BACKGROUND: Results of the Global Adult Tobacco Survey in Kerala, India found that 42 % of adults were exposed to second hand smoke (SHS) inside the home. Formative research carried out in rural Kerala suggests that exposure may be much higher. Numerous studies have called for research and intervention on SHS exposure among women and children as an important component of maternal and child health activities. METHODS: Community-based participatory research was carried out in Kerala. First, a survey was conducted to assess prevalence of SHS exposure in households. Next, a proof of concept study was conducted to develop and test the feasibility of a community-wide smoke free homes initiative. Educational materials were developed and pretested in focus groups. After feasibility was established, pilot studies were implemented in two other communities. Post intervention, surveys were conducted as a means of assessing changes in community support. RESULTS: At baseline, between 70 and 80 % of male smokers regularly smoked inside the home. Over 80 % of women had asked their husband not to do so. Most women felt powerless to change their husband's behavior. When women were asked about supporting a smoke free homes intervention, 88 % expressed support for the idea, but many expressed doubt that their husbands would comply. Educational meetings were held to discuss the harms of second hand smoke. Community leaders signed a declaration that their community was part of the smoke free homes initiative. Six months post intervention a survey was conducted in these communities; between 34 and 59 % of men who smoked no longer smoked in their home. CONCLUSIONS: The smoke free homes initiative is based on the principle of collective efficacy. Recognizing the difficulty for individual women to effect change in their household, the movement establishes a smoke free community mandate. Based on evaluation data from two pilot studies, we can project that between a 30 and 60 % reduction of smoking in the home may be achieved, the effect size determined by how well the smoke free home steps are implemented, the characteristics of the community, and the motivation of community level facilitators.

acase@tulane.edu

Background and Objectives: Environmental tobacco smoke (ETS) is widely recognized as a serious health hazard. No safe level of exposure to ETS has been identified (USDHHS, 2006; WHO, 2007). The importance of smoke-free spaces in improving health outcomes for both smokers and non-smokers is clearly understood and as such, many individuals living in Ontario have made their homes smoke-free. Although those living in units within multi-unit dwellings (MUDs) have the option of making their own unit smoke-free, they may still be involuntarily exposed to ETS drifting from smoking units to their unit. The present study explores tenant’s perceptions of this drifting ETS and the potential market for smoke-free rental housing. Methods: Anonymous surveys were sent to 3724 households within rented MUDs (apartments and row housing) with five or more units in Kitchener, Ontario. In addition to demographic questions, the survey addressed respondents’ experiences with, perceptions of, and reactions to drifting ETS and their views on smoke-free rental housing. Three hundred and five surveys were returned, and 291 met the final inclusion criteria to be included in the analysis. Survey data were weighted by age and education level. Descriptive analyses and logistic regression models were run to answer the research questions. Results: Over half of the respondents who do not smoke in their unit on a daily basis indicated they were exposed to drifting ETS in their home at least ‘sometimes’. Of those who were exposed, 89.5% were bothered and nearly half were bothered ‘a lot’. This suggests drifting ETS is a concern for many tenants living in MUDs. The majority of tenants indicated they did not live in a smoke-free building however there was a strong interest in smoke-free rental housing. Nearly 90% of tenants showed at least some interest in smoke-free rental housing, and many tenants would prefer to live in a building with the strongest possible restrictions on smoking in place. Younger tenants, non-smokers, those who spent less time at home on weekends and those who perceived indoor smoking as a fire risk were more likely to be interested in smoke-free rental housing. Conclusions and Significance: This study provides insight into the magnitude of the problem of drifting ETS in MUDs and can be used to inform policy on smoke-free MUDs. Many respondents indicated they were exposed to drifting ETS and the majority of those who were exposed were bothered by this exposure. There also appears to be a strong market for smoke-free rental housing. The response rate for this study was low at 8.5% and as such the results must be interpreted with caution. Future research should be completed in other jurisdictions and with larger sample sizes. Landlord surveys and air quality monitoring studies are also needed. While additional research is needed, the current study suggests this is an important public health issue, and provides additional evidence supporting the need to explore policy options in the public and private realm for smoke-free housing.

