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. 2025 Jan 13;12(1):4. doi: 10.1007/s40572-024-00470-7

Indoor Air Quality in Multi-Family Housing: Drivers and Interventions

Jonathan I Levy 1,✉, Kai Kibilko 2
PMCID: PMC11729057  PMID: 39804430

Abstract

Purpose of Review

Indoor air pollution is likely to be elevated in multi-family housing and to contribute to health disparities, but limited studies to date have systematically considered the empirical evidence for exposure differentials between multi-family and single-family housing. Our goal is to separately examine the drivers of residential indoor air pollution, including outdoor air pollution, ventilation and filtration, indoor sources, and occupant activity patterns, using secondhand smoke as a case study to examine the behavioral dimensions of indoor environmental interventions.

Recent Findings

Within studies published from 2018 to 2023, multi-family homes have higher average outdoor air pollution than single-family homes given their more frequent presence in urban and near-roadway settings. Systematic differences in ventilation were principally related to the presence of working kitchen and bathroom exhaust fans, with heterogeneity in overall building infiltration. Indoor sources such as smoking and cooking were more prevalent in multi-family housing, partly because of the influence of adjacent units and shared spaces and partly because source utilization was higher among sociodemographic groups who tend to live in multi-family housing. The literature on smoke-free housing demonstrated that additional steps would be required to reduce exposure to secondhand smoke given some of the challenges associated with smoking cessation.

Summary

Publications on the drivers of indoor air pollution in multi-family housing reinforce the likelihood of substantial exposure disparities, indicating the urgency of policy measures that address indoor sources and improve ventilation and filtration in a manner that recognizes the complex behavioral dynamics in the home environment.

Keywords: Housing, Indoor air, Multi-family, Nitrogen Dioxide, Particulate Matter, Secondhand Smoke

Introduction

In the United States (US), according to data from the American Community Survey [1], more than one-third of the housing units in the country are occupied by renters, with more than 90% of the households in these units characterized as low or middle income. The majority of these units, 31.8 million of them [2], are in multi-family buildings, with more than 56 million individuals living in these units.

As for most people in the industrialized world, residents of multi-family housing would be expected to have most of their personal exposure to air pollution occur inside of their homes. Indoor exposures are primarily driven by outdoor air pollution concentrations, indoor sources, ventilation and filtration, other aspects of the physical structure of the home, and activity patterns of the occupants. For multi-family housing, although there is substantial heterogeneity in building types and configurations, each of these factors could play an important role and contribute to elevated exposures for residents relative to single-family housing [3]. For example, multi-family housing may have disproportionate exposure to outdoor air pollution, which readily penetrates into the indoor environment [4, 5], given that multi-family housing may be located to a greater extent in urban areas. Some indoor sources may be more prevalent within multi-family housing, given building age and construction, potential contributions from adjacent units, and because source utilization may be higher among sociodemographic groups who tend to live in multi-family housing. Ventilation and filtration characteristics may also differ systematically, both given the presence of adjacent units or common hallways and the potential for differences in HVAC infrastructure. The smaller size of the units within multi-family housing would amplify the contributions from indoor sources, especially if in conjunction with a lack of robust ventilation and filtration. Activity patterns, in part in response to thermal comfort and other aspects of the physical environment, could also have an important effect.

In spite of the likelihood for elevated air pollution exposures within multi-family housing as well as the higher rates of diseases influenced by air pollution like asthma and cardiovascular disease in settings like public housing or rental assistance housing [6], there have been relatively few studies examining indoor air pollution in multi-family housing. For example, some older studies showed elevated indoor nitrogen dioxide (NO2) in public housing units with gas stoves, related to inadequate ventilation as well as stove usage including for supplemental heating [7]. Others have shown that conventional low-income multi-family housing has higher concentrations of air pollutants such as fine particulate matter (PM2.5) or NO2 in comparison with newer “green” buildings [8]. But these studies have generally been small given the intrinsic limitations of indoor air quality field studies, and it is not clear how the insights generalize across diverse types of multi-family housing in different geographic locations or what interventions would be warranted more broadly.

Given the likelihood of elevated concentrations, the presence of susceptible individuals, and the ability to work with a single landlord to implement change across numerous units at once, multi-family rental housing provides an ideal target for indoor environmental interventions. While there are substantial barriers given resource limitations, there are also strong financial motivations to intervene. In a public housing context in particular, since many households have governmental subsidies for housing and receive health care through governmental programs like Medicare or Medicaid, housing-based investments that improve health can be readily justified. However, not all theoretically desirable interventions will be effective in a real-world setting. While interventions that remove indoor sources or appropriately address filtration and ventilation should be beneficial, there is the possibility of unintended consequences or low uptake if the interventions do not address the root causes of the source contributions or take account of potential behavioral responses.

