Support for smoke-free multi-unit housing policies among racially and ethnically diverse, low-income seniors in south florida

Open access: http://link.springer.com/article/10.1007/s10823-014-9247-4/fulltext.html Previous studies have gauged support for implementing smoke-free MUH policies in the United States, but none have specifically examined attitudes among racially and ethnically diverse seniors living in low-income MUH. As part of an evaluation of a Community Transformation Grant funded program, we surveyed senior residents 62 years of age and older (n = 807) in 24 low-income housing properties in Broward County, Florida, to assess residents’ smoking behaviors, exposure to SHS, and support for smoke-free MUH policies. The study sample was ethnically and racially diverse with Hispanics comprising more than 61% of the population, and 22% of the population identified as Black or other races. Although close to 22% of the sample were former smokers, only 9% of residents reported being current smokers. The majority of residents surveyed supported no-smoking policies: 75% support no-smoking policies for individual units; 77% supported no-smoking policies in common areas; and, 68% supported no-smoking policies in outdoor areas. Over 29% of residents surveyed reported being exposed to secondhand smoke entering their units from elsewhere in their building. In sub-group analysis, Hispanic residents were significantly more likely to support both indoor (84.3 vs. 76.5, p\u3c.05) and outdoor (80.0 vs. 67.4, p\u3c.01) policies compared to non-Hispanic residents. Support for smoke-free policies did not vary significantly by race. This study demonstrates that senior residents living in low-income MUH properties overwhelmingly supported the implementation of smoke-free policies

Smoke-free multi-unit housing policies reduce exposure to secondhand smoke among racially and ethnically diverse, low-income seniors

Conclusions. Considering the vulnerability of low-income seniors to SHS exposure, our findings are particularly relevant to residents, property owners/managers, and public health actors making decisions about smoke-free policies for MUH properties in which seniors reside

Supporting Medical Home Transformation Through Evaluation of Patient Experience in a Large Culturally Diverse Primary Care Safety Net.

CONTEXT: The prevalence of chronic disease in the United States is rapidly increasing, with a disproportionate number of underserved, vulnerable patients sharing the burden. The Patient-Centered Medical Home (PCMH) is a care delivery model that has shown promise to improve primary care and address the burden of chronic illness. OBJECTIVE: The purpose of this study was to (1) understand patient characteristics that might influence perceived patient experience in a large primary care safety net undergoing PCMH transformation; (2) identify community-level quality improvement opportunities to support ongoing transformation activities; and (3) establish a baseline of patient experience across the primary care safety net that could be used in repeated evaluations over the course of transformation. DESIGN: A cross-sectional study design was used to conduct this research. SETTING AND PARTICIPANTS: A total of 351 racially and ethnically diverse patients of 4 primary care safety net organizations in Broward County, Florida, were surveyed regarding their experience with access to care and coordination of care. MAIN OUTCOME MEASURE: Reported access to care and coordination of care. RESULTS: Patients with chronic disease who reported having visited the clinic 3 or more times in the past 12 months reported a better coordination of care experience than patients who had fewer than 3 visits in the past 12 months (odds ratio = 3.57; 95% confidence interval, 1.76-7.24). Patients without chronic disease who had been receiving care at the clinic for 2 or more years of care reported worse experience with access to care than patients with less than 2 years of care (odds ratio = 0.26; 95% confidence interval, 0.11-0.60.) Race, ethnicity, language, and education were not significant predictors of patient experience. CONCLUSION: Findings support ongoing efforts to improve patient engagement among all patients and to enhance resources to manage chronic disease, including community-based self-management programs, in primary care safety nets undergoing PCMH transformation

Supporting medical home transformation through evaluation of patient experience in a large culturally diverse primary care safety net

Prevalence of chronic disease in the United States is rapidly increasing, with a disproportionate number of underserved, vulnerable patients sharing the burden. The Patient Centered Medical Home (PCMH) is a care delivery model that has shown promise to improve primary care and address the burden of chronic illness in the United States. We evaluated patient experience among primary care safety-net providers in Broward County, Florida in order to understand patient characteristics associated with experience and to identify opportunities that could support PCMH transformation among providers. As part of the study we surveyed 351 culturally and ethnically diverse patients. Findings suggest that having a chronic disease, a greater number of primary care visits in the past 12 months, and receiving a referral to a chronic disease workshop were positively associated with better patient experience. Our study also suggests that race, ethnicity, language, and education are not strong predictors of patient experience. These findings will be used to inform county-wide transformation activities including patient engagement and support for a community-based chronic disease self-management network

Training early childcare providers in evidence-based nutrition practices improves nutrition environments, policies, and practices of early childcare centers

Introduction: Due to the amount of time and caloric intake large numbers of children experience in early childcare centers (ECC), plus the benefits of early-targeted anti-obesity interventions, ECCs and their nutrition environments are valuable public health arenas for preventing and addressing childhood obesity. We evaluated the extent to which training early childcare providers in the implementation of evidence-based nutrition practices improved the nutrition environments, policies, and practices of early childcare centers serving racially and ethnically diverse, low-income children in Broward County, Florida. Methods: To determine the extent to which the county-wide initiative improved the nutrition environments and policies of ECCs, we used the nutrition observation and document review portions of the Environment and Policy Assessment and Observation (EPAO) instrument to conduct observations of ECCs as part of a one-group pretest-posttest evaluation design. Our baseline and follow-up data collection consisted of two waves of observations (Spring 2013 and Spring 2014) of the same 18 ECCs by trained EPAO observers. Results: We found statistically significant improvements in the centers’ overall nutrition environments (p=.01). Specific significant gains were made within centers’ written nutrition policies (p=.03), nutrition education (.01), and provisions of fruits and vegetables (p=.05). Discussion: The findings from this evaluation support the idea that training early childcare providers in evidence-based nutrition practices can help improve the nutrition environments, policies, and practices of centers serving racially and ethnically diverse, low- income children. Methods. In Spring 2013 and Summer 2014, we surveyed residents (n=960) at 15 MUH properties as part of a repeated cross-sectional evaluation design. We tested for differences in reported SHS exposure among residents prior to and after implementation of the smoke-free policy. Results. Before policy implementation, 31.1% of residents reported SHS exposure within their apartments from elsewhere in or around their building. At follow-up, the percentage was 23.6% (p=0.017). In multivariate analysis of non-smoking residents after policy implementation, residents who reported having one or more comorbidities were two times more likely to report SHS exposure within their apartments than residents who did not report any comorbidities (aOR=2.23, 95% CI=1.12-4.40, p=0.022). Conclusions. Considering the vulnerability of low-income seniors to SHS exposure, our findings are particularly relevant to residents, property owners/managers, and public health actors making decisions about smoke-free policies for MUH properties in which seniors reside