A systematic examination of smoke-free policies in multiunit dwellings in Virginia as reported by property managers: implications for prevention.

PURPOSE: In most states, smoking has been curtailed to some extent in public buildings, workplaces, and restaurants. The next frontier for smoke-free policies is the multiunit dwelling industry. However, the extent to which smoke-free housing currently is available is unknown. The purpose of this study was to measure the market for smoke-free housing in Virginia and to identify barriers to adopting smoke-free policies. DESIGN: Telephone interviews were conducted with property managers of rental apartments, townhouses, senior housing, and public housing in four Virginia cities. SETTING: Four cities in Virginia. SUBJECTS: Two hundred sixty-three property managers in four cities in Virginia (approximately 75 property managers per city). MEASURES: Property managers were administered a brief telephone survey. RESULTS: Only 33.8% of property managers reported some type of smoke-free policy, with only 15% of those policies prohibiting smoking in residential units. Most property managers without a smoke-free policy were not considering adopting such a policy for a variety of reasons. CONCLUSION: The availability of smoke-free multiunit dwellings is severely lacking. This study identified a number of science-based and legal misperceptions that may prevent the adoption of smoke-free policies. Correction of these misperceptions is warranted to increase the availability of smoke-free housing. Such policies will be useful in creating environments that support good health practices while simultaneously protecting tenants from exposure to secondhand smoke.

Substance use, symptom, and employment outcomes of persons with a workplace mandate for chemical dependency treatment.

OBJECTIVE: This study examined the role of workplace mandates to chemical dependency treatment in treatment adherence, alcohol and drug abstinence, severity of employment problems, and severity of psychiatric problems. METHODS: The sample included 448 employed members of a private, nonprofit U.S. managed care health plan who entered chemical dependency treatment with a workplace mandate (N=75) or without one (N=373); 405 of these individuals were followed up at one year (N=70 and N=335, respectively), and 362 participated in a five-year follow up (N=60 and N=302, respectively). Propensity scores predicting receipt of a workplace mandate were calculated. Logistic regression and ordinary least-squares regression were used to predict length of stay in chemical dependency treatment, alcohol and drug abstinence, and psychiatric and employment problem severity at one and five years. RESULTS: Overall, participants with a workplace mandate had one- and five-year outcomes similar to those without such a mandate. Having a workplace mandate also predicted longer treatment stays and improvement in employment problems. When other factors related to outcomes were controlled for, having a workplace mandate predicted abstinence at one year, with length of stay as a mediating variable. CONCLUSIONS: Workplace mandates can be an effective mechanism for improving work performance and other outcomes. Study participants who had a workplace mandate were more likely than those who did not have a workplace mandate to be abstinent at follow-up, and they did as well in treatment, both short and long term. Pressure from the workplace likely gets people to treatment earlier and provides incentives for treatment adherence.

Mental health system transformation after the Virginia Tech tragedy.

On 16 April 2007, a deeply disturbed Virginia Tech student murdered thirty-two fellow students and faculty and then shot himself. Less than one year later, the Virginia legislature improved the emergency evaluation process, modified the criteria for involuntary commitment, tightened procedures for mandatory outpatient treatment, and increased state funding for community mental health services. The unanswered question, however, is whether the necessary political momentum can be sustained for the long-term investment in community services and the fundamental legal changes needed to transform a system focused on managing access to scarce hospital beds to a community-based system of accessible voluntary services.

Judicially mandated naltrexone use by criminal offenders: a legal analysis.

The starting point for this article is the possibility of improving treatment adherence by making naltrexone therapy, particularly the recently developed depot preparation, a condition of probation or parole for nonviolent opiate-addicted offenders who voluntarily agree to these conditions. (I will characterize these arrangements as "leveraged agreements.") My assigned task is to reflect on the legal principles that would apply to these arrangements. Before addressing the legality of leveraged agreements, however, I want to consider two arrangements. First, I want to consider what I will call "no-agreement arrangements," in which a probationer or a parolee who does not want to receive naltrexone is required to do so under a threat of incarceration for noncompliance. Second, I want to consider a purely voluntary arrangement in which naltrexone treatment is not at all linked to criminal sentence. Finally, I will consider leveraged agreements.