Multiunit Housing Residents Research Articles

State Tobacco Control Program Implementation Strategies for Smoke-Free Multiunit Housing.

Multiunit housing residents are at risk of secondhand smoke exposure from adjoining units and common areas. We developed this case study to document state-level strategies undertaken to address this risk. We explored program documents to identify facilitators, barriers, and outcomes. Three states (Montana, Michigan, and Nebraska) provided detailed information on multiunit housing efforts in the study time frame. We conducted a qualitative analysis using inductive coding to develop themes. Several facilitators relating to existing infrastructure included traditional and nontraditional partnerships, leadership and champions, collecting and using data, efficient use of resources, and strategic plans. We also report external catalysts, barriers, and outcomes. Significant state leadership and effort were required to provide local-level technical assistance to engage traditional and nontraditional partners. Information needs were identified and varied by stakeholder type (i.e., health vs. housing). States recommend starting with public housing authorities, so they can become resources for affordable and subsidized housing. These lessons and resources can be used to inform smoke-free multiunit housing initiatives in other states and localities.

Secondhand Smoke Exposure and Smoke-Free Policy Support Among Public Housing Authority Residents in Rural and Tribal Settings.

Previous research has shown that multi-unit housing (MUH) residents are at risk of secondhand smoke (SHS) exposure, which can transfer between units. The purpose of this study was to determine SHS exposure and examine attitudes towards smoking policies among public housing authority (PHA) residents in rural and tribal settings. A self-administered questionnaire was completed by 895 adult tenants (41% response rate) living in PHA multiunit buildings in Montana in 2013. Our primary outcome was tenant support of smoke-free policies; our secondary outcome was exacerbation of child asthma symptoms due to SHS exposure. In 2014, we used multiple logistic regression models to test associations between independent variables and outcomes of interest. The majority (80.6%) of respondents supported having a smoke-free policy in their building, with support being significantly higher among nonsmokers [adjusted odds ratio (aOR) 4.2, 95% confidence interval (CI) 1.5-11.6] and among residents living with children (aOR 2.9, 95% CI 1.3-6.2). Tribal residents were as likely to support smoke-free policies as non-tribal residents (aOR 1.4; 95% CI 0.5-4.0). Over half (56.5%) of respondents reported SHS exposure in their home; residents in a building with no smoke-free policy in place were significantly more likely to report exposure (aOR 3.5, 95% CI 2.2-5.5). SHS exposure was not significantly associated with asthma symptoms. There is a significant reduction in exposure to SHS in facilities with smoke-free policies and there is strong support for such policies by both tribal and non-tribal MUH residents. Opportunities exist for smoke-free policy initiatives in rural and tribal settings.

Smoke-Free Multi-unit Housing Policies Show Promise in Reducing Secondhand Smoke Exposure Among Racially and Ethnically Diverse, Low-Income Seniors.

Secondhand smoke (SHS) exposure is a public health issue for residents of multi-unit housing (MUH) properties. We evaluated the impact of smoke-free policy implementation on reported SHS exposure among racially, ethnically diverse seniors living in low-income MUH properties. In Spring 2013 and Summer 2014, we surveyed residents (n=960) at 15 MUH properties in Broward and Miami-Dade Counties, Florida. The percentage of residents reporting SHS exposure within their apartments from elsewhere in or around their building decreased from 31.1%, before policy implementation, to 23.6% at follow-up (p=0.02). In multivariate analysis of non-smoking residents after policy implementation, residents who reported having one or more comorbidities were two times more likely to report SHS exposure (aOR 2.23, 95% CI 1.12-4.40). Considering the vulnerability of low-income seniors to SHS exposure, our findings are relevant to residents, property owners/managers, and public health professionals making decisions about smoke-free policies for MUH properties in which seniors reside.

Validity of Self-Reported Tobacco Smoke Exposure among Non-Smoking Adult Public Housing Residents.

