Perceptions about the Federally Mandated Smoke-Free Housing Policy among Residents Living in Public Housing in New York City

Abstract

Background: To assess residents’ attitudes towards the United States (U.S.) Department of Housing and Urban Development’s new smoke-free public housing policy, perceptions about barriers to policy implementation, and suggestions for optimizing implementation. Methods: In 2017, we conducted 10 focus groups among 91 residents (smokers and nonsmokers) living in New York City public housing. Results: Smokers and nonsmokers expressed skepticism about the public housing authority’s capacity to enforce the policy due to widespread violations of the current smoke-free policy in common areas and pervasive use of marijuana in buildings. Most believed that resident engagement in the roll-out and providing smoking cessation services was important for compliance. Resident expressed concerns about evictions and worried that other building priorities (i.e., repairs, drug use) would be ignored with the focus now on smoke-free housing. Conclusions: Resident-endorsed strategies to optimize implementation effectiveness include improving the access to cessation services, ongoing resident engagement, education and communication to address misconceptions and concerns about enforcement, and placing smoke-free homes in a larger public housing authority healthy housing agenda.

Implementation of the Department of Housing and Urban Development’s Smoke-Free Rule: A Socio-Ecological Qualitative Assessment of Administrator and Resident Perceptions

“…These findings are consistent with prior research showing individual-level rule support, especially among non-smokers [27][28][29]. Past research suggests that most of the support is driven by perceived health benefits of the rule [30]. However, despite the support and perceived benefits, there are consistent compliance barriers or resistance making enforcement a challenge for smoking-free rules no matter the geographic location or setting [8,9,27,[30][31][32][33][34].…”

“…Past research suggests that most of the support is driven by perceived health benefits of the rule [30]. However, despite the support and perceived benefits, there are consistent compliance barriers or resistance making enforcement a challenge for smoking-free rules no matter the geographic location or setting [8,9,27,[30][31][32][33][34]. Studies show resident support for smoke-free multi-unit housing policies [3,8,35,36], including racially and ethnically diverse, low-income seniors [37], and property managers [3,8,38], although important differences existed by smoking status [39].…”

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

“…Our findings substantiate published qualitative findings from focus groups where public housing residents reported pervasive marijuana use in their building's common areas. 22 Current non-smoking residents in our sample were also more sensitive to noticing, or at least reporting, pervasive marijuana use in their buildings. Overall, the widespread prevalence of SHMS exposure in MUH is especially concerning given an emerging body of evidence associating SHMS with poor health outcomes.…”

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 ).…”