An Overview of HUD s Smoke-Free Multifamily Housing Initiative National Conference on Tackling Tobacco Use in Vulnerable Populations October 6, 2015 Peter J. Ashley, DrPH Office of Lead Hazard Control and Healthy Homes U.S. Department of Housing and Urban Development 1 HUD Smoke-Free Initiative 2009: Office of Public and Indian Housing issued Notice PIH 2009-21 2010: Office of Housing issued Notice 2010-21 2012: Office of Public and Indian Housing issued Notice 2012-25 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 releases Action Guide 2015: Proposed rule prohibiting smoking in federally financed public housing expected to be published 2 HUD s Smoke-Free Housing Toolkits - Released in June, 2012 - Endorsed by American Academy of Pediatrics, the American Lung Association, and CDC Office of Smoking and Health - Sent to directors of appx. 2,200 PHAs in 2013 - Separate toolkit created for residents 3 1
o Incorporates information from HUD s October 2012 FR Notice soliciting feedback on the Department s SF housing initiative o 116 comments received (summarized in Appendix) o Includes recommendations from 9 housing managers with experience implementing SF policies 4 Major Contents of Action Guide Reasons to adopt a SF housing policy Summarizes interviews with 9 Smoke-free housing pioneers (representing: public housing agencies; federally subsidized multifamily housing, and market-rate housing) Recommended steps to adopting and implementing a SF policy FAQs Appendices (HUD Notices; Resources; summary of Fed Reg comments) 5 Why a Smoke-Free Housing Policy? 6 2
Smoke-Free Pioneer I was adamant that the policy was going to take too much effort, and we were going to be spending our whole lives to get people to stop smoking. It was not actually like that at all. Diane Martin, Property Manager, Housing and Redevelopment Authority of Duluth, Minnesota 7 Smoke-Free Pioneer In September of 2009, HUD issued a letter to owners and agents saying that they were in support of smoke-free housing. It could not have come out at a better time, because in January of 2010, we had two very large smoking-related apartment fires within a 10-day period that cost us well over $1 million. Scott Alderman, Landura Management, Winston-Salem, NC 8 Additional Health and Safety Considerations o > 4,000 chemicals have been identified in tobacco smoke; this includes at least 69 carcinogens. o The U.S. Surgeon General has concluded that there is no safe level of exposure to secondhand smoke (SHS). o Tobacco smoking is the leading cause of fatal fires in the U.S. o SHS is a significant source of lead exposure for children and adults and there is no safe level of lead exposure for young children. o SHS exposure is associated with both the development and exacerbation of asthma in children. 9 3
Smoke-Free Housing Policies: Impact on Smokers There is evidence that SF policies can reduce the amount of cigarettes smoked/day among smokers and increase quit rates among residents (e.g., Pizacani, B. A. et al., 2012 Nicotine and Tobacco Research). Examples of quitting by long-term smokers have been reported by some housing providers (e.g., next slide). 10 Cessation Contest Winner Laura Humphrey (2 packs/day): How can you quit smoking in a place that you can smoke in?! (3/5/15 webinar: Rick Ball Exec. Director, Housing and Redevelopment Authority of Duluth, MN) Progress to Date From review of publically available information: about 600 Public Housing Agencies with SF policies in at least some buildings (~19% of 3,090 PHAs that administer conventional public housing) This covers > 186,000 housing units 9 tribally designated housing entities identified with SF policies Adoption by federally subsidized multifamily owners/agents (i.e., project-based Section 8) thought to be significant 12 4
Proposed HUD Rule to Mandate Smoke- Free Policies in Public Housing HUD has drafted a proposed rule that would mandate that all public housing agencies prohibit the smoking of tobacco products inside of all buildings/units that are federally subsidized. The draft proposed rule and regulatory impact analysis are still in the review stage, with expected publication this calendar year (2015). If implemented, the rule would cover over 3,000 PHAs housing ~ 2 million residents. 13 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 < 18 yrs old 37% 23.1% Income 95% of households are low to extremely low income N/A (relative to local area median income) 14 Prevalence of Public Housing Households with a Smoker (American Housing Survey, 2011) Household Characteristic % With a Smoker All households 25 With 1 or more children (< 18 yrs.) With 1 or more Seniors 10 With a disabled person 29 Householder: in excellent health Householder: in poor health 35 Householder: difficulty walking or climbing stairs 30 Householder: difficulty remembering or concentrating 42 25 22 15 5
Concerns Regarding Rule Implementation Assisting individuals that may have difficulty with compliance (e.g., smokers with cognitive impairments or mental illness, mobility impaired) 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.) 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 16 HUD-Funded 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 17 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 post-cleaning 3 months post-cleaning 18 6
HUD Smoke-Free Housing Support Activities in FY 2015 Delivered 2 webinars on SF housing, with one focused on enforcement of SF housing policies. Significant expansion of content on SF housing website (Office of Lead Hazard Control and Healthy Homes). Developed a video on SF housing implementation in public housing and federally assisted privately owned housing. 19 THANK YOU! peter.j.ashley@hud.gov 20 7