Reduced exposure to secondhand smoke at casinos in Puerto Rico after the implementation of a workplace smoking ban in 2007: a pre-post design.

OBJECTIVE: Tobacco use and the involuntary exposition to secondhand smoke (SHS) is one of the leading causes of cancer. The objective of this study was to assess the effect of the smoke free workplace ban implemented in March of 2007 in Puerto Rico on the exposure of casino workers to secondhand smoke measured in terms of fine particulate matter and cotinine level. METHODS: This study used a pre-post comparison design to measure exposure to secondhand smoke before (February, 2007) and after (December, 2007 to February, 2008) the workplace smoking ban was implemented. The samples included level of cotinine in saliva from 20 randomly sampled casino union workers and indoor concentrations of fine particulate matter (2.5 microm diameter, PM2.5) in 10 casinos located in the San Juan metropolitan area. Paired t-tests were used to test any statistically significant change in particulate matter and cotinine levels before and after the ban went into effect. RESULTS: The average PM2.5 level in San Juan metropolitan area casinos decreased by 88.5% (95% CI: 63.9%, 96.3%) and the average cotinine level for the sample of nonsmoking casino workers decreased by 52.1% (95% CI: 40.6%, 61.4%). Both reductions were statistically significant (p < 0.01). CONCLUSION: The implementation of the smoke free workplace ban in 2007 resulted in a significant reduction of the exposure to secondhand smoke to casino workers in the San Juan metropolitan area of Puerto Rico.

The effect of the smoke-free workplace policy in the exposure to secondhand smoke in restaurants, pubs, and discos in San Juan, Puerto Rico.

BACKGROUND: Tobacco use and the involuntary exposition to secondhand smoke (SHS) is one of the leading causes of all cancers in the world. The objective of this study was to assess the effect of the smoke-free workplace policy implemented in March of 2007 in Puerto Rico on the exposition to secondhand smoke in restaurants, pubs, and discos of the metropolitan area of San Juan, Puerto Rico. METHODS: The study used a pre-post comparison design on a random sample of 55 establishments (32 restaurants and 23 pubs and discos) in the metropolitan area of San Juan, Puerto Rico. Measurements of indoor concentrations of fine particulate matter (PM) (2.5 mm diameter, PM2.5) were taken before and after the introduction of the law banning smoking using a SidePak AM510 Personal Aerosol Monitor (TSI Company). Also, data on the number of smokers, number of customers, and establishment area was collected. Paired t-tests and linear regression analyses were used to test any statistically significant effect of the law. RESULTS: After the smoking ban was implemented, restaurants experienced an 83.6% (p = 0.013) reduction in the mean of PM 2.5 levels, from 0.169 to 0.028 mg/ m3, and pubs and discos experienced a 95.6% (p = 0.004) reduction, from 0.626 to .028 mg/m3. CONCLUSION: The implementation of the smoke-free workplace policy considerably reduced the exposition to SHS of workers and customers in the restaurants, pubs, and discos of the metropolitan area of San Juan, Puerto Rico.

The effect of Medicaid managed care on prenatal care: the case of Puerto Rico.

OBJECTIVES: From 1994 to the year 2000 the government of Puerto Rico implemented a health care reform which included the mandatory enrollment of the entire Medicaid eligible population under Medicaid managed care (MMC) plans. This study assessed the effect of MMC on the use, initiation, utilization, and adequacy of prenatal care services over the reform period. METHODS: Using the vital records of all infants born alive in Puerto Rico from the year 1995-2000, a series of bivariate and multivariate analyses were conducted to assess the effect of insurance status (traditional Medicaid, MMC, private insurance and uninsured) on prenatal care utilization patterns. In order to assess the potential influence of selection bias in generating the health insurance assignments, propensity scores (PS) were estimated and entered into the multivariate regressions. RESULTS: MMC had a generally positive effect on the frequency and adequacy of prenatal care when compared with the experience of women covered by traditional Medicaid. However, the PS analyses suggested that self-selection may have generated part of the observed beneficial effects. Also, MMC reduced but did not eliminate the gap in the amount and adequacy of prenatal care received by pregnant women covered by Medicaid when compared to their counterparts covered by private insurance. CONCLUSIONS: The Puerto Rico Health Reform to implement MMC for pregnant women was associated with a general improvement in prenatal care utilization. However, continued progress will be necessary for women covered by Medicaid to reach prenatal care utilization levels experienced by privately insured women.