AND THAT a detailed transition policy BE DEVELOPED and communicated to all tenants by December 31, 2016.

Transcription

1 TO: FROM: Chair and Members Community Services Committee Rick Williams Commissioner of Community Services DATE: August 8, 2016 SUBJECT: Smoking Policy in Social Housing REPORT NO: CS RECOMMENDATION THAT The District Municipality of Muskoka ESTABLISH a smoke free policy for all District operated or managed social housing buildings to be achieved incrementally beginning January 1, 2017; AND THAT a detailed transition policy BE DEVELOPED and communicated to all tenants by December 31, AND THAT this transition policy address existing leases, designated outside areas, penalties and other matters necessary to achieve the smoke free goal; AND THAT a Smoke Free Coordinating Committee BE ESTABLISHED in September, 2016, comprised of tenant representatives, District staff and representatives from public health supports. ORIGIN At the May, 2016 Community Services Committee meeting, the following motion was approved: THAT staff BE DIRECTED to investigate an initiative that would eliminate smoking in Social Housing Buildings; AND THAT staff prepare a report for Committee's consideration on the matter within a three month time period. This motion was subsequently endorsed by District Council in June. Page 1

2 ANALYSIS The issue of smoking restrictions is not new and there is considerable precedent on policy development and evaluation in a wide range of sectors. For social housing in Ontario, the development has been somewhat mixed. Some municipalities have moved forward dramatically (for example, Waterloo Region instituted a process toward smoke free social housing in 2009). Others, including Muskoka, have awaited more general guidelines and by-laws impacting all persons. Concerns have long been expressed by social advocates and poverty advocates that there should not be increased or unusual restrictions on people simply by the fact they are poor or utilize public services. However there is now strong consensus that social housing/affordable housing areas could well transition to smoke free status. From the previous work in other jurisdictions, it seems apparent that a successful initiative includes: A clear statement of Goal or Outcome. A clear definition of transition to that outcome and supports available. In some locations, the process was assisted by a coordinating committee comprised of stakeholder groups including tenants. The recommendation above meets all the criteria above. Attached are materials related to the Region Municipality of Waterloo policy and a 3 year evaluation of their policy implementation. FINANCIAL CONSIDERATIONS There are no financial considerations at this time. Any costs would be identified through the 2017 Budget process. COMMUNICATIONS Communication with the existing social housing tenants will be necessary. Many will support this goal. For those with concerns, there will be a transition strategy and an opportunity to contribute their suggestions through a committee. STRATEGIC PRIORITIES Reporting on Smoking Policy in Social Housing supports the following goal as outlined in the District of Muskoka s Strategic Priorities: 6. Efficiently deliver community and human services with compassion and dignity while meeting the unique needs of those being served. Focus the measurement of program success on outcomes for the various client programs. Respectfully submitted, Original signed by Rick Williams Commissioner of Community Services Original signed by Michael Duben Chief Administrative Officer Page 2

3 WATERLOO REGION HOUSING Region of WaerIoo Introduction The health of tenants, staff and service personnel is very important to and we would like to do our part in protecting people from exposure Therefore, we have implemented a Smoke-Free Policy. the Region of Waterloo. to second-hand smoke. This Smoke-Free Policy is in effect for all Waterloo Region Housing (WRH) and Region of Waterloo Community Housing Inc. (ROWCHI) buildings/units. All new tenants, as well as current tenants who transfer to another WRH or ROWCHI unit on or after April 1, 2010, must follow this Policy as outlined in the lease agreement they have signed. Tenants who have signed lease agreements before April 1, 2010, must follow the section of the Policy that applies to smoking outside only as well as existing restrictions related to smoking in common areas. Policy New tenants and transfers, and their guestslvisitors: New tenants, transfers, and their guests/visitors are not allowed to smoke or hold lit tobacco of any kind (cigarettes, pipes, cigars, etc.) anywhere on their Leased Premises. This means inside their rental unit, on balconies or patios. When smoking outside all tenants and their guests/visitors must be at least five (5) metres away from any windows, entrances or exits to the building. Non-smoking and smoking areas will be clearly marked and ashtrays provided outside apartment buildings. Current tenants: Tenants who have signed lease agreements before April 1, 2010, will be grandfathered (exempt) from the section of the Policy that applies to smoking indoors as long as they continue to live in the same unit. This means they can continue to smoke in their rental unit, on balconies and patios. If they transfer to another unit that is owned by WRH or ROWCHI, a new lease agreement must be signed, and the Smoke-Free Policy will apply in its entirety as it does to a new tenant. When smoking outside, all tenants (including current tenants) and their guests/visitors must be at least five (5) metres away from any windows, entrances or exits to the building. Non-smoking and smoking areas will be clearly marked and ashtrays provided outside apartment buildings Page 3

4 Current tenants who wish to follow the Smoke-Free Policy can sign a new lease that includes the Smoke-Free Policy. This can be arranged by contacting your Property Manager or Community Relations Worker. Note: The Region of Waterloo also has a No-Smoking Bylaw which states that smoking in public areas of buildings (such as hallways, stairwells, common rooms and lounges) is not allowed. Exemptions to the Smoke-Free Policy Medicinal use of Marijuana The Smoke-Free Policy does not prohibit the smoking of marijuana for medicinal use for those who are suffering from grave and debilitating illnesses. Tenants who fall under this exemption must have Authorization to Possess, which is issued by Health Canada. A copy of the Authorization to Possess must be given to WRH staff and will be kept on file. Traditional Use of Tobacco The Smoke-Free Policy does not prohibit an Aboriginal person from smoking or holding lit tobacco if the activity is carried out for traditional Aboriginal cultural or spiritual purposes, nor does it prohibit a non-aboriginal person from smoking or holding lit tobacco if the activity is carried out with an Aboriginal person for traditional Aboriginal cultural or spiritual purposes. The sacred use of tobacco does not include the recreational use of tobacco. Complaints Tenants who wish to complain about an individual or household that is violating the Smoke-Free Policy must submit their complaint, in writing, to Waterloo Region Housing. The name of the person who is submitting the complaint must be included in the letter the complaint cannot be made anonymously. Staff from Waterloo Region Housing will follow up on any and all complaints. Current tenants who are grandfathered (exempt) from this Smoke-Free Policy when smoking indoors are reminded that they must follow the Policy when smoking outdoors, and that other tenants still have the right to complain about them should they substantially interfere with the reasonable enjoyment of the residential complex by their neighbours Page 4

