Attitudes,Experiences, and Acceptance of Smoke-Free Policies Among US Multiunit Housing Residents

We assessed factors related to smoke-free policies among a cross-sectional, nationally representative, random-digit-dial sample (landline and cell phone) of US multiunit housing residents (n = 418). Overall, 29% reported living in smoke-free buildings, while 79% reported voluntary smoke-free home rules. Among those with smoke-free home rules, 44% reported secondhand smoke incursions in their unit. Among all respondents, 56% supported smoke-free building policy implementation. These findings suggest that smoke-free building policies are needed to protect multiunit housing residents from secondhand smoke in their homes.Secondhand smoke (SHS) contains hundreds of toxic or carcinogenic compounds and can cause significant morbidity and mortality among nonsmoking children and adults.1–3 Currently, there is a growing interest in adopting smoke-free policies in private settings, including multiunit housing (MUH). The home represents a major source of SHS exposure for many individuals,2,4–6 and MUH residents are particularly susceptible to SHS incursions from nearby units and shared areas.6–8 This cross-sectional study evaluated attitudes, experiences, and acceptance of smoke-free home rules and building policies among a nationally representative sample of US MUH residents.     

The New York City Smoke-Free Air Act: second-hand smoke as a worker health and safety issue

BACKGROUND: Despite the provisions of a Smoke-Free Air Act (SFAA) enacted in 1995, more than 415,000 non-smoking New York City workers reported exposure to second-hand smoke in the workplace all or most of the time in 2002. Continued exposure to second-hand smoke in New York City prompted a renewed debate about a broader smoke-free air law. METHODS: The approach taken by the New York City Department of Health and Mental Hygiene to make the case for workplace protection from second-hand smoke, counter the opposition's arguments, and ultimately win the support of policymakers and the public for comprehensive smoke-free workplace legislation is described. RESULTS: On December 30, 2002, New York City's Mayor signed the SFAA of 2002 into law, making virtually all workplaces, including restaurants and bars, smoke-free. CONCLUSIONS: Proponents for a stronger law prevailed by defining greater protection from second-hand smoke as a matter of worker health and safety. Efforts to enact smoke-free workplace laws will inevitably encounter strong opposition, with the most common argument being that smoke-free measures will harm businesses. These challenges, however, can be effectively countered and public support for these measures is likely to increase over time by focusing the debate on worker protection from second-hand smoke exposure on the job.     

Predictors of Senior Center Use among Older Adults in New York City Public Housing

Despite agreement among stakeholders that senior centers can promote physical and mental health, research on senior center use in urban populations is limited. Our objective was to describe demographic and health factors associated with senior center use among urban, low-income older adults in order to inform programming and outreach efforts. We used data from a 2009 telephone survey of 1036 adults randomly selected from rosters of New York City public housing residents aged 65 and older. We analyzed senior center use by race/ethnicity, age, gender, health, housing type, and income, and used a forward selection approach to build best-fit models predicting senior center use. Older adults of all ages and of both genders reported substantial use of senior centers, with nearly one third (31.3%) reporting use. Older adults living alone, at risk of depression, or living in specialized senior housing had the greatest use of centers. Senior center use varied by race/ethnicity, and English-speaking Hispanics had a higher prevalence of use than Spanish-speaking Hispanics (adjusted prevalence ratio [PR]=1.69, 95% CI: 1.11-2.59). Spanish-speaking communities and older adults living in non-senior congregate housing are appropriate targets for increased senior center outreach efforts.     

上海市餐厅服务人员被动吸烟现状及健康效应

目的 了解上海市餐厅服务人员的被动吸烟情况,探讨被动吸烟在餐饮业服务人员中产生的健康效应。方法 采取分层随机抽样方法 ,在上海市城区选取33个餐厅的242名员工参加一对一问卷调查。结果 有90.7%的被调查者在餐厅工作期间有被动吸烟情况,平均每周被动吸烟时间为（23.9±18.6）h,70.7%的调查者支持无烟餐厅政策。43.8%的被调查者报告有呼吸道症状,60.7%的人报告有感觉系统症状。每周被动吸烟时间是气短及眼部刺激症状发生的危险因素,OR（95%CI）分别为1.03（1.01～1.06）和1.02（1.01～1.03）。结论 上海市餐厅服务人员的被动吸烟情况比较严重,被动吸烟能够引起呼吸系统和感觉系统的健康效应。     

