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Berry KM, Drew JAR, Brady PJ, Widome R. Impact of smoking cessation on household food security. Ann Epidemiol 2023; 79:49-55.e3. [PMID: 36657695 PMCID: PMC9957954 DOI: 10.1016/j.annepidem.2023.01.007] [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: 09/30/2022] [Revised: 12/30/2022] [Accepted: 01/08/2023] [Indexed: 01/18/2023]
Abstract
PURPOSE Smokers can spend a substantial amount on cigarettes, potentially constraining their ability to purchase food. We tested the association of smoking cessation and household food security. METHODS Using the Current Population Survey (2001-2019), we longitudinally linked the Tobacco Use Supplement and the Food Security Supplement (n = 71,278). Among adult smokers (n = 13,144), we used modified Poisson regression to model household food insecurity as a function of quit status (continuing smokers vs. recent quitters), adjusting for sex, age, household size, children in the household, and other household smokers. We also used multinomial logistic regression to examine more detailed food security status (high, marginal, low, very low). RESULTS The adjusted probability of household food insecurity at follow-up was 11% (95% CI: 8.7%-13%) for recent quitters and 20% (95% CI: 19%-21%) for continuing smokers. Continuing smokers had a lower adjusted probability of high food security (69% vs. 80%) and a higher adjusted probability of marginal (11% vs. 9.8%), low (12% vs. 7%), and very low food security (7.8% vs. 3.6%) compared to recent quitters. CONCLUSIONS Cigarette cessation is associated with a lower risk of household food insecurity. Therefore, promoting tobacco cessation alongside food assistance and poverty reduction policies may help alleviate food insecurity.
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Affiliation(s)
- Kaitlyn M Berry
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN.
| | - Julia A Rivera Drew
- Institute on Social Research and Data Innovation, University of Minnesota, Minneapolis, MN
| | - Patrick J Brady
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Rachel Widome
- Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis, MN
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Widome R. Invited Commentary: Use of Epidemiologic Methods to Guide Comprehensive and Equitable Approaches to Policy. Am J Epidemiol 2023; 192:34-38. [PMID: 36255180 PMCID: PMC10144725 DOI: 10.1093/aje/kwac184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 01/11/2023] Open
Abstract
Despite a dramatic reduction in the prevalence of commercial cigarette smoking in the United States, children are still commonly exposed to secondhand smoke (SHS), which is a cause of various pediatric health problems. Further, SHS exposure is patterned by race and class, exacting an inequitable toll on children from families with lesser social and economic advantage. In this issue of the Journal, Titus et al. (Am J Epidemiol. 2023;192(1):25-33) use natural experiment evaluation methods (difference-in-differences) to test whether the recently implemented US Department of Housing and Urban Development policy that forbade smoking in and around New York City Housing Authority buildings affected child respiratory health. The results from their work remind us that policies do not always impact outcomes as we might expect. Given that policy is one of the most potent tools for population health promotion, this work underlines the need for epidemiologists to engage in policy evaluation at all stages of the policy life cycle, in order to discover comprehensive approaches to policy development and implementation that prioritize equity and address structural racism.
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Affiliation(s)
- Rachel Widome
- Correspondence to Dr. Rachel Widome, Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South 2nd Street #300, Minneapolis, MN 55454 (e-mail: )
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Medicaid coverage for tobacco dependence treatment: Enrollee awareness and use. Prev Med Rep 2021; 24:101509. [PMID: 34430191 PMCID: PMC8368993 DOI: 10.1016/j.pmedr.2021.101509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 06/16/2021] [Accepted: 07/28/2021] [Indexed: 11/23/2022] Open
Abstract
Medicaid-insured adults smoke at twice the rate of privately insured adults. Insurance coverage for tobacco dependence treatments (TDTs) has been shown to increase quit attempts, but few published studies have measured enrollees’ awareness of Medicaid coverage. We assessed awareness of Medicaid coverage for and use of TDTs among New York State (NYS) Medicaid-insured smokers and recent quitters. In July-August 2017, we conducted a probability-based online survey of Medicaid enrollees in NYS aged 18 to 65 in fee-for-service and managed care plans (n = 266; AAPOR 4RR = 22.5%). In 2017, we estimated descriptive statistics and used Adjusted Wald tests to assess differences in awareness and use of TDTs (p < 0.05). We used logistic regression to assess correlates of coverage awareness and use of TDTs. Most participants (94.3%) were aware of TDTs, but fewer were aware that Medicaid covers them (59.7%). Most participants believed TDTs are effective in helping smokers quit, although many also believed non-evidence-based methods are effective. Awareness of Medicaid coverage was associated with awareness of a Medicaid-related antitobacco television ad (p < 0.05), moderate nicotine dependence (p < 0.05), and believing that TDTs are effective (p < 0.01). Although awareness of Medicaid coverage for TDTs was found to be high, there remains room for improvement, even in a state that actively promotes these benefits. It is important for states to not only expand Medicaid coverage of TDTs but to also promote the benefits to improve the chances of quit success. Understanding Medicaid enrollees’ awareness of and perceptions of covered TDTs can inform messaging to maximize utilization of evidence-based benefits.