Background and Objectives: Environmental tobacco smoke (ETS) is widely recognized as a serious health hazard. No safe level of exposure to ETS has been identified (USDHHS, 2006; WHO, 2007). The importance of smoke-free spaces in improving health outcomes for both smokers and non-smokers is clearly understood and as such, many individuals living in Ontario have made their homes smoke-free. Although those living in units within multi-unit dwellings (MUDs) have the option of making their own unit smoke-free, they may still be involuntarily exposed to ETS drifting from smoking units to their unit. The present study explores tenant’s perceptions of this drifting ETS and the potential market for smoke-free rental housing. Methods: Anonymous surveys were sent to 3724 households within rented MUDs (apartments and row housing) with five or more units in Kitchener, Ontario. In addition to demographic questions, the survey addressed respondents’ experiences with, perceptions of, and reactions to drifting ETS and their views on smoke-free rental housing. Three hundred and five surveys were returned, and 291 met the final inclusion criteria to be included in the analysis. Survey data were weighted by age and education level. Descriptive analyses and logistic regression models were run to answer the research questions. Results: Over half of the respondents who do not smoke in their unit on a daily basis indicated they were exposed to drifting ETS in their home at least ‘sometimes’. Of those who were exposed, 89.5% were bothered and nearly half were bothered ‘a lot’. This suggests drifting ETS is a concern for many tenants living in MUDs. The majority of tenants indicated they did not live in a smoke-free building however there was a strong interest in smoke-free rental housing. Nearly 90% of tenants showed at least some interest in smoke-free rental housing, and many tenants would prefer to live in a building with the strongest possible restrictions on smoking in place. Younger tenants, non-smokers, those who spent less time at home on weekends and those who perceived indoor smoking as a fire risk were more likely to be interested in smoke-free rental housing. Conclusions and Significance: This study provides insight into the magnitude of the problem of drifting ETS in MUDs and can be used to inform policy on smoke-free MUDs. Many respondents indicated they were exposed to drifting ETS and the majority of those who were exposed were bothered by this exposure. There also appears to be a strong market for smoke-free rental housing. The response rate for this study was low at 8.5% and as such the results must be interpreted with caution. Future research should be completed in other jurisdictions and with larger sample sizes. Landlord surveys and air quality monitoring studies are also needed. While additional research is needed, the current study suggests this is an important public health issue, and provides additional evidence supporting the need to explore policy options in the public and private realm for smoke-free housing.