5 SMOKE-FREE HOUSING POLICY EVALUATION Findings of the 2013 Waterloo Region Housing Tenant Survey Report to the Regton of Waterloo Community Services Committee Prepared by: Ryan David Kennedy, PhD Stephanie Ellens-Clark, MSW Pamela Kaufman, PhD Ornell Douglas, MPH PROPEL CENTRE FOR POPULATION HEALTH IMPACT Unvers;ty of Water oo Aatertoo. Ontaro Page 5

6 This report was prepared by Ryan David Kennedy, Stephanie Ellens-Clark, Pamela Kaufman, and Omell Douglas with review by the Region of Waterloo Smoke4ree Housing Evaluation Committee which includes employees from Waterloo Region Housing and Region of Waterloo Public Health. Matt Grey, Stephanie Filsinger and Kayla Snyder of the Propel Centre for Population Health Impact provided assistance in the preparation of this document Region of Waterloo Suggested Citation: Kennedy RD, Ellens-Clark S, Kaufman P, Douglas Smoke-free Housing Policy Evaluation - Findings of the 2013 Waterloo Region Housing and Region of Waterloo Community Housing Inc. Household Tenant Survey. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo. This report is available online at PROPEL CENTRr ror PC PU L AT ION HEALTH :MPArZT, (j Sori(té? Cancer raliadieline Society dii cancer UNIVERSITY OF WATERLOO Page 6

7 Smoke-free Housing Policy Evaluation Highlights The 2013 Waterloo Region Housing Household Tenant Survey Below are some key findings from the 2013 survey mailed to every household managed by Waterloo Region Housing in March The smoke-free policy was passed by Region of Waterloo Council in October 2009 and was approved by the Region of Waterloo Community Housing Inc. Board of Directors in November A pre-policy survey was conducted prior to the policy enactment on April 1st, 2010 and is reported elsewhere. A second survey was conducted after the policy was implemented, in April 2011 and is also reported elsewhere. The 2013 survey was completed by 619 households: 478 respondents indicated that the household had no smokers; 109 indicated that their household had one or more smokers; and 32 households did not indicate the smoking status of the members of their household. 50% of all respondents reported that they, or others in their household, are sometimes or often exposed to second-hand smoke (SHS) in their home. 44% of respondents reported someone in their household has health problems that get worse when they breathe SHS. The majority of respondents, 79%, reported they support the Region of Waterloo smoke-free housing policy. o Support was approximately 90% from households with no smokers and approximately 32% from households with a person who smokes Most respondents reported they already have households that are 100% smoke-free inside (88%) and on their patio or balcony (73%). o o 94% of households with no smokers are 100% smoke-free inside, and 49% of households with smokers are 100% smoke4ree inside; this represents a significant increase from the 2011 survey results 89% of households with no smokers are 100% smoke4ree on their balconies/patios while 28% of households with a smoker are 100% smoke-free on their outdoor spaces When asked how their smoking has changed since the smoke-free policy, 28% of smokers who have grandfathered leases (n=50) reported they smoke less since the policy was implemented and 8% said they have quit smoking (n= 7). For tenants who have always had a smoke-free lease, 37% (n=1 5) report they smoke less and 17% (n=7) report they have quit. Among all respondents who smoke, 45% reported that they tried to quit in the last year. 26% of respondents who smoke reported that because of the new policy they are more likely to go outside to smoke. Page 7

8 BACKGROUND Waterloo Regional Housing (WRH) Smoke-free Housing Policy Evaluation Survey 2013 In October, 2009, Region of Waterloo Council approved a smoke-free housing policy. This policy came into effect on April 1, 2010 and made all new leases signed with Waterloo Region Housing in all buildings and properties 100 per cent smoke-free. These restrictions are applied to all living spaces in the lease, including patios and balconies. This smoke4ree housing policy also restricted smoking outdoors at all properties in the portfolio to a distance of five metres away from any window, entrance or exit to the building/unit; outdoor restrictions applied to all tenants and visitors. Region of Waterloo Community Housing Inc. (ROWCHI) Board of Directors voted and passed the same policy on November 27, ROWCHI housing has since been included with WRH. As per Ontario law, tenants with existing leases were grandfathered meaning tenants who had previously been allowed to smoke in their units, including on the balcony or patio, would still be permitted to do so. This was the first policy in Ontario to make an entire housing portfolio smoke-free, and one of the first in Canada. Region of Waterloo Council requested that regional employees support other local community housing providers to implement similar smoke-free policies. A committee was created to evaluate aspects of the new smoke-free policy. The evaluation committee consists of membership from Waterloo Region Housing, Region of Waterloo Public Health, and a scientist from the Propel Centre for Population Health Impact at the University of Waterloo. The policy evaluation consists of an enforcement database, air quality monitoring, and a tenant survey. The survey of tenants is being conducted to measure support for the smoke-free policy, and to understand how the policy may affect smoking behaviour. Considering the policy permits grandfathering, it is expected that impacts from the policy may take several years to influence behaviour. This report provides the results of the March 2013 survey, which was administered to tenants approximately three years after the no-smoking policy was passed on April 1st, A copy of the tenant household questionnaire is included in Appendix A of this report. This report makes some comparisons to the 2011 survey, which was conducted one year after the policy was implemented; and to the 2010 survey, which was conducted prior to the policy coming into effect. SAMPLE Waterloo Region Housing (WRH) manages 2722 affordable rental housing units. Building types in the portfolio include low and high-rise apartments, townhouses, semi-detached and single family homes. Housing is provided for different tenant groups including seniors, adult, no dependant, and families. Senior units are intended for residents who are 60 years of age or older. Seniors live in low or high rise apartments. Adult, no Page 8

