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Khan JR, Lingam R, Owens L, Chen K, Shanthikumar S, Oo S, Schultz A, Widger J, Bakar KS, Jaffe A, Homaira N. Social deprivation and spatial clustering of childhood asthma in Australia. Glob Health Res Policy 2024; 9:22. [PMID: 38910250 PMCID: PMC11194868 DOI: 10.1186/s41256-024-00361-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 05/28/2024] [Indexed: 06/25/2024] Open
Abstract
BACKGROUND Asthma is the most common chronic respiratory illness among children in Australia. While childhood asthma prevalence varies by region, little is known about variations at the small geographic area level. Identifying small geographic area variations in asthma is critical for highlighting hotspots for targeted interventions. This study aimed to investigate small area-level variation, spatial clustering, and sociodemographic risk factors associated with childhood asthma prevalence in Australia. METHODS Data on self-reported (by parent/carer) asthma prevalence in children aged 0-14 years at statistical area level 2 (SA2, small geographic area) and selected sociodemographic features were extracted from the national Australian Household and Population Census 2021. A spatial cluster analysis was used to detect hotspots (i.e., areas and their neighbours with higher asthma prevalence than the entire study area average) of asthma prevalence. We also used a spatial Bayesian Poisson model to examine the relationship between sociodemographic features and asthma prevalence. All analyses were performed at the SA2 level. RESULTS Data were analysed from 4,621,716 children aged 0-14 years from 2,321 SA2s across the whole country. Overall, children's asthma prevalence was 6.27%, ranging from 0 to 16.5%, with significant hotspots of asthma prevalence in areas of greater socioeconomic disadvantage. Socioeconomically disadvantaged areas had significantly higher asthma prevalence than advantaged areas (prevalence ratio [PR] = 1.10, 95% credible interval [CrI] 1.06-1.14). Higher asthma prevalence was observed in areas with a higher proportion of Indigenous individuals (PR = 1.13, 95% CrI 1.10-1.17). CONCLUSIONS We identified significant geographic variation in asthma prevalence and sociodemographic predictors associated with the variation, which may help in designing targeted asthma management strategies and considerations for service enhancement for children in socially deprived areas.
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Affiliation(s)
- Jahidur Rahman Khan
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia.
| | - Raghu Lingam
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia
- Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Louisa Owens
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia
- Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Katherine Chen
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Shivanthan Shanthikumar
- Murdoch Children's Research Institute, Melbourne, VIC, Australia
- The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Steve Oo
- Perth Children's Hospital, Perth, WA, Australia
| | - Andre Schultz
- Perth Children's Hospital, Perth, WA, Australia
- University of Western Australia, Perth, WA, Australia
| | - John Widger
- Women's and Children's Hospital, Adelaide, SA, Australia
| | - K Shuvo Bakar
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Adam Jaffe
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia
- Sydney Children's Hospital Network, Randwick, NSW, Australia
| | - Nusrat Homaira
- School of Clinical Medicine, University of New South Wales, Randwick, NSW, 2031, Australia
- Sydney Children's Hospital Network, Randwick, NSW, Australia
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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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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Alidoust S, Huang W. A decade of research on housing and health: a systematic literature review. REVIEWS ON ENVIRONMENTAL HEALTH 2023; 38:45-64. [PMID: 34751014 DOI: 10.1515/reveh-2021-0121] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 10/26/2021] [Indexed: 06/13/2023]
Abstract
This paper provides a systematic review of the evidence linking housing and health. This involved a review of 59 peer-reviewed journal papers, that included case studies on the health impacts of housing and were published in English, in the past decade (2010-2020). Our systematic review of the literature suggested most of the research on the health impacts of housing employed quantitative methodology, were conducted in the Global North and were published in Medical and Health Sciences journals. Research findings demonstrated four key areas through which housing impacts health: neighbourhood or context, physical building, housing market and housing policy. This paper provides valuable information to researchers for future research directions on the associations between housing and health and to decision-makers and planners for planning healthy cities.
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Affiliation(s)
- Sara Alidoust
- School of Earth and Environmental Sciences, University of Queensland, Saint Lucia, QLD, Australia
| | - Wei Huang
- School of Earth and Environmental Sciences, University of Queensland, Saint Lucia, QLD, Australia
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Lee B, Fung V, Cheng D, Winickoff JP, Rigotti NA, Shah R, McGlave C, Goldberg S, Song G, Doane J, Kingsley M, Henley P, Ursprung S, Banthin C, Levy DE. Implementation Activities in Smoke-Free Public Housing: The Massachusetts Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:78. [PMID: 36612394 PMCID: PMC9819479 DOI: 10.3390/ijerph20010078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
A 2018 rule requiring federally-subsidized public housing authorities (PHAs) in the United States to adopt smoke-free policies (SFPs) has sparked interest in how housing agencies can best implement SFPs. However, to date, there is little quantitative data on the implementation of SFPs in public housing. Massachusetts PHAs were among the pioneers of SFPs in public housing, and many had instituted SFPs voluntarily prior to the federal rule. The aim of this study was to examine the adoption, implementation, and outcomes of SFPs instituted in Massachusetts PHAs prior to 2018 using a survey conducted that year. The survey asked if PHAs had SFPs and, if so, what activities were used to implement them: providing information sessions, offering treatment or referral for smoking cessation, soliciting resident input, training staff, partnering with outside groups, using a toolkit, and/or providing outdoor smoking areas. We used multivariable regression to investigate associations between implementation activities and respondent-reported policy outcomes (resident support, complaints about neighbors' smoking, and the number of violations reported per year). Of 238 Massachusetts PHAs, 218 (91%) completed the survey and 161 had an SFP prior to 2018. Common implementation activities were offering smoking cessation treatment/referral (89%) and information sessions for residents (85%). Information sessions for residents were associated with higher resident support (adjusted odds ratio [AOR] 4.3; 95%CI 1.2-15.3). Training staff (AOR 6.3, 95%CI 1.2-31.8) and engaging in ≥5 implementation activities (AOR 4.1, 95%CI 1.2-14.1) were associated with fewer smoking-related complaints. Utilization of multiple implementation activities, especially ones that informed residents and trained PHA staff, was associated with more favorable policy outcomes. We identified five groups of PHAs that shared distinct patterns of SFP implementation activities. Our findings, documenting implementation activities and their associations with SFP outcomes among the early adopters of SPFs in Massachusetts public housing, can help inform best practices for the future implementation of SFPs in multiunit housing.
