitivity = 68.9%; specificity = 37.1%). TSE in the home, car, and other peoples' homes was weakly associated with cotinine levels (Spearman correlations rs = 0.15-0.25), while TSE in public places was not associated with cotinine. Among those with airborne nicotine and daily diary data (n = 161), a smaller proportion had household TSE via self-report (41.6%) compared with measurable airborne nicotine (53.4%) (median concentration among those with nicotine>LOD: 0.04 μg/m(3)) (kappa = 0.09, sensitivity = 46.5%, specificity = 62.7%). CONCLUSIONS Self-report alone was not adequate to identify individuals with TSE, as 31% with measurable cotinine and 53% with measurable nicotine did not report TSE. Self-report of TSE in private indoor spaces outside the home was most associated with measurable cotinine in this low-income non-smoking population.
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Affiliation(s)
- Shona C. Fang
- New England Research Institutes, Inc., Watertown, MA, United States of America
| | - Shan Chen
- New England Research Institutes, Inc., Watertown, MA, United States of America
| | | | - Slawa Rokicki
- Interfaculty Initiative in Health Policy, Harvard University, Cambridge, MA, United States of America
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
| | - Douglas E. Levy
- Mongan Institute for Health Policy, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States of America
- * E-mail:
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Rokicki S, Adamkiewicz G, Fang SC, Rigotti NA, Winickoff JP, Levy DE. Assessment of Residents' Attitudes and Satisfaction Before and After Implementation of a Smoke-Free Policy in Boston Multiunit Housing. Nicotine Tob Res 2016; 18:1282-1289. [PMID: 26508397 PMCID: PMC6407845 DOI: 10.1093/ntr/ntv239] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 10/18/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION In 2012, the Boston Housing Authority (BHA) in Massachusetts implemented a smoke-free policy prohibiting smoking within its residences. We sought to characterize BHA resident experiences before and after the smoke-free policy implementation, and compare them to that of nearby residents of the Cambridge Housing Authority, which had no such policy. METHODS We recruited a convenience sample of nonsmoking residents from the BHA and Cambridge Housing Authority. We measured residents' awareness and support of their local smoking policies before and 9-12 months after the BHA's policy implementation, as well as BHA respondents' attitudes towards the smoke-free policy. We assessed tobacco smoke exposure via saliva cotinine, airborne apartment nicotine, and self-reported number of days smelling smoke in the home. We evaluated predictors of general satisfaction at follow-up using linear regression. RESULTS At follow-up, 91% of BHA respondents knew that smoking was not allowed in apartments and 82% were supportive of such a policy in their building. BHA residents believed enforcement of the smoke-free policy was low. Fifty-one percent of BHA respondents indicated that other residents "never" or "rarely" followed the new smoke-free rule and 41% of respondents were dissatisfied with policy enforcement. Dissatisfaction with enforcement was the strongest predictor of general housing satisfaction, while objective and self-reported measures of tobacco smoke exposure were not predictive of satisfaction. At follow-up, 24% of BHA participants had complained to someone in charge about policy violations. CONCLUSIONS Resident support for smoke-free policies is high. However, lack of enforcement of smoke-free policies may cause frustration and resentment among residents, potentially leading to a decrease in housing satisfaction. IMPLICATIONS Smoke-free housing laws are becoming increasingly prevalent, yet little is known about satisfaction and compliance with such policies post-implementation. We evaluated nonsmoking residents' attitudes about smoke-free rules and their satisfaction with enforcement 1 year after the BHA implemented its comprehensive smoke-free policy. We found that while residents were supportive of the policy, they believed enforcement was low, a perception that was associated with a drop in housing satisfaction. Our findings point to a desire for smoke-free housing among public housing residents, and the importance of establishing systems and guidelines to help landlords monitor and enforce these policies effectively.
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Affiliation(s)
- Slawa Rokicki
- Interfaculty Initiative in Health Policy, Harvard University
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Cambridge, MA
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T.H. Chan School of Public Health
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Boston, MA
| | - Shona C. Fang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health
,
Boston, MA
- New England Research Institutes, Inc
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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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17
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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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18
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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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Chambers C, Sung HY, Max W. Home exposure to secondhand smoke among people living in multiunit housing and single family housing: a study of California adults, 2003-2012. J Urban Health 2015; 92:279-90. [PMID: 25466438 PMCID: PMC4411315 DOI: 10.1007/s11524-014-9919-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Public health education efforts continue to encourage people to adopt voluntary smoking bans at home; nonetheless, the home remains a place where many people are exposed to secondhand smoke (SHS). Little is known about how SHS exposure in the home differs between adults residing in multiunit housing (MUH) and those residing in single family housing (SFH). This study (1) compared the socio-demographic characteristics, chronic disease conditions, and smoking status of adults living in MUH with those living in SFH, (2) assessed the correlates of living in MUH for adults, and (3) evaluated the association of residency in MUH and SFH with the odds of being exposed to SHS at home using population-based survey data of California adults. Smoking prevalence was significantly higher among MUH residents than SFH residents. The adjusted odds of exposure to SHS at home were 32 % higher for MUH smokers than SFH smokers but were not significantly different for non-smokers. This study presents evidence that there are significant socio-demographic differences between MUH residents and SFH residents and that MUH smokers have higher rates of exposure to SHS at home than SFH smokers after adjusting for other covariates. To reduce home exposure to SHS among MUH residents, it is important to adopt tobacco control policies that are aimed at reducing SHS exposure in and around MUH and at reducing cigarette smoking among current smokers in MUH.
