Smoke-free policies for multi-unit housing

Evidence Rating  
Expert Opinion
Evidence rating: Expert Opinion

Strategies with this rating are recommended by credible, impartial experts but have limited research documenting effects; further research, often with stronger designs, is needed to confirm effects.

Health Factors  

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 areas1. The US Surgeon General indicates there is no risk-free level of SHS exposure2. Residents, especially children, can also be exposed to thirdhand smoke (tobacco residue on surfaces and furnishings), in their home3, 4. Some local governments cannot enact smoke-free measures due to state preemption legislation5.

Note: The term “tobacco” in this strategy refers to commercial tobacco, not ceremonial or traditional tobacco. County Health Rankings & Roadmaps recognizes the important role that ceremonial and traditional tobacco play for many Tribal Nations, and our tobacco-related work focuses on eliminating the harms and inequities associated with commercial tobacco.

Expected Beneficial Outcomes (Rated)

  • Reduced exposure to secondhand smoke

  • Reduced exposure to thirdhand smoke

Other Potential Beneficial Outcomes

  • Increased quit rates

  • Reduced health care costs

  • Reduced cigarette smoking

Evidence of Effectiveness

Smoke-free multi-unit housing policies are a suggested strategy to reduce secondhand smoke (SHS)3, 6 and thirdhand smoke (THS) exposure among non-smokers3. However, additional evidence is needed to confirm effects7.

Smoke-free multi-unit housing policies may also reduce smoke incursions and exposure. Following policy implementation, multi-unit housing residents in Portland, Oregon8 and elderly low income residents in Florida9 reported decreases in frequent indoor SHS exposure. A Philadelphia-based study found reduced nicotine levels in the public areas of multi-unit housing following policy implementation; however, no change was measured in homes10. The effects of the Boston Housing Authority’s policy on SHS exposure are inconclusive11. Smoking bans in multi-unit housing may increase smoking cessation8 and decrease cigarette consumption8, 12.

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 older properties that have been converted to smoke-free, due to lower and less frequent clean-up costs1, 13.

Smoke-free multi-unit housing policies are supported by most housing residents that do not smoke or are former smokers and may also be supported by some residents who smoke1, 14. Higher income residents of multi-unit housing may be more likely to favor smoke-free policies than lower income residents14, along with residents with children15. A Montana-based study of public housing authority residents in rural and tribal settings suggests that tribal residents may be as likely to support smoke-free policies as non-tribal residents15.

Experts estimate that implementing smoke-free policies in public housing could save $153 million16 to $260 million per year, including at least $110 million in direct medical costs17. 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 losses16.

Impact on Disparities

Likely to decrease disparities

Implementation Examples

As of September 2018, 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 housing18. Emeryville, CA now requires all multi-unit housing to be 100% smoke-free, which includes the majority of homes in this San Francisco Bay Area community19. State legislation pre-empts local government control of smoke-free policies in 12 states5.

In 2017, the US Department of Housing and Urban Development published a rule that requires all public housing properties to be entirely smoke-free by July 31, 201820.

The American Nonsmokers’ Rights Foundation offers guidance and resources for health groups and advocates to support smoke-free multi-unit housing21.

Implementation Resources

ANRF-Multi-family housing - American Nonsmokers’ Rights Foundation (ANRF). Getting started on smoke-free multi-family housing.

US HUD-SF resources - US Department of Housing and Urban Development (US HUD), Office of Healthy Homes and Lead Hazard Control. Smoke-free multifamily housing resource bank.

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

ChangeLab-Smokefree housing - ChangeLab Solutions. Smokefree housing.

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

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.

Footnotes

* Journal subscription may be required for access.

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

2 US DHHS SG-Smoking 2014 - US Department of Health and Human Services (US DHHS). The health consequences of smoking- 50 years of progress: A report of the Surgeon General; 2014.

3 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.

4 Matt 2011* - Matt GE, Quintana PJ, Zakarian JM, et al. When smokers move out and non-smokers move in: residential thirdhand smoke pollution and exposure. Tobacco control 2011;20(1):e1.

5 Grassroots Change - Grassroots Change: Connecting for better health. Preemption Watch.

6 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.

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

8 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.

9 Hollar 2017 - Hollar TL, Cook N, Quinn D, et al. Smoke-free multi-unit housing policies show promise in reducing secondhand smoke exposure among racially and ethnically diverse, low-income seniors. Journal of Immigrant and Minority Health. 2017;19(6):1281-1289.

10 Klassen 2017* - Klassen AC, Lee NL, Pankiewicz A, et al. Secondhand smoke exposure and smoke-free policy in Philadelphia public housing. Tobacco Regulatory Science. 2017;3(2):192-203.

11 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.

12 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.

13 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.

14 Wang 2018* - Wang TW, Lemos PR, McNabb S, King BA. Attitudes toward smoke-free public housing among U.S. adults, 2016. American Journal of Preventive Medicine. 2018;54(1):113-118.

15 Schmidt 2016a - Schmidt LM, Reidmohr AA, Helgerson SD, Harwell TS. Secondhand smoke exposure and smoke-free policy support among public housing authority residents in rural and tribal settings. Journal of Community Health. 2016;41(6):1116-1121.

16 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.

17 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.

18 CDC STATE 2019-Smoking factsheet - Centers for Disease Control and Prevention (CDC). STATE System multi-unit housing fact sheet, effective September 2018. 2019.

19 ANRF-Emeryville - American Nonsmokers’ Rights Foundation (ANRF). Congratulations to Emeryville, California: Expanding smoke-free protections to multi-unit housing! 2018.

20 US HUD-SF public housing - US Department of Housing and Urban Development (US HUD), Office of Healthy Homes and Lead Hazard Control. Smoke-free public housing and multifamily properties.

21 ANRF-Multi-family housing - American Nonsmokers’ Rights Foundation (ANRF). Getting started on smoke-free multi-family housing.

Date Last Updated