9 dependant is typically for residents with no children who are younger than 60 years old. This adult housing is in low or high rise apartments. To simplify this report, the tenant group Adult, no dependant is referred to as adult. Most of the tenants in family units live in townhouses or semi-detached single family dwellings; however, some family units are also in low-rise apartments. METHODS The questionnaire and research methods used in this study received approval from the Region of Waterloo Public Health Research Ethics Board, and the Office of Research Ethics at the University of Waterloo (ORE# 16168). An envelope containing a cover letter that described the new policy, the survey questionnaire, and letter that provided instructions on how to access language translation support for completing the survey was delivered by a private courier to every household in the portfolio. The envelope was labelled with the tenant s name and address, and delivered to their mailbox, or in some cases right to the door. These envelopes were delivered in mid-march 2013, and respondents were asked to return the completed survey by April 15, Copies of the cover letter and translation support material are included in Appendix B. The survey was entitled Survey Evaluation March, 2013 Smoke-free policy for New Leases and Transfers in Waterloo Region Housing. The survey had 27 questions, 18 of which were for all households, and 9 of which were specifically for respondents who smoke cigarettes. Respondents were asked to return the completed survey using a prepaid, self-addressed envelope. Alternatively, respondents were invited to drop off the completed survey in person to the WRH office in either Kitchener or Cambridge. Page 9

10 ANALYSIS Response percentages are reported for each question. Non-responses (missing data) are not included in most response proportions. Some question responses are reported based on household smoking status; households are classified as either not having a resident who smokes, or having a resident who smokes. Response percentages for questions intended for people who smoke only report from the sample of respondents who identified as a person who smokes. Analysis was conducted in SAS9.2. Test of equal or given proportions was used to determine significance, using an alpha of The 2013 survey included, for the first time, the opportunity for open-ended responses from tenants. These comments were also reviewed and a range of comments are included in the report. Like previous reports, some respondents also included written comments throughout the survey. These comments were entered into a spreadsheet along with the anonymous respondent identification and which question the comment was written beside. Page 10

11 FINDINGS Response Rates: The 2013 survey was distributed to all 2722 households and completed by 619 respondents, which represents a response rate of 23%. In 2011, the survey response rate was 25% (n685). The 2010 survey response rate was 26% (n=717). This is considered a good or very good response rate given no incentive was offered for households to complete the survey. This response rate is similar to previous surveys sent to the households across the portfolio by Waterloo Region Housing. Surveys were colour coded based on tenant group. For example, family units were delivered surveys printed on blue paper. Based on the colour of surveys returned, a response rate was calculated for each tenant group, presented in Table 1 below. Table 1. Response rates by tenant group Response Returned Total Units Rate Surveys in portfolio Seniors 36.9% Adult 22.1% Family 11.5% Surveys were delivered to households by a private courier in an addressed envelope. If the survey was delivered to a household that had a lease signed on or after April 1, 2013, the survey was marked. Based on the number of marked surveys, it is possible to report the proportion of the sample completed by households with grandfathered leases, and leases signed since April 1, Results are presented in Table 2 below. Note no personal identifying markers were put on any of the surveys. Table 2. Respondents with Leases since April 2010 Percent Frequency Grandfathered 70.0% 433 Lease Lease since April 30.0% Total 100% 619 Waterloo Region Housing records indicate that on March 31, 2013, approximately 32% of households in the housing portfolio had smoke4ree leases. The proportion of respondents to the survey closely matches this proportion. Page 11

12 Household and Respondent Descriptions: Household and respondent descriptions are reported for the entire sample (n=619) in tables 3-5 below. Table 3. Question 1) Are you: o 18 to 64 years old? o 65 years old, or older? Percent Frequency 18 to 64 years old? 42.5% years old, or 343 older? Total 100% 619 There were 343 respondents that indicated they were 65 years old, or older; this represents approximately 58% of the sample. Missing responses:23; total sample 619. Table 4. Question 2) How many adults live in your household? Percent Frequency Morethanone 18.8% 111 One 81.2% 479 Total 100% 619 Missing responses: 2; total sample: 619 The majority of respondents reported that their household had only one adult (81% n=479). Page 12

13 Table 5a. Question 3) How many children live in your household? Number of infants! toddlers: (0-2 years old) Percent Frequency One 5.7% 26 More than one 0.2% 27 None 94.1% 456 Total 100% 456 MissThg responses: 163; total sample: 619 Table 5b. Question 3) How many children live in your household? Number of children: (3-12 years old) Percent j Frequency One 12.5% I 58 More than one 6.7% 31 None 80.7% 375 Total 100% 465 Missing responses: 154; total sample: 619 Table Sc. Question 3) How many children live in your household? Number of children/teens (13-17 years old) Percent Frequency One 12.3% 56 More than ones 3.7% 17 None 84.0% 383 Total 100% 456 Missing responses: 163; total sampie:619 There were 215 households that their household. This represents n=145). reported that at least one child or teen (under 18 years of age) lived in 35% of the sample, which is greater than the 2011 survey (21%; Note: Based on responses to questions 2 and 3, approximately 93% of the households that completed the survey (n=558) have a person from a population considered more vulnerable to SHS exposure specifically seniors, who are more likely to have compromised pulmonary and cardiovascular health issues, and children/youth who have developing lungs. Page 13

14 Smoking Behaviour in the Household: The survey included questions for all respondents about smoking behaviour and home-smoking practices (questions 4-11). Question 11 asked about respondent s anticipated future smoke-free home policies. The responses to these questions are detailed in Tables 6-14 below. Response percentages do not include non-responses; the number of missing responses is reported below each table. Table 6. Question 4) How many members of your household, including yourself, currently smoke, daily or less? Percent Frequency % % % 7 More than 1.0% 6 3 Total 100% 587 Missing responses: 32; total sample n=619 Respondents reported that approximately 18% of households have at least one resident who smokes daily or less (n=1 09). The responses to this question were used to classify households by smoking status; households that have a smoker (n= 109) or do not have a smoker (n= 478). Table 7. Question 5) Do you smoke cigarettes, either daily or less? Percent Frequency No 83.3% 487 Yes 16.8% 98 Total 100% 585 Missing responses:34; total sample n619 Approximately 17% of survey respondents reported that they smoked cigarettes, either daily or less. The responses to this question were used to classify respondent by smoking status; respondents that reported they smoke (n= 98) or do not have a smoker (n= 487). Page 14

15 Table 8a. Question 6) Since the smoke-free policy have you changed how you smoke? (reported proportions from survey respondents who did not indicate Do not smoke ) Percent Frequency No change 54.8% 69 Smoke less 31.0% 39 Smoke more 3.2% 4 I have quit 2.4% 14 Missing responses: 26; total that they do not smoke. Total 100% 126 sample n=619. This sample included smokers and non-smokers. There were 467 respondents who indicated This question was asked to all respondents and the majority (n= 467) indicated they did not smoke. Table Ba reports the proportion of responses from the remaining sample (n=1 26). There was no reported change in smoking habits after the smoke4ree policy came into effect for approximately 55% of respondents (n=69). Approximately 31% (n=39) reported they smoked less since the policy was implemented, and approximately 2% (n=14) reported they have quit smoking since the smoke-free policy. Page 15