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Snyder K, Vick JH, King BA. Smoke-free multiunit housing: a review of the scientific literature. Tob Control 2015; 25:9-20. [PMID: 25566811 DOI: 10.1136/tobaccocontrol-2014-051849] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Accepted: 12/16/2014] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Multiunit housing (MUH) residents are susceptible to secondhand smoke (SHS) exposure, which can transfer between living units. This review summarises existing scientific literature relevant to smoke-free MUH, discusses knowledge gaps and provides recommendations for future research to inform public health action. DATA SOURCES We conducted a systematic search of peer-reviewed articles using three databases: EBSCOhost CINAHL, PubMed and Web of Science. STUDY SELECTION Article titles, abstracts and text were reviewed to ascertain three inclusion criteria: (1) English language; (2) conducted in the USA; (3) reported on baseline data, development, implementation or evaluation of smoke-free MUH. DATA EXTRACTION We used a multistep process to identify eligible articles: (1) two reviewers separately evaluated article titles; (2) two reviewers separately evaluated abstracts and (3) one reviewer read each article and determined inclusion eligibility. DATA SYNTHESIS We identified and included 35 articles published during 2001-2014, grouped based on broad themes: MUH resident (n=16); MUH operator (n=6); environmental monitoring and biomarkers (n=9); economic (n=2); legal (n=3); and implementation process and policy impact (n=8). Studies with multiple themes were included in all relevant groups. CONCLUSIONS Existing literature has focused on self-reported, cross-sectional studies of MUH residents and operators; some studies of environmental markers, biomarkers and economic indicators have also been conducted. Future research on smoke-free MUH policy compliance and enforcement, and on the impact of these policies on smoking behaviours and health outcomes, could further inform public health planning, policy and practice. Despite these gaps, the current literature provides sufficient evidence for action to eliminate SHS exposure in MUH.
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Affiliation(s)
- Kimberly Snyder
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Janice Hassett Vick
- Public Health and Survey Research Division, ICF International, Atlanta, Georgia, USA
| | - Brian A King
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Burdette LK, Rowe GC, Johansen L, Kerkvliet JL, Nagelhout E, Lewis K, Fahrenwald NL. A statewide assessment of smoke-free policy in multiunit housing settings. Nicotine Tob Res 2014; 16:1593-8. [PMID: 25059499 DOI: 10.1093/ntr/ntu114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The prevalence of smoke-free policies in multiunit housing (MUH) in South Dakota was examined. Owner beliefs about smoke-free policies were identified. METHODS Stratified random sampling included 27 South Dakota counties classified as frontier, large rural, or urban. Data collection with MUH owners in selected counties employed a telephone survey with mailed backup. RESULTS The owner response rate was 41.5% (324/780). A written smoke-free policy was reported by 175 (54.0%) owners, and 31 (10%) reported a verbal smoke-free policy. Owners in large rural counties (57.4%) had more written smoke-free policies than owners in urban (52.2%) and frontier (53.5%) counties. Only 8.5% of properties had policies covering both buildings and grounds. Owners without policies were more than twice as likely to manage U.S. Department of Housing and Urban Development subsidized units and were three times as likely to be current smokers. Owners without a smoke-free policy anticipated that a policy would decrease maintenance costs but increase turnover and vacancy rates. Nearly one-half (47.9%) of owners with no smoke-free policy had previously considered implementing a policy. Owners self-reported beliefs about smoke-free policies identified perceived benefits such as decreased maintenance and costs, improved tenant safety and health, and conscientious tenants. Perceived drawbacks included increased outdoor maintenance, enforcement problems, concerns about long-term tenants who smoke, and freedom/rights of smokers. CONCLUSIONS This study provides a baseline assessment of smoke-free polices in MUH settings. Perceptions of owners without smoke-free policies focused on economic concerns that were inconsistent with reports from those owners with smoke-free policies.
