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1 S m o ke - f ree Housing L e a d e rship Forum Norfolk Workforce Development Center, May 12, 2016 HEALTHY HOMES AND SMOKE-FREE HOUSING Office of Lead Hazard Control and Healthy Homes (OLHCHH) U.S. Department of Housing and Urban Development (HUD) 1
2 What is OLHCHH? The Office of Lead Hazard Control and Healthy Homes (OLHCHH) is an office within the Department of Housing and Urban Development (HUD) that protects children and families from health and safety hazards in housing. The Office was established in 1991 as the Office of Lead Based Paint Abatement and Poisoning Prevention. 5 Divisions: Programs Division Regional Management and Technical Services Division Lead Programs Enforcement Division Grant Services Division Policy and Standards Division 3 HUD s Mission and Goals Mission To create strong, sustainable, inclusive communities and quality affordable homes for all. Goals Strengthen the Nation s housing market Provide quality affordable rental homes Use housing as a platform to improve quality of life Build inclusive and sustainable communities Transform the way HUD does business (HUD, 2014, Plan ) 4 2
3 OLHCHH s Mission, Vision, and Goals Mission To help all Americans, but especially children and other vulnerable populations in low-income households, reach their full potential by making homes safe and healthy. Vision To lead the nation to a future where homes are both affordable and designed, constructed, rehabilitated, and maintained in a manner that supports the health and safety of occupants. Goals Building a National Creating Healthy Housing through Key Research Mainstreaming the Healthy Homes Approach Enabling Communities to Create and Sustain Healthy Homes (OLHCHH, 2009, Healthy Homes Plan) 5 Hazards Health Effects Economic Impacts Lead Pests CO Mold VOCs Noise Secondhand Smoke Lead poisoning, which causes Health problems Hyperactivity Reduced IQ Behavioral Problems Learning Disabilities Asthma Costs to the Individual School absenteeism Academic failure Learning difficulties Lack of employment Life-long health problems Socialization problems Criminal record Housing Problems Radiation Asbestos Entry by Intruder Falls Electrical hazards Fire Flames etc. Collision & entrapment Explosions Ergonomics Cancer Unintentional Injuries Costs to Society Healthcare Hospitalization Joblessness Special education Juvenile and criminal justice Numerous Health Hazards Other Health Impacts (Based on: OLHCHH, 2014, Healthy Homes Rating System Operating Guidance; Loyola University 2015) 6 3
4 Housing Characteristics Our Targets Low-Income Houses with Children Older Housing Housing Units in American Housing Survey (2013) 116 mil occupied units 133 mil total units Year Built < mil mil mil Occupant Owner 76 mil Renter 40 mil Vacant 17 mil % of Poverty Level < 100% 19 mil % 11 mil 150% & Above 86 mil Households with Children Children 37 mil No children 79 mil Households with Children <6 Children <6 16 mil No Children <6 100 mil (HUD & Census, 2013, American Housing Survey) 7 Burden of Housing Costs No one, of any economic class, should have to choose between a home that is affordable and one that is healthy for his or her loved ones. However, according to the American Housing Survey, more people chose their current house for financial reasons than for any other reason (quality of construction, neighborhood, layout, design, etc.). (HUD & Census, 2013, American Housing Survey) 8 4
5 It helps children and other vulnerable populations reach their full potential by Preventing injuries and diseases; Lowering healthcare costs; Increasing school and work performance; and Decreasing the number of school and work days missed due to injuries and diseases. It frees up family expenses that would have been spent on healthcare for other critical needs, such as rent or nutritious food. It saves money and lives. Studies have shown that lead and healthy homes Interventions are effective and are more cost-effective than conventional maintenance. (See Maqbook et al., 2015; Gould, 2009) 9 OLHCHH and Smoke- Smoke-free OLHCHH and Public & Indian Housing (PIH) are working together to promote smoke-free public housing Currently, there are approximately 615 PHAs have implemented smoke-free housing policies OLHCHH and PIH developed tools to assist PHAs interested in implementing policies OLHCHH assisted PIH in the development of the proposed smokefree public housing rule 10 5