Housing Patterns and Correlates of Homelessness Differ by Gender among Individuals Using San Francisco Free Food Programs

Homeless individuals experience high rates of morbidity and mortality, yet many homeless studies include small percentages of female participants. We therefore sought to determine correlates of homelessness separately for men and women in a sample of individuals visiting free food programs. Between August 2003 and April 2004, 324 individuals were recruited from San Francisco free food programs and interviewed regarding housing, sociodemographics, health, drug use, sex trade, and incarceration. Over one-half of women and almost three-fourths of men reported homelessness in the prior year. Among women, white race, younger age, not living with minor children, engaging in sex trade and recent incarceration were strongly associated with homelessness; however, only incarceration maintained the strong association in adjusted analysis (OR = 7.16, CI = 3.83–13.4). Among men, heavy alcohol use, drug use, years spent living in San Francisco and monthly income were strongly associated with homelessness; however, only years living in San Francisco (OR = 0.28, CI = 0.19–0.42) and monthly income maintained strong association in adjusted analysis (OR = 0.27, CI = 0.13–0.57). Housing patterns and the strongest correlates of homelessness among individuals visiting free food programs differ by sex. These results suggest the need to characterize homelessness and develop effective homeless interventions separately for men and women. Riley, Weiser, Dilworth, and Cohen are with the San Francisco General Hospital, Epidemiology and Prevention Interventions Center, University of California, San Francisco, CA, USA; Weiser and Neilands are with the Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA; Sorensen is with the San Francisco General Hospital, Department of Psychiatry, University of California, San Francisco, CA, USA.     

Correlates of daily smoking among female arrestees in New York City and Los Angeles, 1997

OBJECTIVES: I sought to determine correlates of daily smoking among recently arrested women involved in the Drug Use Forecasting Program (DUF), many of whom are illicit drug users. Also, I compared smoking rates among DUF women, who were illicit drug users, with rates among women taking part in the Behavioral Risk Factor Surveillance System (BRFSS) survey, who do not have high levels of drug use, to determine if drug use accounts for heavy smoking. METHODS: I compared daily smoking, illicit drug use, and selected demographic characteristics in 2 DUF cities: New York, with the highest rate of smoking among DUF cities in 1997, and Los Angeles, with the lowest. I also compared DUF and BRFSS daily smoking rates. RESULTS: Although rates of illicit drug use were similar in New York and Los Angeles (69.7% and 61.8%, respectively), the daily smoking rate was higher in New York (90.9% vs 41.7%). DUF smoking rates were higher than BRFSS rates; both rates were higher than the general population (23%). CONCLUSIONS: Illicit drug use does not, in all cases, explain high rates of daily smoking. Future efforts to shape tobacco-related public health policies in New York and elsewhere should involve collaboration with criminal justice transitional health programs.     

The role of obesity in the risk of gestational diabetes among immigrant and U.S.-born women in New York City

Purpose

To examine if the role of obesity in the risk of gestational diabetes differs between immigrant and U.S.-born women.

安徽省2015年18岁及以上居民二手烟暴露状况分析

目的利用2015年中国成人慢性病与营养监测数据,分析安徽省≥18岁人群的二手烟暴露情况。方法采用多阶段分层整群随机抽样,有效样本量为7 553人,使用事后分层权重调整和复杂抽样设计方法进行统计分析。结果 18岁及以上居民二手烟暴露率为65.8%,男性和女性二手烟暴露率分别为68.3%和64.7%,差异无统计学意义(P>0.05)。二手烟暴露率在各年龄组(χ~2=10.460,P=0.010)、文化程度(χ~2=17.630,P=0.002)、婚姻状况(χ~2=8.784,P=0.013)和职业间(χ~2=17853,P=0.001)均存在差异。一周中每天受到暴露的比例最高(34.8%)。结论安徽省成年居民二手烟暴露水平较高,并且长期暴露二手烟者数量多,控烟形势非常严峻。     

Awareness of heart attack symptoms and lifesaving actions among New York city area residents