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Affiliation(s)
- Linda K Burdette
- South Dakota State University, College of Nursing, Brookings, SD
| | - Gina C Rowe
- South Dakota State University, College of Nursing, Brookings, SD
| | - Laurie Johansen
- South Dakota State University, College of Nursing, Brookings, SD
| | | | | | - Kyle Lewis
- South Dakota State University, College of Nursing, Brookings, SD
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Wilson KM, Torok M, McMillen R, Tanski S, Klein JD, Winickoff JP. Tobacco smoke incursions in multiunit housing. Am J Public Health 2014; 104:1445-53. [PMID: 24922124 DOI: 10.2105/ajph.2014.301878] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to describe the prevalence of secondhand tobacco smoke incursions reported by multiunit housing (MUH) residents, pinpoint factors associated with exposure, and determine whether smoke-free building policy was associated with prevalence of reported tobacco smoke incursions. METHODS Data are from a 2011 nationally representative dual-frame survey (random-digit-dial and Internet panels) of US adults aged 18 years and older. Individuals who lived in MUH and who reported no smoking in their homes for the past 3 months, whether or not they reported being smokers themselves, were included in this study. Incursions were defined as smelling tobacco smoke in their building or unit. RESULTS Of 562 respondents, 29.5% reported smoke incursions in their buildings. Of these, 16% reported incursions in their own unit, 36.2% of which occurred at least weekly. Government-subsidized housing and partial smoke-free policies were associated with a higher likelihood of reporting smoke incursions. CONCLUSIONS Many residents of multiunit housing are exposed to tobacco smoke in their units and buildings. Partial smoke-free policies do not appear to protect residents and might increase the likelihood of incursions in residents' individual units.
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Affiliation(s)
- Karen M Wilson
- Karen M. Wilson is with the Section of Hospital Medicine, Children's Hospital Colorado, University of Colorado School of Medicine, Denver. Michelle Torok is with the Children's Outcomes Research Program, University of Colorado School of Medicine. Robert McMillen is with the Department of Psychology and Social Science Research Center, Mississippi State University, Mississippi State. Susanne Tanski is with the Norris Cotton Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, NH. Jonathan D. Klein is with the American Academy of Pediatrics Julius B. Richmond Center of Excellence, Elk Grove Village, IL. Jonathan P. Winickoff is with the Division of General Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA
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Hood NE, Wewers ME, Ferketich AK, Klein EG, Pirie P. Predictors of Voluntary Home-Smoking Restrictions and Associations with an Objective Measure of In-Home Smoking among Subsidized Housing Tenants. Am J Health Promot 2013; 28:97-104. [DOI: 10.4278/ajhp.120816-quan-399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose. Examine predictors of voluntary home-smoking restrictions (HSRs) and associations with an objective measure of in-home smoking. Design. Cross-sectional. Setting. Publicly subsidized multiunit housing units managed by private company in Columbus, Ohio, without a smoke-free housing policy. Subjects. Probability sample of primary leaseholders (N = 301, 64% response rate). Measures. Self-reported knowledge, attitudes, and behaviors collected during face-to-face survey in fall 2011, including individual (e.g., knowledge of health effects), social (e.g., number of friends who smoke), and environmental (e.g., safety) factors hypothesized to be related to having HSRs. Surface nicotine concentration (μg/m2) based on samples collected from wood surface in respondents' living rooms (n = 279). Analysis. Multiple linear and logistic regression were used to identify factors associated with having HSRs and with indoor surface nicotine concentrations. Results. Fewer than one-third (29.2%) of tenants had complete HSRs, while more than half (55.8%) had partial restrictions. Several individual and social factors, but no environmental/community factors, were associated with having HSRs. Type of HSRs (p < .001) and smoking status (p < .001) were independently associated with mean surface nicotine concentrations. Conclusion. Few subsidized housing tenants voluntarily limit in-home smoking. Partial restrictions could be considered as a harm reduction strategy but may be less effective among smokers. Strategies to change social norms are also needed to modify in-home smoking behavior among subsidized housing tenants.
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Diepeveen S, Ling T, Suhrcke M, Roland M, Marteau TM. Public acceptability of government intervention to change health-related behaviours: a systematic review and narrative synthesis. BMC Public Health 2013; 13:756. [PMID: 23947336 PMCID: PMC3765153 DOI: 10.1186/1471-2458-13-756] [Citation(s) in RCA: 287] [Impact Index Per Article: 26.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 07/03/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Governments can intervene to change health-related behaviours using various measures but are sensitive to public attitudes towards such interventions. This review describes public attitudes towards a range of policy interventions aimed at changing tobacco and alcohol use, diet, and physical activity, and the extent to which these attitudes vary with characteristics of (a) the targeted behaviour (b) the intervention and (c) the respondents. METHODS We searched electronic databases and conducted a narrative synthesis of empirical studies that reported public attitudes in Europe, North America, Australia and New Zealand towards interventions relating to tobacco, alcohol, diet and physical activity. Two hundred studies met the inclusion criteria. RESULTS Over half the studies (105/200, 53%) were conducted in North America, with the most common interventions relating to tobacco control (110/200, 55%), followed by alcohol (42/200, 21%), diet-related interventions (18/200, 9%), interventions targeting both diet and physical activity (18/200, 9%), and physical activity alone (3/200, 2%). Most studies used survey-based methods (160/200, 80%), and only ten used experimental designs. Acceptability varied as a function of: (a) the targeted behaviour, with more support observed for smoking-related interventions; (b) the type of intervention, with less intrusive interventions, those already implemented, and those targeting children and young people attracting most support; and (c) the characteristics of respondents, with support being highest in those not engaging in the targeted behaviour, and with women and older respondents being more likely to endorse more restrictive measures. CONCLUSIONS Public acceptability of government interventions to change behaviour is greatest for the least intrusive interventions, which are often the least effective, and for interventions targeting the behaviour of others, rather than the respondent him or herself. Experimental studies are needed to assess how the presentation of the problem and the benefits of intervention might increase acceptability for those interventions which are more effective but currently less acceptable.
