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Kibria MG, Hossain A, Islam T, Islam KR, Mahmud HMM, Nabi MH, Hawlader MDH. Secondhand smoke exposure and associated factors among city residents living in multiunit housing in Bangladesh. PLoS One 2023; 18:e0291746. [PMID: 37733729 PMCID: PMC10513191 DOI: 10.1371/journal.pone.0291746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 09/05/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Secondhand smoke (SHS) poses a high health risk to those living in multiunit housing (MUH) since it can easily spread from unit to unit and throughout the building's communal areas. MUH residents in Bangladesh are particularly vulnerable to SHS due to the absence of smoking restrictions within a housing complex. Therefore, this study aimed to assess the prevalence of SHS exposure and its associated factors among MUH residents living in seven divisional cities of Bangladesh- Dhaka, Chattogram, Rajshahi, Khulna, Sylhet, Barishal, and Rangpur. METHODS From April 2019 to November 2019, a cross-sectional survey was conducted with 616 MUH residents aged 18 or older who had been residing in MUH for at least two years in the seven divisional cities of Bangladesh. A multivariable logistic regression model was performed to determine the associated factors of SHS exposure. RESULTS In MUH complexes, more than half (54.9%) of the 616 respondents were exposed to SHS. The key factors positively associated with SHS exposure were females (aOR: 1.8, 95% CI:1.236-2.681), residents with a low monthly family income (aOR: 1.9, 95% CI: 1.162-3.220), those whose family members smoked (aOR: 2.4, 95% CI: 1.537-3.746), and Dhaka city residents (aOR: 1.9, 95% CI: 1.013-3.440). CONCLUSIONS This study revealed a high prevalence of SHS exposure among Bangladeshi MUH residents. Therefore, a smoking ban is needed in and around MUH complexes to protect non-smoking residents from SHS exposure.
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Affiliation(s)
- Md. Golam Kibria
- Department of Research, Centre for Development Action, Dhaka, Bangladesh
| | - Ahmed Hossain
- Health Services Administrations, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Taslima Islam
- Department of Research, Centre for Development Action, Dhaka, Bangladesh
- Department of Monitoring, Evaluation and Learning, Social Development Foundation, Dhaka, Bangladesh
| | - Kazi Rakibul Islam
- Department of Public Health, Northern University Bangladesh, Dhaka, Bangladesh
| | - H. M. Miraz Mahmud
- Department of Research & Evaluation, Bangladesh Center for Communication Programs, Dhaka, Bangladesh
| | | | - Mohammad Delwer Hossain Hawlader
- Department of Research, Centre for Development Action, Dhaka, Bangladesh
- Department of Public Health, North South University, Dhaka, Bangladesh
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Reyes-Guzman CM, Patel M, Wang TW, Corcy N, Chomenko D, Slotman B, Vollinger RE. Disparities in Smokefree and Vapefree Home Rules and Smokefree Policy Attitudes Based on Housing Type and Cigarette Smoking Status, United States, 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6356. [PMID: 37510588 PMCID: PMC10379655 DOI: 10.3390/ijerph20146356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 07/30/2023]
Abstract
This study examined variations in cigarette smoking status, home smoking and vaping rules, and attitudes toward smoking rules among U.S. adults. We analyzed data from the 2019 U.S. Census Bureau's Current Population Survey Supplements (n = 40,296 adults) and calculated weighted prevalence estimates of adult cigarette smoking based on housing type. In 2019, multi-unit housing (MUH) residents who currently smoked were predominantly residents of privately rented housing (66.9%), followed by privately owned (17.6%) and public housing (15.5%). MUH residents who currently smoked had the highest proportions of allowing smoking (26.7%) or vaping (29.1%) anywhere inside their homes and were least likely to support rules allowing smoking inside all MUH apartments or living areas. In the adjusted models, MUH residents with a current smoking status were 92% less likely to have a complete smoking ban. More than one in four MUH residents with a current smoking status allowed all smoking inside the home and supported allowing smoking inside all MUH apartment or living areas, reinforcing how MUH residents may be at higher risk of experiencing secondhand smoke or aerosol exposure, or incursions within their places of residence. Our results can inform the development, implementation, and sustainment of strategies to reduce exposures from tobacco and nicotine products in all living environments.