16 It is important to understand how the smoke-free policy may have influenced smoking behaviour for people who lived in housing prior to April 1, 2010 (those that have grandfathered leases). Table 8b below reports responses to question 6 for only respondents who had a grandfathered lease and report smoking (n=85). Table 8b. Question 6) Since the smoke4ree policy have you changed how you smoke? (reported proportions from survey respondents who indicated they smoke and had a grandfathered lease) Percent Frequency No change 58.8% 50 Smoke less 28.2% 24 Smoke more 4.7% 4 I have quit 8.2% 7 Missing responses: 19; total that they do not smoke. Total 99.9% 85 sample n=433. This sample included smokers and non-smokers. There were 329 respondents who indicated There were 85 respondents who had grandfathered leases and did not respond I don t smoke. Of this sample of respondents, more than half (approximately 59%) reported they have not changed how they smoke. More than a quarter (28%, n=24) reported that they now smoke less, and more than 8% (n=7) reported they have quit. A smaller proportion, less than 5% (n=4) reported they now smoke more. Page 16

17 Table 8c. Question 6) Since the smoke-free policy have you changed how you smoke? (reported proportions from survey respondents who indicated they smoke and have a smokefree lease) Percent Frequency No change 46.3% 19 Smoke less 36.6% 15 Smoke more 0% 0 Ihavequit 17.1% 7 Total 1 QQ% 41 Missing responses: 7; total sample n=186. This sample included smokers and non-smokers. There were 138 respondents who indicated that they do not smoke. There were 41 respondents who had smoke4ree leases who did not respond I don t smoke. Of this sample of respondents, approximately half (46%, n=1 9) reported that they have not changed how they smoke. More than a third of respondents reported that they smoke less (37%, n=1 5), No respondent reported that they smoke more. There were 7 respondents (17%) that reported they have quit. Page 17

18 Table 9. Question 7) Does anyone, including yourself, smoke inside your home? Percent Frequency Never 87.71% 514 Sometimes 8.7% 51 Often 3.6% 21 Total 100% 586 Missing responses: 33; total sample n=61g The majority of respondents, approximately 88%, reported that their homes are 100% smoke4ree (n=51 4); this is a greater proportion than that which was reported in 2011, at 82% and significantly greater than what which was reported in the 2010 survey, at 75% (alpha 0.05). Approximately 12% of respondents, (n=72) reported that their household permits smoking at least sometimes. Page 18

19 Table 10. Question 7) Does anyone, including yourself, Reported by Smoking Status of the Household smoke inside your home? Never No Smoker in Household Smoker in the Household 94.1% 48.5% (450) (n=50). 3.3% 33.0% Sometimes (n=16) (n=34) Often Total 0.2% 18.5% (n=1) (n=19) 100% 100% (n=450) (n=103) Missing responses: 7(11 for no smokers in the household, and 6 for households with a smoker) ; total sample n= 587. The vast majority of households that do not have a smoker report that smoking never takes place inside their home (approximately 94%, n450). Approximately 3% of households that do not have a resident who smokes report that someone smokes sometimes or often inside their home. Approximately 49% of respondents from households that have a person who smokes reported that their homes are 100% smoke-free. In 2011 the proportion was 38%; this represents a significant increase (alpha 0.05). Of respondents who had a smoke4ree lease, 32 respondents were in households that had a smoker. The majority of these (78.1%, n=25) reported that smoking never takes place inside their home consistent with the requirements of their lease. Only one respondent with a smoke-free lease reported that smoking often takes place inside their unit. Of respondents who had a smoke-free lease and no smoker in the household, (n=140) almost all reported that smoking never takes place inside (99.3%, n=139) with only one reporting that smoking sometimes happens inside. Page 19

20 A similar question was asked of respondents to understand smoking behaviour on patios and balconies. Responses are reported in table 11 below. Table 11. Question 8) Does anyone, including yourself, smoke on your patio or balcony? No Smoker in Smoker in the Household Household Never 85.5% 28.3% (n=395) (n=28) Sometimes 14.1% 46.5% (n=64) (n=46) Often 0.4% 25.3% (n=2) (n=25) Total 100% 100.1% (n=462) (n=99) Missing responses: 11(10 missing from households with no smoker, and 1 missing from households with a smoker); Note, 16 reported they did not have a patio or balcony and were excluded from the analysis; total sample n=587. For households with no smoker, the majority (86%) report that smoking never takes place on their balcony or patio. For households that had a person who smokes, approximately 28% reported that smoking never takes place on their patio or balcony. Approximately half (47%, n=46) reported that smoking sometimes takes place on a patio or balcony. Of respondents that had a smoke4ree lease (which includes 100% smoke4ree patio and balcony areas), 92% of households with no smokers (n=128) reported that smoking never takes place on their patio or balcony. Of respondents that had a smoke-free lease and had a person who smokes in the household, 41% (n11) reported that smoking never takes place on a patio or balcony. The majority of respondents who had a new lease, and had a person in the household who smoked, reported that smoking takes place on the patio or balcony at lease sometimes. Page 20

21 Question 9a asked further details about smoking behaviour in outdoor spaces. Table 12. Question 9a) If someone smokes in your home or on your patio or balcony, is it: % Yourself 12.7% (n=71) Another member of the household 2.5% (n=14) A neighbour/tenant in your building 8.9% (n=50) A non-tenant visitor 21.6% (n=121) No one smokes on my patio/balcony 63.6% (n=357) I do not have a patio or balcony 10.2% (n=57) Total n=561 Missing responses SB respondents; sample size 619. Note respondents could select multiple responses. Table 12 reports the responses to question 9a, which asked respondents to identify broadly who (if anyone) is smoking on their patio or balcony. Table 12 reports results from the entire sample; the majority of respondents (64%, n=357) reported that no one smokes on their patio/balcony. Further, 10% (n=57) reported that they do not have a patio or balcony. Of those who reported a person does go out to the balcony or patio to smoke (n=256), almost half (47%, n=121) reported it was a non-tenant visitor. More than a quarter (27.7%, n=71) reported that they themselves use the patio or balcony to smoke a cigarette. Question 9b asked further about visitors from the same building to understand if tenants with smoke free leases are visiting smoking permitted units to smoke indoors or on neighbours patios/balconies. Page 21