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Kim-Mozeleski JE, Pandey R. The Intersection of Food Insecurity and Tobacco Use: A Scoping Review. Health Promot Pract 2020; 21:124S-138S. [PMID: 31908208 DOI: 10.1177/1524839919874054] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Cigarette smoking is increasingly concentrated in socioeconomically disadvantaged groups, and food insecurity also disproportionately affects lower-income groups. Recent studies have suggested that smoking and food insecurity operate as risk factors for one another, but there is limited understanding of their intersection. This scoping review aimed to synthesize the published literature on the association between food insecurity and tobacco use across population groups in the United States and Canada. We searched PubMed, Web of Science, and PsycINFO using key words. Studies included were published in English between 2008 and 2018, reported empirical findings, measured both tobacco use and food insecurity, and considered either variable as a study outcome. Nineteen articles were identified; 6 examined tobacco use as an outcome variable and 13 examined food insecurity as an outcome variable. Most articles were of studies using cross-sectional designs. Study samples ranged from general populations, clinical samples, and underserved populations. For each article, we extracted information including specific findings related to the association between food insecurity and tobacco use. We synthesized the current research by formulating a model by which food insecurity and tobacco use are bidirectionally associated. This scoping review concludes that the co-occurrence of food insecurity and tobacco use exists across populations in the United States and Canada. As the evidence is largely from cross-sectional investigations, there is a need for longer term, comprehensive assessments of relationships between tobacco use and food insecurity. Such investigations can inform policies and interventions aimed toward addressing the inequitable burden of tobacco use and of food insecurity among disadvantaged populations.
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Geller AC, Borrelli B, Davine JA, Burtner J, Heeren TC, Rees VW, Adegoke A, Brooks DR. Factors Associated with Recent Use of Nicotine Replacement Therapy Among Multiethnic Smokers Residing in Public Housing. J Smok Cessat 2018; 13:162-170. [PMID: 38911966 PMCID: PMC11193361 DOI: 10.1017/jsc.2017.21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Introduction Understanding factors associated with increased use of nicotine replacement therapy (NRT) is critical to implementing cessation interventions for low-income individuals yet the factors associated with NRT use among low-income smokers are poorly understood. Aims Assess factors associated with NRT use among low-income public housing residents. Methods 'Kick it for Good' was a randomised smoking cessation intervention study conducted among residents of public housing sites in Boston, MA. Secondary, cross-sectional analyses were conducted on smokers from a community-based intervention cessation intervention who reported making a quit attempt and use of NRT in the past 12 months (n = 234). Results Among smokers who made a quit attempt in the past year, 29% reported using NRT. Black (prevalence ratio,PR = 0.52, 95% CI: 0.38-0.71) and Hispanic (PR = 0.52, 95% CI: 0.31-0.88) participants were less likely to report use of NRT compared with Whites. The prevalence of recent NRT use was greatest among those both asking for and receiving provider advice (PR = 1.90, 95% CI: 0.96-3.78). Conclusions Minority race and ethnicity and low provider engagement on NRT use were associated with lower NRT use. Providing barrier-free access to NRT and facilitating provider engagement with smokers regarding NRT use can increase NRT use among low-income populations.
