Legislation governing tobacco use in Ontario's retirement homes.

Legislation banning smoking in public places is a key component of comprehensive tobacco control programs, yet residential facilities for aging adults are often exempt from such legislation. In Ontario, Canada, provincial legislation does not comprehensively safeguard retirement homes' residents and staff from tobacco-related health and safety concerns. This study provides a descriptive analysis of municipal-level bylaws in order to begin understanding the regulatory context of tobacco use in retirement homes in the Province. A stratified random sample of retirement homes (n = 75) was selected. A rubric was developed highlighting various components that a model policy would include, to allow for the independent review of municipal-level bylaws governing these 75 homes. Results indicate that 75% of retirement homes were located in areas without municipal-level tobacco legislation that addressed retirement homes. The remaining 25% (n = 19 retirement homes) were governed by eight different municipal-level bylaws, all of which lacked in overall comprehensiveness. Amending Ontario's regulatory framework to eliminate loopholes and include retirement homes, as well as the creation and modification of municipal-level legislation, will aid in safeguarding smokers and nonsmokers from the dangers of tobacco-related risks, including secondhand smoke, fires, igniting cigarettes while connected to oxygen, burns to skin, and damage to clothing and property.

Glycemic and insulinemic responses to different preexercise snacks in participants with impaired fasting glucose.

PURPOSE: To compare serum glucose and insulin responses to 3 preexercise snacks before, during, and after exercise in individuals with impaired fasting glucose (IFG) and healthy (H) men. In addition, in an IFG population, the authors sought to determine whether a natural fruit snack (i.e., raisins) yields more desirable glucose and insulin concentrations than an energy bar or a glucose solution. METHODS: The IFG (n = 11, age = 54.5 ± 1.3 yr, fasting blood glucose [BG] = 6.3 ± 0.1 mmol/L) and H groups (n = 9, age = 48.0 ± 3.1 yr, fasting BG = 4.9 ± 0.1 mmol/L) cycled at 50% of VO2peak for 45 min on 4 occasions after consuming water or 50 g of carbohydrate from raisins (R), an energy bar (EB), or a glucose beverage (GLU). Metabolic markers were measured before, during, and after exercise. RESULTS: In all nutritional conditions, glucose concentrations of the IFG group were consistently higher than in the H group. Differences between IFG and H groups in insulin concentrations were sporadic and isolated. In the IFG group, preexercise glucose concentration was lower in the R condition than in GLU. Ten and 20 min into exercise, glucose concentrations in the R and EB conditions were lower than in GLU. Insulin concentrations were lower in the R condition than in EB and GLU immediately before exercise and at Minute 10 but at 20 min R remained lower than only GLU. CONCLUSION: Glucose concentrations were higher in the IFG group regardless of preexercise snack. Compared with the glucose solution, raisins lowered both the postprandial glycemic and insulinemic responses, whereas the energy bar reduced glycemia but not insulinemia.

An examination of policies addressing resident smoking in nursing homes.

OBJECTIVES: To report findings of a nationwide project that examined nursing homes' tobacco policies for residents. DESIGN: A random selection procedure was used to sample nursing homes proportional to the geographic distribution of nursing homes in the United States. Rubrics were developed to objectively describe and compare policies. SETTING: Policies were obtained from 4 types of facilities: (1) facilities that allow smoking indoors and outdoors (I/O-SFs), (2) facilities that allow residents to smoke outdoors only (O-SFs), (3) facilities that do not allow residents to smoke indoors or out of doors (NSFs), and (4) facilities in transition (TFs) from a smoking facility to an NSF. MEASURES: Rubrics used to score policies had common categories: administrative/authority issues, notification, resident smoking, safety, cessation assistance/encouragement, and smoking areas. Criteria within each category varied to reflect the smoking regulations of each type of facility (eg, policies of facilities that do not allow smoking indoors were not examined for inclusion of issues related to ventilation). RESULTS: Facilities' policies from geographically diverse facilities are described. Across all facilities, mean percentages reflecting policies' overall comprehensiveness were low, and when examining specific components of the policies, few areas were consistently addressed across facilities. CONCLUSIONS: Considerable gaps were found in written policies regarding smoking. Although nursing homes may in fact have practices that are more extensive than their policies portray, creating policies that guide practice can assist these long-term care facilities to promote an environment that aligns with their goals and desired practices to protect the health of residents and staff.

Attitudes toward giving smoking cessation advice among nursing staff at a long-term residential care facility.

The objective of this study was to provide a first assessment of (a) long-term care staffs' prevalence of and attitudes toward giving smoking cessation advice to residents and (b) predictors of advice giving. Results of a survey (N = 115) found that 54.8% of licensed nurses and 34.6% of nursing assistants reported ever advising. Advising was associated with job classification and believing that residents' problem lists should include smoking. Not advising was associated with believing advice is the physicians' responsibility. Staff somewhat endorsed risks of smoking and benefits of cessation for residents, smoking as a right and pleasure, and that some residents cannot make decisions about smoking. Staff moderately endorsed safety concerns: 36% wanted policy changes. Lack of institutional support and perceived residents' cessation disinterest were key barriers. The findings suggest that staff may be missing intervention opportunities and that institutional support of advising cessation may facilitate maintenance and improvement of nursing home residents' health.

Smoking history, knowledge, and attitudes among older residents of a long-term care facility.

In the absence of empirical literature from the resident perspective, this study provided a first assessment of smoking history, knowledge of the risks of smoking, the risks of environmental tobacco exposure, and the benefits of quitting among older (age 50+) nursing home unit residents, as well as readiness to quit, barriers to quitting, frequency of cessation advice by healthcare givers, and quit-attempt history of residents who smoke. Subjects were 25 smokers and 70 non-smokers housed on long-term nursing home units in a county hospital. Results indicated that smoking status for the majority of residents was similar to when they were admitted, although smokers smoked fewer cigarettes (M = 11.6, SD = 9.2) than prior to admission (M = 18.6, SD = 11.8). Smokers were less likely than non-smokers to agree that smoking is harmful to their health. Both smokers and non-smokers were not well informed of the dangers of passive smoke exposure. The majority of smokers were in precontemplation (no interest in quitting within the next 6 months). Fewer than half of residents who smoked reported receiving cessation advice from physicians (40%) or nurses (36%), and no in-house cessation programs were available. These results suggest gaps in knowledge and resources for smoking cessation in this setting and an opportunity for intervention. This study begins to build an evidence base from the residents' perspective that can be used by healthcare providers, administrators, and policy makers in addressing smoking in the nursing home.