Vital signs: disparities in nonsmokers' exposure to secondhand smoke--United States, 1999-2012.

Exposure to secondhand smoke (SHS) from burning tobacco products causes sudden infant death syndrome (SIDS), respiratory infections, ear infections, and asthma attacks in infants and children, and coronary heart disease, stroke, and lung cancer in adult nonsmokers. No risk-free level of SHS exposure exists. SHS exposure causes more than 41,000 deaths among nonsmoking adults and 400 deaths in infants each year, and approximately $5.6 billion annually in lost productivity. Although population exposure to SHS has declined over the past 2 decades, many nonsmokers remain exposed to SHS in workplaces, public places, homes, and vehicles.

Comparison of the characteristics of fire and non-fire households in the 2004-2005 survey of fire department-attended and unattended fires.

OBJECTIVE: Comparison of characteristics of fire with non-fire households to determine factors differentially associated with fire households (fire risk factors). DESIGN, SETTING AND SUBJECTS: National household telephone survey in 2004-2005 by the US Consumer Product Safety Commission with 916 fire households and a comparison sample of 2161 non-fire households. There were an estimated 7.4 million fires (96.6% not reported to fire departments) with 130,000 injuries. MAIN OUTCOME MEASURE: Bivariate analysis and multivariate logistic regression analyses to assess differences in household characteristics. RESULTS: Significant factors associated with fire households were renting vs. owning (OR 1.988 p<0.0001); household members under 18 year of age (OR 1.277 p<0.0001); lack of residents over 64 years old (OR 0.552 p=0.0007); and college or higher education (some college OR 1.444 p=0.0360, college graduate OR 1.873, p<0.0001, postgraduate OR 2.156 p<0.0001). Not significant were age of house; race; ethnicity; and income. Number of smokers was borderline significant (OR 1.132 p=0.1019) but was significant in the subset of fire households with non-cooking fires (OR 1.383 p=0.0011). Single family houses were associated with non-fire households in the bivariate analysis but not in the multivariate analyses. CONCLUSION: Renting, household members under 18 years old and smokers are risk factors for unattended fires, similar to the literature for fatal and injury fires. Differences included household members over 65 years old (associated with non-fire households), college/postgraduate education (associated with fire households) and lack of significance of income. Preventing cooking fires (64% of survey incidents), smoking prevention efforts and fire prevention education for families with young children have the potential for reducing unattended fires and injuries.

Prevalence and predictors of smoke-free policy implementation and support among owners and managers of multiunit housing.

INTRODUCTION: Exposure to secondhand smoke causes disease and premature death. Although many municipalities have instituted policies prohibiting smoking in public areas, personal living areas remain largely unregulated. Individuals who reside in multiunit housing (MUH) facilities where smoking is permitted are particularly susceptible to involuntary exposure. This study assessed the prevalence and predictors of smoke-free policy implementation and support among owners and managers of MUH throughout Western New York State. METHODS: A telephone survey was administered to a sample of owners and managers of MUH buildings in the Erie and Niagara counties, New York. A total of 127 respondents completed the survey between March and July 2008 (62% response rate). Logistic regression was used to assess predictors of policy implementation and support, while adjusting for participant smoking status, quantity of units owned/managed, government subsidy status, as well as building age, construction type, and size. RESULTS: Only 13% of participants reported smoking restrictions within any of their buildings. Among those without a smoke-free policy, 75% would be interested in restricting smoking in at least one of their units, with interest being significantly higher among participants with government-subsidized units (odds ratio = 3.12, 95% CI = 1.14-8.52). Primary barriers to policy implementation included concern over increased vacancy (27%) and a decreased market base (21%). DISCUSSION: Few Western New York MUH owners and managers have implemented smoke-free policies in their buildings, but most are receptive to doing so. Therefore, opportunities exist for interventions to enhance policy acceptance, implementation, and enforcement among these individuals.

The acceptability of comprehensive smoke-free policies to low-income tenants in subsidized housing.

Our objective was to evaluate the acceptability of a comprehensive smoke-free policy among low-income tenants in a group of subsidized, multiunit buildings. We conducted a mixed-methods evaluation that included questionnaires mailed to 839 tenants and follow-up telephone interviews with 23 tenants who were current, former, and never smokers. Most never and former smokers supported the policy, citing improved health, fire safety, and building cleanliness; most current smokers disliked the policy and did not follow it. Messages focusing on shared community-level concerns, accompanied by smoking cessation resources, may support the transition to smoke-free policies in subsidized housing.

Factors associated with crashes involving taxi owners and non-owners: A case of moral hazard and adverse selection?

Taxis experience a higher risk of a motor vehicle crash partly because of their much higher levels of exposure on the roads. Although several studies have been conducted to examine the factors associated with the frequency and severity of taxi collisions, little research has been conducted to examine the differences in the factors associated with owner taxis and non-owner taxis. This study finds that collisions involving non-owners are more likely to be associated with poor or risky driving behaviors than collisions involving taxi vehicle owners. This result is consistent with the economic principles of moral hazard and adverse selection. Hence, policy makers responsible for traffic safety, taxi regulation or taxi operations should consider measures to reduce these market inefficiencies and improve the safety of not only taxi drivers but all road users.