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Affiliation(s)
| | | | - Marc Suhrcke
- Norwich Medical School, University of East Anglia, Norwich, UK
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Martin Roland
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
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Support for No-Smoking Policies Among Residents of Public Multiunit Housing Differs by Smoking Status. J Community Health 2013; 38:1074-80. [DOI: 10.1007/s10900-013-9716-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Satterlund TD, Treiber J, Cassady D. Navigating local smoke-free multi-unit housing policy adoption. JOURNAL OF DRUG EDUCATION 2013; 43:33-47. [PMID: 24855882 DOI: 10.2190/de.43.1.c] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
California state-funded local tobacco control projects have instituted smoke-free multi-unit housing (MUH) policy adoption campaigns in order to secure voluntary policy throughout the state. While landlords can legally prohibit smoking at MUH complexes in California, they often oppose such measures. The objective of this study was to analyze voluntary smoke-free policy campaigns of state-funded local projects by focusing on the challenges they faced. Specifically, we examined 40 local campaigns in California led by county health departments and community based organizations, focusing on the barriers the local projects often had to overcome to enact policy. Our results identify arguments and issues typically raised by MUH property landlords, including the notion of tenant smoker and privacy rights, potential negative effects of smoke-free policy, and issues concerning the enforcement of policy. Moreover, relationships between local project personnel and MUH management often soured, which sometimes derailed smoke-free policy campaigns altogether. Our findings provide agencies with insights from the MUH property landlord perspective that will serve to inform future campaign strategy.
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King BA, Babb SD, Tynan MA, Gerzoff RB. National and state estimates of secondhand smoke infiltration among U.S. multiunit housing residents. Nicotine Tob Res 2012; 15:1316-21. [PMID: 23248030 DOI: 10.1093/ntr/nts254] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Multiunit housing (MUH) residents are susceptible to secondhand smoke (SHS), which can infiltrate smoke-free living units from nearby units and shared areas where smoking is permitted. This study assessed the prevalence and characteristics of MUH residency in the United States, and the extent of SHS infiltration in this environment at both the national and state levels. METHODS National and state estimates of MUH residency were obtained from the 2009 American Community Survey. Assessed MUH residency characteristics included sex, age, race/ethnicity, and poverty status. Estimates of smoke-free home rule prevalence were obtained from the 2006-2007 Tobacco Use Supplement to the Current Population Survey. The number of MUH residents who have experienced SHS infiltration was determined by multiplying the estimated number of MUH residents with smoke-free homes by the range of self-reported SHS infiltration (44%-46.2%) from peer-reviewed studies of MUH residents. RESULTS One-quarter of U.S. residents (25.8%, 79.2 million) live in MUH (state range: 10.1% in West Virginia to 51.7% in New York). Nationally, 47.6% of MUH residents are male, 53.3% are aged 25-64 years, 48.0% are non-Hispanic White, and 24.4% live below the poverty level. Among MUH residents with smoke-free home rules (62.7 million), an estimated 27.6-28.9 million have experienced SHS infiltration (state range: 26,000-27,000 in Wyoming to 4.6-4.9 million in California). CONCLUSIONS A considerable number of Americans reside in MUH and many of these individuals experience SHS infiltration in their homes. Prohibiting smoking in MUH would help protect MUH residents from involuntary SHS exposure.
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Affiliation(s)
- Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Hood NE, Ferketich AK, Klein EG, Wewers ME, Pirie P. Individual, social, and environmental factors associated with support for smoke-free housing policies among subsidized multiunit housing tenants. Nicotine Tob Res 2012; 15:1075-83. [PMID: 23136269 DOI: 10.1093/ntr/nts246] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Mandatory smoke-free policies in subsidized, multiunit housing (MUH) may decrease secondhand smoke exposure in households with the highest rates of exposure. Ideally, policies should be based on a strong understanding of factors affecting support for smoke-free policies in the target population to maximize effectiveness. METHODS A face-to-face survey was conducted from August to October 2011 using a stratified random sample of private subsidized housing units in Columbus, OH, without an existing smoke-free policy (n = 301, 64% response rate). Lease holders were asked to report individual, social, and environmental factors hypothesized to be related to support for smoke-free policies. Multiple logistic regression models were used to identify factors independently associated with policy support. RESULTS Most tenants supported smoke-free policies in common areas (82.7%), half supported policies inside units (54.5%), and one third supported a ban outside the building (36.3%). Support for smoke-free policies in units and outdoors was more common among nonsmokers than smokers (71.5% vs. 35.7%, p < .001 and 46.2% vs. 25.4%, p < .001, respectively). Several individual and social, but no environmental, factors were independently associated with policy support. Smokers who intended to quit within 6 months or less were more likely than other smokers to support in-unit policies (45.3% vs. 21.1%; p = .003). CONCLUSIONS More than half of subsidized MUH tenants supported smoke-free policies inside their units. Strategies to address individual- and social-level barriers to behavior change should be implemented in parallel with smoke-free policies. Policies should be evaluated with objective measures to determine their effectiveness.