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Affiliation(s)
- Boram Lee
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Vicki Fung
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - David Cheng
- Harvard Medical School, Boston, MA 02115, USA
- Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Jonathan P. Winickoff
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Division of General Academic Pediatrics, Massachusetts General for Children, Boston, MA 02114, USA
| | - Nancy A. Rigotti
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Radhika Shah
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Claire McGlave
- School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Sydney Goldberg
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Glory Song
- Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - Jacqueline Doane
- Massachusetts Tobacco Cessation and Prevention Program, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - Melody Kingsley
- Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - Patricia Henley
- Massachusetts Tobacco Cessation and Prevention Program, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - Sanouri Ursprung
- Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA 02108, USA
| | - Christopher Banthin
- Public Health Advocacy Institute, Northeastern University, Boston, MA 02115, USA
| | - Douglas E. Levy
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Harvard Medical School, Boston, MA 02115, USA
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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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Holmes LM, Llamas JD, Smith D, Ling PM. Drifting Tobacco Smoke Exposure among Young Adults in Multiunit Housing. J Community Health 2021; 45:319-328. [PMID: 31535264 DOI: 10.1007/s10900-019-00743-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study evaluated young adults' exposure to drifting secondhand smoke in San Francisco County housing units using the 2014 Bay Area Young Adult Health Survey (N = 1363). Logistic and geographically weighted regression models were used to determine whether residing in multiunit housing or in areas with greater neighborhood disorder were risk factors for exposure, and how drifting smoke exposure varied spatially within San Francisco County. Residing in buildings with five or more units significantly increased the odds of reporting drifting smoke exposure [OR (3.5 1.3, 9.9)], but neighborhood disorder did not have a significant association in the fully adjusted logistic regression model. At the local level, however, neighborhood disorder was significantly associated with exposure in lower income residential and downtown areas. Multiunit housing was significantly associated with exposure across all neighborhoods.
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Affiliation(s)
- Louisa M Holmes
- Department of Geography, State University of New York at Binghamton, 4400 Vestal Parkway E, Binghamton, NY, 13850, USA.
| | - Jasmin D Llamas
- School of Education and Counseling, Santa Clara University, Santa Clara, CA, USA
| | - Derek Smith
- Tobacco Free Project, San Francisco Department of Public Health, San Francisco, CA, USA
| | - Pamela M Ling
- Center for Tobacco Control Research & Education, Department of General Internal Medicine, University of California San Francisco, San Francisco, CA, USA
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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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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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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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11
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Sangmo L, Braune T, Liu B, Wang L, Zhang L, Sosnoff CS, Blount BC, Wilson KM. Secondhand marijuana exposure in a convenience sample of young children in New York City. Pediatr Res 2020; 89:905-910. [PMID: 32403116 PMCID: PMC7882144 DOI: 10.1038/s41390-020-0958-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/24/2020] [Accepted: 04/29/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Biomarkers of exposure to marijuana smoke can be detected in the urine of children with exposure to secondhand marijuana smoke, but the prevalence is unclear. METHODS We studied children between the ages of 0 to 3 years who were coming in for well-child visits or hospitalized on the inpatient general pediatric unit between 2017 and 2018 at Kravis Children's Hospital at Mount Sinai. Parents completed an anonymous survey, and urine samples were analyzed for cotinine and 11-nor-9-carboxy-Δ9-tetrahydrocannabinol (COOH-THC), a metabolite of Δ9-tetrahydrocannabinol. RESULTS Fifty-three children had urine samples available for analysis. COOH-THC was detectable in 20.8% of the samples analyzed and urinary cotinine was detectable in 90.2%. High levels of tobacco exposure (defined as cotinine ≥2.0 ng/ml) were significantly associated with COOH-THC detection (p < 0.01). We found that 34.8% of children who lived in attached housing where smoking was allowed within the property had detectable COOH-THC compared to 13.0% of children who lived in housing where smoking was not allowed at all. CONCLUSIONS This study adds to the growing evidence that children are being exposed to marijuana smoke, even in places where recreational marijuana use is illegal. It is critical that more research be done on the impact of marijuana smoke exposure on children's health and development. IMPACT We found that 20.8% of the 53 children recruited from Mount Sinai Hospital had detectable marijuana metabolites in their urine. Children with household tobacco smoke exposure and children who lived in attached housing where smoking was allowed on the premises were more likely to have detectable marijuana smoke metabolites. This study adds to the growing evidence that children are being exposed to marijuana smoke, even in places where marijuana remains illegal by state law. As states consider marijuana legalization, it is critical that the potential adverse health effects from marijuana exposure in children be taken into account.
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Affiliation(s)
- Lodoe Sangmo
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Tanya Braune
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bian Liu
- Institute for Translational Epidemiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lanqing Wang
- Tobacco and Volatiles Branch, Division of Laboratory SciencesNational Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Li Zhang
- Tobacco and Volatiles Branch, Division of Laboratory SciencesNational Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Connie S. Sosnoff
- Tobacco and Volatiles Branch, Division of Laboratory SciencesNational Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Benjamin C. Blount
- Tobacco and Volatiles Branch, Division of Laboratory SciencesNational Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Karen M. Wilson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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12
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Phetphum C, Noosorn N. Prevalence of secondhand smoke exposure at home and associated factors among middle school students in Northern Thailand. Tob Induc Dis 2020; 18:11. [PMID: 32165877 PMCID: PMC7057047 DOI: 10.18332/tid/117733] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/30/2020] [Accepted: 02/01/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION One-third of youths in Thailand will be exposed to secondhand smoke (SHS) from family members who are smokers. This research aims to study the prevalence of and factors associated with SHS exposure at home among middle school students in Northern Thailand. METHODS This study used a cross-sectional survey. The sample was 780 middle school students in Northern Thailand. A self-administered questionnaire was used for data collection and analyses were performed using a chi-squared test and multiple logistic regression. RESULTS Of the respondents, 46.8% reported that they had been exposed to SHS at home. The main SHS sources were from fathers (45.4%), relatives (24.1%), siblings (12.4%), mothers (3.3%), and neighbours and guests (14.8%). The factors associated with SHS exposure at home included: household members who were smokers (OR=7.43; 95% CI: 5.17–10.68; p<0.001), home without a smoke-free rule (OR=3.40; 95% CI: 1.85–6.24; p<0.001), household members who were alcohol drinkers (OR=2.29; 95% CI: 1.59–3.30; p<0.001), and living in homes with ≤3 rooms (OR=1.79; 95% CI: 1.21–2.63; p=0.003). CONCLUSIONS Thai student’s exposure to SHS at home is high, especially when household members smoke and they live in a home without a smoke-free rule. Our findings highlight the need for policies and interventions to establish smoke-free homes.