<p> </p><p>Bakgrund:</p><p>Policybeslutet att införa Rökfri arbetstid i Motala kommun är ett led i kommunernas och de fackliga organisationernas strävan att skapa en hälsofrämjande miljö. Rökfri arbetstid innebär att ingen ska utsättas för tobaksrök på sitt arbete. I Motala kommun trädde detta beslut i kraft 2007-07-01 och mottogs med olika åsikter bland de kommunanställda. Tidigare forskning har visat samband med engagemang och delaktighet i beslut med empowerment hos de anställda. Syfte: Studiens syfte är att undersöka anställdas reaktioner till Rökfri arbetstid i Motala kommun. Metod: En kvantitativ undersökning i form av fler alternativa och öppna frågor i en enkät som delades ut bland rökande personal på olika enheter i Motala kommun. Även Motala kommuns intranät Kanalen användes, där information om enkäten lades ut och de som ville kunde ta del av den. Resultat: Rökfri arbetstid ger resultat i positiv bemärkelse, de anställda som rökte röker i dag 30 % mindre på arbetstid samt 16 % har slutat. För de som var positivt inställda av deltagarna när beslutet togs visar även en minskning i sitt rökande på fritiden. Då beslutet togs 2007-07-01 var 54 % negativa till detta, i dag är siffran på 32,5 %. Resultatet visar också en stor irritation över att; deltagarna inte fått varit med och tyckt till om Rökfri arbetstid, informationen till de anställda har inte varit bra, cheferna ger inga direktiv och verkar inte veta vilka regler som gäller. I dag följs reglerna olika på olika arbetsplatser. Fortfarande finns det många av studiens deltagare som röker på arbetstid även om de har minskat sin konsumtion. Deltagarna själva vill ha klara regler för vad som gäller när någon trotsar rökförbudet. Diskussion: Mer information, mer empowerment till de anställda i Motala kommun hade gett mer positiva resultat än vi ser idag Låt de rökande få vara med och diskutera fram hur regler ska följas på arbetsplatserna samt vilket stöd de förväntar sig få från kommunen. De anställda måste också ta på sig ansvaret att leta efter information.</p><p> </p> / <p> </p><p>Background</p><p>: The policy decision to introduce non smoking environment in the city of Motala is a part of the city and the unions’ efforts to create a healthy environment. Smoke-free working hours means that no one shall be subjected to tobacco smoke at work. The city of Motala took this decision in full force 2007-07-01 and it was received with different opinions from the city’s employees. Previous research has shown the commitment and involvement is greater if the employee feels empowerment at their work place. Purpose: The purpose of this study is to investigate the employee´s reaction to the decision to introduce non smoking environment in Motala. Method: A quantitative method was used. Questionnaire which included even open-ended questions was distributed among smoking employees in different work areas in the city of Motala. The questionnaire was also laid out on "kanalen" which is a communication platform within the city of Motala. Here could any employee take part of the survey. Results: Smoke free working environment delivers results in a positive way, people smoke 30% less at work and 16% have stopped smoking completely during working hours. For those who were in favor of the decision when it was taken can also show a reduction in their smoking in their free time. When the decision was made 2007-07-01 was 54% negative to this, today the figure is 32.5%. The results also show that irritation over this decision was; the employees had not been involved when it comes to decision around this subject, information has been lousy, directors did not provide any directive for the smokers and does not seem to know clearly what the rules are. Today the rules are followed differently in different workplaces. Still, there are many participants who smoke during working hours although they may have reduced their consumption. Participants themselves would like to have clear rules on what it is that applies. Discussion: More information, more empowerment to the employees in the city of Motala had gotten more positive results than we see today. Where does the information stops? Is it between local government leaders to the directors at different workplaces or is it the director that does not provide the information to the employees. Let the smokers be involved and discuss how the rules should be followed at the workplace and what support they may expect from the city. Employees must also take responsibility to look for information.</p><p> </p>

