A i dh d t b kAssessing secondhand tobacco smoke e pos re among personsAssessing secondhand tobacco smoke exposure among personsAssessing secondhand tobacco smoke exposure among personsAssessing secondhand tobacco smoke exposure among personsAssessing secondhand tobacco smoke exposure among personsAssessing secondhand tobacco smoke exposure among persons g p g pg p g pith d i t t t l illith d i t t t l illwith severe and persistent mental illnesswith severe and persistent mental illnesswith severe and persistent mental illnesswith severe and persistent mental illnesswith severe and persistent mental illnesspp

1 2 2 2Ok li CTC PhD MPH 1 2 J h JL PhD 2 M l h L 2Okoli CTC PhD MPH 1,2 Johnson JL PhD; 2 Malchy L 2Okoli CTC PhD MPH; 1,2 Johnson JL PhD; 2 Malchy L 2 Okoli, CTC., PhD, MPH; Johnson, JL., PhD; Malchy, L., , , ; , , ; y,1B i i h C l bi C f E ll f W H l h 2NEXUS R h U i U i f B i i h C l bi1British Columbia Centre of Excellence for Women’s Health; 2NEXUS Research Unit Univ of British Columbia1British Columbia Centre of Excellence for Women’s Health; 2NEXUS Research Unit Univ of British ColumbiaBritish Columbia Centre of Excellence for Women s Health; NEXUS Research Unit, Univ. of British Columbia British Columbia Centre of Excellence for Women s Health; NEXUS Research Unit, Univ. of British Columbia

B k dBackground Table 1 Sample Characteristics b Smoking Stat sBackground Table 2 Correlates of Perceived SHS Exposure By Smoking StatusTable 1 Sample Characteristics by Smoking StatusBackground Table 2 Correlates of Perceived SHS Exposure By Smoking StatusTable 1. Sample Characteristics by Smoking Status Background Table 2. Correlates of Perceived SHS Exposure By Smoking Statusp y gg p y g

l S l k S k iff * k S kTotal Sample Nonsmokers Smokers Difference* Nonsmokers SmokersTotal Sample Nonsmokers Smokers Difference Nonsmokers Smokers(n = 416) (n = 372) (n = 361) (n = 365)(n = 416) (n = 372) (n = 361) (n = 365)

S (S S)( ) ( )

% % %( ) ( )

B S E Odd 95%CI B S E Odd 95%CI•Secondhand tobacco smoke (SHS) exposure increases the n % n % n % p B S E Odds 95%CI B S E Odds 95%CI•Secondhand tobacco smoke (SHS) exposure increases the n % n % n % p B S.E Odds 95%CI B S.E Odds 95%CI( ) pGender (n = 776) < 0001 Genderrisk for cancer respiratory illness and cardiovascular disease Gender (n = 776) <.0001 Gender risk for cancer, respiratory illness, and cardiovascular disease. ( )M l 376 48 5 145 38 6 231 61 4 F l 56 26 1 72* 1 05 2 89risk for cancer, respiratory illness, and cardiovascular disease. Male 376 48.5 145 38.6 231 61.4 Female - - - - .56 .26 1.72* 1.05-2.89Male 376 48.5 145 38.6 231 61.4 Female .56 .26 1.72 1.05 2.89Female 400 51 5 250 62 5 150 37 5 Male b 1 0Female 400 51.5 250 62.5 150 37.5 Male b 1.0

I di id l ith d i t t t l ill (SPMI)•Individuals with severe and persistent mental illness (SPMI)•Individuals with severe and persistent mental illness (SPMI) p ( )h hi h ki l th th l Relationship Status (n = 775) 041 Educationhave a higher smoking prevalence than the general Relationship Status (n = 775) .041 Education have a higher smoking prevalence than the general M i d d li i ith / l 85 11 0 54 13 7 31 8 1 L th Hi h S h l Ed ti b 1 0g g p g Married and living with spouse/common law 85 11.0 54 13.7 31 8.1 Less than High School Education b - - - - 1.0population placing them at increased risk for related morbidity

ed d v g w spouse/co o w 85 .0 5 3.7 3 8. Less than High School Education 1.0population, placing them at increased risk for related morbidity Separated/Divorced 177 22 8 80 20 4 97 25 4 Some high school /High school 1 14 64 32 09 1 13population, placing them at increased risk for related morbidity Separated/Divorced 177 22.8 80 20.4 97 25.4 Some high school /High school -1.14 .64 .32 .09-1.13and mortality Widowed 28 3 6 16 4 1 12 3 1 T d tifi ti /S ll 1 10 67 33 09 1 23and mortality Widowed 28 3.6 16 4.1 12 3.1 Trade certification /Some college -1.10 .67 .33 .09-1.23and mortality.