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Affiliation(s)
- Chakkraphan Phetphum
- Department of Community Health, Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
| | - Narongsak Noosorn
- Department of Community Health, Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
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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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14
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Leung LT, Ho SY, Wang MP, Lam TH. Secondhand Smoke From Multiple Sources, Thirdhand Smoke and Respiratory Symptoms in Hong Kong Adolescents. Nicotine Tob Res 2019; 20:192-198. [PMID: 27807126 DOI: 10.1093/ntr/ntw302] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/01/2016] [Indexed: 12/28/2022]
Abstract
Introduction Reports on involuntary tobacco smoke exposure in children have focused mostly on secondhand smoke (SHS) from smoking inside the home. We studied the separate and combined prevalence of SHS exposure from multiple sources and thirdhand smoke (THS) and the associations with respiratory symptoms in Hong Kong adolescents. Methods In 2010-2011, 61 810 Secondary 1 (US Grade 7) to seven students reported their smoking status, respiratory symptoms, and exposure to four sources of tobacco smoke in the past 7 days. Weighted prevalence of exposure was calculated. Associations with respiratory symptoms were analyzed in 50 762 never smokers using logistic regression. Results Tobacco smoke exposure at home was 23.2% considering SHS exposure from inside the home, but increased to 33.2% including SHS from neighbors and 36.2% further including THS. Including SHS outside home (55.3%), 63.3% of adolescents were exposed to SHS anywhere or THS at home. In never smokers, SHS from each source and THS at home were linearly associated with respiratory symptoms. Exposure to more sources yielded stronger associations with respiratory symptoms (p for trend<.001). The adjusted odds ratios (95% CI) were 1.04 (0.97-1.11), 1.12 (1.03-1.22), 1.40 (1.26-1.56) and 1.99 (1.74-2.28) for 1, 2, 3, and 4 sources, respectively. Conclusions Although Hong Kong's smoking prevalence is among the lowest in the developed world, over 60% of its adolescents were involuntarily exposed to tobacco smoke from one or more sources with a linear association with respiratory symptoms in never smokers. More stringent policies are needed to protect adolescents from tobacco smoke. Implications In a high-density urban setting, involuntary exposure to tobacco smoke in adolescents can be much higher than the smoking prevalence of the general population, especially if SHS exposure from multiple sources and THS are also considered. Such exposures have important health implications as demonstrated by their linear associations with respiratory symptoms. Tobacco control measures effective in reducing smoking prevalence may have little effect in reducing adolescent exposure to tobacco smoke, especially in the private home, in which other public health strategies are urgently needed.
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Affiliation(s)
- Lok Tung Leung
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
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15
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Gjelsvik A, Rogers ML, Garro A, Sullivan A, Koinis-Mitchell D, McQuaid EL, Smego R, Vivier PM. Neighborhood Risk and Hospital Use for Pediatric Asthma, Rhode Island, 2005-2014. Prev Chronic Dis 2019; 16:E68. [PMID: 31146802 PMCID: PMC6549429 DOI: 10.5888/pcd16.180490] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Studies consistently show that children living in poor neighborhoods have worse asthma outcomes. The objective of our study was to assess the association between negative neighborhood factors (ie, neighborhood risk) and pediatric asthma hospital use. METHODS This retrospective study used data from children aged 2 to 17 years in a statewide (Rhode Island) hospital network administrative database linked to US Census Bureau data. We defined an asthma visit as an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) code of 493 in any diagnosis field. We used 8 highly correlated measures for each census-block group to construct an index of neighborhood risk. We used maps and linear regression to assess the association of neighborhood risk with average annual census-block-group rates of asthma emergency department visits and hospitalizations. We used multivariable analyses to identify child characteristics and neighborhood risk associated with an asthma revisit, accounting for the child's sociodemographic information, season, and multiple measurements per child. RESULTS From 2005 through 2014, we counted 359,195 visits for 146,889 children. Of these, 12,699 children (8.6%) had one or more asthma visits. Linear regression results showed 1.18 (95% confidence interval, 1.06-1.30) more average annual emergency departments visits per 100 children and 0.41 (95% confidence interval, 0.34-0.47) more average annual hospitalizations per 100 children in neighborhoods in the highest-risk index quintile than in neighborhoods in the lowest-risk index quintile. CONCLUSION Interventions to improve asthma outcomes among children should move beyond primary care or clinic settings and involve a careful evaluation of social context and environmental triggers.
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Affiliation(s)
- Annie Gjelsvik
- Department of Epidemiology, Brown University, Providence, Rhode Island
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
- Brown University, Box G-121S, Providence, RI 02912.
| | - Michelle L Rogers
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
| | - Aris Garro
- Department of Emergency Medicine, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Pediatrics, Brown University Warren Alpert Medical School, Providence, Rhode Island
| | - Adam Sullivan
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
- Department of Biostatistics, Brown University, Providence, Rhode Island
| | - Daphne Koinis-Mitchell
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
- Department of Pediatrics, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
| | - Elizabeth L McQuaid
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Psychiatry, Rhode Island Hospital, Providence, Rhode Island
| | - Raul Smego
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
| | - Patrick M Vivier
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
- Department of Pediatrics, Brown University Warren Alpert Medical School, Providence, Rhode Island
- Department of Health Services, Policy and Practice, Brown University, Providence, Rhode Island
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16
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Northrup TF, Stotts AL, Suchting R, Khan AM, Green C, Quintana PJE, Hoh E, Hovell MF, Matt GE. Medical staff contributions to thirdhand smoke contamination in a neonatal intensive care unit. Tob Induc Dis 2019; 17:37. [PMID: 31516480 PMCID: PMC6662774 DOI: 10.18332/tid/106116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/01/2019] [Accepted: 04/02/2019] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Non-smoking policies are strictly enforced in neonatal intensive care units (NICUs), which may still become contaminated by thirdhand smoke (THS), posing potential health risks to medically fragile infants. Study aims were to explore contamination routes by characterizing nicotine levels (THS proxy) found on the fingers of NICU medical staff and to assess finger-nicotine correlates. METHODS NICU medical staff were surveyed regarding smoking and electronic nicotine devices (ENDS) use/exposure, and household characteristics. Approximately 35% of staff were randomly selected for a finger-nicotine wipe. Three separate quantile regressions modeled percentiles associated with: presence of any finger nicotine, finger-nicotine levels above the median field blank level (i.e. 0.377 ng/wipe), and finger-nicotine levels two times the median blank. RESULTS The final sample size was 246 (n=260 approached; n=14 refusals). Over three-quarters (78.5%) reported some exposure to tobacco smoke or ENDS vapor/aerosols. After field-blank adjustments, the median nicotine level (ng/finger wipe) was 0.232 (IQR: 0.021–0.681) and 78.3% of medical staff had measurable finger-nicotine levels. Both being near smoking in friends’/family members’ homes and finger-surface area were related to elevated finger-nicotine levels (p<0.05) in the median blank model. CONCLUSIONS Almost four in five NICU staff had measurable finger nicotine, with finger surface area and frequency of reported exposure to tobacco smoke in friends’/family members’ homes emerging as important correlates. Future research will determine the impact of THS on NICU infants. Medical personnel working in a NICU should be cognizant of secondhand smoke and THS, particularly inside friends’/family members’ homes, to reduce potential NICU contamination and infant exposures.