The American Heart Association has a national network of community-based programs designed to reduce response times to cardiac emergencies by improving access to automatic external defibrillators (AEDs) among laypersons. Success of these Operation Heartbeat programs depends in part on the public’s knowledge of the warning signs of a myocardial infarction (MI) and appropriate response to cardiac arrest victims. In May 2000, a 7-minute telephone survey was administered to a random sample of adults residing within the American Heart Association affiliate territories of New York, New Jersey, and Connecticut to determine the knowledge of MI symptoms, confidence in cardiopulmonary resuscitation (CPR) use, and the awareness of AEDs. Of the respondents, 60% were women (n=1,128), 83% were Caucasians (n=1,558), 15.2% were non-whites (African American, Asian, or Hispanic), and 38.5% had at least a college degree (n=724). Women were significantly more likely than men to know that sex differences exist in the warning signs for an MI (63% vs. 30.7%, respectively; P<.001). Whites had above-average confidence in MI recognition compared with non-whites (39.2% vs. 27.4%, respectively; P<.001) and were more cognizant of the public availability of AEDs (54.5% vs. 33.2%, respectively; P<.001). Our findings suggest that racial/ethnic and sex disparities exist in the awareness of AEDs and in the knowledge of atypical MI symptoms in women, respectively. Innovative CPR outreach programs might be needed in New York area communities to increase CPR training among all adults, to increase AED awareness in vulnerable populations, and to improve knowledge and confidence in the recognition of acute MI symptoms. Presented in part at the national meeting of the Society of General Internal Medicine, Vancouver, Canada, May 2003.     

2010年与2018年中国15岁及以上非现在吸烟人群二手烟暴露情况及影响因素分析

目的了解2010与2018年中国≥15岁非现在吸烟人群二手烟暴露情况及其影响因素。方法 2010与2018年中国成人烟草调查均覆盖全国31个省(自治区、直辖市), 采用多阶段分层整群随机抽样获得全国代表性样本。本研究选择≥15岁非现在吸烟人群作为研究对象, 经基于复杂抽样加权后, 对一般人口学特征、二手烟危害的认知、公共场所室内区域禁烟的态度, 以及不同场所二手烟暴露情况、限制吸烟的规定进行描述, 采用Rao-Scottχ2检验进行率的比较、非条件logistic回归进行二手烟暴露影响因素分析。结果≥15岁非现在吸烟人群中, 看到有人室内吸烟的比例从2010年的84.7%下降到2018年的71.9%, 在各个场所看到吸烟的比例均有所下降, 差异均有统计学意义(P<0.001);女性、45～64岁、教师、医务人员、企业/商业/服务业人员、农村和中部地区人群二手烟暴露情况均有所改善, 差异均有统计学意义(P<0.05)。2018年, 在各年龄组中, 家庭全面禁烟或部分区域允许吸烟的二手烟暴露比例均低于家庭允许吸烟或无禁烟规定;在25～44岁人群中, 所在工作场所全面禁烟的二手烟...     

Socioeconomic disparities in household secondhand smoke exposure among non-smoking adolescents in the Republic of Korea

This nationally representative study examined (a) gender and age differences in household secondhand smoke exposure (HSHSE) and (b) associations between socioeconomic status (SES) and HSHSE among non-smoking Korean adolescents. Two subsamples were analysed: males (n?=?25,648) and females (n?=?30,240). The HSHSE measures were incidence of HSHSE (yes/no) and number of days of HSHSE (1–7 days); the SES measures were parental education, perceived economic status, and family wealth. For the first aim, chi-square test, t-test, and bivariate negative binomial regression analysis were performed; For the second aim, multivariate logistic regression and negative binomial regression analyses were performed. The incidence and number of days of HSHSE were significantly higher among females (32.35% and 3.48 days) than males (26.83% and 3.08 days). The HSHSE incidence was significantly higher among younger adolescents (23.32% to 31.08% of males and 26.58% to 37.03% of females). Lower SES was associated with (a) greater odds of HSHSE (odds ratio: 1.12–1.58 among males and 1.19–1.85 among females) and (b) greater incidence rates of HSHSE (incidence rate ratio: 1.05–1.17 among males and 1.10–1.14 among females). Efforts should be made to decrease HSHSE among adolescents, particularly low-SES youth.     

