Should Public Housing be Smoke-Free?

The federal Department of Housing and Urban Development (HUD) has recently issued a proposed rule that would require all public housing agencies (PHAs) to implement smoke-free policies in their developments. This would entail implementing a policy “prohibiting lit tobacco products in all living units, indoor common areas in public housing, and in PHA administrative buildings” no later than 18 months from the effective date of the final rule. The policy would extend to all outdoor areas up to 25 feet from the housing and administrative office buildings. The stated purpose of the rule is to “improve indoor air quality in the housing, benefit the health of public housing residents and PHA staff, reduce the risk of catastrophic fires, and lower overall maintenance costs.”

Background

Clean indoor air laws have long been recognized as an effective tobacco control policy that limits exposure to secondhand smoke and its resultant adverse health consequences, encourages smoking cessation attempts, and reduces the risk of fires. Over the past several decades smoking has become concentrated among vulnerable populations including those with lower income, mental illness and substance use disorders. Public housing provides a valuable service to these individuals. It is likely, given the historically low current rates of adult smoking, that in public housing most residents are non-smokers and thus at risk from the dangers of secondhand smoke exposure. This means for young children a heightened risk of asthma, upper and lower air way symptoms, ear infections and school absenteeism. For pregnant women and infants, secondhand smoke exposure increases the risk of premature delivery and other pregnancy complications, sudden infant death syndrome, and may impair childhood cognitive development. For adults, especially those with pre-existing cardiovascular disease, it increases the risk of heart attacks and stroke. Thus, there is the potential for benefit to the over 760,000 children and over 329,000 seniors who currently live in public housing. In addition, smoking causes over 100,000 fires annually.

Questions pertaining to this proposed rule:

  • Does it include use of electronic nicotine delivery products, such as the e-cigarette? No, it does not.
  • Does it include combustible marijuana? No it does not, although in most states smoking marijuana is not legal.
  • Can the tenants still smoke? Yes, but not in the public housing or its surrounding 25 feet. No one is being forced to quit smoking.
  • How will this rule be enforced? Presumably by the housing authority, although that is not specified.
  • Is there precedent for this rule? Yes, since 2009 HUD has strongly encouraged Public Housing Agencies (PHAs) to adopt smoke-free buildings. In September 2015, over 612 PHAs, representing over 20% of HUD’s housing portfolio, had voluntarily become smoke free, up from 11% five years earlier. State mental health hospitals have rapidly evolved over the past decade from encouraging and then tolerating smoking to becoming virtually 100% smoke free. It was widely feared that banning smoking would exacerbate disciplinary problems in those settings, but in fact the opposite occurred.
  • Will tenants be offered smoking cessation assistance, such as instructions to call the state quit line or referrals for clinical smoking cessation assistance? That is not yet specified by HUD. Placing resources such as 1-800-QUIT-NOW cards and other educational materials at PHA properties can be a simple solution.
  • Is this fair? Smoking is not banned in private housing. The fact that most public residents are non-smokers yet are being exposed to secondhand smoke is just as unfair. Many successful public health practices, such as drunk driving laws, seat belt laws, and fluoridation of water supplies adopt the principle of “the greater good.” This seems another example of that principle. In addition, individuals with mental Illness may argue this is punitive, thinking that smoking cigarettes helps relieve their symptoms. Evidence supports that this is not true and has been propagated by the tobacco industry1. Taking advantage of the 18 month lead-in plus comprehensive cessation coverage2, smokers who want to quit should get the help they need.

 

HUD is requesting public comments on this proposed rule, which can be read in its entirety at http://portal.hud.gov/hudportal/documents/huddoc?id=smoke-freepublichousing.pdf. Comment should be submitted by January 19, 2016 either electronically through the Federal eRulemaking Portal at www.regulations.gov, or by regular mail to Regulations Division, Office of General Counsel, Department of Housing and Urban Development, 451 7th Street SW, Room 10276, Washington, DC 20410.

This rule has the potential to improve public safety of our most vulnerable citizens and to save thousands of lives.We urge you to send your comments, and also to recommend that smoking cessation assistance be included as part of the proposed rule.

References

  1. Prochaska JJ. Smoking and mental illness—breaking the link. New Engl J Med. 2011;365:196-198
  2. American Lung Association. (2015). Traditional Medicaid Coverage for Tobacco Cessation Medications and Counseling Overlaid with Number of Federal PHAs Per State. Posted with permission from American Lung Association

Related Resources

  1. Proposed Smoke-Free Rule Talking Points, U.S. Department of Housing and Urban Development
  2. The Tobacco Epidemic Among People with Behavioral Health Disorders, SCLC
  3. SCLC's Response to HUD's Proposed Smoke-Free Rule
  4. Webinar: Home is Where the Health Is: HUD’s Proposed Rule Restricting Smoking in Public Housing, Public Health Law Center
  7. Secretary Castro speaking about HUD’s proposed smoke-free rule
  8. Quick Summary of Secretary Castro’s #smokefreechat on Twitter
  9. HUD’s Office of Lead Hazard Control & Healthy Homes – Smoke Free Site
  10. CDC Healthy Homes Manual - Smoke-Free Policies in Multiunit Housing
  11. CDC Vital Signs Report on Secondhand Smoke