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Affiliation(s)
- Thomas F Northrup
- Department of Family and Community Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States
| | - Angela L Stotts
- Department of Family and Community Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States.,Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States
| | - Robert Suchting
- Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States
| | - Amir M Khan
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States
| | - Charles Green
- Department of Pediatrics, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States.,Center for Clinical Research and Evidence-Based Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, United States
| | - Penelope J E Quintana
- Division of Environmental Health, School of Public Health, San Diego State University, San Diego, United States
| | - Eunha Hoh
- Division of Environmental Health, School of Public Health, San Diego State University, San Diego, United States
| | - Melbourne F Hovell
- Center for Behavioral Epidemiology and Community Health, School of Public Health, San Diego State University, San Diego, United States
| | - Georg E Matt
- Department of Psychology, San Diego State University, San Diego, United States
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17
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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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18
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McMillen RC, Winickoff JP, Gottlieb MA, Tanski S, Wilson K, Klein JD. Public Support for Smoke-Free Section 8 Public Housing. West J Nurs Res 2019; 41:1170-1183. [PMID: 30741120 DOI: 10.1177/0193945919826238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The U.S. Department of Housing and Urban Development (HUD) recently issued rules requiring that federally funded authorities administering public housing must have smoke-free policies. Importantly, this requirement does not extend to Section 8 housing. Under the Section 8 program, public housing vouchers provide subsidies for private rental housing to low-income residents. This study examines support for smoke-free policy options in Section 8 housing. Using a nationally representative survey of adults, we asked 3,070 respondents to agree or disagree with two potential policies. The majority (71%) supported prohibiting indoor smoking everywhere inside buildings that have Section 8 housing units. Alternatively, respondents were less supportive (38%) of a policy to prohibit smoking only inside units with Section 8 subsidies, and allowing smoking in nonsubsidized units. Prohibiting smoking in all units in multiunit housing (MUH) buildings would help protect the health of both the 2.2 million households who receive Section 8 subsidies and their neighbors.
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Affiliation(s)
- Robert C McMillen
- 1 American Academy of Pediatrics Julius B. Richmond Center of Excellence, Itasca, IL, USA.,2 Mississippi State University, Starkville, MS, USA
| | - Jonathan P Winickoff
- 1 American Academy of Pediatrics Julius B. Richmond Center of Excellence, Itasca, IL, USA.,3 Massachusetts General Hospital for Children, Boston, MA, USA
| | - Mark A Gottlieb
- 1 American Academy of Pediatrics Julius B. Richmond Center of Excellence, Itasca, IL, USA.,4 Northeastern University School of Law, Boston, MA, USA
| | - Susanne Tanski
- 1 American Academy of Pediatrics Julius B. Richmond Center of Excellence, Itasca, IL, USA.,5 Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Karen Wilson
- 1 American Academy of Pediatrics Julius B. Richmond Center of Excellence, Itasca, IL, USA.,6 Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jonathan D Klein
- 1 American Academy of Pediatrics Julius B. Richmond Center of Excellence, Itasca, IL, USA.,7 The University of Illinois at Chicago, IL, USA
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19
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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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20
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Hollar TL, Cook N, Quinn D, Phillips T, DeLucca M. Smoke-Free Multi-unit Housing Policies Show Promise in Reducing Secondhand Smoke Exposure Among Racially and Ethnically Diverse, Low-Income Seniors. J Immigr Minor Health 2018; 19:1281-1289. [PMID: 27189486 DOI: 10.1007/s10903-016-0430-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Secondhand smoke (SHS) exposure is a public health issue for residents of multi-unit housing (MUH) properties. We evaluated the impact of smoke-free policy implementation on reported SHS exposure among racially, ethnically diverse seniors living in low-income MUH properties. In Spring 2013 and Summer 2014, we surveyed residents (n = 960) at 15 MUH properties in Broward and Miami-Dade Counties, Florida. The percentage of residents reporting SHS exposure within their apartments from elsewhere in or around their building decreased from 31.1 %, before policy implementation, to 23.6 % at follow-up (p = 0.02). In multivariate analysis of non-smoking residents after policy implementation, residents who reported having one or more comorbidities were two times more likely to report SHS exposure (aOR 2.23, 95 % CI 1.12-4.40). Considering the vulnerability of low-income seniors to SHS exposure, our findings are relevant to residents, property owners/managers, and public health professionals making decisions about smoke-free policies for MUH properties in which seniors reside.
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Affiliation(s)
- T Lucas Hollar
- Master of Public Health Program, College of Osteopathic Medicine, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL, 33328, USA.
| | - Nicole Cook
- Master of Public Health Program, College of Osteopathic Medicine, Nova Southeastern University, 3200 South University Drive, Fort Lauderdale, FL, 33328, USA
| | - David Quinn
- Area Health Education Center, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Teina Phillips
- Broward Regional Health Planning Council, Hollywood, FL, USA
| | - Michael DeLucca
- Broward Regional Health Planning Council, Hollywood, FL, USA
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21
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Kegler MC, Lebow-Skelley E, Lea J, Lefevre AM, Diggs P, Herndon S, Haardörfer R. Developing Smoke-Free Policies in Public Housing: Perspectives From Early Adopters in 2 Southern States. Prev Chronic Dis 2018; 15:E83. [PMID: 29935078 PMCID: PMC6016427 DOI: 10.5888/pcd15.170427] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
PURPOSE AND OBJECTIVES In 2016, the US Department of Housing and Urban Development (HUD) issued a new rule requiring smoke-free policies in conventional public housing by July 2018 (HUD, 2016). This process evaluation describes the policy development experiences of conventional and nonconventional public housing authorities (PHAs) in North Carolina and Georgia that had established smoke-free policies before the HUD rule. INTERVENTION APPROACH HUD began to issue guidance that encouraged smoke-free policies in public housing in 2009, and most early adopters were outside of the Southeast. Documenting the process early adopters in the Southeast used to develop their policies provides useful lessons for conventional PHAs and those with properties not covered by the rule. EVALUATION METHODS Semi-structured interviews were conducted with PHA representatives from 23 PHAs with some level of smoking restriction, along with residents from 14 of these PHAs, from January to August 2016. RESULTS Organizational leaders and board members were usually the primary players in making the decision to adopt a policy, with approval processes consistent with any type of policy adoption. Common reasons for establishing the policy included costs of turning a unit; health of children, nonsmokers, and staff; HUD guidance; and concerns or experience with fire caused by cigarettes. Levels of restriction were influenced by layout of the property, perceptions of compliance and enforcement challenges, concerns about smokers congregating, resident mobility, weather concerns, consistency with HUD guidance, and availability of funds for designated smoking areas. Resident input was obtained through general meetings, resident advisory boards or councils, surveys, and formal comment periods. IMPLICATIONS FOR PUBLIC HEALTH Understanding the process of policy development and adoption enables public health practitioners to be more effective partners in advising on the flexible components of the HUD smoke-free rule and accelerating the adoption of comprehensive policies within nonconventional PHAs.
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Affiliation(s)
- Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA 30322.