22 Table 13. Question 9b) If a neighbourltenant in your building or townhouse complex comes to visit, are they permitted to smoke in their own unit, or do they have a smoke4ree lease? % They are permitted to 13.7% smoke in their unit (n=73) They have a smoke-free 8.8% lease (n47) No neighbours or tenants 33.2% come to visit (n=177) Don t know Total (n=237) (n=534) Missing Responses 85; sample n=619 note multiple responses were possible. Less than 10% of respondents (9%, n=47) reported that visitors come who have smoke-free leases. Table 14. Question 10) If you allow smoking in your home, do you plan to make your home 100% smoke4ree within the next 6 months? Reported for households that indicated they permit smokinq (question 7) Smoking Frequency Yes No 5.3% 94.7% Qften (n=1) (n=18) 40.0% 60.0% Sometimes (n=16) (n=24) Missing Responses: 9(2 missing for households that often smoke inside 7 missing from households that sometimes smoke inside); Excluded responses: 4 (4 respondents who previously reported that their households had indoor smoking sometimes reported that their indoor space was already smoke-free ). The results from question 10 indicate that a greater proportion of smokers who only smoke sometimes in their unit are planning to make their home 100% smoke4ree in the next 6 months compared to respondents who smoke often, Page 22

23 Table 15. Question 11) Do you support the new policy that made all new leases in your building 100% smoke4ree, including no smoking on patios or balconies? Reported for entire sample, and based on smoking status of respondent and smoking status of household Respondent Yes Sample size Entire Sample 78.9% 587 (n=463) (32 missing) Non-smoker Smoker 88.2% (n=417) 29.3% (n=27) 473 (14 missing) 92 (6 missing) Household has 89.4% 463 no smokers (n=414 (15 missing) Household has a 32.4% 105 person who (n=34) (4 missing) smokes Missing Responses: 32; total sample n618 Support for the smoke-free policy is high across the sample (79%, n=546). A greater proportion of non smokers and households with no smokers support the policy compared to people who smoke or households that have a smoker. Understanding that there is a range of reasons for why a respondent may support or not support the policy, an open ended question was available. Some of the responses are included here: Respondents who supported the policy: Our world should be a smoke free world! We don t need to pollute this world more. (Even the old policies must be changed to allow smoke free homes which means cleaner air.) I don t smoke and I am concerned about health risks involved in second hand smoking. Respondents who do NOT support the policy: Inside yes, but outside no We (smokers) should be able to smoke wherever we want, when we want. It s up to the person! Page 23

24 Second-hand Smoke Exposure and Health: Questions asked about respondents second-hand smoke exposure (SHS) in their home and how SHS may impact the health of their household. Responses are detailed in tables below. Table 16. Question 12) How often do you smell second-hand smoke coming into your home? Percent Frequency Never 49.6% 283 Sometimes 31% 177 Often 19.4% 111 Total 100% 571 Missing Responses: 48; total sample n619 Half of respondents (approximately 50%, n= 283), indicated that they are sometimes or often exposed to second-hand smoke in their home. This remains unchanged from the previous 2011 survey. Table 17. Question 13) If second-hand smoke comes into your home, where does it come from? [check all that apply] Percent Frequency Neighbouring units 36.0% 196 From outdoors 26.1% 142 Other 6.06% 33 No, it doesn t come Into my unit 43.8% 238 Missing responses: 75; sample n= 544 Note frequency sums to 609as multiple responses were possible. Approximately a third of respondents (36%, n=196) reported that smoke enters their home from neighbouring units. Approximately a quarter of respondents (26%, n=143) reported that smoke enters their home from outdoors. Page 24

25 Table 18. Question 14) Do you or others in your you breathe in second-hand smoke? home have health problems that get worse when Percent Frequency No 56.1% 313 Yes 43.9% 245 Total 100% 558 Missing Responses: 61; total sample n=613 Forty percent of respondents (n=253) reported that someone in their household has health problems that are made worse when exposed to second-hand smoke. Table 19. Question 15) If you live in an apartment building, do you smell second-hand smoke in other parts of the building such as hallways, lobby or other common indoor spaces? Reported for households that live in apartments Percent Frequency Always Often Sometimes Never 37.8% % % % 161 Total 100% 436 Missing responses: 35; Note: sample n=619 More than half of respondents (53%, n= 131) report that they smell second-hand smoke in other parts of the building often or always. Page 25

26 Perceived Policy Compliance in Outdoor Spaces: Table 20. Question 16) In general, when people are smoking outside on the grounds of your property do they step 5 metres away from the building? Percent Frequency Always 14.4% 80 Often 9.7% 54 Sometimes 24.2% 135 Never 13.1% 73 Don t Know 38.6% 215 Total 100% 557 Missing responses: 62; sample n=619 Approximately 13% (n73) respondents reported that outside smokers never smoke 5m away from the building. Important to note is that one third of respondents (39%, n=215) reported they don t know if people are smoking 5m from the building perimeters. Cigarette butts: Question 17 asked respondents to report how often they see cigarette butts around their housing unit. Responses are detailed in Table 22 below1 reporting from the entire sample. Table 22. Question 17) Do you see cigarette butts lying on the ground on the property where you live? Percent Frequency Always 13.9% 78 Often 10.0% 56 Sometimes 41.3% 232 Never 34.9% 196 Total 100% 630 Missing responses: 57; sample n=619 Almost two-thirds (65.2%; n= 366) of respondents reported seeing cigarette butts on their property at least sometimes in This is similar to findings in 2011(65%, n=41 0), however in. 2010, 74% of respondents reported that they saw cigarette butts on their property at least sometimes. This represents a statistically significant decrease in reported cigarette litter (p-value<0.01). Page 26