IntroductionTobacco smoke exposure (TSE) in public multi-unit housing (MUH) is of concern. However, the validity of self-reports for determining TSE among non-smoking residents in such housing is unclear.MethodsWe analyzed data from 285 non-smoking public MUH residents living in non-smoking households in the Boston area. Participants were interviewed about personal TSE in various locations in the past 7 days and completed a diary of home TSE for 7 days. Self-reported TSE was validated against measurable saliva cotinine (lower limit of detection (LOD) 0.02 ng/ml) and airborne apartment nicotine (LOD 5 ng). Correlations, estimates of inter-measure agreement, and logistic regression assessed associations between self-reported TSE items and measurable cotinine and nicotine.ResultsCotinine and nicotine levels were low in this sample (median = 0.026 ng/ml and 0.022 μg/m3, respectively). Prevalence of detectable personal TSE was 66.3% via self-report and 57.0% via measurable cotinine (median concentration among those with cotinine>LOD: 0.057 ng/ml), with poor agreement (kappa = 0.06; sensitivity = 68.9%; specificity = 37.1%). TSE in the home, car, and other peoples’ homes was weakly associated with cotinine levels (Spearman correlations rs = 0.15–0.25), while TSE in public places was not associated with cotinine. Among those with airborne nicotine and daily diary data (n = 161), a smaller proportion had household TSE via self-report (41.6%) compared with measurable airborne nicotine (53.4%) (median concentration among those with nicotine>LOD: 0.04 μg/m3) (kappa = 0.09, sensitivity = 46.5%, specificity = 62.7%).ConclusionsSelf-report alone was not adequate to identify individuals with TSE, as 31% with measurable cotinine and 53% with measurable nicotine did not report TSE. Self-report of TSE in private indoor spaces outside the home was most associated with measurable cotinine in this low-income non-smoking population.

The impact of a smoke-free policy on environmental tobacco smoke exposure in public housing developments

BackgroundSmoke-free housing policies have the potential to reduce secondhand smoke (SHS) exposures for residents of multi-unit housing. Since common areas represent a pathway of SHS movement between units, smoke-free policies would be expected to reduce SHS in these microenvironments. MethodsWeek-long air nicotine and PM2.5 (particulate matter below 2.5μm in aerodynamic diameter) samples were collected in the common areas of 10 Boston Housing Authority (BHA) and 6 Cambridge Housing Authority (CHA) buildings from January 2012 to October 2013. We also measured one outdoor PM level at each study building. Samples from BHA included pre and post- smoke-free policy measurements. Each development was visited three times over the course of the study period. The effect of the smoking ban on indoor PM2.5 was examined using generalized mixed effect models to accommodate repeated measurement at each site. Changes in nicotine concentrations were modeled using quantile mixed regression to reduce the impact of outliers. ResultsAfter controlling for season, site, and background PM2.5 concentrations, PM2.5 levels were 4.05μg/m3 (p-value=0.09) lower in BHA after the smoke-free policy was implemented in the summer of 2012, compared with CHA developments, which had no smoking policy in place. Similarly, nicotine levels decreased by 57% (p-value=0.08) in Boston relative to Cambridge after the ban. ConclusionsOur findings support the use of smoke-free policies as an effective tool to reduce SHS exposure and protect non-smokers, especially residents of multi-unit housing.

Perceptions of Secondhand and Thirdhand Smoke Among Hispanic Residents of Multiunit Housing.

Despite the progressive adoption of smoking bans in public spaces, children living in multi-unit housing remain at risk of exposure to secondhand smoke (SHS) and thirdhand smoke (THS). Hispanic populations in California are particularly vulnerable to the harmful effects of SHS and THS because a large proportion of Hispanics live in multi-unit housing. Three focus groups were conducted in the fall of 2012 (in Spanish and English, N=24) to understand Hispanics' knowledge of and experiences with SHS and THS, including barriers to avoiding smoke exposure and strategies for protecting their homes from smoke. Hispanic residents reported unpleasant experiences with SHS and THS and were generally knowledgeable about the adverse health effects, although they were not familiar with the term "thirdhand smoke." Some participants also mentioned marijuana smoke as a potential health hazard. Hispanic cultural values made participants reluctant to confront their neighbors but also motivated them to find ways to protect their families from smoke. Potential solutions included working with the smokers to designate a smoking area and gaining support from the building owners. Broad smoking policies should be implemented to help Hispanic residents overcome cultural and social barriers to smoke free air.