| | - Erin Lebow-Skelley
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jaimie Lea
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia.,Tobacco Prevention and Control Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Adrienne M Lefevre
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Pam Diggs
- Youth Empowered Solutions, Raleigh, North Carolina
| | - Sally Herndon
- Tobacco Prevention and Control Branch, Division of Public Health, North Carolina Department of Health and Human Services, Raleigh, North Carolina
| | - Regine Haardörfer
- Department of Behavioral Sciences and Health Education, Emory Prevention Research Center, Rollins School of Public Health, Emory University, Atlanta, Georgia
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22
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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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Wilson KM, Torok MR, McMillen RC, Klein JD, Levy DE, Winickoff JP. Tobacco-Smoke Incursions and Satisfaction Among Residents With Children in Multiunit Housing, United States, 2013. Public Health Rep 2017; 132:637-645. [PMID: 28977766 PMCID: PMC5692161 DOI: 10.1177/0033354917732767] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Residents of multiunit housing can be exposed to tobacco smoke even if they do not permit smoking in their homes. Although even low levels of tobacco smoke exposure can cause health problems for children and adults, some landlords are reluctant to ban smoking for fear of decreased occupancy rates or tenant satisfaction. The objective of this study was to assess the impact of tobacco smoke-free policies and tobacco-smoke incursions on housing satisfaction in multiunit housing residences with children. METHODS In 2013, 3696 randomly sampled US adult multiunit housing dwellers were invited to participate in a survey, and 3253 (88%) participated. Of these, 3128 responded to the question about having a child in the home, and 835 (27%) reported having a child in the home. We collected data on demographic characteristics, tobacco-smoke incursions, knowledge and attitudes about smoking policies, and housing satisfaction for this sample of 835 residents. RESULTS Of the 827 residents who responded to the question, 755 (91.3%) agreed that tenants have a right to live in a tobacco smoke-free building. Although 672 of 835 (80.5%) residents were not cigarette smokers, most lived where smoking was permitted in the units (n = 463, 56.9%) or on the property (n = 571, 70.5%). Of 580 non-cigarette smoking residents who lived where no one had smoked cigarettes in the home for the past 3 months, 144 (25.2%) reported a recent tobacco-smoke incursion. Of these 144 residents, 143 (99%) were bothered. Few (36/143, 25.2%) complained to the landlord. Reasons for not complaining were reluctance to upset neighbors or concern about retaliation. Tobacco-smoke incursions and housing/landlord satisfaction were inversely related ( P < .05). CONCLUSION Multiunit housing residents living with children in the United States strongly support smoke-free multiunit housing.
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Affiliation(s)
- Karen M. Wilson
- Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- American Academy of Pediatrics Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
| | - Michelle R. Torok
- Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado, Denver, CO, USA
| | - Robert C. McMillen
- American Academy of Pediatrics Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
- Department of Psychology, Mississippi State University, Starkville, MS, USA
| | - Jonathan D. Klein
- American Academy of Pediatrics Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
| | - Douglas E. Levy
- Mongan Institute Health Policy Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan P. Winickoff
- Department of Pediatrics, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Kim J, Lee K, Kim K. Factors associated with secondhand smoke incursion into the homes of non-smoking residents in a multi-unit housing complex: a cross-sectional study in Seoul, Korea. BMC Public Health 2017; 17:739. [PMID: 28946863 PMCID: PMC5613333 DOI: 10.1186/s12889-017-4774-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 09/19/2017] [Indexed: 11/30/2022] Open
Abstract
Background In a multi-unit housing (MUH) complex, secondhand smoke (SHS) can pass from one living space to another. The aim of this study was to determine the prevalence of SHS incursion, and to establish the relationship between SHS incursion and socio-demographic and built environmental factors in MUH in Korea. Methods A population-based sample of 2600 residents (aged ≥19 years) living in MUH from across the city of Seoul, Korea, was obtained through a web-based selection panel. The residents completed a questionnaire detailing socio-demographic factors, smoking status, frequency of SHS incursion, and built environmental factors. The presence of a personal smoke-free home rule was determined by residents declaring that no one smoked inside the home. Results Of the 2600 participants, non-smoking residents who lived in homes with a personal smoke-free rule were selected for further analysis (n = 1784). In the previous 12 months, 74.7% of residents had experienced SHS incursion ≥1 times. A multivariate ordinal logistic regression analysis indicated that residents who spent more time at home, lived with children, supported the implementation of smoke-free regulations in MUH, lived in small homes, lived in homes with natural ventilation provided by opening a front door or the windows and front door, and lived in homes with more frequent natural ventilation were more likely to report SHS incursion into their homes. Conclusions The majority of the non-smoking residents experienced SHS incursion, even with a personal smoke-free rule in their homes. A smoke-free policy in MUH is needed to protect residents from SHS exposure when they are at home. Electronic supplementary material The online version of this article (10.1186/s12889-017-4774-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeonghoon Kim
- Department of Environmental Health Research, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul, 02053, Republic of Korea.,Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - Kiyoung Lee
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea.,Institute of Health and Environment, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea
| | - KyooSang Kim
- Department of Environmental Health Research, Seoul Medical Center, 156 Sinnae-ro, Jungnang-gu, Seoul, 02053, Republic of Korea.
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Arechavala T, Continente X, Pérez-Ríos M, Schiaffino A, Fernandez E, Cortés-Francisco N, Centrich F, Muñoz G, López MJ. Second-hand smoke exposure in homes with children: assessment of airborne nicotine in the living room and children’s bedroom. Tob Control 2017; 27:399-406. [DOI: 10.1136/tobaccocontrol-2017-053751] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/30/2017] [Accepted: 07/11/2017] [Indexed: 11/03/2022]
Abstract
BackgroundThe introduction of ‘smoke-free laws’ has reduced the population’s exposure to second-hand smoke (SHS), although SHS is still an issue in homes and other public places. Children are vulnerable to its health effects, and their greatest exposure occurs at home.ObjectivesTo assess airborne nicotine concentration of the living room and children’s bedroom of homes with children under 13 years of age, and to analyse factors associated with these levels.MethodsWe conducted a cross-sectional study in Barcelona in 2015–2016, selecting a convenience sample from families with at least one child under 13 years of age. The sample comprised 50 families with smokers and 50 without. We measured airborne nicotine concentrations in the living room and children’s bedroom, and, using a questionnaire administered to the parents, collected information about smoking habits at home.ResultsHomes without smokers showed nicotine concentrations below the limit of detection (<0.02 µg/m3), while those with at least one smoker showed 0.16 µg/m3 in the living room and 0.12 µg/m3 in the bedroom. When smoking was allowed inside home, these values increased to 1.04 and 0.48 µg/m3, respectively. Moreover, nicotine concentrations in both rooms were strongly correlated (r=0.89), and higher nicotine levels were associated with the number of cigarettes smoked in the living room, smoking rules, the number of smokers living at home and tobacco smell.ConclusionsHomes with smokers present SHS in the living room and in the children’s bedroom. Therefore, programmes focused on reducing children’s SHS exposure are urgently needed.
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Drouin O, McMillen RC, Klein JD, Winickoff JP. E-Cigarette Advice to Patients From Physicians and Dentists in the United States. Am J Health Promot 2017; 32:1228-1233. [DOI: 10.1177/0890117117710876] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report on adults’ recall of discussion by physicians and dentists about e-cigarettes. Design: A nationally representative cross-sectional survey (Internet and random digit dialing) in the United States. Participants: Adults who ever used e-cigarettes. Measures: Participant-reported discussion about the potential benefits and harms of e-cigarettes with their doctor, dentist, or child’s doctor in the past 12 months. Analysis: Fisher exact test for the analysis between benefits and harms for each type of provider and for rates of advice between provider types. Results: Among the 3030 adults who completed the survey, 523 (17.2%) had ever used e-cigarettes. Of those who had seen their doctor, dentist, or child’s doctor in the last year, 7.3%, 1.7%, and 10.1%, respectively, reported discussing potential harms of e-cigarettes. Conversely, 5.8%, 1.7%, and 9.3% of patients who had seen their doctor, dentist, or child’s doctor in the last year reported that the clinician discussed the potential benefits of e-cigarettes. Each clinician type was as likely to discuss harms as benefits. Rates of advice were similar between doctors and child’s doctors but lower for dentists. Rates were comparable when the analysis was limited to current e-cigarette users, participants with children, or those who reported using both e-cigarettes and combusted tobacco. Conclusions: Few physicians and dentists discuss either the harms or benefits of e-cigarettes with their patients. These data suggest an opportunity to educate, train, and provide resources for physicians and dentists about e-cigarettes and their use.