27 Perceived Problems Between Neighbours: Question 21 asked respondents to report how often, if at all, smoking has caused problems between households. Responses are described in table 24 for the entire sample. Table 23. Question 18) Has smoking caused problems between youlsomeone in your home and your neighbour(s)? Percent Frequency Not at all 76.8% 437 Just a little 14.44% 82 A fair amount 4.8% 27 A great deal 4.04% 23 Missing responses: 50; total sample n=619 Almost a quarter of respondents reported that smoking has caused at least minor problems between themselves or someone in their home and their neighbours (approximately 23%, n=132), slightly lower than findings in 2011 and Page 27

28 QUESTIONS FOR PEOPLE WHO SMOKE The survey included 8 questions (questions 19-27) for respondents who smoke. This section of the survey included the following statement: If you smoke, please respond to the following questions or statements: Note: Some respondents completed this section that did not indicate in Question 6 that they were a smoker. Tables only report responses from respondents that indicated in Question 6 that they smoked either daily or less. This included 98 respondents. Quitting Intentions and Smoking Behaviours: Table 25. Question 19) At any time during the past year, did you try to quit smoking? Percent Frequency No 54.6% 42 Yes 45.5% 35 Total 100.1% 77 Missing responses: 21; smoker sample n98. Approximately 45% of respondents (n=35) who identified as a smoker, reported that they have tried to quit smoking in the last year, slightly more than respondents that indicated having tried to quit in 2011 (41%; n= 110); which was similar to 2010 findings (p-value = 1). Table 26 Question 20) Do you plan to quit smoking in the next 6 months? Percent Frequency Yes 31.9% 23 No 68.1% 49 Total 100% 72 Missing responses: 26; smoker sample n98. Almost a third of smokers reported that they plan to quit smoking in the next six months (approximately 32%, n=23). This is similar to the 2011 and 2010 survey findings. Page 28

29 Table 27. Question 24) If your lease currently requires you to smoke outside, do you follow the rules? (remember this survey is anonymous) (reported based on respondents with new leases) Percent Frequency Always 56.0% 14 Often 16.0% 4 Sometimes 20.0% 5 Never 8.0% 2 Total 100% 25 Missing responses: 9; smoker sample n=34 There were 34 respondents who had new leases those respondents did not answer this question. that they always go outside to smoke. and identified as smokers. Approximately a third of Of those that did answer, more than half (56%, n=1 4) Table 28: Question 22) Since the new smoke4ree policy in 2010, do you smoke outside more often than before the policy? (reported based on respondents with grandfathered leases) Percent Frequency Yes 26.5% 13 Missing Responses: 20, n=7 I No 73.5% 36 Note 2 respondents with grandfathered leases reported that their lease requires them to smoke outside; sample More than a quarter of respondents with grandfathered leases (who smoke cigarettes) reported that they smoke outside more often than before the smoke-free policy. Although this proportion is encouraging, it is less than what was reported in the 2011 report (35.2%). Page 29

30 Table 29. Question 26) When I smoke on the grounds of my property, I am 5 metres away from the building as per the policy Percent Frequency Always 43.7% 31 Often Sometimes 16.9% % 12 Never 7.0% 5 Neversmokeoutsideon 15.5% 11 my property Total 100% 71 Missing Responses: 27; smoker sample n98. Over half of respondents report that they always or often (61%, n=43) respect the 5 metre distance when smoking on the grounds of their property. A small percentage (7%, n=5) reported they never stand 5 metres away from the building when smoking. Page 30

31 Perceived social norms: Question 24 asked respondents to report how often they think their neighbours go outside to smoke. This question was asked to help inform health promotion strategies that may focus on social norms. Responses are detailed in table 30 below, reporting from sample of respondents who identified as smokers. Table 30. Question 24) How often do you think your neighbours go outside to smoke? Reported for respondents that have a neighbour that smokes Percent Frequency Always 5.2% 4 Don t know 55.8% 43 Never 6.5% 5 None of my neighbours 0 2.6/0 2 smoke Sometimes 16.9% 13 Often 13.0% 10 Missing Responses: 2 ;total sample n=98 Over half of respondents reported they do not know how often their neighbours go outside to smoke (approximately 56%, n=43). Approximately 7% of respondents reported they think their neighbours never go outside (n=5), compared to 6% in 2011 and 9% in the 2010 survey. For this question, neighbour was not defined so respondents may have considered a neighbour to be someone who lived immediately beside them, or someone in the same building. Page 31

32 Social de-normalization of Smoking Behaviour: Evaluations of smoke4ree policies have shown that increases in smoke-free spaces are associated with reductions in the perception of the social acceptability of smoking. Question 25 asked respondents to report about their comfort with smoking outside. Table 31. Question smoking. 25) There are fewer and fewer places outside where I feel comfortable Percent Frequency Strongly Agree 27.4% 20 Agree 43.8% 32 Disagree 17.8% 13 Strongly Disagree 11.0% 8 Total Missing responses: 25; smoke? sample n=98 Page 32

33 Interest in Cessation Support: Region of Waterloo Public Health (ROWPH) provides help to tenants to access smoking cessation supports, such as group or individual counselling, nicotine replacement therapy, etc. Question 29 asked respondents about their interest in accessing a smoking cessation program provided by ROWPH. Table 32. Question 29) Would you consider using one of the Region of Waterloo Public Health quit-smoking programs to help you quit smoking? Percent Frequency Yes 14.4% 11 Don t Know 38.5% 30 No 47.4% 37 Total 100% 78 Missing Responses: 20; smoker sample n=98. Of those who responded to this question, 14% (n=1 1) reported yes, they would consider using one of the ROWPH quit-smoking programs to assist in smoking cessation. Over one third of respondents (39%, n=30) reported they don t know. Page 33

