Health, Secondhand Smoke Exposure, and Smoking Behavior Impacts of No-Smoking Policies in Public Housing, Colorado, 2014-2015.

INTRODUCTION: Exposure to secondhand smoke is problematic for residents living in multiunit housing, as the smoke migrates through shared ventilation systems, unsealed cracks, and door spaces. The objective of our research was to assess resident exposure to secondhand smoke, support for no-smoking policies, and the health impacts of no-smoking policies in multiunit housing. METHODS: Surveys of 312 heads of households who resided in 1 of 3 multiunit buildings managed by a Colorado public housing authority were administered before and after implementation of a no-smoking policy that prohibited smoking in all resident apartments and all indoor common areas. A matched-pairs analysis of initial surveys and 15-month post-policy implementation surveys for 115 respondents was conducted. RESULTS: Decreases were found in the number and percentage of smokers who smoked every day and the number of cigarettes smoked per day, and 30% had quit smoking 15 months after policy implementation. The percentage of residents who smelled secondhand smoke indoors declined significantly. A significant decrease in breathing problems was found after policy implementation. Although decreases were found in the incidence of asthma attacks, emphysema/chronic obstructive pulmonary disease, eye irritation, colds, nasal congestion, and ear/sinus infections, these decreases were not significant. CONCLUSION: Consistent findings across nearly all variables tested suggest that no-smoking policies reduce resident exposure to secondhand smoke, lower the incidence of secondhand smoke-associated breathing problems, decrease daily smoking and cigarette consumption, encourage smoking cessation, and increase quit attempts. If implemented in all multiunit housing, these policies could reduce exposure to secondhand smoke and health problems associated with secondhand smoke, promote smoking cessation, and reduce cigarette consumption.

Association of standing-order policies with vaccination rates in dialysis clinics: a US-based cross-sectional study.

BACKGROUND: Patients with end-stage renal disease are at increased risk of morbidity and mortality because of infection. Quality improvement efforts for this patient population include assessment of institutional policies and practices that may increase vaccination rates for influenza, hepatitis B, and pneumococcal disease. STUDY DESIGN: A survey of vaccination practices, beliefs, and attitudes was sent to all dialysis centers in End-Stage Renal Disease Networks 6, 11, and 15. SETTING & PARTICIPANTS: Of 1,052 dialysis facilities considered, 683 returned the survey, reported vaccination rates for 2005 to 2006, and had 20 or more patients. PREDICTOR OR FACTOR: Standing-order policy of the dialysis facility, categorized as facility-wide orders, preprinted admission orders for each patient (chart orders), physician-specific orders, and individual orders. OUTCOMES: Vaccination rates for influenza, hepatitis B (full or partial series), hepatitis B, and pneumococcal vaccine. MEASUREMENTS: Patient vaccination, given at or outside the center. RESULTS: Overall vaccination rates were 76% +/- 18% (SD) for influenza, 73% +/- 22% for hepatitis B full or partial series, 62% +/- 25% for hepatitis B full series, and 44% +/- 34% for pneumococcal vaccine. Compared with individual orders, facility-wide standing orders and chart orders were not associated with greater vaccination rates for influenza (0.4%; confidence interval, -4 to 5; and 1.27%; confidence interval, -3 to 5, respectively), but were associated with greater vaccination rates for hepatitis B full or partial series (9%; confidence interval, 3 to 15; and 11%; confidence interval, 5 to 17, respectively), hepatitis B full series (11%; confidence interval, 4 to 17; and 13%; confidence interval, 7 to 19, respectively), and pneumococcal disease (21%; confidence interval, 14 to 29; and 20%; confidence interval, 13 to 27, respectively). LIMITATIONS: Data are cross-sectional, and vaccinations outside the center were self-reported. CONCLUSIONS: Existing facility-wide or chart-based order programs may be effective in promoting vaccination against hepatitis B and pneumococcal disease.

Access to renal transplantation among American Indians and Hispanics.

