Smokefree Housing: A Public Health Necessity Blocked by Implementation Challenges
By Lucy ArnoldPublished October 31, 2013By Lucile Arnold, Published 10/31/13
In July 2009, the Department of Housing and Urban Development (HUD) issued a notice to all HUD regional directors, coordinators, and public housing directors, breaking decades of silence on a public health issue that had reached broad consensus many years earlier. The notice stated HUD's new policy on smoking in public housing communities; while HUD was not banning smoking, the notice "strongly encourages Public Housing Authorities (PHAs) to implement non-smoking policies in some or all of their public housing units." Historically, HUD had never issued a policy on smoking within public housing units, allowing the jurisdiction of individual states to govern housing authorities within each state. But as the health effects of tobacco became better known, particularly the dangers of environmental tobacco exposure, calls for HUD to issue a policy became louder and louder, resulting in the 2009 announcement that PHAs will be encouraged to implement smoke-free policies at their discretion.
According to the Centers for Disease Control, cigarette smoking causes 443,000 deaths per year in the United States, or the equivalent of 1 in every 5 deaths. The Surgeon General released a report in 2006 highlighting the dangers of secondhand smoke, and concluding that secondhand tobacco smoke exposure causes an annual 50,000 adult deaths. In addition to the deaths caused by secondhand smoke exposure, each year an estimated 18,700 home fires related to smoking cause an additional 700 deaths and approximately $500 million in property damage. These numbers do not account for the millions more United States adults and children who contract asthma and other lung or heart related diseases due to smoking or secondhand smoke. Given the health costs associated with smoking, many states have implemented smoke-free policies in public spaces, such as parks, bars, and restaurants.
Recently, many researchers of tobacco control policy and the health effects of smoking have begun to see additional negative effects of tobacco use through thirdhand smoke. A 2011 study defines thirdhand smoke as "residual tobacco smoke pollutants that remain on surfaces and in dust after tobacco has been smoked." Like secondhand smoke, thirdhand smoke involuntarily exposes people to the toxins contained in cigarettes when they breathe air in a room that has been smoked in (even years later). Unlike secondhand smoke, however, thirdhand smoke exposure can also occur when one touches surfaces in a room that has been smoked in, and the toxins can be absorbed dermally. Negative health effects have been documented in children and infants residing in units previously occupied by smokers, presenting an ethical problem since the effects of smoking in a private unit are not just limited to those who are smoking or directly exposed to a smoker.
Many private landlords have implemented smoke-free policies in their buildings for the above reasons, as well as the property costs incurred by allowing residents to smoke. An Oregon restoration service estimates that the approximate cost to restore a two-bedroom unit that previously housed smokers could be up to $15,000. In addition to saving restoration costs after smokers vacate a unit, property managers will financially benefit from a reduced risk of fire damage.
Both from a public health and financial perspective, smoke-free housing is clearly an ideal for both tenants and landlords. Implementing smoke-free policies in public housing is an extension of public policies that have targeted smoking in public spaces, and are well within the jurisdiction of public housing authorities. Additionally, 54% of residents in public housing are elderly (over the age of 62) or children under 18, groups that are disproportionately at risk of being negatively affected through direct or indirect exposure to tobacco smoke. HUD's 2009 statement marks the acknowledgement of these facts, and the Department will likely produce a stricter policy in the future. Indeed, in 2012, the Department of Health and Human Services (HHS) and HUD released a set of "Smoke-Free Housing Toolkits" to be used by residents or landlords interested in implementing a smoke-free policy in their property.
Despite the clear health and financial incentives to implement smoke-free policies in public housing units, several logistical barriers stand in the way of a broad implementation of the policy. The decentralized nature of HUD makes it difficult for the department to assist with the implementation since separate departments within HUD manage different types of public housing (publicly owned housing developments or subsidized housing vouchers called "Section 8", or housing choice voucher, programs). Additionally, many states run their own public housing programs with little to no involvement by the federal government.
The implementation of smoke-free policies in public housing is important for public health and should be pursued. But several key factors need to be addressed before the policy can become more widespread: first, how can this policy be implemented in a way that does not jeopardize the housing of low-income smokers? Second, how can landlords be incentivized to implement smoke-free policies in their units?