‘If I pay rent, I’m gonna smoke’: Insights on the social contract of smokefree housing policy in affordable housing settings

Abstract

Smoke-free housing policy in multi-unit housing has emerged as a promising tobacco control initiative, yet full compliance remains elusive and is a critical impediment to policy effectiveness. There is a gap in existing research on potential factors preventing optimal smoke-free policy adoption and corresponding solutions. Using qualitative and quantitative data from resident surveys (N=115) as well as key informant interviews, a focus group, and observational fieldwork, this study 1) assesses smoking behaviors and experience with secondhand smoke in buildings after adoption of a smoke-free policy; 2) examines resident and property management perceptions of the policy; and 3) identifies socioecological factors that influence the policy's effectiveness in affordable housing settings in New York City. Findings indicate that residents view smoking regulations within the context of broader relationships with the housing provider and other residents. We argue that these "social contracts" strongly influence the effectiveness of smoke-free housing policies and must be acknowledged to maximize compliance.

The HUD smoke-free rule: Perceptions of residents post-implementation

“…In general, study results are consistent with evaluations of tobacco policies in public or multi-person housing prior to the nationwide HUD rule. Specifically: a) residents have good knowledge, and are supportive, of the policy, especially non-smokers ( Kennedy et al, 2015 , Rokicki et al, 2016 ); b) residents are concerned that there isn’t enough enforcement ( Hernandez et al, 2019 , Jiang et al, 2018 , Kennedy et al, 2015 ); c) tobacco policies reduce, but do not eliminate self-reported smoking exposure in the building ( Hernandez et al, 2019 , Pizacani et al, 2012 , Rokicki et al, 2016 ); and d) the policy motivates smokers to make positive changes in their tobacco use ( Rokicki et al, 2016 ). Regarding quitting, Pizacani et al (2012) reported a higher policy associated quit rate (14.6%) than in this study (6.4%).…”

“…Generally, residents were knowledgeable of the smoke-free policy and supportive of it ( Kennedy et al, 2015 , Rokicki et al, 2016 ), with non-smokers more supportive than smokers ( Kennedy et al, 2015 ). However, enforcement of the policy was a concern, with some evidence that such enforcement was poor ( Hernandez et al, 2019 , Jiang et al, 2018 , Kennedy et al, 2015 ). Consistent with these concerns, evaluations of these smoke-free housing policies documented reductions, but not elimination, of smoking within the buildings ( Hernandez et al, 2019 , Pizacani et al, 2012 , Rokicki et al, 2016 ).…”

“…However, enforcement of the policy was a concern, with some evidence that such enforcement was poor ( Hernandez et al, 2019 , Jiang et al, 2018 , Kennedy et al, 2015 ). Consistent with these concerns, evaluations of these smoke-free housing policies documented reductions, but not elimination, of smoking within the buildings ( Hernandez et al, 2019 , Pizacani et al, 2012 , Rokicki et al, 2016 ).…”

“…Almost half of the smokers reported that they were smoking less. Research to date has emphasized the need for ongoing communication about a smoke-free policy to residents, their active involvement with its implementation and assistance for those who want to reduce or quit tobacco use ( Hernandez et al, 2019 ). While instructive, the smoke free policies evaluated to date prior to July 2018 were not necessarily the same as the new HUD policy.…”

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

“…35,36 These include a sentiment among many residents that they have a right to privacy and autonomy in their homes (counterbalancing overall support for the policy), a lack of tobacco cessation treatment support, and frustration that other building violations, such as marijuana use, are not being addressed. A study by Hernández and colleagues 35 Downloaded From: https://jamanetwork.com/ on 11/24/2020 agenda into a wider healthy-homes policy agenda. Continued evaluation of the implementation process and assessment of consequences for health outcomes is critical to optimize both.…”