Si l d i d 485 62 6 243 61 8 242 63 4ade ce t cat o /So e co ege . 0 .67 .33 .09 . 3

Single and never married 485 62 6 243 61 8 242 63 4 Completed College/University 95 68 39 10 1 48Single and never married 485 62.6 243 61.8 242 63.4 Completed College/University -.95 .68 .39 .10-1.48p g y

Gi th hi h ki l i thi l ti th•Given the higher smoking prevalence in this population the Ed i ( 781) 0001•Given the higher smoking prevalence in this population, the Education (n = 781) < 0001 P i Di ig g p p p , Education (n 781) <.0001 Primary Diagnosis - - - -risk for SHS exposure among smokers and nonsmokers with Less than High School Education 35 4 5 18 4 6 17 4 4

Primary Diagnosis risk for SHS exposure among smokers and nonsmokers with Less than High School Education 35 4.5 18 4.6 17 4.4 Schizophrenia -1 59 1 03 20 03-1 55s o S S e posu e a o g s o e s a d o s o e s t g

S hi h h l hi h h l l t d 332 42 5 134 34 0 198 51 2Schizophrenia -1.59 1.03 .20 .03-1.55

SPMI should be an issue of concern Yet SHS exposure in Some high school or high school completed 332 42.5 134 34.0 198 51.2 Schi oaffecti e disorder 1 29 1 08 28 03 2 28SPMI should be an issue of concern. Yet, SHS exposure in Some high school or high school completed 332 42.5 134 34.0 198 51.2 Schizoaffective disorder -1.29 1.08 .28 .03-2.28SPMI should be an issue of concern. Yet, SHS exposure in Trade certification or Some community college/University 203 26 0 105 26 6 98 25 3 dthi l ti i d t di dTrade certification or Some community college/University 203 26.0 105 26.6 98 25.3 Mood -1 75 1 03 17 02-1 32this population is understudied

y g yC it C ll /U i it l t d 211 27 0 137 34 8 74 19 1

Mood -1.75 1.03 .17 .02-1.32this population is understudied. Community College/University completed 211 27.0 137 34.8 74 19.1 Anxiety b 1 0Community College/University completed 211 27.0 137 34.8 74 19.1 Anxiety b 1.0y

Th f d i h l f Li i Sit ti ( 781)•The purpose of our study was to examine the correlates of Living Situation (n = 781) Age (in years) 01 01 99 97 1 02•The purpose of our study was to examine the correlates of g ( )i l

Age (in years) -.01 .01 .99 .97-1.02 - - - -p p yLive alone 415 53 1 202 51 0 213 55 3 < 0001

g ( y )SHS exposure in this population Our specific aims were to: Live alone 415 53.1 202 51.0 213 55.3 <.0001SHS exposure in this population. Our specific aims were to: Live with friends or family 214 27 4 132 33 3 82 21 3SHS exposure in this population. Our specific aims were to: Live with friends or family 214 27.4 132 33.3 82 21.3 Substances used in past 30 days 31 22 1 37 90 2 09 15 14 1 16 89 1 51y

Li i h 113 14 5 42 10 6 71 18 4Substances used in past 30 days .31 .22 1.37 .90-2.09 .15 .14 1.16 .89-1.51

Live in a group home 113 14 5 42 10 6 71 18 4p y

Live in a group home 113 14.5 42 10.6 71 18.4) D ib th f d f li t d Other (for e g homeless YMCA/Shelter) 39 5 0 20 5 1 19 4 9a) Describe the frequency sources and feelings towards Other (for e.g. homeless, YMCA/Shelter) 39 5.0 20 5.1 19 4.9a) Describe the frequency, sources, and feelings towards ( g , )

A i t h k) q y g

SHS i di id l ith SPMI i Acquaintances who smokeSHS exposure among individuals with SPMI accessing Acquaintances who smoke bSHS exposure among individuals with SPMI accessing Primary Diagnosis (n = 729) 004 Almost none b 1 0p g g Primary Diagnosis (n = 729) .004 Almost none 1.0

community mental health servicesy g ( )

S hi h i 338 46 4 152 45 0 186 55 0 Some 82 35 2 27* 1 16 4 47 83 44 2 28 97 5 37community mental health services Schizophrenia 338 46.4 152 45.0 186 55.0 Some .82 .35 2.27* 1.16-4.47 .83 .44 2.28 .97-5.37community mental health services Schizophrenia 338 46.4 152 45.0 186 55.0Ab h lf 6 4 1 4 61 4 99 1 0 4 4 * 2 18 13 63Schizoaffective disorder 98 13 4 52 53 1 46 46 9 About half 56 54 1 74 61-4 99 1 70 47 5 45* 2 18-13 63Schizoaffective disorder 98 13.4 52 53.1 46 46.9 About half .56 .54 1.74 .61 4.99 1.70 .47 5.45 2.18 13.63