34 ADDITIONAL COMMENTS THAT WERE HAND WRITTEN ON THE SURVEYS This survey did not include spaces for respondents to add open-ended comments but many did 117 unique respondents (17%) wrote at least one comment on their survey. Most of the respondents (63%, n=74) who included unsolicited comments had indicated that they support the no-smoking policy. Some of the comments asked for policy makers to make the smoke-free policy more stringent while others suggested it was going too far. There were concerns raised about the impact of exposure to second hand smoke on their health, particularly for residents with respiratory issues (e.g., allergies, asthma and emphysema). However, some respondents also raised concerns about the impact of the policy on residents who smoke, and raised other issues that they felt should be a priority in housing (e.g., alcohol and drug use, mold, bothersome odours and safety). Comments were tracked by the anonymous respondent ID and according to where the comment was written on the survey; most comments were associated with a specific question. Here is a sample of the range of comments that were received related to the survey questions: Following question 12, Do you support the new policy that made all new leases in your building 100% smoke-free, including no smoking on patios or balconies? I prefer a smoke-free environment. I wish it applied to everyone that lives here!... Great idea in theory but how do you enforce it? It s an invasion of privacy. It should be someone s decision if you smoke in your own home or not. General Comments: Although not legally possible, Housing should repeal the grandfather clause and go 100% smoke free everywhere. Banning smoking is the best thing you have ever done!! I find some new tenants still smoke in unit and balcony area and throw butts over balcony all the time and in gardens. I would love to see more information about what is available for trying to quit smoking. The smoke-free policy is infringing on people s fights (in my opinion). Although I am a smoker and DO NOT smoke in my unit I do not believe restrictions should be put in place that people (not needing a rental subsidy) would have put on them. Smoking is the hardest addiction to overcome and I don t wish to add hardship on a visitor for an occasional cigarette in an open air space. What government interference is next? Will they not allow obese people to rent their units? Page 34

35 NEXT STEPS The evaluation committee will conduct similar surveys with households in Waterloo Region Housing approximately every 2 to 3 years. With this longitudinal cross sectional data it will be possible to understand trends in policy support and smoking behaviour. The results of subsequent surveys will also be presented to Regional Council in similar reports. It is noted in this report that the proportion of respondents who identified as smokers has decreased with each wave. This may be a result of tenants quitting and/or because people who smoke are less interested in completing the survey. The research evaluation committee will consider altering methods in future surveys to increase the number of surveys completed by people who smoke to better understand how the policy impacts smoking behaviour. Page 35

36 APPENDIX A-TENANT SURVEY E,. 1. Are you: 0 18 to 64 years old 0 65 years old or older 2: How many adults live in your household? More than 1 I Rrgk 41 of A,te.?oo INSTRUCflONS: Please shade the circles below using a dark blue or black ink pen (not pencil) to show your answers to the following questions. How many children live in your household? Number of infants/toddlers: (02 years old) Number of children: (342 years old) Number of teens: (1347 years old) 4 How many members of your household, including OMorcthan3 S. Do you smoke cigarettes, either daily or less? 0 Yes 0 No 6.. Since the smoke-free policy have you changed how much you smoke? SURVEY- EVAWATIC MARCH 2023 Smoke-free policy for New Lease and Transfers In Waterloo Region Koqsing 0 None 0 None 0 None you rse If, [Shade Circles Like This--> 01 OMorethani 01 OMorethanl 01 OMorethan! Not Like This >W currently smoke, daily or less? Cl don t smoke OR 0 I have quit Dl smoke less 0 I smoke more 0 No change 7. Does anyone, including yourself, smoke inside your home? 0 Never 0 Sometimes 0 Often 8. Does anyone, including yourself, smoke on your patio or balcony? o Never 0 Sometimes 0 Often OR 0 Do not have a patio or balcony 9a. If someone smokes in your home or on your patio or balcony, is it: (shade all that apply) o Yourself O Another member of the household o A neighbour/tenant in your building o A non-tenant visitor o No one smokes on my patio/balcony o I do not have a patio or balcony 9b. If a neighbour/tenant in your building or townhouse complex comes to visit, are they permitted to smoke in their own unit, or do they have a smoke-free lease? 0 They are permftted to smoke in their unit 0 They have a smoke-free lease 0 Don t know 0 No neighbours or tenants come to visit 10. If you allow smoking in your home, do you plan to make your home 100% smoke-free within the next 6 months? 0 Yes 0 No OR 0 My home is already 100% smoke-free ha Do you support the policy that made new leases in your building 100% smoke free, including no smoking on patios or balconies? 0 Yes 0 No lib Please describe why you answered yes or no: L J Page 36

37 F 12. How often do you smell second-hand smoke coming into your home? C Never 0 Sometimes C Often Second-hand smoke comes from the burning end of a lit cigarette, cigar or pipe and from the sme blown into the air by the person smoking 13. if second hand smoke comes into your home, where does it come from? (shadeall that apply) o Neighbouring units 0 From outdoors 0 Other OR 0 No, ft doesn t come into my unit 1$. Do you or others in your home have health problems that get worse when you breathe in second-hand smoke? 0 Yes 0 No 15. If you live in an apartment buidling, do you smell second-hand smoke in other pans of the buidling such as hallways, lobby or other common indoor spaces (for example a lounge)? o Never 0 Sometimes 0 Often C Always OR Dl don t live in an apartment 16. In general, when people are smoking outside on the grounds of your property do they step 5 metres away from the buidling? 0 Never 0 Sometimes 0 Often 0 Always 0 Don t know 17. Do you see cigarette butts lying on the ground on the property where you live? o Never 0 Sometimes 0 Often 0 Always 18. Has smoking caused problems or conflict between you/someone in your home, and your neighbour(s)? 0 Not at all C Just a little CA fair amount 0 a great deal If you do not smoke, you are finished this survey If you smoke, please complete the following questions or statements 19. At anytime during the past year did you try to quit smoking? 0 Yes C No 20. Do you plan to quit smoking in the next 6 months? 0 Yes C No 21. If your lease currently requires you to smoke outside, do you follow this rule? (remember that this survey is anonymous) 0 Never C Sometimes C Often 0 Always 22. Since the smoke-free policy in 2010, do you smoke outside more often than before the policy? o Yes 0 No 0 My lease requires me to smoke outside 23. When I smoke outside on the grounds of my property, I am 5 metres away from the building as per the policy. O Never 0 Sometimes 0 Often 0 Always C I never smoke outside on my property 24. How often do you think your neighbours that smoke go outside to have a cigarette? O Never 0 Sometimes 0 Often 0 Always 0 Don t know 0 None of my neighbours smoke 25. There are fewer and fewer places outside where I feel comfortable smoking. C Strongly disagree 0 Disagree 0 Agree 0 Strongly agree 26. Would you consider using one of the Region of Waterloo Public Health quitsmoking programs to help you quit smoking? DYes 0 No C Don t know 27. Please orovide any additional comments THANK YOU! Please return the completed survey using the prepaid, self addressed envelope by April 15, 2013, by mail or in person to: Waterloo Region Housing 235 King Street East, 6th floor in Kitchener or 150 Main Street in Cambridge 7& L -J Page 37