The Role of Housing Type and Housing Quality in Urban Children with Asthma

The goal of this study was to assess the relationship between type and quality of housing and childhood asthma in an urban community with a wide gradient of racial/ethnic, socioeconomic, and housing characteristics. A parent-report questionnaire was distributed in 26 randomly selected New York City public elementary schools. Type of housing was categorized using the participants’ addresses and the Building Information System, a publicly-accessible database from the New York City Department of Buildings. Type of housing was associated with childhood asthma with the highest prevalence of asthma found in public housing (21.8%). Residents of all types of private housing had lower odds of asthma than children living in public housing. After adjusting for individual- and community-level demographic and economic factors, the relationship between housing type and childhood asthma persisted, with residents of private family homes having the lowest odds of current asthma when compared to residents of public housing (odds ratio: 0.51; 95% confidence interval, 0.22, 1.21). Factors associated with housing quality explain some of the clustering of asthma in public housing. For example, the majority (68.7%) of public housing residents reported the presence of cockroaches, compared to 21% of residents of private houses. Reported cockroaches, rats, and water leaks were also independently associated with current asthma. These findings suggest differential exposure and asthma risk by urban housing type. Interventions aimed at reducing these disparities should consider multiple aspects of the home environment, especially those that are not directly controlled by residents.     

浙江省青少年烟草使用流行现况分析

目的 描述浙江省青少年烟草使用的流行特点,为控制烟草使用提供科学依据。方法 2013年11-12月,采用多阶段整群抽样方法抽取浙江省36所学校共计4 797名青少年进行调查,采用尝试吸烟率、现在吸烟率、二手烟暴露率等指标,依据全省初中学生数进行加权计算。结果 青少年学生尝试和现在吸烟率分别为10.91%和2.07%,烟草易感率为7.72%;其中男生和女生尝试吸烟率分别为15.65%和5.58%,农村学生尝试吸烟率(12.13%)高于城市(9.24%);初三学生尝试吸烟率较高(15.15%),初一学生烟草易感率较低(5.22%),"一周可支配零用钱大于30元"学生组的现在吸烟率较高(4.07%);学生"二手烟"暴露依次是室外公共场所(57.60%)、室内公共场所(54.45%)、公共交通工具(46.97%)和家(43.16%);3 071名学生(77.33%)在过去30 d内看到过吸烟镜头,仅1 367名学生(28.30%)在过去12个月内于课堂上接受过烟草危害的知识。结论 浙江省青少年存在尝试吸烟和现在吸烟现象,"二手烟"暴露率较高,学校缺乏对学生的控烟课堂教育;需要开展控烟干预,加强烟草危害健康知识的传播力度和深度,减少青少年烟草易感人群的比例。     

Secular Changes in Mortality Disparities in New York City: A Reexamination

Previously published analyses showed that inequalities in mortality rates between residents of poor and wealthy neighborhoods in New York City (NYC) narrowed between 1990 and 2000, but these trends may have been influenced by population in-migration and gentrification. The NYC public housing population has been less subject to these population shifts than those in other NYC neighborhoods. We compared changes in mortality rates (MRs) from 1989–1991 to 1999–2001 among residents of NYC census blocks consisting entirely of public housing residences with residents of nonpublic housing low-income and higher-income blocks. Public housing and nonpublic housing low-income blocks were those in census block groups with ≥50% of residents living at <1.5 times the federal poverty level (FPL); nonpublic housing higher-income blocks were those in census block groups with <50% of residents living at <1.5 times the FPL. Information on deaths was obtained from NYC’s vital registry, and US Census data were used for denominators. Age-standardized all-cause MRs in public housing, low-income, and higher-income residents decreased between the decades by 16%, 28%, and 22%, respectively. While mortality rate ratios between low-income and higher-income residents narrowed by 8%, the relative disparity between public housing and low-income residents widened by 21%. Diseases amenable to prevention including malignancies, diabetes, and chronic lung disease contributed to the increased overall mortality disparity between public housing and lower-income residents. These findings temper previous findings that inequalities in the health of poor and wealthier NYC neighborhood residents have narrowed. NYC public housing residents should be a high-priority population for efforts to reduce health disparities.