Smoke-Free Policies in Multiunit Housing: Smoking Behavior and Reactions to Messaging Strategies in Support or in Opposition.

IntroductionGiven the high proportion of US adults living in multiunit housing (MUH) and the related risks of secondhand smoke, we examined correlates of having smoke-free MUH policies, level of support for such policies, and reactions to related messaging among a quota-based nonprobability sample of US adults.MethodsIn 2013, 752 adult MUH residents were recruited through an online survey panel to complete a cross-sectional survey assessing tobacco use, personal smoke-free policies in homes and cars, smoke-free MUH policies, and reactions to messaging on smoke-free MUH policies. We sought sufficient representation of smokers, racial/ethnic minorities, and residents of the Southeast.ResultsOverall, 56.3% had no smoke-free MUH policies and 16.2% had complete policies; 62.8% favored living in smoke-free MUH, and 28.9% said they would move if their building became smoke-free. Multivariate regression indicated that correlates of living in MUH with partial or no policies included younger age, less education, lower income, and current smoking (P’s ≤ .01); more restrictive smoke-free MUH policies were associated with lower cigarette consumption and recent quit attempts among current smokers (P’s < .05); and correlates of support for MUH policies included greater education, nonsmoker status, and having complete MUH policies (P’s < .05). Of 9 messages opposing smoke-free MUH policies, the most persuasive was “People have the right to smoke in their own homes”; the most persuasive message of 11 in support was “You have the right to breathe clean air in your home.”ConclusionSmoke-free MUH policies may reduce smoking. Messaging in favor of smoke-free MUH policies was more persuasive than messaging opposing such policies, indicating the potential for using these approaches.

Home exposure to secondhand smoke among people living in multiunit housing and single family housing: a study of California adults, 2003-2012.

Public health education efforts continue to encourage people to adopt voluntary smoking bans at home; nonetheless, the home remains a place where many people are exposed to secondhand smoke (SHS). Little is known about how SHS exposure in the home differs between adults residing in multiunit housing (MUH) and those residing in single family housing (SFH). This study (1) compared the socio-demographic characteristics, chronic disease conditions, and smoking status of adults living in MUH with those living in SFH, (2) assessed the correlates of living in MUH for adults, and (3) evaluated the association of residency in MUH and SFH with the odds of being exposed to SHS at home using population-based survey data of California adults. Smoking prevalence was significantly higher among MUH residents than SFH residents. The adjusted odds of exposure to SHS at home were 32 % higher for MUH smokers than SFH smokers but were not significantly different for non-smokers. This study presents evidence that there are significant socio-demographic differences between MUH residents and SFH residents and that MUH smokers have higher rates of exposure to SHS at home than SFH smokers after adjusting for other covariates. To reduce home exposure to SHS among MUH residents, it is important to adopt tobacco control policies that are aimed at reducing SHS exposure in and around MUH and at reducing cigarette smoking among current smokers in MUH.

National and state cost savings associated with prohibiting smoking in subsidized and public housing in the United States.

