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Smoke-free policies for multi-unit housing

Health Factors: Tobacco Use
Decision Makers: Community Members Employers & Businesses Local Government State Government Federal Government Public Health Professionals & Advocates
Evidence Rating: Expert Opinion
Population Reach: 20-49% of WI's population
Impact on Disparities: Likely to decrease disparities

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Description

Smoke-free multi-unit housing policies prohibit smoking in apartments, duplexes, and similar residences. Policies can apply to both common areas and individual units, and often include adjacent outdoor areas. Private sector rules apply to privately owned rental properties and owner-occupied units such as condo complexes; state and local ordinances apply to public and subsidized housing. Non-smoking residents of multi-unit housing are often exposed to secondhand smoke (SHS) in their homes from other units or common areas (Snyder 2016); the US Surgeon General indicates there is no risk-free level of SHS exposure (US DHHS SG-Smoking 2014). Residents, especially children, can also be exposed to thirdhand smoke (THS), tobacco residue on surfaces and furnishings, in their home (Bartholomew 2015, Matt 2011). Some local governments cannot enact smoke-free measures due to state preemption legislation (Grassroots Change).

Expected Beneficial Outcomes

Reduced exposure to secondhand smoke
Reduced exposure to thirdhand smoke
Reduced cigarette smoking
Increased quit rates
Reduced health care costs

Evidence of Effectiveness

Smoke-free multi-unit housing policies are a suggested strategy to reduce secondhand smoke (SHS) (Bartholomew 2015, MMWR-Homa 2015) and thirdhand smoke (THS) exposure among non-smokers (Bartholomew 2015). Smoking bans in multi-unit housing may increase smoking cessation (Pizacani 2012) and decrease cigarette consumption (Kennedy 2015, Pizacani 2012). However, additional evidence is needed to confirm effects (CG-Tobacco use).

Smoke-free multi-unit housing policies may also reduce smoke incursions and exposure. Residents of multi-unit housing in Portland, Oregon, for example, reported decreases in frequent indoor SHS exposure following policy implementation (Pizacani 2012). The effects of the Boston Housing Authority’s policy on SHS exposure are inconclusive (Levy 2015).

Surveys of property owners and housing managers in Minnesota, Oregon, and South Dakota indicate few, if any, difficulties enforcing smoke-free policies in multi-unit housing. Such policies also do not appear to affect vacancy or turnover rates, rental costs, or management time, and may lead to cost savings at converted properties due to lower and less frequent clean-up costs (Snyder 2016, Burdette 2014). Smoke-free multi-unit housing policies are supported by most housing residents that do not smoke or are former smokers (Snyder 2016, Drach 2010), and may be supported by some residents who smoke (Snyder 2016). 

Experts estimate that implementing smoke-free policies in public housing could save $153 million (King 2014) to $260 million per year, including at least $110 million in direct medical costs (Mason 2015). Prohibiting smoking in all US subsidized housing could save almost $500 million, including $310 million in health care costs, $134 million in renovation expenses, and $53 million in fire losses (King 2014).

Implementation

United States

As of 2015, 15 states prohibit or restrict smoking in common areas of multi-unit housing facilities that are government owned or funded, and 12 states prohibit or restrict smoking in common areas of privately owned housing facilities. Hawaii and Oklahoma restrict smoking in the individual living areas of government-operated buildings, and some communities in California prohibit smoking in individual units of some or all multi-unit housing (CDC STATE 2015-Smoking factsheet). State legislation pre-empts local government control of smoke-free policies in 12 states (Grassroots Change).

In late 2015, the US Department of Housing and Urban Development proposed a rule that would make all public housing properties entirely smoke-free (US HUD-Smoke-free rule).

Wisconsin

Wisconsin bans smoking in common areas of multi-unit housing (CDC STATE 2015-Smoking factsheet).

Implementation Resources

ALA-Smoke-free housing - American Lung Association (ALA). Smokefree policies in multi-unit housing: Steps for success. Accessed on February 10, 2017
CDC-Healthy Homes Manual - Centers for Disease Control and Prevention (CDC). Healthy homes manual: Smoke-free policies in multiunit housing. Accessed on November 4, 2016
ChangeLab-Smokefree housing - ChangeLab Solutions. Smokefree housing. Accessed on November 4, 2016
HealthPartners-CHA - HealthPartners Institute for Education and Research. Community health advisor (CHA): Resource for information on the benefits of evidence-based policies and programs: Helping communities understand, analyze, and model costs. Accessed on May 10, 2017
PHLC-Smoke-free housing - Tobacco Control Legal Consortium (TCLC). Smoke-free & tobacco-free places: Housing. Saint Paul: Public Health Law Center (PHLC). Accessed on November 4, 2016
US HUD-Smoke-free - US Department of Housing and Urban Development (HUD). Smoke-free multifamily housing. Accessed on February 27, 2017