Stroke Risk among Chinese Immigrants in New York City

Background: Little is known of risk factors for stroke among Chinese immigrants to the United States. We have conducted a case–control study to identify risk factors for stroke among foreign-born Chinese in New York City. Methods: From September 2000 to June 2003, 187 sequential stroke cases (44 hemorrhagic) and 204 controls matched on age, gender, and years since immigration were recruited from New York Downtown Hospital, which was located next to New York City Chinatown. Risk factor status was assessed by questionnaire interview and medical chart review, which included clinical factors, sociodemographic characteristics, personal and family histories, and behavior and lifestyle factors, as well as behavioral changes after immigration to the United States. Results: For cases and controls, mean ages were 74.8 and 74.7 years, 47.3% of cases and 47.5% of controls were male, and mean years since immigration to the United States were 26.7 and 26.8, respectively. Sociodemographic characteristics and behavioral pattern including cigarette smoking, exercise, and usage of special diet or dietary supplements were similar between cases and controls. However, stroke patients were more likely to have hypertension (76% vs. 59%, p≤0.001), increased blood pressure (165/84 mmHg vs. 140/74 mmHg, p≤0.001) and left ventricular hypertrophy (LVH) (10.1% vs. 4.3%, p≤0.05), and less likely to consume poultry (odds ratio 0.80, 95% confidence interval (CI) 0.59–1.00); fish (0.70, 95% CI 0.42–0.96), fruit and vegetable juice (0.83, 95% CI 0.70–0.95), and grains (0.79, 95% CI 0.62–0.96) than were controls. Conclusion: Among Chinese immigrants in New York City, as in general population, poor controlled hypertension was related to the risk of stroke. Therefore, Chinese immigrants presenting with hypertension and/or a family history of hypertension should be detected and followed up regularly to monitor the blood pressure level. In addition, difference in food intake between stroke and control patients may present an opportunity for behavior intervention to prevent stroke.     

Neighborhood Walkability and Active Travel (Walking and Cycling) in New York City

Urban planners have suggested that built environment characteristics can support active travel (walking and cycling) and reduce sedentary behavior. This study assessed whether engagement in active travel is associated with neighborhood walkability measured for zip codes in New York City. Data were analyzed on engagement in active travel and the frequency of walking or biking ten blocks or more in the past month, from 8,064 respondents to the New York City 2003 Community Health Survey (CHS). A neighborhood walkability scale that measures: residential, intersection, and subway stop density; land use mix; and the ratio of retail building floor area to retail land area was calculated for each zip code. Data were analyzed using zero-inflated negative binomial regression incorporating survey sample weights and adjusting for respondents’ sociodemographic characteristics. Overall, 44 % of respondents reported no episodes of active travel and among those who reported any episode, the mean number was 43.2 episodes per month. Comparing the 75th to the 25th percentile of zip code walkability, the odds ratio for reporting zero episodes of active travel was 0.71 (95 % CI 0.61, 0.83) and the exponentiated beta coefficient for the count of episodes of active travel was 1.13 (95 % CI 1.06, 1.21). Associations between lower walkability and reporting zero episodes of active travel were significantly stronger for non-Hispanic Whites as compared to non-Hispanic Blacks and to Hispanics and for those living in higher income zip codes. The results suggest that neighborhood walkability is associated with higher engagement in active travel.     

Case history of the Center for Urban Epidemiologic Studies in New York City

This case history describes the history of the Center for Urban Epidemiological Studies (CUES), an urban research center based in New York City. Between 1996 and 1999, CUES was transformed from an institution that worked with the medical schools of the region to a center seeking to define a new practice of community-based participatory research (CBPR). The report summarizes how and why CUES has changed, identifies its main accomplishments and challenges, and discusses some of the lessons learned to date. It illustrates how the principles of CBPR have influenced the development of CUES. The case history suggests that it is possible for an organization to transform itself from a researcher-driven orientation toward a more participatory model. The early history also demonstrates that it is possible to engage community organizations and activists in an ongoing effort to study and address complex urban health problems such as asthma, substance abuse, and infections diseases. Finally, the report illustrates that CBPR is a process that evolves in response to specific situational factors.