An Overview of HUD s Smoke-Free Multifamily Housing Initiative

Transcription

1 An Overview of HUD s Smoke-Free Multifamily Housing Initiative Rachel M. Riley Senior Program Analyst Office of Lead Hazard Control and Healthy Homes U.S. Department of Housing and Urban Development 451 7th Street, S.W. Washington, DC Rachel.M.Riley@hud.gov

2 Snapshot of Public Housing Residents Characteristic Public Housing Residents (2014/15) Comparison Total Population ~ 2 Million N/A African American 45% (head of household) 13.2% of U.S. Population Hispanic 25% (head of household) 17.4% of U.S. population 37% 23.1% < 18 yrs old Income* 95% of households are low to N/A (relative to local extremely low income area median income) *Shown by CDC to influence youth tobacco use 2

3 Prevalence of Public Housing Households with a Smoker (American Housing Survey, 2011) Household Characteristic All households With 1 or more children (< 18 yrs.) % With a Smoker With 1 or more Seniors 10 With a disabled person 29 Householder: in excellent health 22 Householder: in poor health 35 Householder: difficulty walking or climbing stairs 30 Householder: difficulty remembering or concentrating 42 3

4 Boston Housing Authority Largest housing authority in New England Largest property owner in Boston 9% of Boston residents in BHA housing (over 50,000 residents) Boston slides courtesy of Megan Sandel, M.D., M.PH, Boston Medical Center and HUD Grantee

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6 Fair or Poor Self-Rated Health by Housing Status, Boston Adults, 2006 and 2008 Combined 40% Percent of Adults 33% 31% 30% 20% 10% 10% 0% BHA Rental Assistance Non-PH DATA SOURCE: Boston Behavioral Risk Factor Survey 2006 and 2008, Boston Behavioral Risk Factor Surveillance System (BBRFSS), Boston Public Health Commission DATA ANALYSIS: Boston Public Health Commission Research and Evaluation Office

7 Poor Mental Health by Housing Status, Boston Adults, 2006 and 2008 Combined DATA SOURCE: Boston Behavioral Risk Factor Survey 2006 and 2008, Boston Behavioral Risk Factor Surveillance System (BBRFSS), Boston Public Health Commission DATA ANALYSIS: Boston Public Health Commission Research and Evaluation Office

8 Current Smoking by Housing Status, Boston Adults, 2006 and 2008 Combined DATA SOURCE: Boston Behavioral Risk Factor Survey 2006 and 2008, Boston Behavioral Risk Factor Surveillance System (BBRFSS), Boston Public Health Commission DATA ANALYSIS: Boston Public Health Commission Research Office

9 HUD Smoke-Free Initiative 2009: Office of Public and Indian Housing issued Notice PIH voluntary policy 2010: Office of Housing issued Notice voluntary policy 2012: Office of Public and Indian Housing issued Notice and HUD released Smoke-free Housing toolkits 2012 Federal Register Notice published soliciting feedback on HUD initiative (e.g. barriers, effective implementation practices) 2014: Office of Lead Hazard Control and Healthy Homes 9

10 Incorporates information from HUD s October 2012 FR Notice to soliciting feedback on the Department s SF housing initiative 116 comments received (summarized in Appendix) Includes recommendations from 9 housing managers with experience implementing SF 10 policies

11 HUD Smoke-Free Housing Support Activities in FY 2015 Delivered 2 webinars, with one focused on enforcement of SF housing policies. Expanded content on HUD s SF housing website (Office of Lead Hazard Control and Healthy Homes). Resource Bank Developed an executive briefing, a resident handout template, and a brief online video for housing managers, boards of directors, residents etc. Development of Proposed Rule on Smoke-Free Public Housing Did not address youth tobacco use as a specific issue area is wide open for you to help! Access HUD Smoke-Free Housing materials here: then find under Popular Topics j 11

12 Progress to Date During Voluntary Implementation From review of publicly available information: In 2015: >600 Public Housing Agencies with SF policies (~ 20% of 3,090 PHAs that administer conventional public housing) In 2005 only 12 PHAs had SF policies Approximately 1.2 million nonsmoking public housing residents are still exposed to secondhand smoke, including roughly 60,000 children under age 5 living in units where someone smokes. 9 tribally designated housing entities identified with SF policies No estimate on adoption by federally subsidized multifamily owners/agents (i.e., project-based Section 8) 12

13 FY HUD Proposed Regulation Making Public Housing Smoke-Free Indoors Comment period closed January, Estimate for release of final rule Fall, ,100 public housing agencies - Covers only public housing authorities; not other HUD rental assistance programs, such as Housing Choice Voucher Program ( Section 8 ) PHAs would implement SF policy within 18 months of final rule Prohibits lit tobacco products (cigarettes, cigars, pipes) Does not prohibit ENDS or hookas but comments on these were requested Does not ban SMOKERS, only SMOKING-NEED CESSATION SVCS 13

