Non-compliance with smoke-free law in public places: a systematic review and meta-analysis of global studies.

Introduction: Non-compliance with smoke-free law is one of the determinants of untimely mortality and morbidity globally. Various studies have been conducted on non-compliance with smoke-free law in public places in different parts of the world; however, the findings are inconclusive and significantly dispersed. Moreover, there is a lack of internationally representative data, which hinders the evaluation of ongoing international activities towards smoke-free law. Therefore, this meta-analysis aimed to assess the pooled prevalence of non-compliance with smoke-free law in public places. Methods: International electronic databases, such as PubMed/MEDLINE, Science Direct, Cochrane Library, CINAHL, African Journals Online, HINARI, Semantic Scholar, google and Google Scholar were used to retrieve the relevant articles. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA) guidelines. The Higgs I2 statistics were used to determine the heterogeneity of the reviewed articles. The random-effects model with a 95% confidence interval was carried out to estimate the pooled prevalence of non-compliance. Results: A total of 23 articles with 25,573,329 study participants were included in this meta-analysis. The overall pooled prevalence of non-compliance with smoke-free law was 48.02% (95% CI: 33.87-62.17). Extreme heterogeneity was observed among the included studies (I2 = 100%; p < 0.000). The highest non-compliance with smoke-free law was noted in hotels (59.4%; 95% CI: 10.5-108.3) followed by homes (56.8%; 95% CI: 33.2-80.4), with statistically significant heterogeneity. Conclusion: As the prevalence of non-compliance with smoke-free law is high in public places, it calls for urgent intervention. High non-compliance was found in food and drinking establishments and healthcare facilities. In light of these findings, follow-up of tobacco-free legislation and creating awareness that focused on active smokers particularly in food and drinking establishments is recommended.

Support for smoke-free public places among adults in four countries in sub-Saharan Africa.

INTRODUCTION: There is no known safe level of secondhand smoke exposure; yet, less than 30% of the global population is covered by comprehensive smoke-free policies as of 2016 and there are few smoke-free policies in sub-Saharan Africa (SSA). This study examines the support for smoke-free public places in SSA and delineates their correlates. METHODS: Data collected through the Global Adult Tobacco Survey (2012-2017) were analyzed using SAS for descriptive and multivariable analyses, with a significance level set at p < .05. RESULTS: No SSA country had comprehensive smoke-free policies, defined as a prohibition of smoking in eight public places. In the four countries whose Global Adult Tobacco Survey data were analyzed (Nigeria, Cameroon, Kenya, and Uganda), support for the prohibition of smoking in public places was over 90% in all eight public places except bars. Support for smoking prohibition in bars was 65.8%, 81.1%, 81.4%, and 91.0% in Nigeria, Cameroon, Kenya, and Uganda, respectively. Factors associated with support for smoke-free bars differed across the four countries, but in all countries, current smokers had decreased odds of support for smoke-free bars. Knowledge of secondhand smoke harm and living in smoke-free homes were associated with increased odds of support for smoke-free bars in all countries except Kenya. CONCLUSION: The high support for smoke-free public places should inform the efforts of the public health community and policymakers in these four SSA countries toward meeting their obligations of Article 8 of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). IMPLICATIONS: Much of the population in SSA is not protected by comprehensive smoke-free policies. It was found that the overwhelming majority of adults in four large countries in SSA support the prohibition of smoking in public places and that knowledge of the health dangers of smoking and exposure to secondhand smoke and home smoking rules increased support for the prohibition. High support for the prohibition of smoking in these four SSA countries suggests tobacco control proponents should advocate for comprehensive smoke-free policies.

Regulations for using semiautomatic external defibrillators outside health care settings in Spain: a review and comparison of the current situation across autonomous communities. / Regulación de la desfibrilación externa semiautomática fuera del entorno sanitario en las comunidades autónomas de España: situación actual.