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Affiliation(s)
- Olivier Drouin
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- Harvard-Wide Pediatric Health Services Research Fellowship, Boston, MA, USA
| | - Robert C. McMillen
- Social Science Research Center, Mississippi State University, Starkville, MS, USA
- American Academy of Pediatrics, Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
| | - Jonathan D. Klein
- American Academy of Pediatrics, Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
| | - Jonathan P. Winickoff
- Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, MA, USA
- American Academy of Pediatrics, Julius B. Richmond Center of Excellence, Elk Grove Village, IL, USA
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Tannous WK, Agho K. Socio-demographic predictors of residential fire and unwillingness to call the fire service in New South Wales. Prev Med Rep 2017; 7:50-57. [PMID: 28593123 PMCID: PMC5453862 DOI: 10.1016/j.pmedr.2017.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 05/04/2017] [Accepted: 05/15/2017] [Indexed: 11/05/2022] Open
Abstract
In most industrialised countries, the majority of fire-related deaths and injuries occur in the home. Australia has implemented fire prevention programs and strategies, including the use of smoke alarms, to minimise this burden. The number of reported house fires has declined over the past decade. However, there is a growing recognition that unreported fires are important in the estimation of total fire hazards and their associated injuries. This current study used data from the 2014 New South Wales (NSW) Population Health Survey, a yearly telephone survey, consisting of 14,732 survey respondents. Univariate and multiple binary logistic regression models were conducted to examine predictors of residential fire and (un)willingness to call the fire service in the event of a residential fire. The proportion of respondents who experienced residential fires in NSW was 10% (95% confidence interval [CI]: 9.3, 10.8). The proportion of respondents who were willing to call the fire service was 3.1% (95% CI: 2.7%, 3.6%) and that of respondents unwilling to call was 6.9% (95% CI: 6.3%, 7.6%). Multivariate analyses revealed that respondents spoke another language in addition to English were significantly less likely to have experienced a home fire (odds ratio [OR] = 0.46; 95% CI: 0.32, 0.65, p < 0.001) and significantly less likely to call the fire service (OR = 0.34; 95% CI: 0.21, 0.54, p < 0.001), compared with those who only spoke English at home. The results in this study will inform Fire & Rescue NSW's ongoing development of appropriate interventions and awareness-raising programs about residential fire prevention. Unreported fires are important in the estimation of fire hazards and their injuries. In New South Wales 10% of population had reported that they had a residential fire. For those who had residential fire, about 70% were unwilling to call fire brigade. People who spoke other languages plus English were two thirds less likely to call. Future interventions should target NSW residents that spoke other languages.
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Affiliation(s)
- W Kathy Tannous
- Western Sydney University, School of Business, Locked Bag 1797, Penrith NSW 2751, Australia.,Western Sydney University, Centre for Health Research, Australia.,Capital Markets Co-operative Research Centre, Level 3, 55 Harrington Street, Sydney NSW 2000, Australia
| | - Kingsley Agho
- Western Sydney University, School of Science and Health, Locked Bag 1797, Penrith NSW 2751, Australia
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Perceptions Regarding Importance and Skill at Policy Development Among Public Health Staff. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 21 Suppl 6:S141-50. [PMID: 26422484 PMCID: PMC4590525 DOI: 10.1097/phh.0000000000000324] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
This article explores existing competency gaps for policy development among state health agency employees. Policy development is recognized as a core function of public health and a core competency in formal public health education. However, relatively little is known nationally about worker perceptions and competencies related to policy development in the governmental public health workforce.
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Nguyen KH, Gomez Y, Homa DM, King BA. Tobacco Use, Secondhand Smoke, and Smoke-Free Home Rules in Multiunit Housing. Am J Prev Med 2016; 51:682-692. [PMID: 27423656 PMCID: PMC5821129 DOI: 10.1016/j.amepre.2016.05.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 05/03/2016] [Accepted: 05/11/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Multiunit housing (MUH) residents are particularly susceptible to involuntary secondhand smoke (SHS) exposure in their home, which can enter their living units from nearby units and shared areas where smoking occurs. To date, no study has assessed non-cigarette tobacco use among MUH residents. This study assessed the prevalence and sociodemographic correlates of tobacco use (combustible, noncombustible, any tobacco use including electronic cigarettes), smoke-free home rules, and SHS incursions among U.S. MUH residents. METHODS Data came from the 2013-2014 National Adult Tobacco Survey, a telephone survey of U.S. adults aged ≥18 years. Analyses were conducted in 2015. Prevalence of current tobacco use and smoke-free home rules were assessed overall and by sociodemographics, stratified by housing type (single family versus MUH). Prevalence and adjusted odds of SHS incursions among MUH residents with smoke-free home rules were assessed. RESULTS Tobacco use was higher among adults living in MUH (24.7%) than those in single-family housing (18.9%, p<0.05). Smoke-free home rules were higher among adults living in single-family housing (86.7%) than those in MUH (80.9%, p<0.05). Among MUH residents with smoke-free homes, 34.4% experienced SHS incursions. Adjusted odds of SHS incursions were greater among women, younger adults, non-Hispanic blacks, Hispanics, and those with lower income. CONCLUSIONS One quarter of MUH residents use tobacco, and one third of MUH residents with smoke-free rules experience SHS incursions. Interventions are warranted to promote tobacco cessation and smoke-free building policies to protect all MUH residents, employees, and visitors from the dangers of tobacco use and SHS.
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Affiliation(s)
- Kimberly H Nguyen
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
| | - Yessica Gomez
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David M Homa
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Andrews JO, Mueller M, Dooley M, Newman SD, Magwood GS, Tingen MS. Effect of a smoking cessation intervention for women in subsidized neighborhoods: A randomized controlled trial. Prev Med 2016; 90:170-6. [PMID: 27423320 PMCID: PMC5871346 DOI: 10.1016/j.ypmed.2016.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Revised: 05/16/2016] [Accepted: 07/08/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a community based participatory research (CBPR) developed, multi-level smoking cessation intervention among women in subsidized housing neighborhoods in the Southeastern US. METHODS A total of n=409 women in 14 subsidized housing neighborhoods in Georgia and South Carolina participated in this group randomized controlled trial conducted from 2009 to 2013. Intervention neighborhoods received a 24-week intervention with 1:1 community health worker contact, behavioral peer group sessions, and nicotine replacement. Control neighborhoods received written cessation materials at weeks 1, 6, 12, 18. Random coefficient models were used to compare smoking abstinence outcomes at 6 and 12months. Significance was set a p<0.05. RESULTS The majority of participants (91.2%) were retained during the 12-month intervention period. Smoking abstinence rates at 12months for intervention vs. control were 9% vs. 4.3%, p=0.05. Additional analyses accounting for passive smoke exposure in these multi-unit housing settings demonstrated 12month abstinence rates of 12% vs. 5.3%, p=0.016. However, in the multivariate regression analyses, there was no significant effect of the intervention on the odds of being a non-smoker (OR=0.44, 95% CI: 0.18-1.07). Intervention participants who kept coach visits, attended group sessions, and used patches were more likely to remain abstinent. CONCLUSIONS This CBPR developed intervention showed potential to engage smokers and reduce smoking among women in these high-poverty neighborhoods. Effectiveness in promoting cessation in communities burdened with fiscal, environmental and social inequities remains a public health priority.