14 What Public Housing Agencies Say They ve Done Collaborated with State and local health departments (education; signs) Found out where their residents get health care (may be difficult) Provided cessation assistance, classes and tried to provide cessation assistance with varied success Partnered with American Heart Association, American Lung Association, State and Local Quitlines; American for Nonsmokers Rights; Live Smoke-Free Partnered with local coalitions and nearby Community Health Centers and Federally Qualified Health Centers (Providence RI HA) Used materials from ALA Partnered with local colleges, nursing schools, pharmacy schools, mental health providers, home health care providers Worked with local multicultural offices for culturally-specific information Worked with local fire departments 14

15 PHA Concerns Regarding Proposed Rule Cost of staff time required to revise leases, educate residents, identify partners; general lack of resources Biggest challenge will be enforcement of SF policies: not easy, requires a sustained and consistent effort by property managers and staff and requires initial and ongoing communication with residents (a work in progress) Impact on occupancy rates; goal is not to evict anyone, but PHA must be willing to do so as for any lease violation Assisting individuals that may have difficulty with compliance (e.g., smokers with cognitive impairments or mental illness, mobility impaired/disabled) Getting cessation and other support to residents that want to quit (note: HUD encourages housing providers to partner with tobacco control organizations such as ALA chapters, clinics, local health departments, etc.) Need for clarity regarding when a reasonable accommodation should be given to a resident 15

16 What PHAs Want More technical assistance and tools (learning reasons for going smoke-free, getting staff buy-in, FAQ documents, reminder cards for violators, resident meeting planning tools, testimonials) In-person and webinar training for PHA directors and staff on enforcement Free cessation assistance (classes and help telling residents how to obtain counseling and medication) Information on how to design community forums AND designated smoking areas Staff training on conflict resolution, mediation and compliance Staff training on substance abuse, mental health and smoking Model policy and lease language including the federal mandate, when published PHA discussion forum and online portal Note: Some of these materials have been created 16

17 HUD s Partnerships Mirror Local Work Federal Smoke-Free Task Force Working closely with Office of Smoking and Health of CDC, HHS, EPA s Indoor Air Office and NIH Centers for Disease Control staff and grantees Joint outreach to CDC State Tobacco Grantees Cooperative agreements require tracking smoke-free PHAs CDC s national tobacco control partners National Housing Industry Organizations NAHRO Conferences of PHAs regional meetings Resident organizations (NAR-SAAH -- The National Alliance of Resident Services in 17

18 Can I Partner with Housing Providers? Clean Air or Tobacco Free Coalitions (add Housing Provider leader and Resident Council leaders to coalitions; invite housing providers to attend meeting with you!) American Lung Association affiliates also see training on MUH with Resource Toolkits Local or State Health Department Tobacco Control Programs Other non-profit organizations with emphasis on health and populations of low socioeconomic status Find nearby housing authorities and private affordable housing providers locate at resources.hud.gov HUD local and field offices locate at or Google HUD field offices 18

19 Find Your Local Public Housing Authority ndian_housing/pha/contacts 19

20 Helpful Housing Policy Documents online Model and existing smoke-free policies for housing providers Content varies read carefully Sample lease addenda and enforcement plans (meetings/warnings) Resident surveys Signage Promotional and educational videos from variety of organizations Look for ways to incorporate smoke-free policies into residents existing activities (required community service hours, etc.) 20

21 What HUD is Recommending: Enforcement Tips for Housing Providers Can You Help with This? Follow up on all complaints and don t ignore violations. Meet with residents who resist complying to help them problem-solve. Celebrate small successes in newsletters or other communications. Celebrate residents & staff who changed their smoking behavior or quit. On-going: Promote smoking cessation classes or other ways to support people who want to quit. On-going: Communicate 21

22 HUD-Funded Smoke-Free MUH Research (1) FY 2014: A research grant was awarded to Harvard School of Public Health to study the implementation of a comprehensive SF policy by Beacon Communities, LLC. The ban applies to 52 affordable housing properties in 6 states and includes both interior and grounds. Assess the impact of an enhanced resident intervention vs. the standard intervention Enhanced intervention includes cessation messaging and availability of counselling and smart-phone app Outcomes, e.g.: cessation success, self-reported SHS exposure, IAQ measures, reduction in amount smoked 22

23 HUD-Funded Research (2) FY 2015: A research grant was awarded to San Diego State University Foundation to study the distribution of Thirdhand Smoke (THS) residue in low income housing and the efficacy of cleaning protocols in removing it. Will collect nicotine samples in ~ 200 homes in target neighborhoods in San Diego and identify factors associated with higher residue levels. Will assess the efficacy of 3 different protocols for cleaning THS residues and the change in THS markers over time in 40 homes: pre-cleaning immediately postcleaning 3 months post-cleaning 23

24 Questions? 24

25 Next Speaker Roy Priest, Executive Director and CEO Alexandria VA Redevelopment and Housing Authority (ARHA) 25