IntroductionDespite progress in implementing smoke-free laws in indoor public places and workplaces, millions of Americans remain exposed to secondhand smoke at home. The nation’s 80 million multiunit housing residents, including the nearly 7 million who live in subsidized or public housing, are especially susceptible to secondhand smoke infiltration between units.MethodsWe calculated national and state costs that could have been averted in 2012 if smoking were prohibited in all US subsidized housing, including public housing: 1) secondhand smoke-related direct health care, 2) renovation of smoking-permitted units; and 3) smoking-attributable fires. Annual cost savings were calculated by using residency estimates from the Department of Housing and Urban Development and cost data reported elsewhere. Data were adjusted for inflation and variations in state costs. National and state estimates (excluding Alaska and the District of Columbia) were calculated by cost type.ResultsProhibiting smoking in subsidized housing would yield annual cost savings of $496.82 million (range, $258.96–$843.50 million), including $310.48 million ($154.14–$552.34 million) in secondhand smoke-related health care, $133.77 million ($75.24–$209.01 million) in renovation expenses, and $52.57 million ($29.57–$82.15 million) in smoking-attributable fire losses. By state, cost savings ranged from $0.58 million ($0.31–$0.94 million) in Wyoming to $124.68 million ($63.45–$216.71 million) in New York. Prohibiting smoking in public housing alone would yield cost savings of $152.91 million ($79.81–$259.28 million); by state, total cost savings ranged from $0.13 million ($0.07–$0.22 million) in Wyoming to $57.77 million ($29.41–$100.36 million) in New York.ConclusionProhibiting smoking in all US subsidized housing, including public housing, would protect health and could generate substantial societal cost savings.

Tobacco smoke incursions in multiunit housing.

We sought to describe the prevalence of secondhand tobacco smoke incursions reported by multiunit housing (MUH) residents, pinpoint factors associated with exposure, and determine whether smoke-free building policy was associated with prevalence of reported tobacco smoke incursions. Data are from a 2011 nationally representative dual-frame survey (random-digit-dial and Internet panels) of US adults aged 18 years and older. Individuals who lived in MUH and who reported no smoking in their homes for the past 3 months, whether or not they reported being smokers themselves, were included in this study. Incursions were defined as smelling tobacco smoke in their building or unit. Of 562 respondents, 29.5% reported smoke incursions in their buildings. Of these, 16% reported incursions in their own unit, 36.2% of which occurred at least weekly. Government-subsidized housing and partial smoke-free policies were associated with a higher likelihood of reporting smoke incursions. Many residents of multiunit housing are exposed to tobacco smoke in their units and buildings. Partial smoke-free policies do not appear to protect residents and might increase the likelihood of incursions in residents' individual units.

Seasonal variability in environmental tobacco smoke exposure in public housing developments.

The risk of tobacco smoking and second-hand smoke (SHS) exposure combined are the leading contributors to disease burden in high-income countries. Recent studies and policies are focusing on reducing exposure to SHS in multiunit housing (MUH), especially public housing. We examined seasonal patterns of SHS levels within indoor common areas located on Boston Housing Authority (BHA) properties. We measured weekly integrated and continuous fine particulate matter (PM2.5) and passive airborne nicotine in six buildings of varying building and occupant characteristics in summer 2012 and winter 2013. The average weekly indoor PM2.5 concentration across all six developments was 9.2 μg/m3, higher during winter monitoring period (10.3 μg/m3) compared with summer (8.0 μg/m3). Airborne nicotine concentrations ranged from no detection to about 5000 ng/m3 (mean 311 ng/m3). Nicotine levels were significantly higher in the winter compared with summer (620 vs. 85 ng/m3; 95% CI: 72-998). Smoking-related exposures within Boston public housing vary by season, building types, and resident smoking policy. Our results represent exposure disparities that may contribute to health disparities in low-income communities and highlight the potential importance of efforts to mitigate SHS exposures during winter when outdoor-indoor exchange rates are low and smokers may tend to stay indoors. Our findings support the use of smoke-free policy as an effective tool to eliminate SHS exposure and protect non-smokers, especially residents of MUH.