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Affiliation(s)
- Alan C. Geller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Belinda Borrelli
- Boston University Graduate School of Dental Medicine, Boston, Massachusetts
| | - Jessica A. Davine
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Joanna Burtner
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Timothy C. Heeren
- Departments of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Vaughan W. Rees
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Abdulkabir Adegoke
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Daniel R. Brooks
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
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Prevalence and Correlates of Smoking among Low-Income Adults Residing in New York City Public Housing Developments-2015. J Urban Health 2017; 94:525-533. [PMID: 28656541 PMCID: PMC5533671 DOI: 10.1007/s11524-017-0180-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
To guide targeted cessation and prevention programming, this study assessed smoking prevalence and described sociodemographic, health, and healthcare use characteristics of adult smokers in public housing. Self-reported data were analyzed from a random sample of 1664 residents aged 35 and older in ten New York City public housing developments in East/Central Harlem. Smoking prevalence was 20.8%. Weighted log-binomial models identified to be having Medicaid, not having a personal doctor, and using health clinics for routine care were positively associated with smoking. Smokers without a personal doctor were less likely to receive provider quit advice. While most smokers in these public housing developments had health insurance, a personal doctor, and received provider cessation advice in the last year (72.4%), persistently high smoking rates suggest that such cessation advice may be insufficient. Efforts to eliminate differences in tobacco use should consider place-based smoking cessation interventions that extend cessation support beyond clinical settings.
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Helms VE, King BA, Ashley PJ. Cigarette smoking and adverse health outcomes among adults receiving federal housing assistance. Prev Med 2017; 99:171-177. [PMID: 28192095 PMCID: PMC5508864 DOI: 10.1016/j.ypmed.2017.02.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 11/19/2022]
Abstract
Cigarette smoking is higher among low-income adults and individuals who reside in federally assisted housing are particularly susceptible to the adverse effects of smoking and secondhand smoke exposure. This study assessed smoking-related behaviors and health outcomes among U.S. adults who received federal housing assistance during 2006-2012. National Health Interview Survey data linked with administrative data from the U.S. Department of Housing and Urban Development were analyzed; 5218 HUD-assisted adults were assessed. Demographic characteristics associated with smoking, including frequency and consumption, were assessed among adult cigarette smokers. Fourteen adverse health outcomes were examined among cigarette smoking and nonsmoking adults. One-third (33.6%) of HUD-assisted adults were current cigarette smokers. Smoking prevalence was highest among adults aged 25-44 (42.5%), non-Hispanic whites (39.5%), and adults who resided in households with children (37.5%). Half attempted to quit in the past year; 82.1% were daily smokers; and, 35.8% of daily smokers reported smoking 20+ cigarettes a day. Multivariable analyses revealed that compared to nonsmokers, cigarette smokers had increased likelihood of reporting fair or poor health (95% CI: 1.04-1.52), chronic obstructive pulmonary disease (CI: 1.87-3.06), disability (CI: 1.25-1.83), asthma (CI: 1.02-1.55), serious psychological distress (CI: 1.39-2.52), >1 emergency room visit in the past year (CI: 1.09-1.56), and ≥10 work loss days in the past year (CI: 1.15-3.06). Adults who receive housing assistance represent an at-risk population for adverse health outcomes associated with smoking and secondhand smoke. Housing assistance programs provide a valuable platform for the implementation of evidence-based tobacco prevention and control measures, including smokefree policies.
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Affiliation(s)
- Veronica E Helms
- Office of Research, Evaluation, and Monitoring, Office of Policy Development and Research, U.S. Department of Housing and Urban Development, Washington, DC, United States.