Bakgrund: Policybeslutet att införa Rökfri arbetstid i Motala kommun är ett led i kommunernas och de fackliga organisationernas strävan att skapa en hälsofrämjande miljö. Rökfri arbetstid innebär att ingen ska utsättas för tobaksrök på sitt arbete. I Motala kommun trädde detta beslut i kraft 2007-07-01 och mottogs med olika åsikter bland de kommunanställda. Tidigare forskning har visat samband med engagemang och delaktighet i beslut med empowerment hos de anställda. Syfte: Studiens syfte är att undersöka anställdas reaktioner till Rökfri arbetstid i Motala kommun. Metod: En kvantitativ undersökning i form av fler alternativa och öppna frågor i en enkät som delades ut bland rökande personal på olika enheter i Motala kommun. Även Motala kommuns intranät Kanalen användes, där information om enkäten lades ut och de som ville kunde ta del av den. Resultat: Rökfri arbetstid ger resultat i positiv bemärkelse, de anställda som rökte röker i dag 30 % mindre på arbetstid samt 16 % har slutat. För de som var positivt inställda av deltagarna när beslutet togs visar även en minskning i sitt rökande på fritiden. Då beslutet togs 2007-07-01 var 54 % negativa till detta, i dag är siffran på 32,5 %. Resultatet visar också en stor irritation över att; deltagarna inte fått varit med och tyckt till om Rökfri arbetstid, informationen till de anställda har inte varit bra, cheferna ger inga direktiv och verkar inte veta vilka regler som gäller. I dag följs reglerna olika på olika arbetsplatser. Fortfarande finns det många av studiens deltagare som röker på arbetstid även om de har minskat sin konsumtion. Deltagarna själva vill ha klara regler för vad som gäller när någon trotsar rökförbudet. Diskussion: Mer information, mer empowerment till de anställda i Motala kommun hade gett mer positiva resultat än vi ser idag Låt de rökande få vara med och diskutera fram hur regler ska följas på arbetsplatserna samt vilket stöd de förväntar sig få från kommunen. De anställda måste också ta på sig ansvaret att leta efter information. / Background : The policy decision to introduce non smoking environment in the city of Motala is a part of the city and the unions’ efforts to create a healthy environment. Smoke-free working hours means that no one shall be subjected to tobacco smoke at work. The city of Motala took this decision in full force 2007-07-01 and it was received with different opinions from the city’s employees. Previous research has shown the commitment and involvement is greater if the employee feels empowerment at their work place. Purpose: The purpose of this study is to investigate the employee´s reaction to the decision to introduce non smoking environment in Motala. Method: A quantitative method was used. Questionnaire which included even open-ended questions was distributed among smoking employees in different work areas in the city of Motala. The questionnaire was also laid out on "kanalen" which is a communication platform within the city of Motala. Here could any employee take part of the survey. Results: Smoke free working environment delivers results in a positive way, people smoke 30% less at work and 16% have stopped smoking completely during working hours. For those who were in favor of the decision when it was taken can also show a reduction in their smoking in their free time. When the decision was made 2007-07-01 was 54% negative to this, today the figure is 32.5%. The results also show that irritation over this decision was; the employees had not been involved when it comes to decision around this subject, information has been lousy, directors did not provide any directive for the smokers and does not seem to know clearly what the rules are. Today the rules are followed differently in different workplaces. Still, there are many participants who smoke during working hours although they may have reduced their consumption. Participants themselves would like to have clear rules on what it is that applies. Discussion: More information, more empowerment to the employees in the city of Motala had gotten more positive results than we see today. Where does the information stops? Is it between local government leaders to the directors at different workplaces or is it the director that does not provide the information to the employees. Let the smokers be involved and discuss how the rules should be followed at the workplace and what support they may expect from the city. Employees must also take responsibility to look for information.

This study was the first to examine the effect of tobacco policies in prisons on the health of inmates. Kentucky has two types of tobacco policies in its 16 state prisons: indoor smoke-free policies, where smoking is allowed outdoors and tobacco-free policies, in which no tobacco of any kind is allowed on the grounds of the prison. The smoking rate of inmates is three times higher than that of current smokers in the non-incarcerated population which results in high rates of tobacco-related health conditions such as heart disease and lung cancer. A literature review discussed the evolution of tobacco policies in prisons , the motivations for strengthening policies in prisons and the unintended consequences. Health outcomes in the non-incarcerated population on the benefits to cardiovascular and respiratory health following passage of smoke-free laws in public places were reviewed. No studies have been found on the health outcomes of inmates with varying degrees of smoke-free or tobacco-free policies. The first study was a time series analysis comparing the frequency of medication refills for asthma and/or COPD before and after a tobacco-free policy was implemented. Short-acting inhaler refills decreased in the first few months following the tobacco-free policy date but returned to baseline within 12 to 15 months. Rapid turnover of inmates, minimum security status of the prisons, and possible loosening of enforcement may have been related to the gradual increase in use. The second study was a survival analysis on the time to an inmate’s first acute myocardial infarction (AMI) with tobacco policy status (tobacco-free or smoke-free) of the prison as the primary predictor variable. Controlling for the multiple movements over time, facilities, co-morbidities, past smoking history, age and race, there was a 2.87 hazard for AMI for time spent in a smoke-free (indoors) prison compared to a tobaccofree prison. This finding may be due to the fact that tobacco is considered contraband after prisons become tobacco-free and inmates risk disciplinary action by smuggling or using tobacco in the prison, thereby reducing secondhand smoke for non-smokers and probably reducing the consumption of current smokers.

