Evidence of Support for Smoke-Free Public Housing Among New York City Residents

The high costs of secondhand smoke exposure can be measured both by negative health outcomes and economic impact, as quantified in an article by Mason et al., “The Economic Burden of Exposure to Secondhand Smoke for Child and Adult Never Smokers Residing in U.S. Public Housing,” in the May/June 2015 issue of Public Health Reports. In that article, the authors concluded that implementing smoke-free policies in all U.S. public housing would save both lives and money.¹

The New York City (NYC) Department of Health and Mental Hygiene (DOHMH) agrees that smoke-free housing is important to protect health and has long supported smoke-free housing for all, including those in public housing. Since 2009, the U.S. Department of Housing and Urban Development (HUD) has repeatedly encouraged public housing authorities (PHAs) to voluntarily adopt smoke-free housing regulations for their buildings, including publishing a smoke-free housing toolkit to help both PHAs and owners/agents of subsidized or market-rate multiunit housing become smoke-free.^2–5 As of July 1, 2015, more than 250 PHAs had enacted smoke-free building policies.⁶ Moreover, on November 12, 2015, HUD officially proposed rules that would require all PHAs to establish a smoke-free housing policy that prohibits lit tobacco products in all indoor areas of public housing.⁷ It is worth noting that as of October 2015, no organization that had implemented smoke-free housing had faced a legal challenge. The absence of a legal challenge is no surprise, as the law does not confer smokers, as a group, with special legal rights or privileges.^8–10 Furthermore, nicotine dependence is not a disability recognized by law.¹¹ Consequently, to survive a legal challenge, a smoke-free policy must pass a relatively easy test; it must be rationally related to a legitimate government interest (e.g., protecting the health of its residents).

DOHMH is committed to improving access to smoke-free housing for all New Yorkers and has been working with the New York State Department of Health and partner organizations for many years to encourage the voluntary adoption of smoke-free housing among operators of multiunit housing. The federal government's support of smoke-free housing in public housing will have a substantial impact that, as shown by Mason et al., would be measurable in health and economic terms. It is our hope that this federal action will demonstrate to housing operators that implementing smoke-free policies for all multiunit housing is an achievable goal that will lead to measurable health and economic impacts on all multiunit housing residents, regardless of income.

In 2012, DOHMH, the NYC Housing Authority (NYCHA), and NYC Smoke-Free at Public Health Solutions partnered to conduct the Clean-Air Survey (CAS), a cross-sectional telephone survey of a random sample of 1,200 adult (aged ≥18 years) residents of NYCHA—the largest public housing authority in the United States, with more than 400,000 residents^12,13 —to assess their experiences with secondhand smoke exposure, associated health outcomes, and support for smoke-free housing. In a comparison of results from the CAS with the annual NYC Community Health Survey (CHS), a cross-sectional telephone survey of about 8,500 randomly selected adults aged ≥18 years from NYC, residents of NYCHA reported smelling cigarette smoke in their home that came from another apartment or outside more often than New Yorkers overall (54% vs. 40%) (CHS 2013), and 84% of those NYCHA residents reported being bothered by secondhand smoke. NYCHA residents were about twice as likely to report having asthma as NYC adults (23% vs. 12%) (CHS 2013), and more than one-third (34%) of NYCHA residents reported having one or more children with asthma compared with one in eight children (13%) among New Yorkers overall (CHS 2009). Consistent with other studies, 75% of NYCHA residents preferred to live in a building where smoking was not allowed anywhere inside the building, including apartments.^14–16 Additionally, 64% of NYCHA residents responded that all NYC public housing or projects should be smoke-free.

Given the financial burden and health impact caused by secondhand smoke, as well as the popular support among NYCHA residents for smoke-free housing, DOHMH concurs that nationwide, increased smoke-free housing, including in public housing, would be one way to begin to reduce adverse health outcomes and the fiscal burden associated with secondhand smoke exposure.