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Assessing Smoke-Free Housing Implementation Approaches to Inform Best Practices: A National Survey of Early-Adopting Public Housing Authorities

Ellen Childs, Abt Global; Alan C. Geller, Jessica Davine, and Vaughan W. Rees, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health; Daniel R. Brooks, Department of Epidemiology, Boston University School of Public Health; John Kane, Boston Housing Authority; Robyn Keske, Football Players Health Study; and Jodi Anthony, Mathematica (now at Abt Global)


August 18, 2022

Chronic secondhand smoke (SHS) exposure is associated with serious health challenges, particularly in children, the elderly, and those with compromised immune systems. SHS’ capacity to travel from one unit to the next  means multi-unit dwellings are a major site of SHS exposure. In the U.S., SHS exposure is dramatically more prevalent among people living below the poverty level (47.9 percent) compared with those at or above the poverty level (21.2 percent). Because socioeconomically disadvantaged people are more likely to live in multi-unit dwellings, and because this population has above-average higher smoking rates, SHS exposure is recognized as an important driver of health disparities.

To address persistent disparities in SHS exposure among residents of federally assisted public housing, the U.S. Department of Housing and Urban Development (HUD) adopted a rule requiring Public Housing Authorities (PHAs) to implement smoke-free housing policies. To identify a best practice framework, Abt’s Drs. Ellen Childs, Jodi Anthony and partners conducted this study—the first national assessment of PHAs that had voluntarily adopted a smoke-free policy.

The findings, when considered in the context of existing research, suggest a set of “universal” approaches used by housing officials to implement smoke-free policies:

  1. Engaging residents, including measuring resident support for the efforts and involving them in policy decision-making,
  2. Providing tenants access to smoking cessation resources and services,
  3. Providing staff training on anti-smoking policies,
  4. Partnering with external organizations, such as departments of public health and the American Lung Association to provide technical assistance and training,
  5. Enforcing the policy (e.g., defining violations and resulting penalties), and
  6. Supporting policy adherence among residents by implementing the policy in a flexible and supportive way.

The article provides regional data on the implementation of policies and offers suggestions for future research and other potential best practices.

Learn more about the project at Building Success: Implementing Effective Smoke-Free Housing Policies.