The goal of this article is to systematically evaluate the current evidence for elevated indoor air pollution in multi-family housing, with an emphasis on rental units, considering the key drivers of indoor air pollution given limited evidence on indoor air itself. We consider whether there are systematic differences between multi-family and single-family housing, and given the heterogeneity within the multi-family housing sector, we describe the attributes of multi-family housing developments at greatest risk for elevated indoor air pollution. We also evaluate the evidence for effective interventions in multi-family housing, using secondhand smoke (SHS) in public housing as an example that acknowledges important behavioral dimensions of indoor environmental interventions. We conclude by considering the implications for future efforts to improve indoor air quality in multi-family housing.

Methods

In July 2023, we conducted a literature search in PubMed using the keywords (“multifamily” or “public housing” or “apartment”) and (smoking or “air pollution” or “pm2.5” or “particulate matter” or “nitrogen dioxide”). This selection of keywords, including the specific pollutants indicated, was based on preliminary literature reviews and keyword searches that ascertained the number and nature of the articles identified. With these keywords, we identified 723 articles, 228 of which were published between 2018 and 2023. We reviewed each of these 228 articles for relevance, focusing on articles that addressed outdoor air pollution, ventilation characteristics, indoor source contributions, activity patterns, or efficacy of interventions within multi-family housing (noting that many articles addressed multiple themes). This led to a subset of 97 articles that were relevant to at least one of these themes, with some providing direct empirical evidence and others providing contextual information relevant to assessing indoor air quality. We focus below on the 46 articles providing empirical evidence related to these themes.

Outdoor Air Pollution

The share of multi-family housing is typically higher in urban versus suburban or rural settings, which increases the likelihood of higher outdoor air pollution. While there is limited literature that speaks directly to the average exposure differential between multi-family and single-family dwellings, multiple studies provide insight on some aspects of this question. A study in Los Angeles County [9] found higher NO2 near apartments and other multi-family dwellings as compared to single-family dwellings, attributed to both traffic and combustion sources within the apartments that are vented outdoors. A national-scale study found that ambient PM2.5 concentrations were higher for the 1.2 million US households living in public housing [10], with the authors concluding that public housing developments may have been disproportionately placed proximate to pollution sources and that pollution sources may have been more likely to be sited near public housing developments. While this represents only a fraction of multi-family housing, similar factors would have likely affected other low-income developments. Within Denmark, outdoor levels of PM2.5, ultrafine particulate matter (UFP), elemental carbon, and NO2 were highest among those living in apartments, followed by semi-detached homes, with the lowest levels among single-family homes [11].

Other identified literature reinforced the elevated outdoor concentrations of pollutants such as UFP, nitrogen oxides (NOx), and black carbon (BC) in urban or near-road settings, with a heightened contribution near apartment buildings given street canyon effects [12]. Studies outside of our literature review emphasized the importance of vertical concentration profiles for high-rise multi-family housing, with a dependence on height, traffic presence, and season [13].

Ventilation

Ventilation has a complex effect on indoor air quality, as low ventilation can increase the effects of indoor sources but reduce the contribution from outdoor air pollution. The complexity is enhanced within multi-family dwellings given the influence of air exchange with adjacent units as well as the presence of spot ventilation (e.g., kitchen exhaust).

Comparisons are further complicated by the substantial heterogeneity in ventilation characteristics by climate zone and building age and type [14], but a subset of the studies identified in our literature review directly addressed potential differences between multi-family and single-family dwellings. In one study in California [15], lower-income apartments were found to have higher mechanical air exchange rates than single-family detached homes but lower total ventilation flow. This was attributed to the apartments having bath fans or range hoods that were either not functioning or not up to code. This is in agreement with an earlier study in Sweden that similarly documented higher air exchange rates in apartments than single-family homes [16]. Earlier literature also documented substantially lower prevalence of bathroom fans [17] or range hoods found in rental units, older buildings, and smaller units [18]. Additional studies identified in our literature review reinforced that working kitchen exhaust fans could substantially reduce indoor air pollution [19, 20], strengthened by natural and mechanical ventilation [21–25], and that air exchange rates were lower within multi-family buildings without mechanical ventilation relative to those with exhaust and balanced ventilation [26].

In another study examining three different types of multi-family dwellings in the Northeastern US, there were substantial differences in indoor/outdoor ratios of culturable bioaerosols between buildings with central HVAC vs. window AC units. This provided an indication of the effects on air exchange as well as dew point, a strong correlate of the levels of indoor culturable fungi [27]. A study in Sweden [28] of multi-family housing residents confirmed the heterogeneity within the sector, as rented apartments were significantly less likely than self-owned apartments to have mechanical ventilation and were significantly more likely to report mold and dampness.