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Affiliation(s)
- Carolyn M Reyes-Guzman
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA
| | - Minal Patel
- Tobacco Control Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD 20892, USA
- American Cancer Society, Atlanta, GA 30303, USA
| | - Teresa W Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
| | - Nalini Corcy
- BLH Technologies, Inc., Rockville, MD 20850, USA
| | | | | | - Robert E Vollinger
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Boderie NW, Sheikh A, Lo E, Sheikh A, Burdorf A, van Lenthe FJ, Mölenberg FJ, Been JV. Public support for smoke-free policies in outdoor areas and (semi-)private places: a systematic review and meta-analysis. EClinicalMedicine 2023; 59:101982. [PMID: 37256097 PMCID: PMC10225670 DOI: 10.1016/j.eclinm.2023.101982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 04/10/2023] [Accepted: 04/12/2023] [Indexed: 06/01/2023] Open
Abstract
Background Smoke-free policies are essential to protect people against tobacco smoke exposure. To successfully implement smoke-free policies that go beyond enclosed public places and workplaces, public support is important. We undertook a comprehensive systematic review of levels and determinants of public support for indoor (semi-)private and outdoor smoke-free policies. Methods In this systematic review and meta-analysis, six electronic databases were searched for studies (published between 1 January 2004 and 19 January 2022) reporting support for (semi-)private and outdoor smoke-free policies in representative samples of at least 400 respondents aged 16 years and above. Two reviewers independently extracted data and assessed risk of bias of individual reports using the Mixed Methods Appraisal Tool. The primary outcome was proportion support for smoke-free policies, grouped according to location covered. Three-level meta-analyses, subgroup analyses and meta-regression were performed. Findings 14,749 records were screened, of which 107 were included; 42 had low risk of bias and 65 were at moderate risk. 99 studies were included in the meta-analyses, reporting 326 measures of support from 896,016 individuals across 33 different countries. Support was pooled for indoor private areas (e.g., private cars, homes: 73%, 95% confidence interval (CI): 66-79), indoor semi-private areas (e.g., multi-unit housing: 70%, 95% CI: 48-86), outdoor hospitality areas (e.g., café and restaurant terraces: 50%, 95% CI: 43-56), outdoor non-hospitality areas (e.g., school grounds, playgrounds, parks, beaches: 69%, 95% CI: 64-73), outdoor semi-private areas (e.g., shared gardens: 67%, 95% CI: 53-79) and outdoor private areas (e.g., private balconies: 41%, 95% CI: 18-69). Subcategories showed highest support for smoke-free cars with children (86%, 95% CI: 81-89), playgrounds (80%, 95% CI: 74-86) and school grounds (76%, 95% CI: 69-83). Non-smokers and ex-smokers were more in favour of smoke-free policies compared to smokers. Support generally increased over time, and following implementation of each smoke-free policy. Interpretation Our findings suggested that public support for novel smoke-free policies is high, especially in places frequented by children. Governments should be reassured about public support for implementation of novel smoke-free policies. Funding Dutch Heart Foundation, Lung Foundation Netherlands, Dutch Cancer Society, Dutch Diabetes Research Foundation and Netherlands Thrombosis Foundation.
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Affiliation(s)
- Nienke W. Boderie
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Asiyah Sheikh
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Erika Lo
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Aziz Sheikh
- Centre for Medical Informatics, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Alex Burdorf
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Frank J. van Lenthe
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Famke J.M. Mölenberg
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
| | - Jasper V. Been
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Division of Neonatology, Department of Neonatal and Paediatric Intensive Care, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
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Titus AR, Mijanovich TN, Terlizzi K, Ellen IG, Anastasiou E, Shelley D, Wyka K, Elbel B, Thorpe LE. A Matched Analysis of the Association Between Federally Mandated Smoke-Free Housing Policies and Health Outcomes Among Medicaid-Enrolled Children in Subsidized Housing, New York City, 2015-2019. Am J Epidemiol 2023; 192:25-33. [PMID: 35551590 PMCID: PMC10175658 DOI: 10.1093/aje/kwac089] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 01/11/2023] Open
Abstract
Smoke-free housing policies are intended to reduce the deleterious health effects of secondhand smoke exposure, but there is limited evidence regarding their health impacts. We examined associations between implementation of a federal smoke-free housing rule by the New York City Housing Authority (NYCHA) and pediatric Medicaid claims for asthma, lower respiratory tract infections, and upper respiratory tract infections in the early post-policy intervention period. We used geocoded address data to match children living in tax lots with NYCHA buildings (exposed to the policy) to children living in lots with other subsidized housing (unexposed to the policy). We constructed longitudinal difference-in-differences models to assess relative changes in monthly rates of claims between November 1, 2015, and December 31, 2019 (the policy was introduced on July 30, 2018). We also examined effect modification by baseline age group (≤2, 3-6, or 7-15 years). In New York City, introduction of a smoke-free policy was not associated with lower rates of Medicaid claims for any outcomes in the early postpolicy period. Exposure to the smoke-free policy was associated with slightly higher than expected rates of outpatient upper respiratory tract infection claims (incidence rate ratio = 1.05, 95% confidence interval: 1.01, 1.08), a result most pronounced among children aged 3-6 years. Ongoing monitoring is essential to understanding long-term health impacts of smoke-free housing policies.
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Widome R. Invited Commentary: Use of Epidemiologic Methods to Guide Comprehensive and Equitable Approaches to Policy. Am J Epidemiol 2023; 192:34-38. [PMID: 36255180 PMCID: PMC10144725 DOI: 10.1093/aje/kwac184] [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: 05/25/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 01/11/2023] Open
Abstract
Despite a dramatic reduction in the prevalence of commercial cigarette smoking in the United States, children are still commonly exposed to secondhand smoke (SHS), which is a cause of various pediatric health problems. Further, SHS exposure is patterned by race and class, exacting an inequitable toll on children from families with lesser social and economic advantage. In this issue of the Journal, Titus et al. (Am J Epidemiol. 2023;192(1):25-33) use natural experiment evaluation methods (difference-in-differences) to test whether the recently implemented US Department of Housing and Urban Development policy that forbade smoking in and around New York City Housing Authority buildings affected child respiratory health. The results from their work remind us that policies do not always impact outcomes as we might expect. Given that policy is one of the most potent tools for population health promotion, this work underlines the need for epidemiologists to engage in policy evaluation at all stages of the policy life cycle, in order to discover comprehensive approaches to policy development and implementation that prioritize equity and address structural racism.