6 History of the Smoke- Initiative 2008: SF Housing Session 2010: MFH Notice issued 2012: Federal Register solicitation 2015: Proposed Smoke- Free Public Housing Rule published 2009: PIH Notice issued 2012: Smoke- Free Housing Toolkits Published 2014: Change is in the Air Published
7 13 Summary of Changes Applicability: units only Requirements: prohibit all lit tobacco products in dwelling units, indoor common areas, outdoor areas within 25 feet of the housing, and PHA administrative office buildings Implementation: within 18 months from the effective date of the final rule and must be documented in PHA plan Lease Provisions: policies will need to be incorporated into the leases of each tenant by the effective date of the policy 14 Comment Period Public Comments were accepted through January 19,2016 HUD sought comments on the following questions: 1. Expected barriers & costs? 2. Does the policy adequately address the adverse effects? 3. Burden specific to families, children, disabled, elderly? 4. Those with policies already, what exceptions have been granted based on tenants' requests? 5. Lessons learned from those with policies? 6. What cessation services were provided? 7. What can HUD to support implementation? 8. Should the policy extend to e-cigarettes? 9. Should the policy extend to waterpipe tobacco smoking? 7
8 Estimated Cost Savings Frequently Asked Questions Will PHAs with existing policies be grandfathered in? How should PHAs enforce these regulations? Will this rule result in public housing residents getting displaced or evicted? Smoking prevalence is high among people with mental illness. Could a smoking ban be harmful to this population? What about residents that smoke and have difficulty getting outside, or have mobility impairments can they be allowed to still smoke in their units? 8
9 17 What to Expect Next Comments will be reviewed and taken into consideration The final rule will be published giving PHAs 18 months in which to adopt policies HUD seeks to help PHAs in this transition Resident education is key Resident meetings Provide cessation services Make sure rules are clear Establish clear signage to explain policy Enforce policy consistently Collaboration and support from partner agencies will be extremely helpful during this time MICHAEL MCGREEVY REGION III & IV HEALTHY HOMES REPRESENTATIVE Office of Lead Hazard Control and Healthy Homes (OLHCHH) U.S. Department of Housing and Urban Development (HUD) 9
10 Smoke Free Leadership Forum: Gaining Support for Implementation and Enforcement Norfolk Workforce Development Center May 12, 2016 Amy Paulson, MPH, AE-C Eastern Virginia Medical School Communicate Health Impacts Surgeon General s Report: No safe level of exposure to Secondhand Smoke Over 50,000 deaths annually in the U.S. are result of secondhand smoke-related diseases Secondhand smoke is known to cause: Cancers Sudden Infant Death Syndrome Asthma & COPD, lung problems Ear Infections Heart disease 10
11 Secondhand Smoke is Toxic Separate no smoking sections do NOT protect you from secondhand smoke Filtering air, opening windows, or smoking outside do not protect you from secondhand smoke More problematic third-hand smoke, carcinogenic particles left over once smoke has cleared Smoking in Multi-Unit Properties Smoke travels through ventilation systems Smoking in common areas impacts everyone Smoking outside doorways impacts indoor air quality 11
12 Benefits: Lower Housing Costs Smoke-free policies Reduce Liability for Landlords = lower costs for tenants Save money in maintenance Unit turnover costs 6x greater when smoking allowed Benefits: Insurance & Fire Risk Most residential fires are caused by smoking or smoking related activities Many insurance companies offer discounts to property owners with smoke-free policies 12
13 But is it Legal? No laws prohibit property owners from implementing smoke-free policies Policy requires that all tenants and visitors abide by policy on property Smoking policy for new tenants in public or Section 8 housing is permissible in all 50 states No constitutional right to smoke Enforcement Enforceable like any other lease condition, such as noise violation etc.. Have process in place for enforcement Follow through with consequences no exceptions 13