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Affiliation(s)
- Nancy E Hood
- The Ohio State University College of Public Health, Health Behavior & Health Promotion, Columbus, OH 48106-1248, USA.
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Secondhand smoke and smokefree policies in owner-occupied multi-unit housing. Am J Prev Med 2012; 43:S187-96. [PMID: 23079216 DOI: 10.1016/j.amepre.2012.07.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/26/2012] [Accepted: 07/30/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Studies have documented movement of secondhand smoke (SHS) between units in multi-unit buildings, but none has focused on owner-occupied units in common-interest communities (CICs). In Minnesota, approximately 170,000 households (8%) live in such units. CIC households may experience long-term SHS exposure because owner-occupants typically live in the same unit for many years. PURPOSE This study estimated the prevalence of SHS incursion in CICs and assessed residents' attitudes toward SHS incursions and interest in smokefree policies. METHODS A stratified sample of Minnesota CIC owner-occupants was surveyed in 2009, with analysis in 2010-2011. Data were weighted to account for differing sampling, response, and coverage rates by stratum, then calibrated to population control totals for housing type, age, and smoking status. RESULTS The response rate was 35.6%, with 495 completions. Twenty-eight percent of households reported SHS incursion into their unit in the preceding 6 months; 59% of these said this bothers them a lot. Only 6% report that their CIC has a smokefree policy for residents' units. Forty-two percent would prefer such a policy whereas 26% would prefer smoking-permitted. Sixty-three percent definitely and 17% probably would choose a no-smoking building over a smoking-permitted building if they were buying a new unit, and 46% would be willing to pay more for such a unit. CONCLUSIONS Secondhand smoke incursion is common in CICs, and interest in smokefree CICs greatly exceeds the supply. Given the known health risks of SHS exposure, tobacco control efforts in multi-housing should address CICs as well as rental households.
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Licht AS, King BA, Travers MJ, Rivard C, Hyland AJ. Attitudes, experiences, and acceptance of smoke-free policies among US multiunit housing residents. Am J Public Health 2012; 102:1868-71. [PMID: 22897557 DOI: 10.2105/ajph.2012.300717] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We assessed factors related to smoke-free policies among a cross-sectional, nationally representative, random-digit-dial sample (landline and cell phone) of US multiunit housing residents (n = 418). Overall, 29% reported living in smoke-free buildings, while 79% reported voluntary smoke-free home rules. Among those with smoke-free home rules, 44% reported secondhand smoke incursions in their unit. Among all respondents, 56% supported smoke-free building policy implementation. These findings suggest that smoke-free building policies are needed to protect multiunit housing residents from secondhand smoke in their homes.
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Affiliation(s)
- Andrea S Licht
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA.
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Pizacani BA, Maher JE, Rohde K, Drach L, Stark MJ. Implementation of a smoke-free policy in subsidized multiunit housing: effects on smoking cessation and secondhand smoke exposure. Nicotine Tob Res 2012; 14:1027-34. [PMID: 22318686 DOI: 10.1093/ntr/ntr334] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION We studied the impact of implementing a comprehensive smoke-free policy in multiunit housing in the Portland, Oregon metropolitan area. Among low-income tenants living in a subset of subsidized multiunit buildings, we evaluated cessation-related behaviors, policy knowledge and compliance, and secondhand smoke (SHS) exposure. METHODS We mailed a self-administered questionnaire to a random sample of 839 current tenants of 17 subsidized buildings 4 months after policy implementation in January 2008 and sent another questionnaire to participants 1 year later. Results are based on 440 tenants who completed both surveys. RESULTS We observed a self-reported annualized quit rate of 14.7% over the study period (95% CI = 7.9%-21.6%) compared with a historical quit rate in this population of 2.6% (95% CI = 0.6%-4.5%). Almost half of ongoing smokers reduced their cigarette consumption. More smokers correctly reported policy rules for indoor settings than for outdoor settings; self-reported indoor smoking decreased significantly from 59% to 17%. Among nonsmokers, frequent indoor SHS exposure (multiple times per week) decreased significantly from 41% prepolicy to 17% postpolicy. CONCLUSIONS The implementation of a smoke-free policy was associated with positive changes in cessation-related behaviors and reduced SHS exposure in this population of low-income adults.
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Affiliation(s)
- Barbara A Pizacani
- Program Design and Evaluation Services, 827 NE Oregon Street., Ste. 250, Portland, OR 97232, USA.