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Affiliation(s)
- Rachel Widome
- Correspondence to Dr. Rachel Widome, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street #300, Minneapolis, MN 55454 (e-mail: )
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Fu R, Kundu A, Mitsakakis N, Elton-Marshall T, Wang W, Hill S, Bondy SJ, Hamilton H, Selby P, Schwartz R, Chaiton MO. Machine learning applications in tobacco research: a scoping review. Tob Control 2023; 32:99-109. [PMID: 34452986 DOI: 10.1136/tobaccocontrol-2020-056438] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Accepted: 04/14/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Identify and review the body of tobacco research literature that self-identified as using machine learning (ML) in the analysis. DATA SOURCES MEDLINE, EMABSE, PubMed, CINAHL Plus, APA PsycINFO and IEEE Xplore databases were searched up to September 2020. Studies were restricted to peer-reviewed, English-language journal articles, dissertations and conference papers comprising an empirical analysis where ML was identified to be the method used to examine human experience of tobacco. Studies of genomics and diagnostic imaging were excluded. STUDY SELECTION Two reviewers independently screened the titles and abstracts. The reference list of articles was also searched. In an iterative process, eligible studies were classified into domains based on their objectives and types of data used in the analysis. DATA EXTRACTION Using data charting forms, two reviewers independently extracted data from all studies. A narrative synthesis method was used to describe findings from each domain such as study design, objective, ML classes/algorithms, knowledge users and the presence of a data sharing statement. Trends of publication were visually depicted. DATA SYNTHESIS 74 studies were grouped into four domains: ML-powered technology to assist smoking cessation (n=22); content analysis of tobacco on social media (n=32); smoker status classification from narrative clinical texts (n=6) and tobacco-related outcome prediction using administrative, survey or clinical trial data (n=14). Implications of these studies and future directions for ML researchers in tobacco control were discussed. CONCLUSIONS ML represents a powerful tool that could advance the research and policy decision-making of tobacco control. Further opportunities should be explored.
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Affiliation(s)
- Rui Fu
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Anasua Kundu
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nicholas Mitsakakis
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Wei Wang
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Sean Hill
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Susan J Bondy
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Hayley Hamilton
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Robert Schwartz
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michael Oliver Chaiton
- Ontario Tobacco Research Unit, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Zajac L, Gallate X, Gu G, Liu B, Elaiho C, Lin E, Mogilner L, Oliver K, Vangeepuram N, Wilson K. Disparities in Marijuana and Tobacco Smoke Incursions Among New York City Families During Early Months of the COVID-19 Pandemic. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:248-257. [PMID: 34750327 PMCID: PMC8963431 DOI: 10.1097/phh.0000000000001440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Once the COVID-19 pandemic arrived in New York City (NYC), stay-at-home orders led to more time spent indoors, potentially increasing exposure to secondhand marijuana and tobacco smoke via incursions from common areas or neighbors. The objective of this study was to characterize housing-based disparities in marijuana and tobacco incursions in NYC housing during the pandemic. DESIGN We surveyed a random sample of families from May to July 2020 and collected sociodemographic data, housing characteristics, and the presence, frequency, and pandemic-related change in incursions. SETTING Five pediatric practices affiliated with a large NYC health care system. PARTICIPANTS In total, 230 caregivers of children attending the practices. MAIN OUTCOME MEASURES Prevalence and change in tobacco and marijuana smoke incursions. RESULTS Tobacco and marijuana smoke incursions were reported by 22.9% and 30.7%, respectively. Twenty-two percent of families received financial housing support (public housing, Section-8). Compared with families in private housing, families with financial housing support had 3.8 times the odds of tobacco incursions (95% CI, 1.4-10.1) and 3.7 times the odds of worsening incursions during pandemic (95% CI, 1.1-12.5). Families with financially supported housing had 6.9 times the odds of marijuana incursions (95% CI, 2.4-19.5) and 5 times the odds of worsening incursions during pandemic (95% CI, 1.9-12.8). Children in financially supported housing spent more time inside the home during pandemic (median 24 hours vs 21.6 hours, P = .02) and were more likely to have asthma (37% vs 12.9%, P = .001) than children in private housing. CONCLUSIONS Incursions were higher among families with financially supported housing. Better enforcement of existing regulations (eg, Smoke-Free Public Housing Rule) and implementation of additional policies to limit secondhand tobacco and marijuana exposure in children are needed. Such actions should prioritize equitable access to cessation and mental health services and consider structural systems leading to poverty and health disparities.