ABSTRACT: We compared Spanish autonomous communities' regulations affecting the use of semiautomatic external defibrillators (semi-AEDs), including requirements for training and providing devices outside health care settings. We analyzed differences in the development of regulations across the different geographic areas. Regulations published in the official bulletins of Spain's 17 autonomous communities and 2 autonomous cities in effect in May 2019 were reviewed to extract directives affecting training, authorized use, and the provision of semi-AEDs outside health care centers. We found that both doctors and nurses are authorized to use the devices in most communities, with the exception of Murcia, where only doctors may use them. Fourteen communities also authorize emergency responders to operate semi-AEDs. Other individuals must call for emergency help before using one, and specific rules vary by community. In the Basque Country anyone may use them, but in other communities, only individuals who have taken a training course on how to use a semi-AED may. The duration of training programs varies from 4 to 9 hours in different parts of Spain, and retraining is required at intervals that vary from 1 to 3 years. However, in 11 communities any citizen may use a semi-AED in an emergency in which authorized persons are not present (after first calling for emergency responders). Eleven autonomous communities regulate the required provision of semi-AEDs outside health care centers. We conclude that although Spain's autonomous communities have regulations in place for the use of these devices, the regulatory map is highly diverse. Therefore, we think that harmonization is desirable in the interest of unifying criteria and encouraging the use of semi-AEDs when they are needed.

RESUMEN: El objetivo de este trabajo es comparar las legislaciones autonómicas españolas en materia de formación, utilización y obligatoriedad de la instalación de desfibriladores externos automatizados (DEA) fuera del ámbito sanitario y analizar la variabilidad territorial con que se han desarrollado las regulaciones. Llevamos a cabo una revisión de las normativas publicadas en los boletines oficiales de las 17 comunidades autónomas y las 2 ciudades autónomas de España hasta mayo de 2019, extrayendo datos referidos a la regulación de la formación, el uso y la instalación de los DEA fuera del ámbito sanitario. Observamos que médicos y enfermeros están autorizados a utilizar los DEA, salvo en Murcia, donde únicamente tienen autorizado su uso los médicos. En 14 comunidades autónomas también se consideran habilitados los técnicos en emergencias sanitarias. Excepto en el País Vasco, donde cualquier ciudadano puede utilizar un DEA previa alerta a los servicios de emergencia, es necesario realizar un curso inicial acreditado para estar habilitado en el uso de estos dispositivos (cuya duración varía, según la comunidad, entre 4 y 9 horas) y debe ser renovado con una periodicidad que oscila entre uno y 3 años. Sin embargo, 11 comunidades permiten que, en caso de emergencia y en ausencia de personal habilitado, cualquier ciudadano pueda utilizar un DEA, previa alerta a los servicios de emergencia. Once autonomías regulan la obligación de instalar DEA fuera del ámbito sanitario. Se concluye que si bien todas las comunidades autónomas de España disponen de una normativa reguladora del uso y la acreditación de DEA, el mapa legislativo es muy diverso, por lo que sería deseable una política armonizadora para unificar criterios e incentivar el uso de estos dispositivos en caso de necesidad.

The effect of smoke-free legislation on the mortality rate of acute myocardial infarction: a meta-analysis.

BACKGROUND: Several studies have demonstrated that smoke-free legislation is associated with a reduced risk of mortality from acute myocardial infarction (AMI). This study aimed to examine and quantify the potential effect of smoke-free legislation on AMI mortality rate in different countries. METHODS: Studies were identified using a systematic search of the scientific literature from electronic databases, including PubMed, Web of Science, ScienceDirect, Embase, Google Scholar, and China National Knowledge Infrastructure (CNKI), from their inception through September 30, 2017. A random effects model was employed to estimate the overall effects of smoke-free legislation on the AMI mortality rate. Subgroup analysis was performed to explore the possible causes of heterogeneity in risk estimates based on sex and age. The results of meta-analysis after excluding the studies with a high risk of bias were reported in this study. RESULTS: A total of 10 eligible studies with 16 estimates of effect size were included in this meta-analysis. Significant heterogeneity in the risk estimates was identified (overall I2 = 94.6%, p < 0.001). Therefore, a random effects model was utilized to estimate the overall effect of smoke-free legislation. There was an 8% decline in AMI mortality after introducing smoke-free legislation (RR = 0.92, 95% confidence interval (CI): 0.90-0.94). The results of subgroup analyses showed that smoke-free legislation was significantly associated with lower rates of mortality for the following 5 diagnostic subgroups: smoke-free in workplaces, restaurants and bars (RR = 0.92, 95% CI: 0.90-0.95), smaller sample size (RR = 0.92, 95% CI: 0.89-0.95), study location in Europe (RR = 0.90, 95% CI: 0.85-0.94), regional study area (RR = 0.92, 95% CI: 0.89-0.94), and no previous local smoke-free legislation (RR = 0.91, 95% CI: 0.90-0.93). However, there was not much difference in AMI mortality rates after the legislation between the longer (RR = 0.92, 95% CI: 0.86-0.98) and shorter follow-up duration subgroups (RR = 0.92, 95% CI: 0.89-0.94). CONCLUSION: Smoke-free legislation could significantly reduce the AMI mortality rate by 8%. The reduction in the AMI mortality rate was more significant in studies with more comprehensive laws, without prior smoke-free bans, with a smaller sample size, at the regional level, and with a location in Europe.