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Jackson SL, Bonnie RJ. A systematic examination of smoke-free policies in multiunit dwellings in Virginia as reported by property managers: implications for prevention. Am J Health Promot 2012; 26:37-44. [PMID: 21879941 DOI: 10.4278/ajhp.091005-quan-329] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE In most states, smoking has been curtailed to some extent in public buildings, workplaces, and restaurants. The next frontier for smoke-free policies is the multiunit dwelling industry. However, the extent to which smoke-free housing currently is available is unknown. The purpose of this study was to measure the market for smoke-free housing in Virginia and to identify barriers to adopting smoke-free policies. DESIGN Telephone interviews were conducted with property managers of rental apartments, townhouses, senior housing, and public housing in four Virginia cities. SETTING Four cities in Virginia. SUBJECTS Two hundred sixty-three property managers in four cities in Virginia (approximately 75 property managers per city). MEASURES Property managers were administered a brief telephone survey. RESULTS Only 33.8% of property managers reported some type of smoke-free policy, with only 15% of those policies prohibiting smoking in residential units. Most property managers without a smoke-free policy were not considering adopting such a policy for a variety of reasons. CONCLUSION The availability of smoke-free multiunit dwellings is severely lacking. This study identified a number of science-based and legal misperceptions that may prevent the adoption of smoke-free policies. Correction of these misperceptions is warranted to increase the availability of smoke-free housing. Such policies will be useful in creating environments that support good health practices while simultaneously protecting tenants from exposure to secondhand smoke.
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Affiliation(s)
- Shelly L Jackson
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville, Virginia 22908-0660, USA.
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Intervention to promote smoke-free policies among multiunit housing operators. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2011; 17:E1-8. [PMID: 21464678 DOI: 10.1097/phh.0b013e3181ffd8e3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the efficacy of an intervention to encourage the adoption of smoke-free policies among owners and managers of multiunit housing. DESIGN A pretest-posttest quasi-experimental design was employed. PARTICIPANTS The study population included 287 multiunit housing operators (MUHOs) from across New York State who were recruited to complete a baseline survey designed to assess policies about smoking in the housing units that they owned and/or managed. Subjects were surveyed between March and July 2008 (n = 128 intervention, n = 159 control) and recontacted 1 year later to complete a follow-up survey (n = 59 intervention, n = 95 control). INTERVENTION An informational packet on the benefits of implementing a smoke-free policy was mailed to MUHOs in the New York State counties of Erie and Niagara between March and July 2008. For comparison purposes, a sample of MUHOs located outside of Erie and Niagara counties who did not receive the information packet were identified to serve as control subjects. MAIN OUTCOME MEASURES Logistic regression was used to assess predictors of policy interest, concern, and implementation at follow-up. Predictors included: intervention group, baseline status, respondent smoking status, survey type, government-subsidy status, quantity of units operated, and average building size, construction type, and age. RESULTS Multiunit housing operators who received the information packet were more likely to report interest in adopting a smoke-free policy (OR = 6.49, 95% CI = 1.44-29.2), and less likely to report concerns about adopting such a policy (OR = 0.16, 95% CI = 0.04-0.66) compared to MUHOs who did not receive the information packet; however, the rate of adoption of smoke-free policies was comparable between the groups. CONCLUSION Sending MUHOs an information packet on the benefits of adopting a smoke-free policy was effective in addressing concerns and generating interest toward smoke-free policies but was not sufficient in itself to generate actual policy adoption.
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Baezconde-Garbanati LA, Weich-Reushé K, Espinoza L, Portugal C, Barahona R, Garbanati J, Seedat F, Unger JB. Secondhand smoke exposure among Hispanics/Latinos living in multiunit housing: exploring barriers to new policies. Am J Health Promot 2011; 25:S82-90. [PMID: 21510793 DOI: 10.4278/ajhp.100628-qual-219] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Despite a high prevalence of voluntary home smoking bans and laws protecting Californians from exposure to secondhand smoke (SHS) in the workplace, many Hispanic/Latino (H/L) residents of multiunit housing (MUH) are potentially exposed to SHS from neighboring apartments. An advocacy/policy intervention was implemented to reduce tobacco-related health disparities by encouraging H/L living in MUH to implement voluntary policies that reduce exposure to SHS. This article presents findings from qualitative and quantitative data collected during development of the intervention, as well as preliminary results of the intervention. DESIGN, SETTING, AND SUBJECTS MUH residents in Southern California participated in focus groups (n = 48), door-to-door surveys (n = 142), and a telephone survey (n = 409). MEASURES Exposure to SHS, attitudes toward SHS, and attitudes toward policies restricting SHS in MUH were assessed. RESULTS H/L MUH residents reported high levels of exposure to SHS and little ability to protect themselves and their families from SHS. Respondents expressed positive attitudes toward adopting antismoking policies in MUH, but they also feared retaliation by smokers. The cultural values of familismo, respeto, simpatía, and personalismo influenced their motivation to protect their families from SHS as well as their reluctance to ask their neighbors to refrain from smoking. Nonsmokers were more likely to favor complete indoor and outdoor smoking bans in MUH, whereas smokers were more likely to favor separate smoking areas. The Regale Salud advocacy/policy intervention, implemented to reduce SHS exposure, prompted the passage of seven voluntary policies in apartment complexes in Southern California to prevent smoking in MUH. CONCLUSIONS H/L in California support voluntary policies, local ordinances, and state laws that prevent exposure to SHS in MUH, especially those that are consistent with H/L cultural values and norms for interpersonal communication.