Tobacco use and secondhand smoke exposure are leading causes of preventable morbidity and mortality in the United States. Outdoor tobacco smoke exposure conveys many of the same risks as indoor secondhand smoke exposure. Tobacco-free campuses policies are an intervention to promote a positive social norm that encourages smoking cessation, as well as reduces exposure to outdoor tobacco smoke. This dissertation contains a review of the policy implementation literature; findings from a psychometric analysis of the newly developed Tobacco-free Compliance Assessment Tool (TF-CAT) to assess compliance with tobacco-free campus policies; and results of a campus intervention study to promote compliance. The TF-CAT protocol is designed to count cigarette butts, observe smokers, and use GIS mapping to display hot spots. A total of 413 observations in primary and secondary campus locations yielded compliance data on both the academic healthcare and main campuses. Results show support for the concurrent validity of the TF-CAT. Inter-rater reliability of the measure is strong, and the tool is feasible, though time- and resource-intensive. The intervention study tested the effects of an efficacy-based messaging campaign on the number of cigarette butts observed on campus. After distributing 6,000 message cards in high-traffic areas over three days, there were fewer cigarette butts per day per site post-intervention compared to pre-intervention (n = 312 observations; median = 4.7 vs. 1.9; U=2239, p=.004). It is crucial for tobacco control advocates to ensure implementation effectiveness of tobacco-free policies. Future research needs to refine methods to measure policy implementation effectiveness. In addition, interventions need to be developed and tested to promote policy implementation effectiveness.

Background: Supporting the public health care system is a priority for any advanced society. In line with who's recommendations, a key Law on The Protection of Health Against Harmful Effects of Addictive Substances was adopted in 2017, the main priority of which is to reduce passive smoking with its negative effects on humans. Objective: The aim of the study was to determine whether there was a change in tobacco use patterns and a change in smoking cessation incentives following the introduction of new legislative changes (Act No. 65/2017 Coll.). Methods: A prospective cohort study was carried out in connection with the introduction of Act No. 65/2017 Coll. Trained nurses were distributed in two waves, before the introduction of the law and three months after its introduction, prepared questionnaires were distributed to adult clients/patients addressed by general practitioners' offices in Prague. The condition was participation in both waves of the study. 131 completed adult questionnaires were submitted for subsequent processing. Changes in daily cigarette consumption, the ratio of cigarettes smoked in a restaurant, on the street, at home, and motivation to quit smoking were analysed. Results: A statistically significant reduction in daily cigarette consumption (on average 1.7 cigarettes per day)...

Within the last few decades, the prevalence of cigarette smoking has decreased because of the vast amount of research which indicates that smoking leads to health problems many of which are potentially fatal. Also, smoking harms not only those whom choose to smoke but non-smokers in the area are affected by even low levels of cigarette smoke. Thus, cigarette smoking has become a public health concern. Around the globe, countries are passing smoke-free laws in public areas such as businesses, restaurants, and bars. In the United States, many universities have enacted smoke-free campus policies to ensure the health of all their students in all places on campus. The purpose of this research is to identify the support or opposition for a smoke-free campus policy at the University of Central Florida by UCF students. A survey was distributed to undergraduate students at UCF which asks whether they would support such a policy along with characterizing questions about their smoking habits, lifestyle, history, and opinion. The analysis of the data shows that the majority of UCF student would support a smoke-free campus policy.