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Affiliation(s)
- Lauren Zajac
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Xanthe Gallate
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Gregory Gu
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Bian Liu
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Cordelia Elaiho
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Elaine Lin
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Leora Mogilner
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Kristin Oliver
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Nita Vangeepuram
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
| | - Karen Wilson
- Department of Environmental Medicine and Public Health (Drs Zajac and Oliver), Department of Pediatrics, and Kravis Children's Hospital (Ms Elaiho and Drs Lin, Mogilner, Vangeepuram, and Wilson), Medical Education (Ms Gallate), and Department of Population Health Science and Policy, and Institute for Translational Epidemiology (Dr Liu), Icahn School of Medicine at Mount Sinai, New York City, New York; and Columbia University Post-Baccalaureate Program, New York City, New York (Mr Gu)
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Patel M, Donovan EM, Liu M, Solomon-Maynard M, Schillo BS. Policy Support for Smoke-Free and E-Cigarette Free Multiunit Housing. Am J Health Promot 2021; 36:106-116. [PMID: 34344161 DOI: 10.1177/08901171211035210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Estimate public support for prohibiting multiunit housing (MUH) e-cigarette and cigarette use. DESIGN Cross-sectional study. SETTING Data from an online panel survey. SAMPLE A Fall 2018 nationally representative sample of 3,415 (99.3% response rate) United States (US) adults 18-64 years old. MEASURES Policy support for prohibiting MUH smoking and e-cigarette use, sociodemographics, and tobacco perceptions and behaviors. ANALYSIS Weighted multivariate logistic regression examined predictors of support for prohibiting 1) cigarette use and 2) e-cigarette use in MUH. RESULTS Most respondents expressed support for prohibiting smoking (76.9%) and e-cigarette use (74.0%) in MUH. About 17% (n = 588) of the sample lived in MUH, and living in MUH was not predictive of support for either policy. For both cigarette and e-cigarette policies, current smokers (n = 630; OR = 0.44, p < 0.001; OR = 0.59, p < 0.01) and current e-cigarette users (n = 305; OR = 0.42, p < 0.001; OR = 0.22, p < 0.001) had lower odds of support. Notably, while most smokers supported prohibiting cigarette (51.4%) and e-cigarette use in MUH (51.1%), there was less support among current e-cigarette users for prohibiting cigarette (48.1%) and e-cigarette use in MUH (34.5%). CONCLUSION Majority support for prohibiting smoking and e-cigarette use in MUH is promising for policy adoption; however, lower support of both policies among e-cigarette users needs to be examined, as increasing use of e-cigarettes may be shifting social norms away from support for smoke free housing policies.
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Affiliation(s)
- Minal Patel
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Emily M Donovan
- Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Michael Liu
- Schroeder Institute at Truth Initiative, Washington, DC, USA
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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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Driezen P, Fong GT, Hyland A, Craig LV, Sansone G, Hitchman SC, Cummings KM. Self-Reported Exposure to Secondhand Smoke and Support for Complete Smoking Bans in Multiunit Housing Among Smokers in the United States, Canada, and the United Kingdom. Prev Chronic Dis 2020; 17:E147. [PMID: 33241991 PMCID: PMC7735481 DOI: 10.5888/pcd17.200201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Introduction Involuntary exposure to secondhand smoke most frequently occurs at home, which is problematic for residents of multiunit housing (MUH). The primary objective of this study was to estimate the extent of secondhand smoke incursions into the homes of MUH smokers who banned smoking in their homes but lived in buildings where smoking is allowed. Methods We used data from Wave 9 of the International Tobacco Control Four Country Survey. We estimated 1) the prevalence of complete smoking bans among smokers living in single-family homes vs MUH in the United States (n = 3,208), Canada (n = 1,592), and the United Kingdom (n = 1,403) from 2013 to 2015; 2) the extent of secondhand smoke incursions into the homes of MUH smokers who banned smoking in their units but lived in buildings that allow smoking; and 3) MUH smokers’ preferences for complete smoking bans in MUH. Weighted multivariable logistic regression estimated the country-specific adjusted prevalence of all outcomes. Results Overall, 53.0% of smokers living in single-family homes completely banned smoking in their homes, compared with 44.8% of smokers in MUH. Across all 3 countries, only 27.8% of MUH smokers reported that smoking was completely prohibited in their building. A similar percentage of MUH smokers who banned smoking in their home but lived in buildings allowing smoking reported a secondhand smoke incursion into their home in the United States (29.9%; 95% CI, 20.4%–41.5%), Canada (38.4%; 95% CI, 26.7%–51.6%), and the United Kingdom (24.7%; 95% CI, 15.7%–36.7%). Across all 3 countries, 36.1% (95% CI, 33.4%–38.9%) of smokers in MUH reported they preferred a complete smoking ban in all building areas. Conclusion A need remains to educate MUH operators and residents about the benefits of comprehensive smoke-free policies.
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Affiliation(s)
- Pete Driezen
- Department of Psychology, University of Waterloo, 200 University Ave W, Waterloo, ON, Canada, N2L 3G1.
| | - Geoffrey T Fong
- University of Waterloo, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
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11
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Lozinsky CH, Touchie MF. Inter-zonal airflow in multi-unit residential buildings: A review of the magnitude and interaction of driving forces, measurement techniques and magnitudes, and its impact on building performance. INDOOR AIR 2020; 30:1083-1108. [PMID: 32643179 DOI: 10.1111/ina.12712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/15/2020] [Accepted: 06/26/2020] [Indexed: 06/11/2023]
Abstract
Inter-zonal airflows within multi-unit residential buildings (MURBs) have profound impacts on an array of building performance metrics, including energy, indoor air quality (IAQ), fire and acoustical separations, and distribution of ventilation air. Although there are wide-ranging implications, most building codes/standards have yet to incorporate airtightness requirements for interior partitions in large, multi-zone structures, and instead focus primarily on exterior envelope airtightness. Despite the multi-disciplinary nature of the topic, previous reviews have been limited to one domain (eg, energy performance, IAQ, specific test methods). This paper presents a comprehensive summary of the literature on inter-zonal airflow in MURBs including the magnitude and interaction of driving forces; its relevance to/effect on building performance; current code requirements; testing methods; and previous measurements. While considerable efforts have been made in recent years to quantify and control inter-zonal airflows, most measurement techniques are still labor-intensive and disruptive, and there is no framework for how to implement performance-based requirements into building codes and standards. Further research efforts should be focused on refining testing methods and preparing the construction industry for code changes.