Reported fire safety and first-aid amenities in Airbnb venues in 16 American cities.

Airbnb helps hosts rent all or part of their home to guests as an alternative to traditional hospitality settings. Airbnb venues are not uniformly regulated across the USA. This study quantified the reported prevalence of fire safety and first-aid amenities in Airbnb venues in the USA. The sample includes 120 691 venues in 16 US cities. Proportions of host-reported smoke and carbon monoxide (CO) detectors, fire extinguishers and first-aid kits were calculated. The proportion of venues that reportedly contained amenities are as follows: smoke detectors 80% (n=96 087), CO detectors 57.5% (n=69 346), fire extinguishers 42% (n=50 884) and first-aid kits 36% (n=43 497). Among this sample of Airbnb venues, safety deficiencies were noted. While most venues had smoke alarms, approximately 1/2 had CO alarms and less than 1/2 reported having a fire extinguishers or first-aid kits. Local and state governments or Airbnb must implement regulations compliant with current National Fire Protection Association fire safety standards.

Public Accommodation Laws and Gender Panic in Clinical Settings.

Public accommodation laws (PALs) are used to address discrimination against minorities. There is broad discussion about using such laws to either protect or prohibit access to sex-segregated spaces for transgender people. Health care facilities are subject to PALs, which affect rooming assignments and access to sex-segregated environments. Around the time that a Massachusetts transgender PAL went into effect in October 2016, the first author (EB) facilitated 18 professional trainings at 5 health care facilities in greater Boston. During these trainings, staff repeatedly brought up 2 areas of moral concern reflecting public conversations about transgender rights: risk posed by the presence of transwomen in sex-segregated spaces and feelings of unpreparedness for dealing with anti-trans bias. This article discusses the role of education in responding to gender panic in inpatient settings.

Compliance Assessment of Cigarette and Other Tobacco Products Act in Public Places in Delhi Government Hospitals

Objective: Tobacco-free policies in hospital campus reduce exposure to tobacco smoke; change the demeanour of the professionals, patients and people visiting hospitals towards tobacco use. Section-4, 5 and 6 of COTPA (Cigarettes and Other Tobacco Products Act) necessitates the need for implementation of the prohibition on smoking in public places. Against this background, the present work was designed to evaluate the status of compliance Section 4, 5 and 6 of COTPA in Delhi Government hospitals Methods: A cross-sectional observational study was conducted within Government hospitals. Multistage random sampling was used to select 18 hospitals out of 39 hospitals from 5 zones. Standard assessment Proforma developed by John Hopkins School of Public Health for assessing compliance to Tobacco-Free Law was used and modified to address certain aspects of Section-4, 5 and 6 of COTPA. Hospital campuses were assessed by dividing them into zones like hospital buildings, office buildings, public places outside the hospital and residential areas. Result: Signs of active tobacco use observed in 40.6% of hospital buildings, 35.3% in office buildings, and 75.4% in public places outside the buildings. 'No smoking signage was not as per the COTPA guidelines in 21.4% of the hospitals and 72% were not tobacco free outdoors in these positions. Conclusion: The study highlighted a lower compliance rate than expected which raises questions on law enforcement concerning tobacco. Hence necessary measures have to be used up for sustained awareness campaigns, backed by enforcement drives. Periodic compliance surveys will strengthen the implementation of tobacco free legislation in health care institutions.