Housing issues and realities facing grandparent caregivers who are renters.

PURPOSE: This study determined the prevalence of grandparents raising grandchildren who are living in rental housing and explored the sociodemographic characteristics and challenges faced by such renters. DESIGN AND METHODS: Data were obtained from the Census 2000 Supplementary Survey, a nationally representative survey of 700,000 households with a response rate of 96.8%. Frequencies and bivariate analyses were focused on the 2,639 respondents who were grandparent caregiver renters. RESULTS: Of the 2,350,000 grandparent caregivers in the United States in 2000, 26% were renters, almost one third of whom were spending 30% or more of their income on rent. For the quarter of a million grandparent caregiver renters living below the poverty line, 60% were spending at least 30% of their household income on rent and 3 of 10 were living in overcrowded conditions. IMPLICATIONS: Grandparent caregivers who are renters represent a particularly vulnerable population. The need for further research, policy, and programs for this group is discussed.

Uncovering your hidden occupancy costs.

Senior managers at large companies may not believe that they can have much impact on the "bricks and mortar" of their cost structure. They may even think that occupancy costs are too insignificant to worry about, too technical to analyze, and too fixed to control. But as real estate consultant Mahlon Apgar argues, occupancy costs can hurt a company's earnings, share value, and overall performance. On the other hand, every dollar saved drops straight to the bottom line. Shearson Lehman Brothers, for example, has found that it can save as much as $20 million annually by reducing occupancy costs in its branch offices and headquarters. Managing occupancy costs isn't easy. But it is timely. As companies strive to improve productivity by consolidating functions and downsizing staff, they are saddled with excess office space. Expansions abroad present completely different market conditions that put a premium on reducing occupancy costs. At the same time, the changing nature of work is challenging deeply held beliefs about the workplace, and, consequently, traditional expectations of office space are giving way to innovations that are less costly and more productive. To manage occupancy costs, managers must be able to identify their components, measure their impact, understand what drives them, and develop options to change them. Four basic tools help diagnose problems: a cost history, a loss analysis, a component analysis, and a lease aging profile. Understanding cost drivers like leasing, location, and layout can give executives the insights they need to reduce occupancy costs while improving the effectiveness of facilities to support day-to-day operations.

Another record year for dealmaking. Activity among medium-size companies fuels continued drive toward consolidation.

The nation's hospitals continued to change hands at a record-setting pace in 1996, according to Modern Healthcare's third annual list of healthcare transactions. The bulk of this year's deals came from an increased number of corporate deals by medium-size companies.

Utilization rates of neuroradiology across neuroscience specialties in the private office setting: who owns or leases the scanners on which studies are performed?

BACKGROUND AND PURPOSE: Recent literature shows an increasing portion of imaging studies being conducted and interpreted by nonradiologists, especially across the modalities with the highest RVUs. We examined the trends in the Medicare technical charges for private office neuroradiology studies submitted by subspecialists to identify utilization trends among MR and CT scanner owners or lessees over the last decade. MATERIALS AND METHODS: The number of neuroradiology studies performed on MR and CT machines owned or leased in private offices was determined from the CMS PSPSMF for 1998-2008. Studies billed through technical and global charges were aggregated. Utilization rates and utilization rate CAGRs were computed by specialty and by imaging study. RESULTS: Between 1998 and 2008, MR studies grew by a factor of 2.5 and CT studies grew by 2.1. In 2008, radiologists charged the technical/global fee in 1,386,669 (56.6%), neurologists in 82,360 (3.4%), neurosurgeons in 29,218 (1.2%), multi/IDTF in 617,933 (25.2%), and other specialists in 334,843 (13.7%) of neuroradiology cases. Changes from the 1998 base rate to the 2008 rate per 1000 Medicare beneficiaries were 24.1 to 39.7 for radiologists, 1.03 to 2.4 for neurologists, 0.15 to 0.84 for neurosurgeons, 2.2 to 17.7 for multi/IDTF, and 1.3 to 9.6 for other specialists. All specialties, except for multi/IDTF, showed greater MR utilization increases than CT. Neurology (CAGR of 10.6%), neurosurgery (22.1%), multi/IDTF (23.2%), and other specialists' (24.6%) MR growth outpaced that of radiology's (5.3%). CONCLUSIONS: All nonradiologists showed greater overall utilization growth in private office neuroradiology than did radiology. Also, nonradiologists generally showed greater utilization increases in MR than CT. Radiologists' private office neuroradiology technical fee share shrank from 83.6% to 56.6% between 1998 and 2008.

Physician ownership of medical equipment.