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Affiliation(s)
- Cara H Lozinsky
- Department of Civil and Mineral Engineering, University of Toronto, Toronto, ON, Canada
| | - Marianne F Touchie
- Department of Civil and Mineral Engineering, University of Toronto, Toronto, ON, Canada
- Department of Mechanical and Industrial Engineering, University of Toronto, Toronto, ON, Canada
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12
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Smith CE, Hill SE, Amos A. Impact of population tobacco control interventions on socioeconomic inequalities in smoking: a systematic review and appraisal of future research directions. Tob Control 2020; 30:tobaccocontrol-2020-055874. [PMID: 32994297 PMCID: PMC8666809 DOI: 10.1136/tobaccocontrol-2020-055874] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND While price increases and targeted cessation support have been found to reduce inequalities in smoking by socioeconomic status (SES), evidence on other measures is mixed. We aimed to update the most recent (2014) previous review by identifying and appraising evidence published since 2013 on the equity impact of population tobacco control measures. METHODS Systematic searching of 10 electronic databases and hand-searching of four key journals identified 68 primary research articles published since 2013 that sought to examine the equity impact of population tobacco control measures in high-income countries with a negative socioeconomic gradient in smoking. Reported equity impacts were categorised as positive (greater impact among lower SES), neutral (no difference by SES), negative (greater impact among higher SES) or mixed/unclear. RESULTS There was substantial growth in research seeking to evaluate the equity impact of tobacco control interventions, but the majority of new studies showed mixed/unclear results. Findings for price increases and targeted cessation support continue to suggest an equity-positive impact, but limitations in the available evidence make further assessment difficult. Substantial differences in the context, scale and implementation of tobacco control policies make straightforward comparison of findings from the previous 2014 and current reviews problematic. CONCLUSION Researchers need to adopt more sophisticated, multidisciplinary approaches in evaluating the equity impact of tobacco control measures-developing robust measures of equity effect and using frameworks that take account of context, existing systems/processes and the likely mechanisms of action. Socioeconomic differences in intervention impact within low-income and middle-income countries require evaluation.
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Affiliation(s)
| | - Sarah E Hill
- Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
| | - Amanda Amos
- Usher Institute, University of Edinburgh, Edinburgh, UK
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13
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Matt GE, Quintana PJE, Hoh E, Zakarian JM, Dodder NG, Record RA, Hovell MF, Mahabee-Gittens EM, Padilla S, Markman L, Watanabe K, Novotny TE. Persistent tobacco smoke residue in multiunit housing: Legacy of permissive indoor smoking policies and challenges in the implementation of smoking bans. Prev Med Rep 2020; 18:101088. [PMID: 32368436 PMCID: PMC7186560 DOI: 10.1016/j.pmedr.2020.101088] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/13/2020] [Accepted: 03/29/2020] [Indexed: 01/04/2023] Open
Abstract
Secondhand smoke (SHS) is a common indoor pollutant in multiunit housing (MUH). It is also the precursor of thirdhand smoke (THS), the toxic mixture of tobacco smoke residue that accumulates in indoor environments where tobacco has been used. This study examined the levels, distribution, and factors associated with THS pollution in low-income MUH. Interviews were conducted 2016-2018 in a cross-sectional study of N = 220 MUH homes in San Diego, California. Two surface wipe samples were collected per home and analyzed for nicotine, a THS marker, using liquid chromatography-triple quadrupole mass spectrometry. Nicotine was detected in all homes of nonsmokers with indoor smoking bans (Geo Mean = 1.67 µg/m2; 95% CI = [1.23;2.30]) and smokers regardless of an indoor ban (Geo Mean = 4.80 µg/m2; 95% CI = [1.89;12.19]). Approximately 10% of nonsmokers' homes with smoking bans showed nicotine levels higher than the average level in homes of smokers without smoking bans from previous studies (≥30 µg/m2). Housing for seniors, smoking bans on balconies, indoor tobacco use, difficult to reach surfaces, and self-reported African-American race/ethnicity were independently associated with higher THS levels. Individual cases demonstrated that high levels of surface nicotine may persist in nonsmoker homes for years after tobacco use even in the presence of indoor smoking bans. To achieve MUH free of tobacco smoke pollutants, attention must be given to identifying and remediating highly polluted units and to implementing smoking policies that prevent new accumulation of THS. As THS is a form of toxic tobacco product waste, responsibility for preventing and mitigating harmful impacts should include manufacturers, suppliers, and retailers.
