Correlates of Smoke-Free Housing Policies and Interest in Implementing Policies among Multiunit Housing Owners in New York City

Secondhand smoke exposure is a concern in multiunit housing, where smoke can migrate between apartments. In 2012, the New York City (NYC) Department of Health and Mental Hygiene conducted a cross-sectional mail and phone survey among a random sample of low-income and market-rate multiunit housing owners and managers in NYC. The study compared experiences and attitudes regarding smoke-free policies between owners/managers (owners) with and without low-income units. Logistic regression analysis was used to assess the correlates of smoke-free residential unit rules and interest in adopting new smoke-free rules. Perceived benefits and challenges of implementing smoke-free rules were also examined. Overall, one-third of owners prohibited smoking in individual units. Among owners, nearly one-third owned or managed buildings with designated certified low-income units. Owners with low-income units were less likely than those without to have a smoke-free unit policy (26 vs. 36 %, p < 0.01) or be aware that owners can legally adopt smoke-free building policies (60 vs. 70 %, p < 0.01). In the final model, owners who believed that owners could legally adopt smoke-free policies were more likely to have a smoke-free unit policy, while current smokers and owners of larger buildings were less likely to have a policy. Nearly three quarters of owners without smoke-free units were interested in prohibiting smoking in all of their building/units (73 %). Among owners, correlates of interest in prohibiting smoking included awareness that secondhand smoke is a health issue and knowledge of their legal rights to prohibit smoking in their buildings. Current smokers were less likely to be interested in future smoke-free policies. Educational programs promoting awareness of owners’ legal right to adopt smoke-free policies in residential buildings may improve the availability of smoke-free multiunit housing.     

Peer Reviewed: Moving Multiunit Housing Providers Toward Adoption of Smoke-Free Policies

Background

Tenants in multiunit housing are at elevated risk for exposure to secondhand smoke at home because of smoke migration from other units.

Community Context

In 2004, tobacco control advocates in the Portland, Oregon, metropolitan area began to address this issue by launching a campaign to work with landlord and tenant advocates, private- and public-sector property managers, and other housing stakeholders to encourage smoke-free policies in multiunit housing.

Methods

We outline the 6-year campaign that moved local housing providers toward adopting no-smoking policies. We used the stages of change model, which matches potential messages or interventions to a smoker''s readiness to quit smoking.

Outcome

The campaign resulted in Oregon''s largest private property management company and its largest public housing authority adopting no-smoking policies for their properties and a 29% increase in the availability of smoke-free rental units in the Portland-Vancouver metro area from 2006 through 2009.

Interpretation

We learned the importance of building partnerships with public and private stakeholders, collecting local data to shape educational messages, and emphasizing to landlords the business case, not the public health rationale, for smoke-free housing.     

Support for No-Smoking Policies Among Residents of Public Multiunit Housing Differs by Smoking Status

We compared perceptions of smoking and non-smoking Tacoma, WA multiunit public housing residents regarding smoke-free policies and in-home smoking rules. Two-hundred-twenty-nine completed surveys (~16 % of units) of a modified version of the CDC’s multiunit housing resident survey were analyzed. Smokers differed significantly (p < 0.05) from non-smokers with respect to agreement with policies that would ban smoking in homes (41 % of smokers and 82 % of non-smokers strongly agreed or agreed), in common indoor areas (74 % of smokers and 82 % of non-smokers strongly agreed or agreed), and for outdoor areas (38 % of smokers and 68 % of non-smokers strongly agreed or agreed). For in-home smoking rules, smokers and non-smokers again differed significantly (p < 0.05) with 53 % of smokers and 90 % of non-smokers not allowing smoking in their homes. Twenty-five percent of residents reported smelling secondhand smoke that infiltrated their residence from the outside on a daily basis. The most notable findings are that more than 50 % of smokers do not allow smoking in their homes and that more than 50 % of smokers are supportive of or neutral with respect to smoke-free policies for one’s home. This suggests that implementation of smoke-free policies may not greatly impact vacancy rates even in populations with high rates of smoking (37 % in this study).     