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Affiliation(s)
- Jeannette O Andrews
- University of South Carolina, College of Nursing, 1601 Greene Street, Columbia, SC 29208, USA.
| | - Martina Mueller
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., MSC 160, Charleston, SC 29425-1600, USA
| | - Mary Dooley
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., MSC 160, Charleston, SC 29425-1600, USA
| | - Susan D Newman
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., MSC 160, Charleston, SC 29425-1600, USA
| | - Gayenell S Magwood
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., MSC 160, Charleston, SC 29425-1600, USA
| | - Martha S Tingen
- Augusta University, Medical College of Georgia, 1120 Fifteenth Street, HS-1755, Augusta, GA 30912, USA
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Rockhill KM, Tong VT, Farr SL, Robbins CL, D’Angelo DV, England LJ. Postpartum Smoking Relapse After Quitting During Pregnancy: Pregnancy Risk Assessment Monitoring System, 2000-2011. J Womens Health (Larchmt) 2016; 25:480-8. [PMID: 26717489 PMCID: PMC11261314 DOI: 10.1089/jwh.2015.5244] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Relapsing to smoking postpartum jeopardizes a woman's health and her infant's health. Our study estimated the proportion and identified characteristics associated with postpartum relapse using a large population-based sample. MATERIALS AND METHODS We analyzed Pregnancy Risk Assessment Monitoring System data among women with live births. Relapse was defined as smoking at survey completion among those who quit by the last 3 months of pregnancy. We assessed linear trends for relapse during 2000-2011 in 40 sites overall and individually using logistic regression. Adjusted prevalence ratios (aPRs) were calculated to assess characteristics associated with relapse during 2009-2011 (n = 13,076). RESULTS During 2000-2011, the proportion of women who relapsed postpartum remained unchanged overall (p = 0.84) and by site (p ≥ 0.05 for each), ranging in 2011 from 30.8% to 52.2% (Wyoming-Arkansas). Characteristics associated with relapse compared with reference groups were prepregnancy daily smoking (aPR = 1.80; 95% confidence interval (CI): 1.59-2.04); age <20 years (aPR = 1.51; 1.24-1.84), 20-24 years (aPR = 1.39; 1.17-1.65), or 25-34 years (aPR = 1.26; 1.07-1.48); not initiating breastfeeding (aPR = 1.34; 1.24-1.44); not having a complete home smoking ban (aPR = 1.27; 1.14-1.42); being black non-Hispanic (aPR = 1.25; 1.14-1.38); being multiparous (aPR = 1.20; 1.11-1.28); experiencing 3-5 stressors during pregnancy (aPR = 1.12; 1.01-1.24); having an unintended pregnancy (aPR = 1.11; 1.03-1.19); and having 12 years of education (aPR = 1.09; 1.01-1.17). CONCLUSIONS There was no change in the proportion of women relapsing postpartum during 2000-2011. In 2011, nearly half (42%) of women relapsed after quitting smoking during pregnancy. Disparities exist by site and by maternal characteristics. A comprehensive approach maximizing tobacco control efforts and developing effective clinical interventions delivered across sectors is necessary for long-term tobacco abstinence among women.
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Affiliation(s)
- Karilynn M. Rockhill
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
- Oak Ridge Institute for Science and Education, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Van T. Tong
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sherry L. Farr
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Cheryl L. Robbins
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Denise V. D’Angelo
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lucinda J. England
- Office of Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Fabian MP, Lee SK, Underhill LJ, Vermeer K, Adamkiewicz G, Levy JI. Modeling Environmental Tobacco Smoke (ETS) Infiltration in Low-Income Multifamily Housing before and after Building Energy Retrofits. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13030327. [PMID: 26999174 PMCID: PMC4808990 DOI: 10.3390/ijerph13030327] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 11/16/2022]
Abstract
Secondhand exposure to environmental tobacco smoke (ETS) in multifamily housing remains a health concern despite strong recommendations to implement non-smoking policies. Multiple studies have documented exposure to ETS in non-smoking units located in buildings with smoking units. However, characterizing the magnitude of ETS infiltration or measuring the impact of building interventions or resident behavior on ETS is challenging due to the complexities of multifamily buildings, which include variable resident behaviors and complex airflows between numerous shared compartments (e.g., adjacent apartments, common hallways, elevators, heating, ventilating and air conditioning (HVAC) systems, stack effect). In this study, building simulation models were used to characterize changes in ETS infiltration in a low income, multifamily apartment building in Boston which underwent extensive building renovations targeting energy savings. Results suggest that exterior wall air sealing can lead to increases in ETS infiltration across apartments, while compartmentalization can reduce infiltration. The magnitude and direction of ETS infiltration depends on apartment characteristics, including construction (i.e., level and number of exterior walls), resident behavior (e.g., window opening, operation of localized exhaust fans), and seasonality. Although overall ETS concentrations and infiltration were reduced post energy-related building retrofits, these trends were not generalizable to all building units. Whole building smoke-free policies are the best approach to eliminate exposure to ETS in multifamily housing.
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Affiliation(s)
- Maria Patricia Fabian
- Department of Environmental Health, Boston University School of Public Health. 715 Albany Street, Boston, MA 02118, USA.
- Department of Environmental Health, Harvard T. H. Chan School of Public Health. 401 Park Drive, Boston, MA 02115, USA.
| | - Sharon Kitman Lee
- Department of Environmental Health, Boston University School of Public Health. 715 Albany Street, Boston, MA 02118, USA.
| | - Lindsay Jean Underhill
- Department of Environmental Health, Boston University School of Public Health. 715 Albany Street, Boston, MA 02118, USA.
| | - Kimberly Vermeer
- Urban Habitat Initiatives Inc., 328A Tremont Street, Boston, MA 02116, USA.
| | - Gary Adamkiewicz
- Department of Environmental Health, Harvard T. H. Chan School of Public Health. 401 Park Drive, Boston, MA 02115, USA.
| | - Jonathan Ian Levy
- Department of Environmental Health, Boston University School of Public Health. 715 Albany Street, Boston, MA 02118, USA.
- Department of Environmental Health, Harvard T. H. Chan School of Public Health. 401 Park Drive, Boston, MA 02115, USA.