M d 278 38 1 163 58 6 115 41 4 Most of them 1 72 45 5 58* 2 29 13 57 1 90 42 6 66* 2 95 15 03B A f t (i d d hi li i Mood 278 38.1 163 58.6 115 41.4 Most of them 1.72 .45 5.58* 2.29-13.57 1.90 .42 6.66* 2.95-15.03B Assess factors (i e gender demographics living Mood 278 38.1 163 58.6 115 41.4B Assess factors (i.e., gender, demographics, living Anxiety 15 2 1 5 33 3 10 66 7( g g p git ti i di i d b t hi t )

Anxiety 15 2.1 5 33.3 10 66.7situation primary diagnosis and substance use history)situation, primary diagnosis, and substance use history) , p y g , y)

i d i h SHS k d Number of sources of exposure 42 10 1 52* 1 25 1 83 24 07 1 28* 1 12 1 46associated with SHS exposure among smokers and Number of sources of exposure .42 .10 1.52* 1.25-1.83 .24 .07 1.28* 1.12-1.46associated with SHS exposure among smokers and Perceived frequency of exposure (n = 770)pp g Perceived frequency of exposure (n 770)

nonsmokers with SPMI accessing community mental health Low 549 71 3 309 78 2 240 64 0 < 0001nonsmokers with SPMI accessing community mental health Low 549 71.3 309 78.2 240 64.0 <.0001nonsmokers with SPMI accessing community mental health M d /hi h 221 28 7 86 21 8 135 36 0services Moderate/high 221 28 7 86 21 8 135 36 0 N t a l i bl th t i ifi tl i t d ith i d f f i th fi t t i l d d i th fi l d lservices Moderate/high 221 28.7 86 21.8 135 36.0 Note. a only variables that were significantly associated with perceived frequency of exposure in the first step are included in the final modelservices. y g y p q y p p

b f tb referent groupS f ( 788)

g pSources of exposure (n = 788)Sources of exposure (n 788)Where you live 296 37 6 113 28 4 183 46 9 < 0001Where you live 296 37.6 113 28.4 183 46.9 <.0001yO th t t t b t 507 64 3 290 72 9 217 55 6 < 0001On the street or at a bus stop 507 64.3 290 72.9 217 55.6 <.0001

C l iOn the street or at a bus stop 507 64.3 290 72.9 217 55.6 .0001

M th d ConclusionsAt your family’s home 109 13 8 48 12 1 61 15 6 145Methods ConclusionsAt your family s home 109 13.8 48 12.1 61 15.6 .145Methods Conclusionsy yAt f i d h 272 34 5 106 26 6 166 42 6 < 0001Methods ConclusionsAt your friends homes 272 34.5 106 26.6 166 42.6 <.0001Methods At your friends homes 272 34.5 106 26.6 166 42.6 .0001At a drop-in center 219 27 8 99 24 9 120 30 8 065At a drop-in center 219 27.8 99 24.9 120 30.8 .065At a coffee shop bar or resta rant** 397 50 4 193 48 5 204 52 3 284At a coffee shop, bar, or restaurant** 397 50.4 193 48.5 204 52.3 .284

SHS exposure among individuals with SPMI may be an issue of publicp, ,

k/ bli SHS exposure among individuals with SPMI may be an issue of public In a park/public space 369 46 8 200 50 3 169 43 3 052 S S e posu e a o g d dua s S ay be a ssue o pub cIn a park/public space 369 46.8 200 50.3 169 43.3 .052

A i l bt i d b l t ti i ti f health concernOther (for e g car school work) 130 16 5 81 20 4 49 12 6 003•A convenience sample was obtained by voluntary participation of health concern.Other (for e.g., car, school, work) 130 16.5 81 20.4 49 12.6 .003•A convenience sample was obtained by voluntary participation of health concern. ( g , , , )p y y p pindividuals from the population receiving mental health servicesindividuals from the population receiving mental health services Acquaintances who smoke (n = 774)individuals from the population receiving mental health services

Th i t t f hi hli ht d b ti i t iAcquaintances who smoke (n = 774)

(N = 788) The important sources of exposure highlighted by participants in ourq ( )

Al t 337 43 5 254 64 6 83 21 8 0001(N = 788) The important sources of exposure highlighted by participants in our Almost none 337 43.5 254 64.6 83 21.8 <.0001(N 788). p p g g y p pt d i di t th d f th t t d f t f

Almost none 337 43.5 254 64.6 83 21.8 <.0001study may indicate the need for the enactment and enforcement ofSome 178 23 0 76 19 3 102 26 8 study may indicate the need for the enactment and enforcement of Some 178 23.0 76 19.3 102 26.8