Indoor Sources and Activity Patterns

Given our focus on indoor air pollution in general and PM2.5 and NO2 specifically, the indoor sources most commonly considered in the identified studies were cooking and smoking, with evidence indicating systematically higher exposures in multi-family housing. For example, a field study in Massachusetts [29] found higher indoor PM2.5 concentrations among multi-family units versus single-family homes, attributable to cooking and smoking along with range hood use and building size. Simulation modeling that assumed identical activity patterns demonstrated higher concentrations of PM2.5 from both cooking and smoking in apartments than in single-family homes, with 6-unit apartments having higher concentrations than 2-unit apartments [30]. Home size was a key factor, as all else being equal, contributions to indoor air pollution will be greater in multi-family homes on average given the smaller home volume.

An additional question addressed by the literature is whether there are systematic differences in source prevalence or activity in multi-family housing vs. single-family housing, beyond the structural factors that will lead to differential source contributions. Because of the intrinsic nature of multi-family housing having air transfer between units, described in articles found within our literature review as well as earlier studies [31–36], multi-family housing will have more potential indoor sources than single-family housing. Coupled with the strong inverse association between income and smoking prevalence [37], multi-family housing would be expected to have much higher risks of residential SHS exposure than single-family dwellings. 34% of multi-family housing residents with smoke-free homes reported SHS incursions [38], which in turn places them at higher risk of SHS-related morbidity and mortality [39]. A study of high-rise buildings in New York City [40] detected nicotine in non-smoking apartments, stairwells, and hallways, with higher concentrations on higher floors especially in the winter, consistent with a stack effect. Across 21 high-rise buildings in New York City without smoke-free policies [41], most hallways and stairwells had detectable nicotine but fewer than 10% of non-smoking apartments did, partly attributable to smoking in indoor common areas.

Substantial heterogeneity would be anticipated in the contributions of smoking to indoor air pollution in multi-family housing, both because of structural differences and because there are some buildings and developments with smoke-free policies. For example, the US Department of Housing and Urban Development (HUD) implemented a mandatory smoke-free policy for public housing in 2018. While this policy is a major step forward in trying to address exposures among people most vulnerable to adverse health outcomes [42], it only covers about 15.5% of multi-family housing residents in the US who smoke [39], and other developments may not have voluntary smoke-free policies in place [38]. Smoke-free policies also do not entirely eliminate indoor smoking, though improvements were noted [33, 42–44]. For example, in New York State public housing, residents reported substantial reductions in smoking behaviors, but more than one-third still reported smoke incursions at least a few times a week [45]. The influence of continued smoking was clearly seen in a study that showed increases in indoor PM2.5 in public housing developments in Virginia during the COVID-19 pandemic [46].

In multi-family buildings without smoking, residential cooking has been shown to dominate indoor PM2.5 concentrations, especially when considering short-term peaks [47]. Cooking contributions to indoor air can derive from fuel type and from the cooking process itself. Studies reinforced that cooking style can have a substantial influence on indoor PM2.5, with pan-frying leading to elevated concentrations for hours [20]. While we did not identify evidence from the recent peer-reviewed literature on systematic differences in cooking practices between multi-family and single-family homes, cooking time has been shown to be higher among individuals receiving food assistance, not in the workforce, or over age 65, which would be expected to correlate with housing type [48].

Efficacy of Interventions

Given the dominant contributions of indoor sources to indoor air pollution in multi-family housing, amplified by smaller unit size and limitations with spot ventilation, source removal would theoretically be the most desirable intervention option. However, there are multiple practical barriers given the behavioral dimensions associated with many indoor sources. Using smoking as an example, while smoke-free policies would theoretically eliminate SHS exposure risks, as mentioned above, there is ample evidence that additional steps are required for the intervention to be successful. Our review found methods to improve smoke-free policies and their implementation through the following elements: Information/education sessions and resources for residents [34, 35, 43–45, 49–54], cessation support (counseling, medications, or referral to cessation services) [35, 42, 44, 49, 51, 52, 55–58], resident input on implementation of smoke-free policies [42, 49, 51], staff training [45, 49–51, 54], partnerships with outside groups (community organizations, health care providers, etc.) [34, 42, 43, 49, 51, 54], use of toolkits to guide policy implementation or enforcement [34, 49, 51], support groups [43], and the provision of outdoor smoking areas or areas that are not inside of a multi-unit building [42, 43, 49, 53, 54]. The use of multiple interventions simultaneously is associated with increased success [49, 51]. One article noted measured increases in pollutants following the implementation of smoke-free housing, but it was indicated that this would have likely been alleviated with additional or alternative implementation activities, such as the ones mentioned [54].