BACKGROUND: African Americans have decreased access to renal transplantation compared with whites. Whether similar barriers exist for American Indians or Hispanics is not well defined. METHODS: The authors identified a total of 1,335 patients ages 20 to 59 years without prior renal transplantation undergoing dialysis in December 1994 in Arizona and New Mexico. For each patient, information was collected on identification as a potential candidate for renal transplantation, referral to a renal transplantation center, completion of 4 stages in the evaluation process, and receipt of a transplant over 7 years. RESULTS: American Indians were more likely than whites to be identified as potential candidates (relative risk [RR] 1.30, 95% confidence interval [CI] 1.15 to 1.44) and to be referred to a transplant center (RR 1.16, 95% CI 1.09 to 1.19). There were no significant differences in candidacy or referral status between Hispanics and whites. Among potential candidates referred to a transplant center, both American Indians (RR 0.73, 95% CI 0.51 to 0.96) and Hispanics (RR 0.68, 95% CI 0.50 to 0.88) were less likely than whites to be placed on a waiting list. Both American Indians (hazard ratio [HR] 0.37, 95% CI 0.24 to 0.58) and Hispanics (HR 0.58, 95% CI 0.39 to 0.86) were much less likely than whites to undergo renal transplantation. CONCLUSION: Despite similar referral rates for renal transplantation, American Indians and Hispanics were less likely than whites to be placed on a transplant waiting list or receive a transplant. Policies to address these disparities should address specific barriers within the transplant evaluation process.

Increasing the use of arteriovenous fistulas (AVF): a network QI project.

In 2002, the Intermountain End-Stage Renal Disease Network Inc., Network 15, initiated a quality improvement project, "Increasing Arteriovenous Fistulas Within Network 15." The primary objective of this project was to maximize the placement of arteriovenous fistulas (AVF) within the adult in-center hemodialysis population in Network 15. A closely related objective was to ensure policies and procedures were in place at each facility to encourage placement and maintenance of fistulae after they had been placed. Based on the facility-specific percentage of adult patients reported to have a fistula in January 2001, eight facilities were selected to participate in the project. Approximately 100 project partners (facility staff, nephrologists, and surgeons) collaborated to improve AVF rates for incident and prevalent patients. The interventions for this project were multifaceted and included face-to-face meetings with project partners, dissemination of a National Kidney Foundation-Kidney Disease Outcomes Quality Initiative (NKF-K/DOQI) summary paper on vascular access, video materials and written information for patient and staff, post-operative "Fistula Care Packages" educational meetings, and data feedback to facility staff nephrologists and surgeons. Of the seven indicators selected for this project, the predicted improvement was met in four. Overall improvement was noted in six of the seven process/outcome measures. A statistically significant (p=0.05) improvement was noted in the rate of fistulas used for treatment for prevalent (all) hemodialysis patients. This rate increased by about one-third from baseline to remeasurement.

Economic impacts of the Pueblo Smoke-Free Air Act.

BACKGROUND: On July 1, 2003, the city of Pueblo CO enacted a smokefree ordinance (Pueblo Smoke-Free Air Act [PSFAA]) that prohibited smoking in public places and workplaces, including taverns and restaurants. Opponents to this ordinance argued that it would have a negative impact on tavern and restaurant sales. PURPOSE: The purpose of this study was to determine whether the PSFAA had a negative economic impact on tavern and restaurant sales tax revenues. METHODS: With data gathered in 2007, this study implemented an interrupted time-series model in 2008, using 42 months of pre- and post-intervention sales tax revenue data for Pueblo to determine whether implementation of this ordinance had an effect on tavern and restaurant sales tax revenues. Ratios of tavern and restaurant openings to closings were also computed for the pre- and post-intervention periods. RESULTS: Pre-post sales tax revenue data showed slight losses in sales tax revenue for taverns, and gains for restaurants, which more than offset the tavern losses. After adjusting for the consumer price index, the city of Pueblo experienced a 20.3% gain in combined tavern and restaurant sales tax revenues from the pre-ordinance period to the post-ordinance period. The ratio of tavern openings to closings improved from 1:1 pre-period to 3.3:1 post-period and the restaurant ratio remained unchanged at approximately 1.78:1 from pre- to post-period. CONCLUSIONS: There is no evidence that the PSFAA had a negative economic impact on consumer price index-adjusted tavern and restaurant sales tax revenues. From a fiscal policy perspective, this ordinance may have contributed to a net increase in sales tax revenues for the city of Pueblo. The business openings/closings data suggest that the confidence Pueblo's business sector had in the local hospitality industry was not negatively influenced by the PSFAA.