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Affiliation(s)
- Georg E Matt
- San Diego State University Department of Psychology, San Diego, CA, USA
| | | | - Eunha Hoh
- San Diego State University School of Public Health, San Diego, CA, USA
| | - Joy M Zakarian
- San Diego State University Research Foundation, San Diego, CA, USA
| | - Nathan G Dodder
- San Diego State University Research Foundation, San Diego, CA, USA
| | - Rachael A Record
- San Diego State University School of Communication, San Diego, CA, USA
| | | | - E Melinda Mahabee-Gittens
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Samuel Padilla
- San Diego State University Research Foundation, San Diego, CA, USA
| | - Laura Markman
- San Diego State University School of Public Health, San Diego, CA, USA
| | - Kayo Watanabe
- San Diego State University School of Public Health, San Diego, CA, USA
| | - Thomas E Novotny
- San Diego State University School of Public Health, San Diego, CA, USA
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Hafez AY, Gonzalez M, Kulik MC, Vijayaraghavan M, Glantz SA. Uneven Access to Smoke-Free Laws and Policies and Its Effect on Health Equity in the United States: 2000-2019. Am J Public Health 2019; 109:1568-1575. [PMID: 31536405 DOI: 10.2105/ajph.2019.305289] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Tobacco control measures have played an important role in the reduction of the cigarette smoking prevalence among US adults.However, although overall smoking prevalence has declined, it remains high among many subpopulations that are disproportionately burdened by tobacco use, resulting in tobacco-related health disparities. Slow diffusion of smoke-free laws to rural regions, particularly in the South and Southeast, and uneven adoption of voluntary policies in single-family homes and multiunit housing are key policy variables associated with the disproportionate burden of tobacco-related health disparities in these subpopulations.Developing policies that expand the reach of comprehensive smoke-free laws not only will facilitate the decline in smoking prevalence among subpopulations disproportionately burdened by tobacco use but will also decrease exposure to secondhand smoke and further reduce tobacco-caused health disparities in the United States.
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Affiliation(s)
- Amy Y Hafez
- Amy Y. Hafez and Stanton A. Glantz are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Mariaelena Gonzalez is with the School of Social Sciences, Humanities & Arts, University of California, Merced. Margarete C. Kulik is with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Maya Vijayaraghavan is with the Zuckerberg San Francisco General Hospital and the Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Mariaelena Gonzalez
- Amy Y. Hafez and Stanton A. Glantz are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Mariaelena Gonzalez is with the School of Social Sciences, Humanities & Arts, University of California, Merced. Margarete C. Kulik is with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Maya Vijayaraghavan is with the Zuckerberg San Francisco General Hospital and the Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Margarete C Kulik
- Amy Y. Hafez and Stanton A. Glantz are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Mariaelena Gonzalez is with the School of Social Sciences, Humanities & Arts, University of California, Merced. Margarete C. Kulik is with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Maya Vijayaraghavan is with the Zuckerberg San Francisco General Hospital and the Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Maya Vijayaraghavan
- Amy Y. Hafez and Stanton A. Glantz are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Mariaelena Gonzalez is with the School of Social Sciences, Humanities & Arts, University of California, Merced. Margarete C. Kulik is with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Maya Vijayaraghavan is with the Zuckerberg San Francisco General Hospital and the Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Stanton A Glantz
- Amy Y. Hafez and Stanton A. Glantz are with the Center for Tobacco Control Research and Education, University of California, San Francisco. Mariaelena Gonzalez is with the School of Social Sciences, Humanities & Arts, University of California, Merced. Margarete C. Kulik is with the Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock. Maya Vijayaraghavan is with the Zuckerberg San Francisco General Hospital and the Center for Tobacco Control Research and Education, University of California, San Francisco
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15
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Butz AM, Tsoukleris M, Elizabeth Bollinger M, Jassal M, Bellin MH, Kub J, Mudd S, Ogborn CJ, Lewis-Land C, Thompson RE. Association between second hand smoke (SHS) exposure and caregiver stress in children with poorly controlled asthma. J Asthma 2019; 56:915-926. [PMID: 30307351 PMCID: PMC6551304 DOI: 10.1080/02770903.2018.1509989] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 10/28/2022]
Abstract
Objective: Urban children with asthma experience high rates of second hand smoke (SHS) exposure. The objective was to examine whether SHS exposure is associated with symptom frequency in children with poorly controlled asthma. Methods: Children were enrolled in a RCT to test the efficacy of an environmental control behavioral intervention versus an attention control group and followed over 12 months. SHS exposure assessed using salivary cotinine measurement. Frequency of child asthma symptoms, healthcare utilization, household smoking and caregiver daily life stress were obtained via caregiver report. Time of enrollment was recorded to assess seasonal factors. Symptom days and nights were the primary outcomes. Multivariable models and odds ratios examined factors that best predicted increased frequency of daytime/nighttime symptoms. Results: Children (n = 222) with a mean age of 6.3 (SD 2.7) years, were primarily male (65%), African American (94%), Medicaid insured (94%), and had poorly controlled asthma (54%). The final multivariable model indicated symptoms in the fall (OR 2.78; 95% CI 1.16, 6.52) and increased caregiver daily life stress (OR 1.13, 95% CI 1.02, 1.25) were significantly associated with increased symptom days when controlling for cotinine level, intervention status, child age and home and car smoking restrictions. Conclusions: There was no impact of SHS exposure on increased symptom frequency. High caregiver daily life stress and symptoms in fall season may place children with asthma at risk for increased day/nighttime symptoms. Close monitoring of symptoms and medication use during the fall season and intervening on caregiver life stress may decrease asthma morbidity in children with poorly controlled asthma.