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Peter J Ashley
- Office of Lead Hazard Control and Healthy Homes, U.S. Department of Housing and Urban Development, Washington, DC, United States
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Kennedy RD, Ellens-Clark S, Nagge L, Douglas O, Madill C, Kaufman P. A Smoke-Free Community Housing Policy: Changes in Reported Smoking Behaviour-Findings from Waterloo Region, Canada. J Community Health 2016; 40:1207-15. [PMID: 26070870 DOI: 10.1007/s10900-015-0050-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In 2010, Waterloo Region Housing (Canada) enacted a smoke-free (SF) housing policy that made all new leases in their community-housing portfolio (2722 units) 100 % SF. Existing lease holders were 'grandfathered'-meaning tenants could still smoke in their homes. A survey to measure support for the policy and how the policy had impacted smoking behaviour was delivered to all 2722 households in the Waterloo Region Housing portfolio in 2010 (pre-policy), 2011 and 2013 (post-policy). The proportion of households that completed the survey was 26 % (n = 717) in 2010, 25 % (n = 685) in 2011, and 23 % (n = 619) in 2013. Support for the SF housing policy was 72 % pre-enactment (2010), and increased to 78 % in 2011 and 79 % in 2013; however, most smokers do not support the policy. In 2010, prior to the SF policy, 65 % of tenants who smoke reported someone smoked inside their home; in 2013 this was reduced to approximately half of smokers (52 %). In 2013, 44 % of smokers reported smoking outside more often than before the SF policy was enacted, almost half of tenants with a smoke-free lease (46 %) and more than a third of tenants who have a grandfathered lease (34 %) reported they smoke less since the smoke-free policy. There has been no significant change in the proportion of respondents (>50 %) who reported being exposed to second-hand smoke in their home. This SF housing policy is associated with increased reported outdoor smoking and reduced smoking. Smoke-free policies may support smokers interested in quitting.
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Affiliation(s)
- Ryan David Kennedy
- Department of Health, Behaviour and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, 2213 Mc Elderry Street, 4th Floor, Baltimore, MD, 21205, USA. .,Propel Centre for Population Health Impact, University of Waterloo, Waterloo, ON, Canada.
| | | | - Laurie Nagge
- Public Health and Emergency Services, Region of Waterloo, Cambridge, ON, Canada
| | - Ornell Douglas
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, ON, Canada
| | - Cheryl Madill
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, ON, Canada
| | - Pamela Kaufman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Ontario Tobacco Research Unit, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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Widome R, Joseph AM, Hammett P, Van Ryn M, Nelson DB, Nyman JA, Fu SS. Associations between smoking behaviors and financial stress among low-income smokers. Prev Med Rep 2015; 2:911-5. [PMID: 26844167 PMCID: PMC4721304 DOI: 10.1016/j.pmedr.2015.10.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Many American households struggle to bring in sufficient income to meet basic needs related to nutrition, housing, and healthcare. Nicotine addiction and consequent expenditures on cigarettes may impose extra financial strain on low-income households. We examine how cigarette use behaviors relate to self-reported financial stress/strain among low-income smokers. METHODS At baseline in 2011/12, OPT-IN recruited adult smokers age 18-64 from the administrative databases of the state-subsidized Minnesota Health Care Programs (N = 2406). We tested whether nicotine dependency, type of cigarettes used, and smoking intensity were associated with self-reported difficulty affording food, healthcare, housing, and living within one's income. All regression models were adjusted for race, education, income, age, and gender. RESULTS Difficulty living on one's income (77.4%), paying for healthcare (33.6%), paying for housing (38.4%), and paying for food (40.8%) were common conditions in this population. Time to first cigarette and cigarettes smoked per day predicted financial stress related to affording food, housing, and living within one's income (all p < 0.05). For instance, those whose time to first cigarette was greater than 60 minutes had about half the odds of reporting difficulty paying for housing compared to those who had their first cigarette within five minutes of waking (adjusted odds ratio = 0.55 [95% CI: 0.41, 0.73]). Type of cigarette used was not associated with any type of financial stress/strain. CONCLUSIONS Smoking and particularly heavy smoking may contribute in an important way to the struggles that low-income households with smokers face in paying for necessities.