Alcohol management practices in community sporting clubs: Validation of an online self-report tool.

INTRODUCTION AND AIMS: Those involved in organised sport have a high risk of excessive alcohol consumption and alcohol-related harm, the implementation of alcohol management practices have been proven to reduce these risks. Measuring alcohol management practice implementation by sporting clubs is impeded by a lack of valid tools. The aim of this study was to determine the validity of online self-report of alcohol-management practices by community football clubs via comparison with observational methods. DESIGN AND METHODS: A cross-sectional study was undertaken with a sample of community football clubs within Australia. The implementation of 12 alcohol management practices was collected via: (i) an online survey; and (ii) observational audit at a clubs home ground. The prevalence of implementation of alcohol management practices for both data collection methods was calculated as was percent agreement and Kappa/Prevalence Adjusted and Bias Adjusted Kappa (PABAK) statistics. RESULTS: Data were collected from 58 football clubs. For both assessment methods, implementation prevalence was greater than 80% for 6 of the 12 alcohol management practices. A total of 75% (n = 9) of practices had at least 70% agreement between the online and observation methods of assessment. Kappa/PABAK scores ranged from -0.08 (poor agreement) to 0.97 (almost perfect agreement). DISCUSSION AND CONCLUSION: The online survey provided valid measure of assessing some but not all alcohol management practices in community sporting clubs. The validity of the measure may be improved by enhancements to the manner in which the self-report data are collected.

Attitudes towards community gambling venues and support for regulatory reform: an online panel study of residents in New South Wales, Australia.

BACKGROUND: Harmful gambling has been identified as an important public health issue that affects individuals, families and the broader community. One gambling product, electronic gambling machines (EGMs), has been associated with significant gambling harm in Australia. There has been limited research that has explored community perceptions of EGMs and attitudes towards reform. This study, conducted in NSW, Australia, aimed to explore community use of EGM venues (clubs and hotels containing EGMs), attitudes towards EGMs and whether the use of these venues influenced attitudes towards EGM reform. METHODS: An online survey was conducted with 500 adults aged 16 years and over, representative of the population for age and gender. Discrete choice and open-ended questions were used to gather data on gambling behaviours, use of and attitudes towards EGMs and EGM venues and support for gambling harm reduction measures. RESULTS: Three quarters of participants had visited an EGM venue in the previous year. Participants who had attended such venues were significantly more likely to use EGMs at least once per month. Participants attended EGM venues for a range of reasons including use of non-gambling facilities such as restaurants, the social aspects of the venue and ease of access to the venue. Some participants also attended EGM venues specifically for the gambling facilities. Most participants identified some negative impacts of EGMs for local communities and were supportive of measures to reduce the number of EGMs and prevent children's exposure to EGMs in such venues. CONCLUSIONS: This study shows a high level of support for EGM reform amongst both individuals who attend EGM venues and also those who do not. There is potential for government to further regulate EGMs and the environments where they are located.

Legal issues for transgender people: a review of persistent threats.

Background The legal status of transgender (trans) people is in constant flux. Over the past 70 years, gradually increasing transgender visibility, national and global advocacy, and, more recently, widespread Internet access, communication, and broadening support from allies, have all contributed to successful campaigns that have improved transgender lives and legitimised transgender. Still, traumatic interactions with the legal system or policing agencies remain plentiful. This is a very general overview of the most common legal issues confronting trans people. It aims to inform medical and mental health providers about the trepidation with which their patients and clients must engage legal systems, and the scope of their concerns, which ultimately affect their health. This review relies upon reports generated by advocacy organisations based on population surveys in several countries, the projects undertaken by legal and human rights advocacy groups, the topics most frequently discussed in academic texts examining transgender legal issues, and draws upon the author's personal advocacy experience. The most complicated and persistent issues are identity recognition, family law and relationship issues, adverse discrimination and anti-transgender violence and its aftermath. Criminal law, almost universally, treats trans people according to the lowest common denominator, their genital status, which supposedly supports expediency and "safety". Global legal and human rights efforts remain desperately needed to lift transgender people from the margins of society and provide them with equal opportunities to lead healthy and fulfilling lives. Access to appropriate and meaningful health care is a crucial element necessary to affirm the humanity of any person.