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Affiliation(s)
- Arlene M Butz
- a Department of Pediatrics, The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Mona Tsoukleris
- b The Univeristy of Maryland School of Pharmacy , Baltimore , MD , USA
| | - Mary Elizabeth Bollinger
- c Department of Pediatrics, The University of Maryland School of Medicine , Baltimore , MD , USA
| | - Mandeep Jassal
- a Department of Pediatrics, The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Melissa H Bellin
- d The University of Maryland School of Social Work , Baltimore , MD , USA
| | - Joan Kub
- e Department of Nursing, The USC Suzanne Dworak-Peck School of Social Work , Los Angeles , CA , USA
| | - Shawna Mudd
- f The Johns Hopkins University School of Nursing , Baltimore , MD , USA
| | - C Jean Ogborn
- g Department of Pediatric Emergency Medicine, The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Cassia Lewis-Land
- a Department of Pediatrics, The Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Richard E Thompson
- h Biostatistics Department, The Johns Hopkins University Bloomberg School of Public Health , Baltimore , MD , USA
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16
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Kegler MC, Lebow-Skelley E, Lea J, Haardörfer R, Lefevre A, Diggs P, Herndon S. A qualitative study of the process of adoption, implementation and enforcement of smoke-free policies in privately-owned affordable housing. BMC Public Health 2019; 19:1071. [PMID: 31395051 PMCID: PMC6686249 DOI: 10.1186/s12889-019-7404-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 07/30/2019] [Indexed: 11/23/2022] Open
Abstract
Background Household smoke-free home rules cannot fully protect nonsmokers from secondhand smoke (SHS) if they live in multi-unit housing (MUH). Instead, property-level smoke-free policies are needed to prevent SHS incursion into apartment units and to keep common areas smoke-free. Smoke-free policies are usually at the discretion of property management companies and owners within the context of market-rate and privately-owned affordable housing in the U.S. Methods Semi-structured interviews on the policy development, implementation and enforcement experiences of 21 different privately-owned affordable housing management companies were conducted with representatives from properties in North Carolina and Georgia who had established smoke-free policies before 2016. Results The decision to adopt was typically made by corporate leadership, board members, owners or property managers, with relatively little resident input. Policy details were influenced by property layout, perceptions of how best to facilitate compliance and enforcement, and cost of creating a designated smoking area. Policies were implemented through inclusion in leases, lease addenda or house rules with 6 months’ notice most common. Participants thought having a written policy, the norms and culture of the housing community, public norms for smoke-free environments, and resident awareness of the rules and their consequences, aided with compliance. Violations were identified through routine inspections of units and resident reporting. Resident denial and efforts to hide smoking were shared as challenges to enforcement, along with a perception that concrete evidence would be needed in eviction court and that simply the smell of SHS was insufficient evidence of violation. Over half had terminated leases or evicted residents due to violations of the smoke-free policy. The most common benefits cited were reduced turnover cost and time, and lower vacancy rates. Conclusions Understanding the smoke-free policy process in privately-owned affordable housing can help practitioners encourage policies within subsidized housing contexts. The study identified salient benefits (e.g., reduced cost, time, and vacancies) that can be highlighted when encouraging MUH partners to adopt policies. Additionally, study findings provide guidance on what to consider when designing smoke-free policies (e.g., layout, costs), and provide insights into how to enhance compliance (e.g., resident awareness) and manage enforcement (e.g., routine inspections). Electronic supplementary material The online version of this article (10.1186/s12889-019-7404-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30033, USA.
| | - Erin Lebow-Skelley
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30033, USA
| | - Jaimie Lea
- Center for Maternal and Infant Health, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27599, USA
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30033, USA
| | - Adrienne Lefevre
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30033, USA
| | - Pam Diggs
- Director of Programs and Racial Equity, Youth Empowered Solutions [YES!], 4021 Carya Drive, Suite 160, Raleigh, NC, 27610, USA
| | - Sally Herndon
- North Carolina Department of Health and Human Services, Tobacco Prevention and Control Branch, Division of Public Health, 1932 Mail Service Center, Raleigh, NC, 27699, USA
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A cross-sectional study of the relationship of proximal smoking environments and cessation history, plans, and self-efficacy among low-income smokers. J Smok Cessat 2019; 14:229-238. [PMID: 33777240 DOI: 10.1017/jsc.2019.15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction Proximal environments could facilitate smoking cessation among low-income smokers by making cessation appealing to strive for and tenable. Aims We sought to examine how home smoking rules and proximal environmental factors such as other household members' and peers' smoking behaviors and attitudes related to low-income smokers' past quit attempts, readiness, and self-efficacy to quit. Methods This analysis used data from Offering Proactive Treatment Intervention (OPT-IN) (randomized control trial of proactive tobacco cessation outreach) baseline survey, which was completed by 2,406 participants in 2011/12. We tested the associations between predictors (home smoking rules and proximal environmental factors) and outcomes (past-year quit attempts, readiness to quit, and quitting self-efficacy). Results Smokers who lived in homes with more restrictive household smoking rules, and/or reported having 'important others' who would be supportive of their quitting, were more likely to report having made a quit attempt in the past year, had greater readiness to quit, and greater self-efficacy related to quitting. Conclusions Adjustments to proximal environments, including strengthening household smoking rules, might encourage cessation even if other household members are smokers.
