Abstract
In 2018, the U.S. Department of Housing and Urban Development required public housing authorities to implement a smoke-free housing (SFH) policy that included individual apartments. We analyzed the policy implementation process in the New York City Public Housing Authority (NYCHA). From June–November 2019, we conducted 9 focus groups with 64 NYCHA residents (smokers and nonsmokers), 8 key informant interviews with NYCHA staff and resident association leaders, and repeated surveys with a cohort of 130 nonsmoking households pre- and 12-month post policy. One year post policy implementation, participants reported widespread smoking violations and multi-level factors impeding policy implementation. These included the shared belief among residents and staff that the policy overreached by “telling people what to do in their own apartments”. This hindered compliance and enforcement efforts. Inconsistent enforcement of illegal marijuana use, staff smoking violations, and a lack of accountability for other pressing housing issues created the perception that smokers were being unfairly targeted, as did the lack of smoking cessation resources. Resident support for the policy remained unchanged but satisfaction with enforcement declined (60.1% vs. 48.8%, p = 0.047). We identified multilevel contextual factors that are influencing SFH policy implementation. Findings can inform the design of strategies to optimize policy implementation.
Highlights
Exposure to secondhand smoke (SHS) is associated with significant adverse health effects and more than 40,000 deaths annually in the U.S [1,2] Despite large declines in SHS exposure over the last two decades, 58 million nonsmokers are still routinely exposed, primarily at home [1,3]
Residents in public housing report a disproportionately high smoking rate than the general U.S adult population (33.6% vs. 16.8%) [4] and they are more likely to live in multiunit housing, which place this group at elevated risk of exposure to SHS [5,6,7,8]
To reduce health disparities related to SHS exposure, the U.S Department of Housing and Urban Development (HUD) issued a rule requiring public housing authorities (PHAs) to implement a smoke-free housing (SFH) policy in July 2018 [9]
Summary
Exposure to secondhand smoke (SHS) is associated with significant adverse health effects and more than 40,000 deaths annually in the U.S [1,2] Despite large declines in SHS exposure over the last two decades, 58 million nonsmokers are still routinely exposed, primarily at home [1,3]. Home exposure is highest among low-income and racial/ethnic minorities, reflecting higher smoking prevalence and differential risks across housing environments. Residents in public housing report a disproportionately high smoking rate than the general U.S adult population (33.6% vs 16.8%) [4] and they are more likely to live in multiunit housing, which place this group at elevated risk of exposure to SHS [5,6,7,8]. To reduce health disparities related to SHS exposure, the U.S Department of Housing and Urban Development (HUD) issued a rule requiring public housing authorities (PHAs) to implement a smoke-free housing (SFH) policy in July 2018 [9]. Existing literature has concluded that the majority of multiunit housing residents support smoke-free building policies [10]. With more than 2 million people living in public housing, the potential public health impact of the SFH policy is substantial [11]
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