Citations - Description

Bartholomew 2015* - Bartholomew KS. Policy options to promote smokefree environments for children and adolescents. Current Problems in Pediatric and Adolescent Health Care. 2015;45(6):146-181. Accessed on November 4, 2016
Grassroots Change - Grassroots Change. Connecting for better health. Accessed on February 13, 2017
Matt 2011* - Matt GE, Quintana PJ, Zakarian JM, et al. When smokers move out and non-smokers move in: residential thirdhand smoke pollution and exposure. Tobacco control 2011;20(1):e1. Accessed on November 16, 2016
Snyder 2016* - Snyder K, Vick JH, King BA. Smoke-free multiunit housing: A review of the scientific literature. 2016;25:9-20. Accessed on November 4, 2016
US DHHS SG-Smoking 2014 - US Department of Health and Human Services (US DHHS). The health consequences of smoking- 50 years of progress: A report of the Surgeon General, executive summary. 2014. Accessed on March 7, 2017

Citations - Evidence

Bartholomew 2015* - Bartholomew KS. Policy options to promote smokefree environments for children and adolescents. Current Problems in Pediatric and Adolescent Health Care. 2015;45(6):146-181. Accessed on November 4, 2016
Burdette 2014* - Burdette LK, Rowe GC, Johansen L, et al. A statewide assessment of smoke-free policy in multiunit housing settings. Nicotine & Tobacco Research. 2014;16(12):1593-1598. Accessed on November 4, 2016
CG-Tobacco use - The Guide to Community Preventive Services (The Community Guide). Tobacco. Accessed on May 15, 2017
Drach 2010 - Drach LL, Pizacani BA, Rohde KL, Schubert S. The acceptability of comprehensive smoke-free policies to low-income tenants in subsidized housing. Preventing Chronic Disease. 2010;7(3):A66. Accessed on November 15, 2016
Kennedy 2015* - Kennedy RD, Ellens-Clark S, Nagge L, et al. A smoke-free community housing policy: Changes in reported smoking behavior- Findings from Waterloo region, Canada. Journal of Community Health. 2015;40(6):1207-1215. Accessed on November 4, 2016
King 2014 - King BA, Peck RM, Babb SD. National and state cost savings associated with prohibiting smoking in subsidized and public housing in the United States. Preventing Chronic Disease. 2014;11:140222. Accessed on November 4, 2016
Levy 2015 - Levy DE, Adamkiewicz G, Rigotti NA, Fang SC, Winickoff JP. Changes in tobacco smoke exposure following the institution of a smoke-free policy in the Boston Housing Authority. PLoS ONE. 2015;10(9):e0137740. Accessed on November 4, 2016
Mason 2015 - Mason J, Wheeler W, Brown MJ. The economic burden of exposure to secondhand smoke for the child and adult never smokers residing in U.S. public housing. Public Health Reports. 2015;130(3):230-244. Accessed on November 4, 2016
MMWR-Homa 2015 - Homa DM, Neff LJ, King BA, et al. Vital signs: Disparities in nonsmokers' exposure to secondhand smoke & United States, 1999-2012. Morbidity and Mortality Weekly Report (MMWR). 2015;64(4):103-108. Accessed on November 4, 2016
Pizacani 2012* - Pizacani BA, Maher JE, Rohde K, Drach L, Stark MJ. Implementation of a smoke-free policy in subsidized multiunit housing: Effects on smoking cessation and secondhand smoke exposure. Nicotine & Tobacco Research. 2012;14(9):1027-1034. Accessed on November 4, 2016
Snyder 2016* - Snyder K, Vick JH, King BA. Smoke-free multiunit housing: A review of the scientific literature. 2016;25:9-20. Accessed on November 4, 2016

Citations - Implementation

CDC STATE 2015-Smoking factsheet - Centers for Disease Control and Prevention (CDC). STATE System Multiunit Housing Fact Sheet. 2015. Accessed on November 4, 2016
Grassroots Change - Grassroots Change. Connecting for better health. Accessed on February 13, 2017
US HUD-Smoke-free rule - US Department of Housing and Urban Development (US HUD). HUD secretary Castro announces new rule making public housing smoke-free. Accessed on February 27, 2017

Page Last Updated

November 16, 2016

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