Public Housing Smoking Ban Presents an Opportunity to Improve Health.

The proposed federal ban on smoking in public housing will only fulfill its potential if it is enacted with sufficient funding for smoking cessation programs and with community input into implementation and enforcement, according to a JAMA viewpoint article co-authored by a School of Public Health researcher.

Daniel Brooks, associate professor of epidemiology, and two colleagues from the Harvard T.H. Chan School of Public Health said the proposed rule for smoke-free public housing—slated to take effect by the end of 2016—was an important step to safeguard public health.

Residents of public housing are more likely to smoke or to be exposed to secondhand smoke than the general population, they said. While the smoking rate in the adult population is now below 17 percent, it remains “stubbornly high” among individuals with incomes below the poverty line.

Most public housing residents live in multi-unit housing, where secondhand smoke travels into neighbors’ homes through ventilation ducts and other airborne pathways.

For the ban to be effective, federal officials and local public housing authorities (PHAs) should make “strong efforts to involve residents in the development and communication” of the policy, Brooks and colleagues said.

“Successful implementation of the new rule will depend on resident engagement and support, and the perception that policies are implemented fairly and with sensitivity. PHAs will need to frame messages to residents focusing on ‘the smoke, not the smoker,’” they wrote.

Implementation of a smoke-free policy presents “both an unparalleled opportunity and a duty” to help low-income smokers quit and to narrow the gap in smoking rates that contributes to the higher burden of poor health outcomes experienced by public housing residents.

“As a matter of equity, resources must be made available to help smokers quit,” they said. “Best practice smoking cessation services must be made available to every smoker who wants to quit smoking, both during and well after the transition to smoke-free housing. “

The proposed rule would require that PHAs prohibit lit cigars, cigarettes, and pipes in all living units, indoor common areas, administrative offices and outdoor areas within 25 feet of housing and administrative office buildings.

The authors noted that tobacco control policies in the US have yielded remarkable gains in the past 50 years, but that Americans of lowest socioeconomic position have not shared equally in these gains.

The authors point out that the experience with the rule could have implications beyond public housing—for the nearly 80 million Americans who live in multi-unit housing.

“A best practice, systematic plan for implementation that is responsive to residents’ needs, while providing efficacious cessation support, will ensure that this momentous opportunity realizes its potential,” they said.

Co-authors of the article are Alan Geller and Vaughan Rees of the Department of Social & Behavioral Sciences, Center for Global Tobacco Control, Harvard T.H. Chan School of Public Health.

—Lisa Chedekel