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Affiliation(s)
- Lourdes A Baezconde-Garbanati
- Institute for Health Promotion and Disease Prevention Research, Department of Preventive Medicine, University of Southern California Keck School of Medicine, 1000 South Fremont, Unit 8, Alhambra, CA 91803, USA.
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Moving multiunit housing providers toward adoption of smoke-free policies. Prev Chronic Dis 2010; 8:A21. [PMID: 21159233 PMCID: PMC3044032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Tenants in multiunit housing are at elevated risk for exposure to secondhand smoke at home because of smoke migration from other units. COMMUNITY CONTEXT In 2004, tobacco control advocates in the Portland, Oregon, metropolitan area began to address this issue by launching a campaign to work with landlord and tenant advocates, private- and public-sector property managers, and other housing stakeholders to encourage smoke-free policies in multiunit housing. METHODS We outline the 6-year campaign that moved local housing providers toward adopting no-smoking policies. We used the stages of change model, which matches potential messages or interventions to a smoker's readiness to quit smoking. OUTCOME The campaign resulted in Oregon's largest private property management company and its largest public housing authority adopting no-smoking policies for their properties and a 29% increase in the availability of smoke-free rental units in the Portland-Vancouver metro area from 2006 through 2009. INTERPRETATION We learned the importance of building partnerships with public and private stakeholders, collecting local data to shape educational messages, and emphasizing to landlords the business case, not the public health rationale, for smoke-free housing.
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Cramer ME, Roberts S, Stevens E. Landlord attitudes and behaviors regarding smoke-free policies: implications for voluntary policy change. Public Health Nurs 2010; 28:3-12. [PMID: 21198809 DOI: 10.1111/j.1525-1446.2010.00904.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The study purpose was to describe multiunit landlord attitudes and behaviors toward smoke-free policies. DESIGN AND SAMPLE This was a descriptive, cross-sectional survey of multiunit landlords in Douglas County (N=392). MEASURES A 25-item survey was developed and pilot tested. It was administered by telephone (n=143) and mail (n=249) to multiunit landlords. RESULTS Combined response rate was 30.1% (81/143 telephone, 37/249 mail) representing 24,080 units on 974 properties with 34,399 tenants. Most respondents (73.7%) allowed smoking. Reasons for not implementing smoke-free policies were potential enforcement problems (57.0%), tenant objections (43.0%), loss of market share (39.5%). Respondents without smoke-free policies expected vacancy (53.6%) and turnover (50.0%) rates to increase, which was significantly different (p <.0001) than respondents with smoke-free policies where only 10.7% reported increased vacancy and only 3.7% reported increased turnover. CONCLUSIONS Expected adverse impacts of smoke-free policies do not reflect real experiences of smoke-free policy implementation. Public health advocates can use these study findings to develop community-based education and social marketing messages directed at voluntary smoke-free policy changes. Respondents without smoke-free policies expressed interest at the end of the survey in learning how to implement smoke-free policies indicating a readiness for change.
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Affiliation(s)
- Mary E Cramer
- Community-based Health Department, University of Nebraska Medical Center College of Nursing and College of Public Health, Omaha, Nebraska, USA.
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Nakkash RT, Khalil J, Chaaya M, Afifi RA. Building Research Evidence for Policy Advocacy: A Qualitative Evaluation of Existing Smoke-Free Policies in Lebanon. Asia Pac J Public Health 2010; 22:168S-174S. [DOI: 10.1177/1010539510373020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Secondhand smoke is harmful to smokers and nonsmokers, and smoke-free legislation worldwide improves health status. Lebanon has one of the weakest tobacco control regulatory environments in the Eastern Mediterranean region. However, several Lebanese workplaces and hospitality venues have chosen to implement such policies on their own. The objective of this study was to document their experiences. Qualitative interviews and focus group discussions were conducted with management, employees, and clients. Thematic analysis was used to identify recurrent themes. Results describe the types of bans implemented; the reasons for adopting a policy; and the barriers and facilitators to implementation, enforcement, and compliance. A main facilitator was management support, whereas a main barrier was prosmoking norms. This analysis provides insight and lessons learned that can aid in scaling up tobacco control efforts in Lebanon and the Eastern Mediterranean region.
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Affiliation(s)
- Jonathan P Winickoff
- Department of Pediatrics, Massachusetts General Hospital for Children and Harvard Medical School, Boston, USA
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Drach LL, Pizacani BA, Rohde KL, Schubert S. The acceptability of comprehensive smoke-free policies to low-income tenants in subsidized housing. Prev Chronic Dis 2010; 7:A66. [PMID: 20394705 PMCID: PMC2879998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Our objective was to evaluate the acceptability of a comprehensive smoke-free policy among low-income tenants in a group of subsidized, multiunit buildings. We conducted a mixed-methods evaluation that included questionnaires mailed to 839 tenants and follow-up telephone interviews with 23 tenants who were current, former, and never smokers. Most never and former smokers supported the policy, citing improved health, fire safety, and building cleanliness; most current smokers disliked the policy and did not follow it. Messages focusing on shared community-level concerns, accompanied by smoking cessation resources, may support the transition to smoke-free policies in subsidized housing.