•Measures included: Demographics Primary Mental Healthy y

Ab t h lf 85 11 0 29 7 4 56 14 7•Measures included: Demographics, Primary Mental Health policies to curtail SHS exposure in outdoor public settingsAbout half 85 11.0 29 7.4 56 14.7Measures included: Demographics, Primary Mental Health policies to curtail SHS exposure in outdoor, public, settings.About half 85 11.0 29 7.4 56 14.7Diagnosis Smoking Status Substance Use Sources of SHS

policies to curtail SHS exposure in outdoor, public, settings.Most /All of them 174 22 5 34 8 7 140 36 7Diagnosis Smoking Status Substance Use Sources of SHS Most /All of them 174 22.5 34 8.7 140 36.7Diagnosis, Smoking Status, Substance Use, Sources of SHS

P i d F f SHS E N b fexposure Perceived Frequency of SHS Exposure Number of F t h ith d f SHS ( hexposure, Perceived Frequency of SHS Exposure, Number of Future research with sounder measures of SHS exposure (such asBothered by exposure (n = 770)p q y pA i t h k

Future research with sounder measures of SHS exposure (such as Bothered by exposure (n = 770)Acquaintances who smoke

p (i ti it bi k t ) h d t di fNot at all 243 31 6 46 11 7 197 52 4 < 0001Acquaintances who smoke nicotine monitors biomarkers e t c ) may enhance our understanding ofNot at all 243 31.6 46 11.7 197 52.4 <.0001q nicotine monitors, biomarkers, e.t.c.) may enhance our understanding of

A li l bi 166 21 6 82 20 8 84 22 3, , ) y g

A little bit 166 21 6 82 20 8 84 22 3D t A l i i l d d d i ti l i d t t d l the extent and impact of SHS exposure in this populationA little bit 166 21.6 82 20.8 84 22.3

•Data Analysis included a descriptive analysis and a two-step model the extent and impact of SHS exposure in this population.Somewhat 131 17 0 80 20 3 51 13 6Data Analysis included a descriptive analysis and a two step model the extent and impact of SHS exposure in this population.Somewhat 131 17.0 80 20.3 51 13.6y p y pb ildi d t d t i i bl t i l d i l i ti A d l 230 29 9 186 47 2 44 11 7building procedure to determine variables to include in a logistic A great deal 230 29 9 186 47 2 44 11 7building procedure to determine variables to include in a logistic A great deal 230 29.9 186 47.2 44 11.7g p g

f f f S Smodel assessing the correlates of perceived frequency of SHS Acknowledgement:model assessing the correlates of perceived frequency of SHS Acknowledgement:M SD M SD M SDg p q y Acknowledgement:Mean SD Mean SD Mean SD pexposure

Mean SD Mean SD Mean SD pexposure This research was supported by a grant from the National Cancer Institute ofNumber of sources of exposure (n = 788) 2 9 1 8 2 8 1 7 3 0 2 0 306exposure This research was supported by a grant from the National Cancer Institute of Number of sources of exposure (n = 788) 2.9 1.8 2.8 1.7 3.0 2.0 .306 pp y g

C d ith f d f th C di C S i t (#016334) S l t fp ( )

A (i 778) 48 7 12 1 50 1 12 4 47 2 11 6 003 Canada with funds from the Canadian Cancer Society (#016334). Salary support forAge (in years, n = 778) 48.7 12.1 50.1 12.4 47.2 11.6 .003 Canada with funds from the Canadian Cancer Society (#016334). Salary support for Age (in years, n 778) 48.7 12.1 50.1 12.4 47.2 11.6 .003CTCO on this project was provided by the CIHR-STIHR IMPART postdoctoralNumber of substances used in past 30 days (n = 771) 0 6 0 8 0 4 0 6 0 8 0 9 < 0001 CTCO on this project was provided by the CIHR-STIHR IMPART postdoctoral Number of substances used in past 30 days (n = 771) 0.6 0.8 0.4 0.6 0.8 0.9 <.0001 p j p y ptraineeshiptraineeshiptraineeship

N t *Diff b t k d k i b d hi l f t i l i bl d M Whit U t t f d d d t i l i blNote. *Differences between nonsmokers and smokers groups is based on chi-square analyses for categorical variables and Mann-Whitney U test for and ordered categorical variablesg p q y g y g** Of th ti i ff h b t t 5 3% f d t d i id th 78 3% d t id th d 16 3% t d** Of those reporting exposure in a coffee shop, bar, or restaurant, 5.3% of respondents were exposed inside the venue, 78.3% were exposed outside the venue, and 16.3% reported p g p p, , , p p , p , pexposure both inside and outside the venueexposure both inside and outside the venue.p