14 Administrative Support HUD Mandate Good for Housing Good for People Enforcement ok Lowered costs Smoke Free Properties Bottom Line Resident Health decreased health risks from smoke and vapor, decreased risk of unit fire Resident Appeal Cost Savings & Liability Reduction Unit Maintenance Legal 14
15 Gaining Support Step 1: Assessment Ask residents for input Survey Community meetings 1:1 dialogues Assess smoking status & Support of SF environments Begin communicating benefits Step 2: Planning Build your knowledge Identify how to opportunities for implementation Provide education and awareness - BENEFITS Develop plan for implementation Timing Logistics (lease agreements, which properties, etc,) Identify enforcement protocol & policy language 15
16 Step 3: Implementation Inform residents of adopting smoke-free policy ~ 6-12 months Sign smoke-free lease and/or addendum before policy change Post signs on property to remind everyone of new policy Assess/enforce gain support Step 4: Reaping Benefits Advertise smoke-free properties Document cost savings Continue to maintain education/awareness to increase compliance and word of mouth referrals Periodically reassess community 16
17 We couldn t do this without YOU! Questions? Electronic Nicotine Delivery Systems (ENDS) or Vaping Devices Matt Herman, MPH, CHES CINCH Eastern Virginia Medical School 17
18 What Are Vaping Devices? Handheld & battery-powered Electronically heats liquid that creates a vapor or aerosol Inhaled into the lungs Referred to as vaping or to vape 18
19 Vaping Device Timeline 2003: Developed in Beijing China 2007: Hits the US market 2016: FDA Ruling Extending regulatory authority to cover all tobacco products, vaping devices and includes e-liquid Review new tobacco products not yet on the market Help prevent misleading claims by tobacco product manufacturers Communicate the potential risks of tobacco products August 8, 2016 Background Lit Tobacco Annual deaths, adults 35+ = > 480,000 Annual costs = > $289 billion Current cigarette smoking is declining Vaping device use is rising More than 3 million middle and high school students were current users of e- cigarettes in 2015, up from an estimated 2.46 million in 2014 Most commonly used tobacco product among youth for the second consecutive year ( ) Approximately users in the US: 2,750,000 19
20 Vaping Devices All consist of: battery heating element e-liquid cartridge Image adapted from Utah Public Radio. Image source guidetovaping.com E-liquid or E-Juice Kid friendly flavors & packaging Coffee Candy Cola Fruit Belgian waffle Safe to eat, but not to inhale Diacetyl, microwave popcorn butter flavoring Popcorn lung 20
21 Types of Vaping Devices E-cigarettes Hookah pens E-cigars Vape pens E-pipes E-hookahs Over 450 different brands Vaping Devices Cigarette Style Image adapted from Grana et al., Circulation,
22 Serious Health Threat Personal Use Primary vapor inhalation, nicotine Countless stories of severe injuries from devices exploding in mouth & pockets Lead former smokers to relapse to nicotine use or use of other tobacco products Delay smoking cessation among current smokers Family & Friends Secondhand Thirdhand Poisonings Serious Health Threat: Secondhand Vapor After the user inhales from the vaping device, vapor that is exhaled by the user is secondhand vapor and can be breathed in by adults & children NOT harmless water vapor NOT safe at any level Vapor contains toxic chemicals, found in traditional tobacco cigarettes, like heavy metals & cancer-causing agents Adults & children with asthma are more vulnerable 22
23 Serious Health Threat: Thirdhand Vapor Exhaled by the user, land & stick to surfaces of the car and can remain on surfaces for weeks to months Dangerous, hidden leftover vapor contain toxic chemicals & nicotine Potential for adults and children to absorb through their skin or breathe in Pregnant women and fetuses Serious Health Threat: Risk of Poisonings or Overdosing Children, drawn to e-liquid cartridges that come in a variety kid-friendly flavors and bright packaging E-liquid that contain high levels of nicotine Accidental poisonings by drinking, inhaling or absorbing Calls to poison control show: vomiting, nausea & eye irritation On average, every 3 hours, poison center receives a call about a young child exposed to an e-cigarette or liquid nicotine The number of children under 6 poisoned by nicotine in e-cigarettes rose by nearly 1,500% between 2013 and 2015, and one child died 23
24 THANK YOU! THANKS! (757)
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