Perceptions of Secondhand and Thirdhand Smoke Among Hispanic Residents of Multiunit Housing

Despite the progressive adoption of smoking bans in public spaces, children living in multi-unit housing remain at risk of exposure to secondhand smoke (SHS) and thirdhand smoke (THS). Hispanic populations in California are particularly vulnerable to the harmful effects of SHS and THS because a large proportion of Hispanics live in multi-unit housing. Three focus groups were conducted in the fall of 2012 (in Spanish and English, N = 24) to understand Hispanics’ knowledge of and experiences with SHS and THS, including barriers to avoiding smoke exposure and strategies for protecting their homes from smoke. Hispanic residents reported unpleasant experiences with SHS and THS and were generally knowledgeable about the adverse health effects, although they were not familiar with the term “thirdhand smoke.” Some participants also mentioned marijuana smoke as a potential health hazard. Hispanic cultural values made participants reluctant to confront their neighbors but also motivated them to find ways to protect their families from smoke. Potential solutions included working with the smokers to designate a smoking area and gaining support from the building owners. Broad smoking policies should be implemented to help Hispanic residents overcome cultural and social barriers to smoke free air.     

Secondhand Smoke Exposure and Smoke-Free Policy Support Among Public Housing Authority Residents in Rural and Tribal Settings

Previous research has shown that multi-unit housing (MUH) residents are at risk of secondhand smoke (SHS) exposure, which can transfer between units. The purpose of this study was to determine SHS exposure and examine attitudes towards smoking policies among public housing authority (PHA) residents in rural and tribal settings. A self-administered questionnaire was completed by 895 adult tenants (41 % response rate) living in PHA multiunit buildings in Montana in 2013. Our primary outcome was tenant support of smoke-free policies; our secondary outcome was exacerbation of child asthma symptoms due to SHS exposure. In 2014, we used multiple logistic regression models to test associations between independent variables and outcomes of interest. The majority (80.6 %) of respondents supported having a smoke-free policy in their building, with support being significantly higher among nonsmokers [adjusted odds ratio (aOR) 4.2, 95 % confidence interval (CI) 1.5–11.6] and among residents living with children (aOR 2.9, 95 % CI 1.3–6.2). Tribal residents were as likely to support smoke-free policies as non-tribal residents (aOR 1.4; 95 % CI 0.5–4.0). Over half (56.5 %) of respondents reported SHS exposure in their home; residents in a building with no smoke-free policy in place were significantly more likely to report exposure (aOR 3.5, 95 % CI 2.2–5.5). SHS exposure was not significantly associated with asthma symptoms. There is a significant reduction in exposure to SHS in facilities with smoke-free policies and there is strong support for such policies by both tribal and non-tribal MUH residents. Opportunities exist for smoke-free policy initiatives in rural and tribal settings.     

Smoke-Free Multi-unit Housing Policies Show Promise in Reducing Secondhand Smoke Exposure Among Racially and Ethnically Diverse,Low-Income Seniors

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.     

Evaluating the Implementation Process of a Citywide Smoke-Free Multiunit Housing Ordinance: Insights from Community Stakeholders

We evaluated the implementation process of Richmond, California’s citywide smoke-free multiunit housing ordinance. We conducted semistructured focus groups with multiunit housing tenants, owners, and managers. Residents understood the harms of secondhand smoke but lacked accurate information about the ordinance and questioned its enforceability. They shared concerns that the city lacked cessation resources for smokers wishing to quit because of the ordinance. To increase compliance with the ordinance, tenants, owners, and managers need accurate information.Implementing smoke-free multiunit housing (MUH) policies is the most effective way to protect MUH residents from secondhand smoke exposure.1,2 We have discussed how MUH tenants, owners, and managers view the implementation of Richmond, California’s citywide smoke-free MUH ordinance and potential barriers to its equitable implementation across the city’s diverse neighborhoods.The majority (78%) of Richmond’s 106 516 residents are ethnic minorities; 38% of Richmond’s population live in MUH residences.3,4 In 2009, Richmond passed an ordinance to prohibit the smoking of any tobacco product or marijuana in residential dwellings containing 2 or more units; it was fully implemented in 2011.5     

Attitudes Toward Sexuality Among Nursing Home Residents

There is a paucity of data regarding sexuality among nursing home residents. The aim of the present study was to evaluate sexual attitudes in a group of independent residents in a large urban nursing home. Ten items covering different aspects of sexual attitude were scored by two board certified psychiatrists following a semistructured interview. The study was undertaken at a large 1,200-bed nursing home providing services to both healthy independent elderly as well as geriatric patients. Subjects were 31 volunteers: 15 men and 16 women (mean age: 82.4 and 74.1 years, respectively), who consented to participate. Participants were cognitively intact and living independently at the nursing home. Exclusion criteria were: a) current major psychiatric morbidity, b) drug or alcohol abuse, c) Geriatric Depression Scale (short version) score 5, and d) Clinical Dementia Rating >0. A hierarchy of basic functions was constructed wherein each function was graded on a 5-point Likert-like scale reflecting its endorsed importance. The majority (23/31) felt that sexuality should be openly discussed with the elderly by health professionals. Twenty-one of 31 expressed willingness to receive medical consultation and treatment for sexual dysfunction as needed and 20/31 expressed a similar attitude if their partner so needed. The hierarchy of needs was rated by the participants (men and women, respectively) as follows: Mood (4.4; 4.3), Memory (4.2; 4.2), Sleep (3.8; 3.9), Sex (3.5; 2.8), and Appetite (2.8; 2.6). Sex is graded as moderately important among nursing home residents, more so in males. The majority of residents expressed positive attitudes towards open discussion of sexual matters and willingness to accept therapeutic interventions when needed.     