38 APPENDIX B-COVER LETTER AND TRANSLATION Dear Tenant: On April 1, 2010, Waterloo Region Housing (WRH) implemented a smoke-free policy. Tenants who signed a lease on or after April 1, 2010 must not allow smoking in areas covered by their lease. These areas include the inside of the unit, as well as the balcony or patio. Tenants who signed a lease before April 1, 2010, are grandfathered. Under their lease, they are still allowed to smoke in their units and on their balcony or patio. Under the smoke-free policy, smoking is not allowed at any time in common outdoor areas within five metres of windows, entrances or exits. This applies to all tenants, grandfathered tenants and visitors. Now that this policy has been in place for three years, we would like to know how the policy has affected you. Each household will receive one survey. Anyone aged 18 or older can fill out the survey on behalf of the household. There are no risks associated with participating in this survey. Please fill out and return the survey by April 15, 2013 in the prepaid, self-addressed envelope, or drop it off in person to: Waterloo Region Housing OR Waterloo Region Housing 235 King St. E., 6thfloor 150 Main St. Kitchener, ON N2G 4N5 Cambridge, ON N1R 8R7 This survey is anonymous. Please do not put your name or address on the survey. You do not have to fill out the survey if you do not want to. Filling out this survey will not affect your housing status. If you have questions about how to fill out or return the survey, please contact: Lynda Fitzgerald Julia Pilliar Community Relations Worker Region of Waterloo Public Health Waterloo Region Housing OR Tobacco & Cancer Prevention ext Page 38

39 This is the fourth survey of a larger study to help us learn how the smoke-free policy affects all tenants. As part of the study, we plan to send you similar surveys about the smoke-free policy in future years. Personal information in this survey is collected under the authority of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA) and will be used to assist Regional Staff to monitor and evaluate the impact of the smoke-free policy. This information will help us to share our experience with other housing providers who would like to know more about smoke-free policies. Surveys returned to Waterloo Region Housing will be kept in a locked room at Region of Waterloo Public Health. Only authorized staff will have access to the room. All surveys will be destroyed in eight years when the study is completed. Selected researchers from the University of Waterloo will have access to the results of the survey, to help understand the findings. The results of these surveys will be put together in a report by Region of Waterloo Public Health and the University of Waterloo. Information from your survey will be combined with the other surveys and presented as a group. No individual identifying information will be shared publically. This study has been reviewed by the Office of Research Ethics at the University of Waterloo and the Region of Waterloo Public Health. It has received ethics clearance through the Research Approval Process. We will share the survey results with you in the fall/winter of 2013 by newsletter. Thank you for taking the time to fill it out! Sincerely, Irwin Peters Manager, Waterloo Region Housing Page 39

40 PLANNING, HOUSING AND COMMUNITY SERVICES Housing W.ztetfoo Arabic: Chinese: ) Ktchener-Watedoo Multicultural Centre - J?iI L) Ci &r.la.(519) :i J45 ij1fi kj4zfl ii i. t[(51 9) jjkitchener-waterloo Multicultural Centre j jicj Dan: Kitchener-Watedoo Multicultural Centre l Lih3 LiZ a..s.&.j,,i JiZi L AU%1 Lh (519) j4 English: If you need help in filling out this form, please call the Kitchener-Watedoo Multicultural Centre at Farsi: I L_aiaa.2jIi A.s J. ±h (519) ji 1 Kitchener-Waterloc Multicultural Centre French: Si vous avez besoin daide pour remplir ce fomiulaire, veuillez appeler le Kitchener-Watedoo Multicultural Centre au numéro (519) Gemian: Falls Sie Hilfe beim AustiJIlen dieses Formulais brauchen, rufen Sie bifte das Kjtchener-Watedoo Multicultural Centre unter der Nummer (519) an. Polish: Jeli potrzebna jest pomoc przy.ypelnianiu tego fomiularza, prosimy dzwoniã do Kitchener-Watedoo Multicultural Centre pod numer (519) Portuguese: Se precisar de ajuda pan preencher este irnpresso. por favor telefone para o Kitchener-Watenloo Multicultural Centre pelo (519) Punjabi: ti. c raz HI uj. & Ki1chener-WqteMno MijI:rjjiiijrnI Centr& i (l9) i Th Thiz document refen ftidkiduals who need,anaóon ass,stance 5 the Kitchene,-Watefloo Llu&u,uraJ Cenrie Page 40

41 PLANNING, HOUSING AND COMMUNITY SERVICES Housing Serbo-Croatian: Mo yarn je potrebna pom& za ispunjavanje ovog formulara, molirno pozovfte Kitchener-Waterioo Multicultural Centre na telefon (519) Sonrnli: Haddil aad u baahan tahay in Iagaa caa Myo buuxinta foornkan, fadlan ka wac Ktchener-Watedoo Multicultural Centre telefoonka larnbarkhsu yahay (519) Spanish: Si necesfta ayuda pam Ilenar este fomiulaño, Ilame al Kitchener-Waterloo Multicultural Centre, al (519) Urdu: Kitchener.Waterloo Multicultural Centre %j Li L LI/ r1 _.f.t A Vietnamese: - - Neu qui vj can sir giup d& dê then hoân tat bëu rnu nay, hay gci cho Ktchener-Watedoo Multicultural Centre theo sã (519) (519) Thio document refen thdwiôuais who need ansa5on a&otar.,e to the Kitchener-Wate,ioo Muhieuibral Ceitre Page 41

42 Findings End Notes and References Kennedy, RD. Smoke /i ce Housing Policy Evaluation Findings from the 2010 Waterloo Region Housing and Region of Waterloo Community Housing Inc. Household Tenant Survey. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo. Available at: lutp: / Kennedy, RD. Smoke-free Housing Policy Evaluation from the 2011 Waterloo Region Housing and Region of Waterloo Community Housing Inc. Household Tenant Sun ey. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo. Available at: Region of Waterloo, Community Services Committee Report P IV Region of Waterloo Public Health, Environmental Health and Lifestyle Resources, Memorandum to Ken Seiling and Memebers of Council. Results of survey on second-hand smoke in regionally owned housing. March 3,2009. Housing. V Hammond D, Fong GT, Zanna MP, Thrasher JF, and Borland R. Tobacco denormalization and industry beliefs among smokers from four countries. Am J Prey Med 2008; 31(3): Page 42