A multiple-stakeholder evaluation of the nature and extent of secondhand smoke in multi-unit housing
King, Brian A.
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Objective. To establish an empirical evidence base for the enhancement of community-driven advocacy efforts to reduce secondhand smoke (SHS) exposure in multi-unit housing (MUH). Background. Exposure to SHS causes significant morbidity and mortality. Due to greater implementation of smoke-free policies in public areas, the home represents an increasingly larger share of total SHS exposure for both adults and children. The estimated 78.6 million Americans who live in close proximity to one another in MUH are particularly susceptible to SHS incursions. However, data on the nature and extent of SHS exposure in MUH is currently limited. Methods. This dissertation is comprised of three distinct, yet complementary, manuscripts. Manuscript 1 provides the findings of a real-time analysis of indoor air quality inside 16 smoke-permitted and 14 smoke-free units within 11 MUH buildings throughout Western New York. Manuscript 2 presents a secondary analysis of data on the preferences and practices of 5,936 MUH residents who participated in the New York State Adult Tobacco Survey between May 2007 and May 2009. Finally, Manuscript 3 provides the results of a pre-post assessment of a mail-based educational intervention implemented between August 2008 and February 2009 to enhance smoke-free policy interest among MUH operators. Results. Real-time assessments of PM 2.5 , a validated measure of SHS, indicated that air pollution levels in smoke-free units (13.05 μg/m 3 ), shared hallways (26.28 μg/m 3 ), and smoking-permitted units (53.45 μg/m 3 ) were significantly higher than outdoor levels (11.54 μg/m 3 ). These results confirm reports of MUH residents, which show that 47% of non-smokers and 38% of smokers have experienced a SHS incursion into their unit during the past year. Although a majority of MUH residents (55.6%) favor a smoke-free building policy and over three-quarters of MUH operators are interested in adopting one, less than one-fifth of operators have designated smoke-free buildings. MUH operators who received a short-term, mail-based educational intervention were more likely than controls to report interest in [OR: 6.49, 95% CI: 1.44-29.2], and less likely to report concern [OR: 0.16, 95% CI: 0.04-0.66] toward, policy implementation at follow-up. Conclusions. Findings from these studies suggest that few MUH residents are protected by smoke-free buildings policies and many have experienced SHS incursions into their living spaces. Since a majority of MUH residents favor such policies and most already prohibit smoking in their homes, opportunities exist for efforts to enhance policy adoption. In the short-term, a mail-based educational intervention was shown to be an effective means of increasing policy interest and decreasing barriers to implementation among MUH operators. Significance: Together, these findings provide an important and unique empirical foundation for the development and refinement of initiatives to actively promote smokefree policy implementation and support among MUH residents and operators.