Peer Reviewed: The Acceptability of Comprehensive Smoke-Free Policies to Low-Income Tenants in Subsidized Housing

Our objective was to evaluate the acceptability of a comprehensive smoke-free policy among low-income tenants in a group of subsidized, multiunit buildings. We conducted a mixed-methods evaluation that included questionnaires mailed to 839 tenants and follow-up telephone interviews with 23 tenants who were current, former, and never smokers. Most never and former smokers supported the policy, citing improved health, fire safety, and building cleanliness; most current smokers disliked the policy and did not follow it. Messages focusing on shared community-level concerns, accompanied by smoking cessation resources, may support the transition to smoke-free policies in subsidized housing.     

Attitudes Toward Telehealth Use Among Rural Residents: A Danish Survey

ABSTRACT:  Context: Rural communities tend to be underserved by medical services. Low access to medical services affects quality of life and may also affect settlement decisions. The use of telehealth has often been mentioned as an alternative way to provide health care services in remote, underserved areas. One prerequisite for successful delivery of health care by means of telehealth is the existence of positive attitudes toward telehealth solutions among the potential end beneficiaries. Purpose: The purpose of this study was to examine the attitudes toward telehealth use among residents in a Danish rural area. Method: A representative sample from the island of Ærø (n = 1,000) was selected and attitudes toward 2 telehealth applications were examined by structured telephone interviews regarding: (1) video consultation between patient and specialist, and (2) transfer of work tasks from local hospital to a hospital outside Denmark. Findings: As many as 58% did not like the idea of having a consultation with a specialist carried out by video consultation, whereas 26% did not like the idea of having their X-rays assessed by a hospital outside Denmark. The reluctance regarding both telehealth solutions was higher among older people and people with no education beyond primary school. Conclusions: As the rural population in Denmark, as well as in other countries, tends to be older and less educated than the national average, the introduction of telehealth services faces special challenges in rural areas.     

The Burden and Treatment of Chronic Constipation Among US Nursing Home Residents

ObjectiveTo evaluate the burden of chronic constipation (CC) and the use of drugs to treat constipation (DTC) in 2 complementary data sources.DesignRetrospective cohort study.Setting and ParticipantsUS nursing home residents aged ≥65 years with CC.MethodsWe conducted 2 retrospective cohort studies in parallel using (1) 2016 electronic health record (EHR) data from 126 nursing homes and (2) 2014-2016 Medicare claims, each linked with the Minimum Data Set (MDS). CC was defined as (1) the MDS constipation indicator and/or (2) chronic DTC use. We described the prevalence and incidence rate of CC and the use of DTC.ResultsIn the EHR cohort, we identified 25,739 residents (71.8%) with CC during 2016. Among residents with prevalent CC, 37% received a DTC, with an average duration of use of 19 days per resident-month during follow-up. The most frequently prescribed DTC classes included osmotic (22.6%), stimulant (20.9%), and emollient (17.9%) laxatives. In the Medicare cohort, a total of 245,578 residents (37.5%) had CC. Among residents with prevalent CC, 59% received a DTC and slightly more than half (55%) were prescribed an osmotic laxative. Duration of use was shorter (10 days per resident-month) in the Medicare (vs EHR) cohort.Conclusions and ImplicationsThe burden of CC is high among nursing home residents. The differences in the estimates between the EHR and Medicare data confirm the importance of using secondary data sources that include over-the-counter drugs and other treatments unobservable in Medicare Part D claims to assess the burden of CC and DTC use in this population.     

Interprofessional Experiences and Attitudes Toward Interprofessional Health Care Teams Among Health Sciences Students

This study examined how the interprofessional experience, including education and practice, affects graduate health science students’ attitudes toward interprofessional practice in health care teams. Data were collected from 227 graduate students, using the Attitudes toward Health Care Teams (ATHCT) scale. Both social work and other health science students had positive attitudes toward interprofessional collaboration with regard to its ability to improve the quality of a patient’s care. The results from hierarchical linear regression analyses demonstrated that female students, older students, and students with longer interprofessional practice experiences had more positive attitudes toward interprofessional collaboration in health care teams. Based on these results, implications for interprofessional education are discussed.     

