A protocol for measuring the impact of a smoke-free housing policy on indoor tobacco smoke exposure

Abstract

Background Tobacco remains a leading cause of preventable death in the U.S., responsible for more than 440,000 deaths each year. Approximately 10% of these deaths are attributable to exposure of non-smokers to secondhand smoke (SHS). Residents living in public multi-unit housing (MUH) are at excess risk for SHS exposure compared to the general population. On November 30, 2016, the U.S. Department of Housing and Urban Development (HUD) passed a rule requiring all public housing agencies to implement smoke-free housing (SFH) policies in their housing developments by July 30, 2018. Methods As part of a larger natural experiment study, we designed a protocol to evaluate indoor SHS levels before and after policy implementation through collection of repeat indoor air samples in non-smoking apartments and common areas of select high-rise NYCHA buildings subject to the HUD SFH rule, and also from socio-demographically matched private-sector high-rise control buildings not subject to the rule. A baseline telephone survey was conducted in all selected buildings to facilitate rapid recruitment into the longitudinal study and assess smoking prevalence, behaviors, and attitudes regarding the SFH policy prior to implementation. Data collection began in early 2018 and will continue through 2021. Discussion The baseline survey was completed by 559 NYCHA residents and 471 comparison building residents (response rates, 35, and 32%, respectively). Smoking prevalence was comparable between study arms (15.7% among NYCHA residents and 15.2% among comparison residents). The majority of residents reported supporting a building-wide smoke-free policy (63.0 and 59.9%, respectively). We enrolled 157 NYCHA and 118 comparison non-smoking households into the longitudinal air monitoring study and performed air monitoring in common areas. Follow up surveys and air monitoring in participant households occur every 6 months for 2.5 years. Capitalizing on the opportunity of this federal policy rollout, the large and diverse public housing population in NYC, and robust municipal data sources, this study offers a unique opportunity to evaluate the policy’s direct impacts on SHS exposure. Methods in this protocol can inform similar SFH policy evaluations elsewhere.

Self-reported Secondhand Marijuana Smoke (SHMS) Exposure in Two New York City (NYC) Subsidized Housing Settings, 2018: NYC Housing Authority and Lower-Income Private Sector Buildings

“…The demographic composition and prevalence of cigarette smoking among NYCHA and Section 8 residents were highly comparable (p>0.05) (Table 1). 19 More than half of residents reported smelling cigarette smoke (60%) and two-thirds report smelling marijuana smoke (67%) in their home over the past year. Cigarette smoking status and smelling SHS were both strong predictors of smelling SHMS.…”

“…The study population and procedures have been described elsewhere. 19 Study protocol and procedures were approved by the Institutional Review Board at the New York University School of Medicine on July 20, 2017; IRB number: i17-00968. Written informed consent was obtained from study participants by trained field staff and Memorandums of Understanding were signed by all institutions involved for the appropriate exchange of data following good clinical practice and HIPAA compliance.…”

“…Using building resident rosters as sampling frames, surveys were administered to NYCHA residents between April-July 2018 (pre-SFH policy implementation) and to Section 8 building residents between August -November 2018. 19 Of 4,628 eligible residents, 1,030 participated (response rates, 35% NYCHA, 32% Section 8).…”

Evaluation of Secondhand Smoke Exposure in New York City Public Housing After Implementation of the 2018 Federal Smoke-Free Housing Policy

“…This study followed the Transparent Reporting of Evaluations With Nonrandomized Designs (TREND) reporting guideline. 21 Detailed information on the study population and procedures has been described elsewhere. 22…”

Feasibility of Low-Cost Particle Sensor Types in Long-Term Indoor Air Pollution Health Studies After Repeated Calibration Over a 2-Year Timeframe

“…After each laboratory calibration, the Airbeam units were deployed in a large, natural experiment evaluating the impact of new smoke-free housing (SFH) policies on air quality in public housing units every 6 months. 11,23 Due to the onset of the COVID-19 pandemic, we were unable to perform Airbeam sensor calibration 24 months post-SFH policy implementation (April-September 2020). A calibration technical error for select Airbeam 2 sensors occurred at 30 months post-SFH policy (December-March 2021), leading to their exclusion from data analysis at that timepoint.…”