This Data Bulletin presents findings from the Center for Studying Health System Change (HSC) 2008 Health Tracking Physician Survey, a nationally rep­resentative mail survey of U.S. physicians providing at least 20 hours per week of direct patient care. The sample of physicians was drawn from the American Medical Association master file and included active, nonfederal, office- and hospital-based physicians. Residents and fellows were excluded, as well as radiologists, anesthesiologists and pathologists. The survey includes responses from more than 4,700 phy­sicians, and the response rate was 62 percent. Since this Data Bulletin examines the extent of physician practice ownership or leasing of medical equipment, the sample was limited to 2,750 physicians practic­ing in community-based, physician-owned practices, who represent 58 percent of all physicians surveyed. Physicians employed by hospitals, who practiced in hospital-based settings or who worked in hospital-owned practices were excluded.

Ownership or leasing of CT scanners by nonradiologist physicians: a rapidly growing trend that raises concern about self-referral.

PURPOSE: The aim of this study was to examine recent nationwide trends in the ownership or leasing of computed tomographic (CT) scanners in private offices by nonradiologist physicians. METHODS AND MATERIALS: The Medicare Part B fee-for-service data sets for 2001 though 2006 were used to identify all CT scans performed in nonhospital, private-office settings. Ownership or leasing of CT scans was determined by tabulating all global and technical-component-only claims. Professional-component claims were excluded. The specialty of the owner or lessee was determined using Medicare's physician specialty codes. Procedure volume trends and growth rates among all nonradiologist physicians as a group were compared with those among radiologists. Individual specialty volume trends and growth rates were also studied. RESULTS: From 2001 to 2006, Medicare private-office CT scan volume in facilities owned by radiologists increased by 85%. CT scan volume in facilities owned or leased by nonradiologist physicians as a group increased by 263%. The nonradiologic specialties with the largest volumes in 2006 were primary care (192,255 scans), internal medicine subspecialties other than cardiology and medical oncology (184,991 scans), urology (125,850 scans), cardiology (104,739 scans), and medical oncology (61,976 scans). Excluding CT scans performed in independent diagnostic testing facilities (for which physician ownership cannot be determined), nonradiologists' private-office CT market share rose from 16% in 2001 to 28% in 2006. CONCLUSIONS: The majority of Medicare private-office CT scans are done in facilities owned by radiologists. However, nonradiologist physicians are acquiring or leasing CT scanners in increasing numbers, and the growth trend is much more rapid among them than it is among radiologists (85% among radiologists from 2001 to 2006, compared with 263% among nonradiologists). As a result, nonradiologists' market share has increased considerably. At a time when both cost containment and reduction in radiation exposure are urgent priorities, the self-referral opportunities resulting from this trend should be of concern to payers and policymakers.

Ownership or leasing of MRI facilities by nonradiologist physicians is a rapidly growing trend.

PURPOSE: To study growth trends in the ownership of magnetic resonance imaging (MRI) examinations by nonradiologist physicians who either own the equipment outright or are involved in scan leasing arrangements. METHODS AND MATERIALS: Medicare Part B data sets from 2000 through 2005 were reviewed, and procedure codes for MRI examinations were selected. The focus was on only those procedures performed at nonhospital, private-office facilities. Using Medicare's physician specialty codes, all such studies were categorized according to the specialties of the physicians who performed them. Ownership was determined by including only those claims for global or technical-component-only reimbursement. Physicians owning or leasing MRI facilities would use one or the other of these two types of claims. Professional-component-only claims were not included. Procedure volumes and growth trends were compared among radiologists and other specialists. RESULTS: From 2000 to 2005, private-office MRI examinations performed by radiologists increased by 83%. During the same period, private-office MRI examinations performed by nonradiologist physicians, either through owning or leasing the equipment, increased by 254%. Excluding studies performed by independent diagnostic testing facilities (for which physician ownership cannot be determined), nonradiologists' share of the private-office MRI market rose from 11% in 2000 to 20% in 2005. The nonradiologic specialties most actively involved in performing MRI were orthopedic surgery (161,296 Medicare studies in 2005), neurology (63,363 studies), primary care (58,092 studies), internal medicine subspecialties (34,317 studies), and neurosurgery (20,712 studies). CONCLUSIONS: In the private-office setting in 2005, radiologists performed most MRI examinations. However, the growth rate from 2000 to 2005 among nonradiologist physicians was far higher, 254% compared with 83% among radiologists. Because scans performed by nonradiologists through ownership or leasing are subject to self-referral, the much more rapid growth among those physicians should be of concern to policymakers and payers.

Cashing in on the trend toward variable-term computer leases.

Lessors make a large part of their profit from customer-requested changes such as upgrades or early termination of fixed-term computer leases. As lessees recognize the financial penalty associated with these changes, they are increasingly negotiating for variable-term computer leases.

Leasing capital assets and durable goods: opinions and practices in Florida hospitals.

Although leasing is a major source of financing for hospital capital acquisitions, the rationale for choosing leasing over conventional financing is not clear. This article examines academic and leasing company views, and then surveys hospital executives to obtain their views.