Establishment of lactaton rooms in public and private companies: potentialities and difficulties. / Implantação de salas de apoio à amamentação em empresas públicas e privadas: potencialidades e dificuldades.

OBJECTIVE: To know how managers of public and private companies view lactation support rooms and their implantation. METHOD: This is study is based on qualitative, exploratory, and descriptive research. Twenty managers from Greater Florianópolis participated in the research, in 2015. Data were collected by means of semi-structured/projective interviews, and subjected to content analysis associated with Atlas.ti software. RESULTS: Data analysis led to the following two categories: difficulties and facilities of establishing a lactation room, with a predominance of financial difficulties and the lack of physical space. Dialectically, the subjects also recognised the low cost involved, which facilitates establishment. CONCLUSION: Financial, cultural, and political aspects make it difficult to set up lactation rooms, but the importance of this measure was acknowledged. Although the success of breastfeeding partly depends on these support rooms, it also requires multiple actions, especially the effective participation of nurses and other health workers.

Facilitators and Barriers of Smokers' Compliance with Smoking Bans in Public Places: A Systematic Review of Quantitative and Qualitative Literature.

Background: Environmental tobacco smoke (ETS) exposure is associated with an increased risk of many diseases. Many countries have ratified a national smoking ban in public places, but studies on factors related to smoking issues in public places post-ban are lacking. Aim: To identify facilitators and barriers that influenced smokers' compliance with smoking bans in public places. Methods: Using PubMed, MEDLINE, and the Web of Science database, we conducted a systematic search of English articles published before June 2015 on factors of smokers' compliance with the smoking bans in public places. Results: A total of 390 references were identified, among which seventeen articles (twelve quantitative studies, two qualitative studies, three mixed-method studies) were included in this review. These studies focused on four types of public places including recreational venues (n = 7), hospital (n = 5), school (n = 4), and workplace (n = 1). Factors at the  individual-, interpersonal-, and organizational-level were identified: at the individual level, nicotine dependence, insufficiency of tobacco-related knowledge, and the negative attitudes towards smoking bans were the most commonly identified barriers; at the interpersonal level, the smoking behaviors of people around, close relatives, and friends' approval were the main barriers; and at the organizational level, the main barriers were inefficient implementation of the bans and the inconvenience of the designative smoking areas. Conclusions: This synthesis of the literature provided evidence of the identified barriers and facilitators of smokers' compliance with the smoking bans. It will be beneficial for the policy-maker to consider interventions on multiple levels of factors to overcome the barriers and enhance smokers' compliance with the smoking bans in public places.

Immediate Closures and Violations Identified During Routine Inspections of Public Aquatic Facilities - Network for Aquatic Facility Inspection Surveillance, Five States, 2013.

