The Proposal for Smoke Free Public Housing

As pharmacy students in a city, we interact regularly with a wide variety of patient populations. It is not uncommon to speak with patients who live in government provided public housing and whose incomes fall below the poverty line. Unfortunately, most of these patients suffer from poor health outcomes. Home life and income are both social determinants of health; smoking rates are higher in these populations than the general population. In fact, though the US smoking rates have dropped in the general adult population to under 17%, yet it remains above 26% in populations with incomes below the poverty line. The effects of smoking reach even further because of secondhand smoke. Therefore, children and people nearby also suffer the consequences of their parents or neighbors smoking. In housing projects, 37% of children experience smoking related health problems simply by second hand smoke.

These are alarming statistics and the US Department of Housing and Urban Development (HUD) is taking action. By the end of 2016, HUD-provided housing will require non-indoor smoking to be listed in the lease agreement. This type of policy has the ability to impact more than 2 million individuals living in 954,000 government provided homes throughout the country. The Public Housing Authorities will be responsible for implementing this rule, and will not allow any form of lit cigars, cigarettes or pipes indoors. Residents will have to walk more than 25 feet away from the property in order to smoke. If a neighbor sees someone smoking, they are encouraged to report it. Though this seems like an intrusion on individual rights, the majority of current residents in public housing are in support of this new rule, as they are currently subjected to excessive second hand smoke through open windows and air vents from their neighbors.

In addition to the obvious health benefits of decreased smoking and second hand smoke, this plan also has several financial perks. A nation-wide effort would result in annual cost savings of $153 million, including $94 million in health care savings and $59 million in reduced poverty costs.

Implementation of a plan like this would help health professionals in the movement for smoking cessation all together. I believe making residents go outside in the cold to smoke rather than in the comfort of their own home will help push the patient to make the decision him/herself to quit. Pharmacists and other health professionals should jump on this opportunity and be ready to provide cessation resources to patients currently addicted to smoking who live in public housing.

Do you think a plan like this is feasible? Do you think this is violating a patient’s right to make personal lifestyle decisions?

 

Read the original article here.

Geller AC, Rees VW, Brooks DR. The Proposal for Smoke-Free Public Housing: Benefits, Challenges, and Opportunities for 2 Million Residents. JAMA. 2016;1380

Resistance to key HIV drug ‘concerningly common’

HIV has different phases through which the drug’s effectiveness decreases. As a first-line drug, Tenofovir, has been becoming less and less effective in population around the world. This raises concern, as first-line drug is needed to last a longer amount of time in  order to have it’s effectiveness in the treatment regimen. Patients in Africa are unable to afford second-line treatment medications even with the best treatment help from the doctors around with world. This causes patient adherence issues. HIV drugs need to be taken 85-90% of its treatment regimen, and if failed, it can cause drug resistance. Drug resistance in one patient can be a concern to other HIV patients as it is transmissible from one person to another. To avoid this, doctors are trying to reach out to patients and diagnose them at an earlier stage to reduce the cost in Africa and help them understand the importance of adherence.

I believe that this drug has a great ability to treat first phase of HIV in patients. But with drug resistance issues and financial needs in third world country, it makes it harder for this resistance to be constricted in one population. Resistance being able to spread from one person to another causes concerns in a population with less resources and becomes more important for the health care professionals in the that area to address that issue to the population. Physicians or pharmacist, the drug experts, are great resources that can help reduce the problem in this population as they can explain the potential side effects and treatment options to the population better than any other health professional.

Resistance to key HIV drug ‘concerningly common’ (2016, January 28). Retrieved February 11, 2016, from http://www.eurekalert.org/pub_releases/2016-01/ucl-rtk012516.php

http://www.eurekalert.org/pub_releases/2016-01/ucl-rtk012516.php