Smoke-Free Policies in Subsidized Housing

Author: Nancy Hood

Dissertation School: The Ohio State University

Abstract:

This study will examine two types of policies to limit in-home secondhand smoke (SHS) exposure among subsidized housing tenants. First, voluntary home smoking restrictions (VHSRs), which households voluntarily impose on themselves will be assessed. Second, tenant support for mandatory smoke-free policies imposed by housing owners or managers will be assessed. Individual, interpersonal, social, and environmental factors associated with VHSRs and support for mandatory policies will also be identified. The study population is tenants in 1,000 private, project-based Section 8 housing units in Columbus, Ohio. Methods include a face-to-face survey with a probability sample of tenants, surface nicotine sampling, and focus group interviews. Results will be used to inform the design and implementation of smoke-free policies in subsidized housing.

This study will determine how to maximize effectiveness and minimize negative unintended consequences of mandatory smoke-free policies in subsidized housing settings. This is an important topic because the U.S. Department of Housing and Urban Development (HUD) has strongly encouraged subsidized housing providers to adopt mandatory smoke-free policies since 2009. These policies could potentially decrease SHS exposure in households with the highest rates of exposure. However, subsidized housing tenants likely experience multiple individual, interpersonal, social, and environmental barriers to maintaining smoke-free homes. Additionally, limited evaluation of existing mandatory policies shows low compliance. More nuanced and effective policies or other strategies may be developed by understanding multiple levels of factors influencing in- home smoking behaviors in this population.

This is a mixed-method, cross-sectional, observational study. A face-to-face, interviewer-administered survey will be conducted with primary leaseholders in a stratified random sample of subsidized housing units. Three hundred completed surveys will be collected. Surface nicotine levels will be measured to validate self-reported in-home smoking with an objective environmental indicator of in-home smoking. Surface wipe samples will be collected in a random subsample of 100 survey respondents. Qualitative focus groups interviews will be used to obtain a more in-depth understanding of survey findings. Four focus groups will be conducted with a total of 40 participants.

This will be the first study of VHSRs in a probability sample of low- socioeconomic status (SES) households, and the first to examine multiple levels of potential barriers to maintaining smoke-free homes in this population. It will be only the second study of support for mandatory smoke-free policies among subsidized housing tenants, and the first to assess support prior to policy implementation. Another unique contribution is the use of a feasible yet specific environmental measure to validate self- reported in-home smoking.

Adopting mandatory smoke-free policies in subsidized housing in an innovative approach to using affordable housing as a foundation for improving health outcomes. However, policies must be based on a strong understanding of factors affecting in-home smoking behaviors in the target population. This study is expected to show that factors beyond tenants' immediate control-such as having household visitors who smoke or living in unsafe neighborhoods-are barriers to maintaining smoke-free homes. Thus, simply telling tenants they cannot smoke in their homes is unlikely to change their behaviors. Results will be used to inform complementary strategies such as social marketing, education, and housing design, which should be systematic and supported components of any policy-based initiatives to restrict in-home smoking in subsidized housing.

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