Smoke-free policies for multi-unit housing

Smoke-free multi-unit housing policies prohibit smoking in apartments, duplexes, and similar residences. Policies can apply to both common areas and individual units, and often include adjacent outdoor areas. Private sector rules apply to privately owned rental properties and owner-occupied units such as condo complexes; state and local ordinances apply to public and subsidized housing. Non-smoking residents of multi-unit housing are often exposed to secondhand smoke (SHS) in their homes from other units or common areas (); the US Surgeon General indicates there is no risk-free level of SHS exposure (US DHHS SG-Smoking 2014). Residents, especially children, can also be exposed to thirdhand smoke (THS), tobacco residue on surfaces and furnishings, in their home (, ). Some local governments cannot enact smoke-free measures due to state preemption legislation (Grassroots Change).

Expected Beneficial Outcomes (Rated)

  • Reduced exposure to secondhand smoke

  • Reduced exposure to thirdhand smoke

Other Potential Beneficial Outcomes

  • Reduced cigarette smoking

  • Increased quit rates

  • Reduced health care costs

Evidence of Effectiveness

Smoke-free multi-unit housing policies are a suggested strategy to reduce secondhand smoke (SHS) (, MMWR-Homa 2015) and thirdhand smoke (THS) exposure among non-smokers (). Smoking bans in multi-unit housing may increase smoking cessation () and decrease cigarette consumption (, ). However, additional evidence is needed to confirm effects (CG-Tobacco use).

Smoke-free multi-unit housing policies may also reduce smoke incursions and exposure. Residents of multi-unit housing in Portland, Oregon, for example, reported decreases in frequent indoor SHS exposure following policy implementation (). The effects of the Boston Housing Authority’s policy on SHS exposure are inconclusive (Levy 2015).

Surveys of property owners and housing managers in Minnesota, Oregon, and South Dakota indicate few, if any, difficulties enforcing smoke-free policies in multi-unit housing. Such policies also do not appear to affect vacancy or turnover rates, rental costs, or management time, and may lead to cost savings at converted properties due to lower and less frequent clean-up costs (, ). Smoke-free multi-unit housing policies are supported by most housing residents that do not smoke or are former smokers (, Drach 2010), and may be supported by some residents who smoke (). 

Experts estimate that implementing smoke-free policies in public housing could save $153 million (King 2014) to $260 million per year, including at least $110 million in direct medical costs (Mason 2015). Prohibiting smoking in all US subsidized housing could save almost $500 million, including $310 million in health care costs, $134 million in renovation expenses, and $53 million in fire losses (King 2014).

Impact on Disparities

Likely to decrease disparities

Implementation Examples

As of 2015, 15 states prohibit or restrict smoking in common areas of multi-unit housing facilities that are government owned or funded, and 12 states prohibit or restrict smoking in common areas of privately owned housing facilities. Hawaii and Oklahoma restrict smoking in the individual living areas of government-operated buildings, and some communities in California prohibit smoking in individual units of some or all multi-unit housing (CDC STATE 2015-Smoking factsheet). State legislation pre-empts local government control of smoke-free policies in 12 states (Grassroots Change).

In late 2015, the US Department of Housing and Urban Development proposed a rule that would make all public housing properties entirely smoke-free (US HUD-Smoke-free rule).

Implementation Resources

ALA-Smoke-free housing - American Lung Association (ALA). Smokefree policies in multi-unit housing: Steps for success.

ChangeLab-Smokefree housing - ChangeLab Solutions. Smokefree housing.

US HUD-Smoke-free - US Department of Housing and Urban Development (HUD). Smoke-free multifamily housing.

HealthPartners-CHA - HealthPartners Institute for Education and Research. Community health advisor (CHA): Resource for information on the benefits of evidence-based policies and programs: Helping communities understand, analyze, and model costs.

CDC-Healthy Homes Manual - Centers for Disease Control and Prevention (CDC). Healthy homes manual: Smoke-free policies in multiunit housing.

PHLC-Smoke-free housing - Tobacco Control Legal Consortium (TCLC). Smoke-free & tobacco-free places: Housing. Saint Paul: Public Health Law Center (PHLC).

Citations - Evidence

* Journal subscription may be required for access.

CG-Tobacco use - The Guide to Community Preventive Services (The Community Guide). Tobacco.

Bartholomew 2015* - Bartholomew KS. Policy options to promote smokefree environments for children and adolescents. Current Problems in Pediatric and Adolescent Health Care. 2015;45(6):146-181.

Burdette 2014* - Burdette LK, Rowe GC, Johansen L, et al. A statewide assessment of smoke-free policy in multiunit housing settings. Nicotine & Tobacco Research. 2014;16(12):1593-1598.

MMWR-Homa 2015 - Homa DM, Neff LJ, King BA, et al. Vital signs: Disparities in nonsmokers' exposure to secondhand smoke & United States, 1999-2012. Morbidity and Mortality Weekly Report (MMWR). 2015;64(4):103-108.

Kennedy 2015* - Kennedy RD, Ellens-Clark S, Nagge L, et al. A smoke-free community housing policy: Changes in reported smoking behavior- Findings from Waterloo region, Canada. Journal of Community Health. 2015;40(6):1207-1215.

King 2014 - King BA, Peck RM, Babb SD. National and state cost savings associated with prohibiting smoking in subsidized and public housing in the United States. Preventing Chronic Disease. 2014;11:140222.

Levy 2015 - Levy DE, Adamkiewicz G, Rigotti NA, Fang SC, Winickoff JP. Changes in tobacco smoke exposure following the institution of a smoke-free policy in the Boston Housing Authority. PLOS ONE. 2015;10(9):e0137740.

Mason 2015 - Mason J, Wheeler W, Brown MJ. The economic burden of exposure to secondhand smoke for the child and adult never smokers residing in US public housing. Public Health Reports. 2015;130(3):230-244.

Pizacani 2012* - Pizacani BA, Maher JE, Rohde K, Drach L, Stark MJ. Implementation of a smoke-free policy in subsidized multiunit housing: Effects on smoking cessation and secondhand smoke exposure. Nicotine & Tobacco Research. 2012;14(9):1027-1034.

Snyder 2016* - Snyder K, Vick JH, King BA. Smoke-free multiunit housing: A review of the scientific literature. 2016;25:9-20.

Drach 2010 - Drach LL, Pizacani BA, Rohde KL, Schubert S. The acceptability of comprehensive smoke-free policies to low-income tenants in subsidized housing. Preventing Chronic Disease. 2010;7(3):A66.

Citations - Implementation Examples

* Journal subscription may be required for access.

CDC STATE 2015-Smoking factsheet - Centers for Disease Control and Prevention (CDC). STATE System Multiunit Housing Fact Sheet. 2015.

US HUD-Smoke-free rule - US Department of Housing and Urban Development (US HUD). HUD secretary Castro announces new rule making public housing smoke-free.

Grassroots Change - Grassroots Change. Connecting for better health.

Date Last Updated

Nov 16, 2016