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Debchoudhury I, Farley SM. Implementing Smoke-Free Housing Policies Among Multiunit Housing Owners in New York City Between 2012 and 2015. Tob Use Insights 2019; 12:1179173X19859355. [PMID: 31320807 PMCID: PMC6610436 DOI: 10.1177/1179173x19859355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 05/23/2019] [Indexed: 11/16/2022] Open
Abstract
Smoke-free regulations are the norm in workplaces and public outdoor areas across New York City (NYC), and smoke-free apartment building regulations are less widespread. In 2017, more than one-third (37.6%) of NYC multiunit housing (MUH) residents reported breathing secondhand smoke (SHS) from neighboring units. In 2015, the NYC Health Department conducted a cross-sectional phone survey among a random sample of NYC low-income and market-rate MUH property owners/managers as a follow-up to a 2012 study. The study compared owners' experiences and attitudes regarding smoke-free policies. Bivariate and multivariable logistic regression analyses were used. Overall, the proportion of owners who have a policy prohibiting smoking in individual units (33% vs 37%) increased between 2012 and 2015. In both waves, owners without low-income units (wave 1: 36%, wave 2: 40%) were more likely to have smoke-free housing policies than those with low-income units (wave 1: 26%, wave 2: 30%). The models adjusted for factors such as current smoking, size and nature of housing units, and several beliefs. Owners in 2015 were more likely to have a smoke-free policy (adjusted odds ratio [AOR]: 1.25, 95% confidence interval (CI): 1.003, 1.564) and, among those without a current smoke-free policy, to have future interest in smoke-free unit policies (AOR: 1.68, 95% CI: 1.17, 2.39) than in 2012. An increasing proportion of NYC MUH owners are reducing tenant exposure to SHS and providing them with a healthier environment. We expect to see further expansion of smoke-free housing in NYC as positive norms grow.
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Affiliation(s)
- Indira Debchoudhury
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
| | - Shannon M Farley
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Queens, NY, USA
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19
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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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Barrenechea GG, da Silva CMFP, Figueiredo VC. [Behavioral changes in smokers after implementation of anti-smoking legislation in ArgentinaMudança de comportamento nos fumantes após a implementação da legislação antifumo na Argentina]. Rev Panam Salud Publica 2019; 43:e5. [PMID: 31093229 PMCID: PMC6393724 DOI: 10.26633/rpsp.2019.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 07/27/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Identify factors related to behavioral changes in smokers over 18 years of age following implementation of provincial policies for 100% smoke-free spaces in Argentina. METHODS A cross-sectional analytical study was conducted. The multilevel technique was used with data from different hierarchies. Secondary data sources were used: National Risk Factor Surveys 2005, 2009, and 2013. RESULTS The individual analysis of explanatory variables revealed that residents of provinces that do not have smoke-free legislation were 40% less likely to consider quitting smoking than people who live in provinces with such legislation. In provinces without smoke-free spaces, males over 65 years old are even less likely to think about quitting smoking. CONCLUSIONS The results suggest that legislation based on Article 8 of the Framework Convention would be effective in promoting tobacco cessation in Argentina.
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Affiliation(s)
| | - Cosme Marcelo Furtado Passos da Silva
- Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública Sergio Arouca. Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
| | - Valeska Carvalho Figueiredo
- Centro de Estudos sobre Tabaco e Saúde e Departamento de Epidemiologia, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.
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Butz AM. Implementing tobacco control policies for minority youth with second-hand smoke exposure and respiratory disease. Thorax 2018; 73:1004-1005. [PMID: 30049840 PMCID: PMC6464386 DOI: 10.1136/thoraxjnl-2018-212071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2018] [Indexed: 11/03/2022]
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Jiang N, Thorpe L, Kaplan S, Shelley D. Perceptions about the Federally Mandated Smoke-Free Housing Policy among Residents Living in Public Housing in New York City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102062. [PMID: 30241291 PMCID: PMC6210957 DOI: 10.3390/ijerph15102062] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 09/12/2018] [Accepted: 09/18/2018] [Indexed: 11/20/2022]
Abstract
Background: To assess residents’ attitudes towards the United States (U.S.) Department of Housing and Urban Development’s new smoke-free public housing policy, perceptions about barriers to policy implementation, and suggestions for optimizing implementation. Methods: In 2017, we conducted 10 focus groups among 91 residents (smokers and nonsmokers) living in New York City public housing. Results: Smokers and nonsmokers expressed skepticism about the public housing authority’s capacity to enforce the policy due to widespread violations of the current smoke-free policy in common areas and pervasive use of marijuana in buildings. Most believed that resident engagement in the roll-out and providing smoking cessation services was important for compliance. Resident expressed concerns about evictions and worried that other building priorities (i.e., repairs, drug use) would be ignored with the focus now on smoke-free housing. Conclusions: Resident-endorsed strategies to optimize implementation effectiveness include improving the access to cessation services, ongoing resident engagement, education and communication to address misconceptions and concerns about enforcement, and placing smoke-free homes in a larger public housing authority healthy housing agenda.
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Affiliation(s)
- Nan Jiang
- Department of Population Health, School of Medicine, New York University, New York, NY 10016, USA.
| | - Lorna Thorpe
- Department of Population Health, School of Medicine, New York University, New York, NY 10016, USA.
| | - Sue Kaplan
- Department of Population Health, School of Medicine, New York University, New York, NY 10016, USA.
| | - Donna Shelley
- Department of Population Health, School of Medicine, New York University, New York, NY 10016, USA.
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