Support for No-Smoking Policies Among Residents of Public Multiunit Housing Differs by Smoking Status

We compared perceptions of smoking and non-smoking Tacoma, WA multiunit public housing residents regarding smoke-free policies and in-home smoking rules. Two-hundred-twenty-nine completed surveys (~16% of units) of a modified version of the CDC's multiunit housing resident survey were analyzed. Smokers differed significantly (p < 0.05) from non-smokers with respect to agreement with policies that would ban smoking in homes (41% of smokers and 82% of non-smokers strongly agreed or agreed), in common indoor areas (74% of smokers and 82% of non-smokers strongly agreed or agreed), and for outdoor areas (38% of smokers and 68% of non-smokers strongly agreed or agreed). For in-home smoking rules, smokers and non-smokers again differed significantly (p < 0.05) with 53% of smokers and 90% of non-smokers not allowing smoking in their homes. Twenty-five percent of residents reported smelling secondhand smoke that infiltrated their residence from the outside on a daily basis. The most notable findings are that more than 50% of smokers do not allow smoking in their homes and that more than 50% of smokers are supportive of or neutral with respect to smoke-free policies for one's home. This suggests that implementation of smoke-free policies may not greatly impact vacancy rates even in populations with high rates of smoking (37% in this study).

National and State Estimates of Secondhand Smoke Infiltration Among U.S. Multiunit Housing Residents

Multiunit housing (MUH) residents are susceptible to secondhand smoke (SHS), which can infiltrate smoke-free living units from nearby units and shared areas where smoking is permitted. This study assessed the prevalence and characteristics of MUH residency in the United States, and the extent of SHS infiltration in this environment at both the national and state levels. National and state estimates of MUH residency were obtained from the 2009 American Community Survey. Assessed MUH residency characteristics included sex, age, race/ethnicity, and poverty status. Estimates of smoke-free home rule prevalence were obtained from the 2006-2007 Tobacco Use Supplement to the Current Population Survey. The number of MUH residents who have experienced SHS infiltration was determined by multiplying the estimated number of MUH residents with smoke-free homes by the range of self-reported SHS infiltration (44%-46.2%) from peer-reviewed studies of MUH residents. One-quarter of U.S. residents (25.8%, 79.2 million) live in MUH (state range: 10.1% in West Virginia to 51.7% in New York). Nationally, 47.6% of MUH residents are male, 53.3% are aged 25-64 years, 48.0% are non-Hispanic White, and 24.4% live below the poverty level. Among MUH residents with smoke-free home rules (62.7 million), an estimated 27.6-28.9 million have experienced SHS infiltration (state range: 26,000-27,000 in Wyoming to 4.6-4.9 million in California). A considerable number of Americans reside in MUH and many of these individuals experience SHS infiltration in their homes. Prohibiting smoking in MUH would help protect MUH residents from involuntary SHS exposure.

Attitudes, Experiences, and Acceptance of Smoke-Free Policies Among US Multiunit Housing Residents

We assessed factors related to smoke-free policies among a cross-sectional, nationally representative, random-digit-dial sample (landline and cell phone) of US multiunit housing residents (n = 418). Overall, 29% reported living in smoke-free buildings, while 79% reported voluntary smoke-free home rules. Among those with smoke-free home rules, 44% reported secondhand smoke incursions in their unit. Among all respondents, 56% supported smoke-free building policy implementation. These findings suggest that smoke-free building policies are needed to protect multiunit housing residents from secondhand smoke in their homes.

Secondhand Smoke Exposure among Hispanics/Latinos Living in Multiunit Housing: Exploring Barriers to New Policies

Despite a high prevalence of voluntary home smoking bans and laws protecting Californians from exposure to secondhand smoke (SHS) in the workplace, many Hispanic/Latino (H/L) residents of multiunit housing (MUH) are potentially exposed to SHS from neighboring apartments. An advocacy/policy intervention was implemented to reduce tobacco-related health disparities by encouraging H/L living in MUH to implement voluntary policies that reduce exposure to SHS. This article presents findings from qualitative and quantitative data collected during development of the intervention, as well as preliminary results of the intervention. MUH residents in Southern California participated in focus groups (n = 48), door-to-door surveys (n = 142), and a telephone survey (n = 409). Exposure to SHS, attitudes toward SHS, and attitudes toward policies restricting SHS in MUH were assessed. H/L MUH residents reported high levels of exposure to SHS and little ability to protect themselves and their families from SHS. Respondents expressed positive attitudes toward adopting antismoking policies in MUH, but they also feared retaliation by smokers. The cultural values of familismo, respeto, simpatía, and personalismo influenced their motivation to protect their families from SHS as well as their reluctance to ask their neighbors to refrain from smoking. Nonsmokers were more likely to favor complete indoor and outdoor smoking bans in MUH, whereas smokers were more likely to favor separate smoking areas. The Regale Salud advocacy/policy intervention, implemented to reduce SHS exposure, prompted the passage of seven voluntary policies in apartment complexes in Southern California to prevent smoking in MUH. H/L in California support voluntary policies, local ordinances, and state laws that prevent exposure to SHS in MUH, especially those that are consistent with H/L cultural values and norms for interpersonal communication.

