Public Housing Resident Perspectives on Smoking, Barriers for Smoking Cessation, and Changes in Smoking Mandates.

BACKGROUND: Individuals from low-income groups report disproportionate rates of cigarette use, secondhand smoke (SHS) exposure with increased morbidity and mortality. Smoking bans in public housing have been enacted in attempt to reduce tobacco use and SHS exposure among lower income individuals. This study investigated the support needs of tobacco users living in two public housing complexes in Detroit, Michigan (USA), including their perspectives on smoking, resources and barriers for smoking cessation, and the impact of policy changes. METHODS: This is a mixed-methods study, using a qualitative focus groups approach and a short survey, public housing residents interview data was analyzed to explore themes related to smoking-related issues. Specifically, six themes were assessed across four focus groups: (1) Quitting Smoking, (2) Current Smoking Cessation Resources, (3) Legal Mandates, (4) Education and Perceptions of Smoking, (5) Community Needs and Barriers, and (6) Medical Experiences. RESULTS: There were 59 participants; the majority (39/42, 93%) of smokers reported at least one quit attempt. During the focus groups, several participants indicated a desire to quit smoking but reported barriers to smoking cessation, such as lack of access to medications, social triggers to continue smoking, and socioeconomic stressors. A number of suggestions were provided to improve smoking cessation resources, including support groups, graphic images of smoking-related diseased tissue, and better communication with health care providers. CONCLUSIONS: These findings demonstrate smoking bans in two public housing complexes can be effective yet are dependent upon a complex set of issues, including numerous barriers to care.

Impact of a hypertension management/health promotion program on commercial driver's license employees of a self-insured utility company.

OBJECTIVE: Federal regulations governing transportation safety disqualify commercial drivers with persistent uncontrolled hypertension. We sought to determine whether a hypertension management and health promotion program designed for commercial drivers improved blood pressure (BP) outcomes among drivers employed by a self-insured utility company. METHODS: This retrospective study examined the employment-related medical examinations of 501 randomly selected commercial drivers for measurements of BP, height, and weight taken before and after the intervention. RESULTS: After the program, significantly fewer employees had uncontrolled hypertension according to the Department of Transportation hypertension guidelines (17.2% vs 26.1%, P < 0.01). This improvement was consistent across subgroups defined by diabetes, obesity, and use of antihypertensive medication. CONCLUSIONS: An education program improved control of BP among commercial drivers, improving their health and safety, and reducing the number at high risk of medical disqualification.

In-home monitoring of persons with dementia: ethical guidelines for technology research and development.

Innovative technologies are rapidly emerging that offer caregivers the support and means to assist older adults with cognitive impairment to continue living "at home." Technology research and development efforts applied to older adults with dementia invoke special grant review and institutional review board concerns, to ensure not only safe but also ethically appropriate interventions. Evidence is emerging, however, that tensions are growing between innovators and reviewers. Reviewers with antitechnology biases are in a position to stifle needed innovation. Technology developers who fail to understand the clinical and caregiving aspects of dementia may design applications that are not in alignment with users' capabilities. To bridge this divide, we offer an analysis of the ethical issues surrounding home monitoring, a model framework, and ethical guidelines for technology research and development for persons with Alzheimer's disease and their caregivers.