PROBLEM/CONDITION: Aquatic facility-associated illness and injury in the United States include disease outbreaks of infectious or chemical etiology, drowning, and pool chemical-associated health events (e.g., respiratory distress or burns). These conditions affect persons of all ages, particularly young children, and can lead to disability or even death. A total of 650 aquatic facility-associated outbreaks have been reported to CDC for 1978-2012. During 1999-2010, drownings resulted in approximately 4,000 deaths each year in the United States. Drowning is the leading cause of injury deaths in children aged 1-4 years, and approximately half of fatal drownings in this age group occur in swimming pools. During 2003-2012, pool chemical-associated health events resulted in an estimated 3,000-5,000 visits to U.S. emergency departments each year, and approximately half of the patients were aged <18 years. In August 2014, CDC released the Model Aquatic Health Code (MAHC), national guidance that can be adopted voluntarily by state and local jurisdictions to minimize the risk for illness and injury at public aquatic facilities. REPORTING PERIOD COVERED: 2013. DESCRIPTION OF SYSTEM: The Network for Aquatic Facility Inspection Surveillance (NAFIS) was established by CDC in 2013. NAFIS receives aquatic facility inspection data collected by environmental health practitioners when assessing the operation and maintenance of public aquatic facilities. This report presents inspection data that were reported by 16 public health agencies in five states (Arizona, California, Florida, New York, and Texas) and focuses on 15 MAHC elements deemed critical to minimizing the risk for illness and injury associated with aquatic facilities (e.g., disinfection to prevent transmission of infectious pathogens, safety equipment to rescue distressed bathers, and pool chemical safety). Although these data (the first and most recent that are available) are not nationally representative, 15.7% of the estimated 309,000 U.S. public aquatic venues are located in the 16 reporting jurisdictions. RESULTS: During 2013, environmental health practitioners in the 16 reporting NAFIS jurisdictions conducted 84,187 routine inspections of 48,632 public aquatic venues. Of the 84,187 routine inspection records for individual aquatic venues, 78.5% (66,098) included data on immediate closure; 12.3% (8,118) of routine inspections resulted in immediate closure because of at least one identified violation that represented a serious threat to public health. Disinfectant concentration violations were identified during 11.9% (7,662/64,580) of routine inspections, representing risk for aquatic facility-associated outbreaks of infectious etiology. Safety equipment violations were identified during 12.7% (7,845/61,648) of routine inspections, representing risk for drowning. Pool chemical safety violations were identified during 4.6% (471/10,264) of routine inspections, representing risk for pool chemical-associated health events. INTERPRETATION: Routine inspections frequently resulted in immediate closure and identified violations of inspection items corresponding to 15 MAHC elements critical to protecting public health, highlighting the need to improve operation and maintenance of U.S. public aquatic facilities. These findings also underscore the public health function that code enforcement, conducted by environmental health practitioners, has in preventing illness and injury at public aquatic facilities. PUBLIC HEALTH ACTION: Findings from the routine analyses of aquatic facility inspection data can inform program planning, implementation, and evaluation. At the state and local level, these inspection data can be used to identify aquatic facilities and venues in need of more frequent inspections and to select topics to cover in training for aquatic facility operators. At the national level, these data can be used to evaluate whether the adoption of MAHC elements minimizes the risk for aquatic facility-associated illness and injury. These findings also can be used to prioritize revisions or updates to the MAHC. To optimize the collection and analysis of aquatic facility inspection data and thus application of findings, environmental health practitioners and epidemiologists need to collaborate extensively to identify public aquatic facility code elements deemed critical to protecting public health and determine the best way to assess and document compliance during inspections.

Reactions to smoke-free public policies and smoke-free home policies in the Republic of Georgia: results from a 2014 national survey.

OBJECTIVES: We examined receptivity to public smoke-free policies and smoke-free home status among adults in the Republic of Georgia. METHODS: In Spring 2014, we conducted a national household survey of 1163 adults. RESULTS: Our sample was on average 42.4 years old, 51.1 % male, and 43.2 % urban. Current smoking prevalence was 54.2 % in men and 6.5 % in women. Notably, 42.2 % reported daily secondhand smoke exposure (SHSe). Past week SHSe was 29.9 % in indoor public places and 33.0 % in outdoor public places. The majority reported no opposition to public smoke-free policies. Correlates of greater receptivity to public policies included being older, female, and a nonsmoker. Past week SHSe in homes was 54.2 %; 38.8 % reported daily SHSe at home. Only 14.3 % reported complete smoke-free home policies; 39.0 % had partial policies. The only correlate of allowing smoking in the home was being a smoker. Among smokers, correlates of allowing smoking in the home were being male and lower confidence in quitting. CONCLUSIONS: SHSe is prevalent in various settings in Georgia, requiring efforts to promote support for public smoke-free policies and implementation of personal policies.

Implantação de salas de apoio à amamentação em empresas públicas e privadas: potencialidades e dificuldades / Despliegue de habitaciones lactancia de apoyo en empresas públicas y privadas: capacidades y dificultades / Establishment of lactaton rooms in public and private companies: potentialities and difficulties

