Smoke-Free Policy Disparities in Long-Term Care Facilities

Ellen J. Hahn, Kathy Rademacher, Amanda Bucher, Karlee Sine, Amanda T. Wiggins, Mary Kay Rayens

Research output: Contribution to journalArticlepeer-review

Abstract

Older adults in long-term care (LTC) facilities suffer disproportionately from health conditions caused or worsened by secondhand smoke. Long-term care facilities in many states and municipalities permit smoking. Americans for Nonsmokers’ Rights compiles data on smoke-free policies only in institutional facilities (e.g., nursing homes), but not in transitional (e.g., independent living) or community-based settings (e.g., adult day). A cross-sectional, observational study was conducted of smoke-free policies using cluster random sampling in Kentucky to compare differences in policy location of coverage and strength of smoke-free policies in institutional, transitional, and community-based LTC facilities by rural/urban status. Online or phone surveys of LTC administrators representing 306 facilities were conducted. Of the facilities sampled, 35.5% were institutional, 33.4% transitional, 25.1% community-based, and 6.0% multi-type. Only one in five (19.6%) facilities restricted smoking indoors and outdoors. Only 17.3% of the policies were comprehensive (i.e., prohibiting use of all tobacco products by all persons living, frequenting, or working in LTC facilities). Compared to transitional facilities, institutional and community-based facilities were more likely to have comprehensive policies and restrict smoking indoors and outdoors. Facilities located in rural communities were less likely to restrict smoking indoors or outdoors and less likely to have comprehensive smoke-free policies, reflecting a disparity in policy protections. Strong, consistent smoke-free policies and policy enforcement are needed to reduce the disparity in smoke-free protections for older adults, LTC employees, and visitors. More research is needed to investigate the best strategies for implementing and enforcing policies that completely restrict smoking in all LTC facilities.

Original languageEnglish
Pages (from-to)403-409
Number of pages7
JournalAmerican Journal of Health Promotion
Volume36
Issue number3
DOIs
StatePublished - Mar 2022

Bibliographical note

Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This publication was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR001998. The views expressed in the submitted article are our own and not an official position of the institution or funder.

Funding Information:
We express our appreciation and thanks to Sherry Culp, President, Kentucky State Long Term Care Ombudsman and Mary Crowley-Schmidt, Assistant Director, Bluegrass Area Agency on Aging, for their invaluable assistance in crafting survey items and connecting the research team with the organizations needed to help us recruit long-term facility administrators to complete the survey for this research study. The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This publication was supported by the National Center for Advancing Translational Sciences, National Institutes of Health, through Grant UL1TR001998. The views expressed in the submitted article are our own and not an official position of the institution or funder.

Publisher Copyright:
© The Author(s) 2022.

Keywords

  • long-term care facilities
  • populations
  • smoke-free policy
  • tobacco-free policy

ASJC Scopus subject areas

  • Health(social science)
  • Public Health, Environmental and Occupational Health

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