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Affiliation(s)
- Linda L. Drach
- Oregon Department of Human Services, Public Health Division
| | - Barbara A. Pizacani
- Multnomah County Health Department and Oregon Department of Human Services/Public Health Division, Portland, Oregon
| | - Kristen L. Rohde
- Multnomah County Health Department and Oregon Department of Human Services/Public Health Division, Portland, Oregon
| | - Stacey Schubert
- Multnomah County Health Department and Oregon Department of Human Services/Public Health Division, Portland, Oregon
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King BA, Cummings KM, Mahoney MC, Juster HR, Hyland AJ. Multiunit housing residents' experiences and attitudes toward smoke-free policies. Nicotine Tob Res 2010; 12:598-605. [PMID: 20395360 DOI: 10.1093/ntr/ntq053] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Secondhand smoke (SHS) causes significant disease and death. A person's home represents a prominent source of SHS, and the potential for exposure is elevated among those who live in close proximity to smokers in multiunit housing (MUH). This study assessed the prevalence and predictors of SHS exposure and smoke-free policy support among MUH residents. METHODS Data were obtained from 5,936 MUH residents who participated in the New York State Adult Tobacco Survey between May 2007 and May 2009. Bivariate analyses were used to assess the prevalence of smoke-free home policies, SHS incursions, and support for smoke-free policies. Logistic regression was used to identify predictors of these measures while adjusting for gender, age, ethnicity, education, region, children in household, and housing type. RESULTS A total of 73.1% of respondents reported a personal smoke-free home policy in their home. Among these individuals, 46.2% indicated that SHS has ever entered their home in the past year, while 9.2% reported daily incursions. Overall, a majority of respondents (55.6%) support a policy that bans smoking in all areas of their building, including residential units; support was significantly higher among ethnic minorities and individuals who reside with children. DISCUSSION Nearly half of New York MUH residents with a smoke-free home policy have experienced a SHS incursion in their home. Since a majority of MUH residents support smoke-free policies and nearly three quarters already prohibit smoking in their home, opportunities exist for initiatives to promote smoke-free building policies.
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Affiliation(s)
- Brian A King
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
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King BA, Travers MJ, Cummings KM, Mahoney MC, Hyland AJ. Prevalence and predictors of smoke-free policy implementation and support among owners and managers of multiunit housing. Nicotine Tob Res 2009; 12:159-63. [PMID: 19959570 DOI: 10.1093/ntr/ntp175] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Exposure to secondhand smoke causes disease and premature death. Although many municipalities have instituted policies prohibiting smoking in public areas, personal living areas remain largely unregulated. Individuals who reside in multiunit housing (MUH) facilities where smoking is permitted are particularly susceptible to involuntary exposure. This study assessed the prevalence and predictors of smoke-free policy implementation and support among owners and managers of MUH throughout Western New York State. METHODS A telephone survey was administered to a sample of owners and managers of MUH buildings in the Erie and Niagara counties, New York. A total of 127 respondents completed the survey between March and July 2008 (62% response rate). Logistic regression was used to assess predictors of policy implementation and support, while adjusting for participant smoking status, quantity of units owned/managed, government subsidy status, as well as building age, construction type, and size. RESULTS Only 13% of participants reported smoking restrictions within any of their buildings. Among those without a smoke-free policy, 75% would be interested in restricting smoking in at least one of their units, with interest being significantly higher among participants with government-subsidized units (odds ratio = 3.12, 95% CI = 1.14-8.52). Primary barriers to policy implementation included concern over increased vacancy (27%) and a decreased market base (21%). DISCUSSION Few Western New York MUH owners and managers have implemented smoke-free policies in their buildings, but most are receptive to doing so. Therefore, opportunities exist for interventions to enhance policy acceptance, implementation, and enforcement among these individuals.
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Affiliation(s)
- Brian A King
- Department of Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
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Abstract
BACKGROUND Evidence of the effectiveness of smoking restrictions in workplaces and other public places is creating awareness of the role of bans in private spaces. The purpose of this study was to examine who is affected by strict home smoking bans at the household level. METHODS Using the 1998/1999 Tobacco Use Supplement to the U.S. Current Population Survey, we examined the characteristics of 43,613 households with two or more adults who responded to the home ban question. Analyses were conducted in 2003-2004. RESULTS An estimated 12% of sample households provided inconsistent reports about home smoking bans. Multimember households with smokers were substantially less likely to consistently report strict home bans. Discrepancies vary systematically by smoking behavior, socioeconomic status, and race/ethnicity. Children living with smokers are especially at risk of inconsistent adult reports. CONCLUSIONS Analyses should not rely on individual reports of home bans, especially in households with smokers and children. Policies should be directed toward educating members of households with smokers and children about the importance of household bans.
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