HIV/AIDS Knowledge and Attitudes Among Chinese College Students in the US

This study assessed knowledge and attitudes about HIV/AIDS and sources of HIV/STI information among Chinese college students living in the USA and explored specific factors associated with knowledge levels and types of sources of information. We surveyed 133 Chinese students enrolled in three US universities. About 41.4 % believed that HIV could be contracted through mosquito bites, and 22.6 % were unaware that condoms could prevent HIV. Sources of HIV/STI information were the mass media. Males were more likely to demonstrate a higher HIV/AIDS knowledge level than females. Graduate students were more likely to cite television as a source of information, and less likely to mention school teachers, than were undergraduate students. These ethnic minority immigrant students held misconceptions about HIV transmission and prevention, and possibly utilized information of varying quality. Accordingly this study identifies specific objectives for education, including basic biology and diversity issues from evidence-based sources.     

2010年广州市部分社区居民艾滋病歧视状况及影响因素分析

[目的]了解广州市社区居民艾滋病歧视状况及其影响因素,为消除对艾滋病的歧视提供科学依据。[方法]2010年9～12月,随机抽取广州市越秀区3个社区居民2 546人进行调查,并对性别、年龄、婚姻、文化程度以及艾滋病12个知识点的知晓情况与艾滋病相关歧视进行分析。[结果]调查2 463人,不愿意与HIV感染者/艾滋病病人交往的比例,婚姻状况、不同文化程度、不同年龄差异有统计学意义(P<0.01);共用坐厕、蚊虫叮咬、一起吃饭不会传染艾滋病,共用注射器吸毒会传染艾滋病知晓者与不知晓者对HIV感染者/艾滋病病人态度差异有统计学意义(P<0.01)。多因素Logistic回归方程分析结果,已婚(包括丧偶和离婚者)、共用坐厕、蚊虫叮咬不会传染HIV、一起吃饭和感染了艾滋病病毒的人不能从外表上看出来不知晓者更不愿意与HIV感染者/艾滋病病人交往。OR值分别为0.71、1.37、1.60、1.37、1.27。[结论]广州市社区艾滋病歧视普遍存在,特别是在已婚及丧偶和离婚居民中较严重,在艾滋病的反歧视宣传中应重点加强对非传播途径的宣传。     

Attitudes and Beliefs Regarding Cardiovascular Risk Factors Among Bangladeshi Immigrants in the US

The US has increasingly growing Bangladeshi population, a South Asian sub-ethnic group with a high prevalence of cardiovascular disease (CVD). We conducted a qualitative study using individual in-depth interviews to explore attitudes towards and difficulties with modifying CVD related behaviors among a Bangladeshi cohort. We interviewed 55 patients before reaching data saturation. Bangladeshis discussed the meaning of health and heart disease in the context of how disease can potentially impact their ability to care for their family. Behavioral and psychological factors were discussed as the causes of CVD. Internal forces and external forces were brought up to explain difficulties addressing the causes of CVD. Bangladeshi individuals in our study were aware of CVD, but felt unable to address behavioral risk factors. They cite a combination of internal and external factors as barriers to lifestyle modification. Interventions to address these barriers must simultaneously addressing self-efficacy and work-life balance.     

Second and Thirdhand Smoke Exposure,Attitudes and Protective Practices: Results from a Survey of Hispanic Residents in Multi-unit Housing

Secondhand and third hand smoke (SHS, THS) exposure is prevalent in multi-unit housing (MUH). Minorities and low-income MUH residents are disproportionally exposed to SHS and THS compared to other populations. This study describes the characteristics, attitudes, knowledge, and behaviors related to SHS, THS and marijuana smoke exposure (MSHS) of a sample of Hispanic tenants in randomly selected MUH units in eastern metro Los Angeles (n?=?402). Although most participants (97%) banned smoking inside their homes, 80% reported infiltration of SHS inside their apartments within the last year. Most (85%) favored a complete ban on smoking in apartment buildings. Twenty-eight percent did not know that marijuana (MSHS) smoke exposure is also harmful to their health. Knowledge scores were higher among Spanish-speakers (p?<?0.05). Given the interpersonal barriers to advocating for change, widespread policy and communication interventions are also necessary to protect Hispanic MUH residents’ rights to clean air in their living space.