RESUMO Objetivo Conhecer a visão de gestores de empresas públicas e privadas acerca das salas de apoio à amamentação, com vistas à sua implantação. Método Pesquisa qualitativa, exploratória descritiva, realizada em 2015, da qual participaram 20 gestores da Grande Florianópolis. Para a coleta de dados, foram utilizadas entrevistas semiestruturadas/projetivas e, para a análise, a Análise de Conteúdo, associada aos recursos do software Atlas.ti. Resultados Emergiram duas categorias, a saber, dificuldades e facilidades na implantação de sala de apoio à amamentação, com predomínio de aspectos dificultadores, especialmente financeiros, envolvidos na disponibilização de espaço físico. Dialeticamente, também houve reconhecimento do baixo custo envolvido, o que facilitaria sua implantação. Conclusões Aspectos financeiros, culturais e políticos dificultam a implantação de salas de apoio à amamentação, mas há o reconhecimento da importância da medida. Para o sucesso da amamentação, a implantação de salas de apoio é importante, porém, não suficiente, sendo necessárias múltiplas ações e, principalmente, uma atuação mais efetiva da enfermagem e dos demais profissionais de saúde.

RESUMEN Objetivo Conocer la visión de los gestores de la empresa pública y privada sobre las habitaciones de apoyo a la lactancia, con vistas a su puesta en práctica. Método La investigación fue cualitativa, exploratoria y descriptiva. Participaron 20 gerentes en Florianópolis en 2015. Para la recolección de datos se utilizaron entrevistas semiestructuradas/proyectiva y para análisis, Análisis de Contenido asociado a los recursos del software Atlas.ti. Resultados Surgieron dos categorías, las dificultades y las facilidades en la implantación de sala de apoyo a la lactancia, donde predominan los aspectos que obstaculizan, especialmente los financieros, involucrados en el espacio físico. Dialécticamente, también hubo reconocimiento del bajo costo involucrado, lo que facilitaría su aplicación. Conclusión Los aspectos financieros, culturales y políticos dificultan la implantación de salas de lactancia materna,es importsnte implantar salas de apoyo, sin embargo, no es suficiente, requiere múltiples acciones y, sobre todo, un funcionamiento más eficaz de la enfermería y otros profesionales de la salud.

ABSTRACT Objective To know how managers of public and private companies view lactation support rooms and their implantation. Method This is study is based on qualitative, exploratory, and descriptive research. Twenty managers from Greater Florianópolis participated in the research, in 2015. Data were collected by means of semi-structured/projective interviews, and subjected to content analysis associated with Atlas.ti software. Results Data analysis led to the following two categories: difficulties and facilities of establishing a lactation room, with a predominance of financial difficulties and the lack of physical space. Dialectically, the subjects also recognised the low cost involved, which facilitates establishment. Conclusion Financial, cultural, and political aspects make it difficult to set up lactation rooms, but the importance of this measure was acknowledged. Although the success of breastfeeding partly depends on these support rooms, it also requires multiple actions, especially the effective participation of nurses and other health workers.

Evaluating the Impact of the Healthy Beverage Executive Order for City Agencies in Boston, Massachusetts, 2011-2013.

INTRODUCTION: Intake of sugar-sweetened beverages (SSBs) is associated with negative health effects. Access to healthy beverages may be promoted by policies such as the Healthy Beverage Executive Order (HBEO) established by former Boston mayor Thomas M. Menino, which directed city departments to eliminate the sale of SSBs on city property. Implementation consisted of "traffic-light signage" and educational materials at point of purchase. This study evaluates the impact of the HBEO on changes in beverage availability. METHODS: Researchers collected data on price, brand, and size of beverages for sale in spring 2011 (899 beverage slots) and for sale in spring 2013, two years after HBEO implementation (836 beverage slots) at access points (n = 31) at city agency locations in Boston. Nutrient data, including calories and sugar content, from manufacturer websites were used to determine HBEO beverage traffic-light classification category. We used paired t tests to examine change in average calories and sugar content of beverages and the proportion of beverages by traffic-light classification at access points before and after HBEO implementation. RESULTS: Average beverage sugar grams and calories at access points decreased (sugar, -13.1 g; calories, -48.6 kcal; p<.001) following the implementation of the HBEO. The average proportion of high-sugar ("red") beverages available per access point declined (-27.8%, p<.001). Beverage prices did not change over time. City agencies were significantly more likely to sell only low-sugar beverages after the HBEO was implemented (OR = 4.88; 95% CI, 1.49-16.0). DISCUSSION: Policies such as the HBEO can promote community-wide changes that make healthier beverage options more accessible on city-owned properties.