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Leung LT, Ho SY, Wang MP, Lo WS, Lam TH. Exposure to secondhand smoke from neighbours and respiratory symptoms in never-smoking adolescents in Hong Kong: a cross-sectional study. BMJ Open 2015; 5:e008607. [PMID: 26537497 PMCID: PMC4636600 DOI: 10.1136/bmjopen-2015-008607] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 07/04/2015] [Accepted: 07/31/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To investigate secondhand smoke (SHS) exposure at home from neighbours in Hong Kong adolescents and its association with respiratory symptoms in never-smokers. DESIGN A cross-sectional study. SETTING 79 randomly selected secondary schools in Hong Kong. PARTICIPANTS 61,810 secondary 1 (USA grade 7) to 7 students, in which 50,762 never-smokers were identified and included in the analysis of the association between SHS exposure at home from neighbours and respiratory symptoms. MAIN OUTCOME MEASURES Smoking status, family smoking status, SHS exposure at home from inside the home and from neighbours in the past 7 days, respiratory symptoms and sociodemographic characteristics were reported. Adjusted ORs (AORs) of respiratory symptoms for SHS exposure from the 2 sources in never-smokers were calculated using logistic regression. RESULTS In all students, 33.2% were exposed to SHS at home, including 16.2% from inside the home only, 10.0% from neighbours only and 7.0% from both. The prevalence of SHS exposure from neighbours was 17.1%, including 13.5% for 1-4 days/week and 3.6% for 5-7 days/week. In never-smokers (n=50,762), respiratory symptoms were significantly associated with SHS exposure from neighbours with AORs (95% CI) of 1.29 (1.20 to 1.39) for any exposure (p<0.001), 1.21 (1.12 to 1.31) for 1-4 days/week (p<0.001) and 1.63 (1.44 to 1.86) for 5-7 days/week (p<0.001) (P for trend <0.001). Compared with no SHS exposure at home from any source, the AORs were 1.16 (1.07 to 1.25) for SHS from inside the home only (p<0.001), 1.20 (1.11 to 1.31) from neighbours only (p<0.001), and 1.74 (1.56 to 1.94) from both (p<0.001). CONCLUSIONS SHS exposure at home from neighbours was prevalent in Hong Kong adolescents, and was associated with respiratory symptoms in never-smokers. SHS exposure at home may be underestimated by ignoring the neighbouring source. Smoke-free housing policy is needed to protect children and adolescents from harms of SHS.
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Affiliation(s)
- Lok Tung Leung
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Sai Yin Ho
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Man Ping Wang
- School of Nursing, The University of Hong Kong, Hong Kong
| | - Wing Sze Lo
- School of Public Health, The University of Hong Kong, Hong Kong
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong
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Global and Regional Patterns of Tobacco Smoking and Tobacco Control Policies. Eur Urol Focus 2015; 1:3-16. [DOI: 10.1016/j.euf.2014.10.001] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 10/20/2014] [Indexed: 01/24/2023]
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Mason J, Wheeler W, Brown MJ. The economic burden of exposure to secondhand smoke for child and adult never smokers residing in U.S. public housing. Public Health Rep 2015; 130:230-44. [PMID: 25931627 DOI: 10.1177/003335491513000310] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The World Health Organization (WHO) reports that nonsmokers experience disease and death due to secondhand smoke (SHS) exposure in the home. We estimated the total excess burden and costs to society due to SHS exposure in U.S. public housing. METHODS We quantified the public health burden for outcomes causally related to SHS exposure for nationally representative never-smoking residents in U.S. public housing using (1) WHO-recommended health outcomes and methodology, (2) publicly available and other large databases, and (3) published estimates of morbidity and mortality rates. We used published estimates of direct medical and nonmedical care costs and the value of productivity losses to estimate SHS-related societal costs for disease and death. We estimated the public health and economic burden for two serum cotinine limits of detection (LODs): 0.05 nanograms per milliliter (ng/mL) and 0.015 ng/mL. RESULTS In 2011, an estimated 37,791 never-smoking child and adult U.S. public housing residents experienced illness and death due to SHS exposure at home based on an LOD=0.05 ng/mL (50,967 residents at LOD=0.015 ng/mL). Costs incurred by society for these illnesses and deaths totaled $183 million (LOD=0.05 ng/mL) and $267 million (LOD=0.015 ng/mL) annually. Of the total costs, direct costs (medical and nonmedical) accounted for $128 million and $176 million for LOD=0.05 ng/mL and LOD=0.015 ng/mL, respectively. Medical care accounted for the majority of direct costs-$110 million at LOD=0.05 ng/mL and $153 million at LOD=0.015 ng/mL. Adverse respiratory health outcomes accounted for approximately one-half (56% at LOD=0.05 ng/mL and 52% at LOD=0.015 ng/mL) of total societal costs. CONCLUSION Implementing smoke-free policies in all U.S. public housing could save lives and decrease SHS-related morbidity and mortality in never-smoking residents, resulting in annual societal savings of $183 million at LOD=0.05 ng/mL and $267 million at LOD=0.015 ng/mL.
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Affiliation(s)
- Jacquelyn Mason
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Emergency and Environmental Health Services, Atlanta, GA
| | - William Wheeler
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Emergency and Environmental Health Services, Atlanta, GA ; Current affiliation: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity, and Obesity, Atlanta, GA
| | - Mary Jean Brown
- Centers for Disease Control and Prevention, National Center for Environmental Health, Division of Emergency and Environmental Health Services, Atlanta, GA
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Stein A, Suttie J, Baker L, Agans R, Xue W, Bowling JM. Predictors of smoke-free policies in affordable multiunit housing, North Carolina, 2013. Prev Chronic Dis 2015; 12:E73. [PMID: 25974143 PMCID: PMC4438422 DOI: 10.5888/pcd12.140506] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Smoke-free policies can effectively protect nonsmokers from secondhand smoke (SHS) exposure in multiunit housing. We surveyed all affordable multiunit housing properties in North Carolina to determine the statewide prevalence of smoke-free policies and to identify predictors of smoke-free policies. Methods Representatives of affordable housing properties in North Carolina completed a mailed or online survey during June through October 2013. The primary outcome measure was presence of a smoke-free policy, defined as prohibiting smoking in all residential units. We used χ2 analysis and multivariate logistic regression to identify correlates of smoke-free policies. Results Of 1,865 eligible properties, responses were received for 1,063 (57%). A total of 16.5% of properties had policies that prohibited smoking in all residential units, while 69.6% prohibited smoking in indoor common areas. In multivariate analysis, an increase in the number of children per unit was associated with a decrease in the odds of having a smoke-free policy at most properties. Newer properties across all company sizes were more likely to have smoke-free policies. Accessing units from interior hallways predicted smoke-free policies among medium-sized companies. Conclusion More smoke-free policies in affordable multiunit housing are needed to protect vulnerable populations, particularly children, from SHS exposure. Public health professionals should continue to educate housing operators about SHS and the benefits of smoke-free policies at all properties, including older ones and ones where units are accessed from outside rather than from an interior hallway.
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Affiliation(s)
- Anna Stein
- North Carolina Division of Public Health, Raleigh, North Carolina,1932 Mail Service Center, Raleigh, NC 27699-1932.
| | - Janet Suttie
- North Carolina Division of Public Health, Raleigh, North Carolina
| | - Laura Baker
- North Carolina Division of Public Health, Raleigh, North Carolina
| | - Robert Agans
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Wei Xue
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - J Michael Bowling
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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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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