Barriers to successfully implementing these practices include a misconception that smoking is a “right” guaranteed to everyone [42, 59], unsuccessful staff training to enforce smoke-free policies [42, 54], an inability to address the underlying stress that often leads to smoking [43], unavailability of alternative/outdoor spaces to smoke [50], loopholes in rules by allowing vape products that generate similar levels of pollution [50], perceived lack of support for residents trying to quit [53], and lack of explicitly mentioning cannabis that generates similar SHS [60]. There have also been concerns about resident turnover [52, 53, 61], although it has been shown that smoke-free policies can reduce resident turnover and the costs of managing properties [38]. Some smaller dwellings might also have trouble accessing necessary resources to address indoor smoking [49]. The HUD rule also does not provide guidance on how smoke-free policies should be implemented [44, 49].

While most of these insights are specific to SHS given the addictive nature of smoking and the complex behavioral interventions required, some generalize to cooking or other indoor sources. For example, any efforts to replace gas stoves with other technologies will only be effective if they educate residents on both the rationale and technology, provide relevant resources (e.g., new cookware required for induction stoves), and get resident input on implementation.

Conclusions

Collectively, the recent literature relevant to indoor air quality in multi-family housing reinforces the likelihood of higher exposures to pollutants like PM2.5 and NO2 relative to single-family housing. Outdoor air pollution is higher on average near multi-family homes, related in large part to urban and near-roadway presence. There is heterogeneity in the infiltration of outdoor air pollution across multi-family homes, largely as a function of presence/absence of mechanical ventilation, leading to multi-family homes sometimes having higher and sometimes having lower ventilation relative to single-family homes. In contrast, there appeared to be systematic differences in the presence of working kitchen and bathroom exhaust fans, which when coupled with smaller units would contribute to greater contributions from any indoor sources to indoor air pollution. Smoking contributions to SHS are far more substantial in multi-family housing given both higher smoking prevalence and the influence of adjacent units, and cooking contributions are greater as well, further increasing the gap between multi-family and single-family housing.

The crucial questions center on the viability of interventions to reduce indoor exposures in multi-family housing and therefore reduce inequities. Although the hierarchy of controls is intended for occupational exposures, it provides a valuable organizational structure for thinking about improvements in indoor air in multi-family housing [62]. Elimination of the hazard is the preferred strategy, but this is often not possible. Outdoor air pollution is largely outside of the control of the resident or building manager. Indoor sources can in theory be removed, but the literature reinforces that there are considerable challenges in eliminating sources. Smoke-free housing has been implemented in public housing and other developments, but additional steps are required to truly eliminate SHS. Smoking is distinct from other indoor sources, but analogous challenges remain for other sources. Substitution of one technology for another is the next level in the hierarchy of controls. While this is viable in theory for gas stoves, which can be replaced by electric or induction stoves, this is a complex structural investment that would greatly reduce NO2 and other pollutants from fuel combustion but does not eliminate contributions from the cooking process itself.

Engineering controls are therefore required in many settings to address indoor sources, which would include improvements to HVAC systems, portable or other filtration systems, sealing and other efforts to reduce infiltration between units, and so forth. There is no one-size-fits-all recommendation given the wide range of multi-family buildings, but working exhaust fans would be a key part of any intervention strategy that would not elicit complex tradeoffs between indoor and outdoor sources.

There are some limitations in the insights that can be drawn from our literature review. First, the multi-family housing developments included in the peer-reviewed literature are not a representative random sample. A disproportionate number of studies related to SHS were conducted in public housing given the recent smoke-free housing policy, and broadly, many field studies have been based in individual developments that were selected for proximity to researchers more than representativeness. A parallel modeling literature has provided some insight on geographic variation in meteorology or building attributes and ventilation or indoor air [63, 64], but some of these studies were not captured in our literature search either because of the search terms or because of our focus on publications since 2018. We recommend an increased emphasis in future studies on measurements or models that capture heterogeneity to allow for more generalizable insights.

In spite of these and other limitations, our literature review reinforces the public health importance of measures that address indoor air in multi-family housing. The documented disparities in SHS exposure as a function of housing type [59] and in other indoor pollutants indicate the urgency of both further research and policy measures that incentivize interventions.

Author Contributions

J.L. designed the project and drafted the manuscript, and K.K. conducted the literature review. Both authors contributed to manuscript preparation and reviewed the final manuscript.

Funding

This project has been funded in part by the United States Environmental Protection Agency under assistance agreement 84048001 to Boston University. The contents of this document do not necessarily reflect the views and policies of the Environmental Protection Agency, nor does the EPA endorse trade names or recommend the use of commercial products mentioned in this document. KK was additionally supported by the Health Effects Institute Summer Fellowship Program.

Data Availability

No datasets were generated or analysed during the current study.

Declarations

Competing Interests

The authors declare no competing interests.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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