Multiunit housing residents' experiences and attitudes toward smoke-free policies

Secondhand smoke (SHS) causes significant disease and death. A person's home represents a prominent source of SHS, and the potential for exposure is elevated among those who live in close proximity to smokers in multiunit housing (MUH). This study assessed the prevalence and predictors of SHS exposure and smoke-free policy support among MUH residents. Data were obtained from 5,936 MUH residents who participated in the New York State Adult Tobacco Survey between May 2007 and May 2009. Bivariate analyses were used to assess the prevalence of smoke-free home policies, SHS incursions, and support for smoke-free policies. Logistic regression was used to identify predictors of these measures while adjusting for gender, age, ethnicity, education, region, children in household, and housing type. A total of 73.1% of respondents reported a personal smoke-free home policy in their home. Among these individuals, 46.2% indicated that SHS has ever entered their home in the past year, while 9.2% reported daily incursions. Overall, a majority of respondents (55.6%) support a policy that bans smoking in all areas of their building, including residential units; support was significantly higher among ethnic minorities and individuals who reside with children. Nearly half of New York MUH residents with a smoke-free home policy have experienced a SHS incursion in their home. Since a majority of MUH residents support smoke-free policies and nearly three quarters already prohibit smoking in their home, opportunities exist for initiatives to promote smoke-free building policies.

Legal Options for Condominium Owners Exposed to Secondhand Smoke

As scientific warnings about the hazards of secondhand tobacco smoke grow stronger, condominium owners, along with other residents of multi-unit housing, are becoming increasingly concerned about involuntary exposure to drifting smoke from adjacent units. These concerns are justified. U.S. Surgeon General Richard Carmona recently warned in a comprehensive scientific report that breathing even a little secondhand smoke can be harmful. Secondhand smoke contains more than 4,000 chemicals and more than 50 carcinogens. This article describes legal options available to a condominium owner exposed to drifting secondhand smoke from a neighboring condominium unit. Section I describes preliminary steps an owner should take in preparation for any legal action. Section II discusses legal options available under the Federal Fair Housing Act, the Americans with Disability Act, and state disability laws. Section III briefly reviews the use of arbitration or mediation. Section IV examines legal theories that could be used in a lawsuit against the neighbor or the condominium association. The article concludes with observations about the implementation of smoke-free policies for condominium complexes.

Residential Water Demand in a Fast-growing Metropolis: The Case of Honolulu, Hawaii

Multi-unit housing residents are important consumers of fresh water in the City and County of Honolulu (CCH). This study examined water use in private multi-unit residences as well as Hawaii Housing Authority (HHA) multi-units in relation to variables such as price of water, number of units, income of residents, etc. using monthly water use data of the top 100 Honolulu Board of Water Supply (BWS) water users. The generalized least squares (GLS) procedure was used to estimate the regressionequations, although the results of ordinary least squares (OLS) estimation are also presented.Based on the results, inducing lower water use by raising the water price appeared somewhat feasible in the case of private multi-unit residences. The same was not, however, true in the case of HHA housing units. A long-term plan to make the water users (who have so far been shielded from bearing the cost directly) pay for water directly (by installing water meters for individual units) has been suggested to promote the prudent use of water.