Legal Protections in Public Accommodations Settings: A Critical Public Health Issue for Transgender and Gender-Nonconforming People.

POLICY POINTS: Since 2012, Massachusetts law has provided legal protections against discrimination on the basis of gender identity in employment, housing, credit, public education, and hate crimes. The law does not protect against discrimination based on gender identity in public accommodations settings such as transportation, retail stores, restaurants, health care facilities, and bathrooms. A 2013 survey of Massachusetts transgender and other gender minority adults found that in the past 12 months, 65% had experienced public accommodations discrimination since the law was passed. This discrimination was associated with a greater risk of adverse emotional and physical symptoms in the past 30 days. Nondiscrimination laws inclusive of gender identity should protect against discrimination in public accommodations settings to support transgender people's health and their ability to access health care. CONTEXT: Gender minority people who are transgender or gender nonconforming experience widespread discrimination and health inequities. Since 2012, Massachusetts law has provided protections against discrimination on the basis of gender identity in employment, housing, credit, public education, and hate crimes. The law does not, however, protect against discrimination in public accommodations (eg, hospitals, health centers, transportation, nursing homes, supermarkets, retail establishments). For this article, we examined the frequency and health correlates of public accommodations discrimination among gender minority adults in Massachusetts, with attention to discrimination in health care settings. METHODS: In 2013, we recruited a community-based sample (n = 452) both online and in person. The respondents completed a 1-time, electronic survey assessing demographics, health, health care utilization, and discrimination in public accommodations venues in the past 12 months. Using adjusted multivariable logistic regression models, we examined whether experiencing public accommodations discrimination in health care was independently associated with adverse self-reported health, adjusting for discrimination in other public accommodations settings. FINDINGS: Overall, 65% of respondents reported public accommodations discrimination in the past 12 months. The 5 most prevalent discrimination settings were transportation (36%), retail (28%), restaurants (26%), public gatherings (25%), and health care (24%). Public accommodations discrimination in the past 12 months in health care settings was independently associated with a 31% to 81% increased risk of adverse emotional and physical symptoms and a 2-fold to 3-fold increased risk of postponement of needed care when sick or injured and of preventive or routine health care, adjusting for discrimination in other public accommodations settings (which also conferred an additional 20% to 77% risk per discrimination setting endorsed). CONCLUSIONS: Discrimination in public accommodations is common and is associated with adverse health outcomes among transgender and gender-nonconforming adults in Massachusetts. Discrimination in health care settings creates a unique health risk for gender minority people. The passage and enforcement of transgender rights laws that include protections against discrimination in public accommodations-inclusive of health care-are a public health policy approach critically needed to address transgender health inequities.

Industry Speed Bumps on Local Tobacco Control in Japan? The Case of Hyogo.

BACKGROUND: Despite being a signatory since 2004, Japan has not yet fully implemented Article 8 of the World Health Organization's Framework Convention on Tobacco Control regarding 100% protection against exposure to second-hand smoke (SHS). The Japanese government still recognizes designated smoking rooms (DSRs) in public space as a valid control measure. Furthermore, subnational initiatives for tobacco control in Japan are of limited effectiveness. Through an analysis of the Hyogo initiative in 2012, we identified key barriers to the achievement of a smoke-free environment. METHODS: Using a descriptive case-study approach, we analyzed the smoke-free policy development process. The information was obtained from meeting minutes and other gray literature, such as public records, well as key informant interviews. RESULTS: Hyogo Prefecture established a committee to propose measures against SHS, and most committee members agreed with establishing completely smoke-free environments. However, the hospitality sector representatives opposed regulation, and tobacco companies were allowed to make a presentation to the committee. Further, political power shifted against completely smoke-free environments in the context of upcoming local elections, which was an obvious barrier to effective regulation. Throughout the approving process, advocacy by civil society for stronger regulation was weak. Eventually, the ordinance approved by the Prefectural Assembly was even weaker than the committee proposal and included wide exemptions. CONCLUSIONS: The analysis of Hyogo's SHS control initiative shed light on three factors that present challenges to implementing tobacco control regulations in Japan, from which other countries can also draw lessons: incomplete national legislation, the weakness of advocacy by the civil society, and the interference of the tobacco industry.