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Affiliation(s)
- Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA
| | - Anne M Joseph
- Department of Medicine, University of Minnesota Medical School, MN, USA
| | - Patrick Hammett
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, MN, USA; Department of Medicine, University of Minnesota Medical School, MN, USA; VA HSR&D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA
| | - Michelle Van Ryn
- Mayo Clinic, Division of Health Care Policy & Research, Rochester, MN, USA
| | - David B Nelson
- VA HSR&D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA
| | - John A Nyman
- Division of Health Policy and Management, University of Minnesota School of Public Health, MN, USA
| | - Steven S Fu
- Department of Medicine, University of Minnesota Medical School, MN, USA; VA HSR&D Center for Chronic Disease Outcomes Research (CCDOR), Minneapolis VA Health Care System, MN, USA
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Kegler MC, Haardӧrfer R, Berg C, Escoffery C, Bundy L, Williams R, Mullen PD. Challenges in Enforcing Home Smoking Rules in a Low-Income Population: Implications for Measurement and Intervention Design. Nicotine Tob Res 2015; 18:976-81. [PMID: 26246049 DOI: 10.1093/ntr/ntv165] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 07/23/2015] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Smoke-free homes reduce exposure to secondhand smoke, contribute to lower levels of consumption, and help smokers to quit. Even when home smoking rules are established however, they may not be consistently enforced. METHODS This study uses data from a randomized controlled trial of a brief intervention to create smoke-free homes among callers to the United Way of Greater Atlanta 2-1-1. Participants with partial or full home smoking bans at 6-month follow-up were asked about enforcement challenges, rooms where smoking occurred, and exceptions to the rules. Air nicotine monitors were placed in a subset of homes. RESULTS Participants (n = 286) were mostly female (84.6%) and African American (84.9%). Most were smokers (79.0%) and reported at least half of their friends and relatives smoked (63.3%). Among those with a full ban, 4.3% reported their rules were broken very often whereas 52.6% stated they were never broken. Bad weather and parties were the most common exceptions to rules. Among nonsmokers with full bans, 16% reported exposure to secondhand smoke in the home 1-3 days in the past week. In multivariate analyses, having a partial ban, being a nonsmoker, and living with three or more smokers predicted higher levels of enforcement challenges. CONCLUSIONS Findings suggest the majority of households with newly adopted smoke-free rules had no or rare enforcement challenges, but about one-fifth reported their rules were broken sometimes or very often. Interventions to create smoke-free homes should address enforcement challenges as newly adopted rules may be fragile in some households. IMPLICATIONS Interventions that promote smoke-free homes should address enforcement challenges.
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Affiliation(s)
- Michelle C Kegler
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA;
| | - Regine Haardӧrfer
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Carla Berg
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Cam Escoffery
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Lucja Bundy
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Rebecca Williams
- Cancer Prevention and Control Research Network, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Patricia Dolan Mullen
- Center for Health Promotion and Prevention Research, Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX
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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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Andrews JO, Mueller M, Newman SD, Magwood G, Ahluwalia JS, White K, Tingen MS. The association of individual and neighborhood social cohesion, stressors, and crime on smoking status among African-American women in southeastern US subsidized housing neighborhoods. J Urban Health 2014; 91:1158-74. [PMID: 25316192 PMCID: PMC4242849 DOI: 10.1007/s11524-014-9911-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of this study was to examine the associations between individual and neighborhood social contextual factors and smoking prevalence among African-American women in subsidized neighborhoods. We randomly sampled 663 adult women in 17 subsidized neighborhoods in two Southeastern US states. The smoking prevalence among participants was 37.6%, with an estimated neighborhood household prevalence ranging from 30 to 68%. Smokers were more likely to be older, have lower incomes, have lower BMI, and live with other smokers. Women with high social cohesion were less likely to smoke, although living in neighborhoods with higher social cohesion was not associated with smoking prevalence. Women with higher social cohesion were more likely to be older and had lived in the neighborhood longer. Women with high stress (related to violence and disorder) and who lived in neighborhoods with higher stress were more likely to smoke. Younger women were more likely to have higher stress than older women. There were no statistically significant associations with objective neighborhood crime data in any model. This is the first study to examine both individual and neighborhood social contextual correlates among African-American women in subsidized neighborhoods. This study extends findings about smoking behaviors and neighborhood social contexts in this high-risk, urban population. Future research is needed to explore age and residential stability differences and perceptions of social cohesion, neighborhood disorder, and perceived violence in subsidized housing. Further research is also warranted on African-American women, subsidized housing, smoking, social context, health disparities' effective strategies to address these individual and contextual factors to better inform future ecological-based multilevel prevention, and cessation intervention strategies.
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