Creating Smoke-Free Housing: Boston’s Example

Posted February 14, 2017 by Wendy Loveland


In this occasional Innovation Showcase feature series, NICHQ highlights nonprofits and unique initiatives that are having an impact on children’s health.

Reducing smoking in housing could make for a healthier Boston.

Smoking can have profound effects on children’s health, including increased risks for cancer, ear infections, asthma and infections in children, and sudden infant death syndrome (SIDS) in infants. Even if no one smokes in the home, second-hand smoke is still dangerous. It can travel through a building’s ventilation system, or waft in through open windows or to an outside common area such as a playground creating exposure risks for children.

On the national level, a recent ruling by the Department of Housing and Urban Development requires all public housing authorities to implement a smoke-free policy. This includes no smoking anywhere inside units, common areas or within 25 feet of an outside residential building. However, the Boston Public Health Commission (BPHC) was ahead of the curve. In 2009 the BPHC started the Boston Smoke Free Homes initiative to promote the benefits of smoke-free housing among landlords and tenants of Boston, and to provide training support to landlords of public, affordable and market-rate multi-unit housing on the effective transition and adoption processes of these policies.

“Our goal is to have equitable access to a smoke-free housing environment,” says Eugene Barros, director of the Division of Healthy Homes and Community Supports, Boston Public Health Commission.

The BPHC smoke-free initiative has always been voluntary, rather than regulatory.

“Smoke-free housing benefits everyone and is popular among tenants and landlords across all housing markets. We devote most our resources to affordable and public housing where data shows us that people are more exposed to tobacco smoke and have higher rates of tobacco related health conditions.  In addition, our voluntary approach makes smoke free policies easier to enforce because it’s part of the lease and enforced like any other lease policy,” says Barros.

As a first step when deciding to go smoke free, BPHC encourages housing owners and managers to survey their tenants to determine the level of support and identify potential challenges. Resident engagement and education are important components of this process to make the implementation and enforcement of the new policy successful. BPHC strongly encourages resident meetings to allow residents to hear from their peers as to why these policies are important, the health of their children, their elders, to prevent fires, etc. 

“Resident engagement is crucial. When a mother talks about needing to bring her baby to the emergency room with an acute asthma attack, and many other stories, it changes the dynamic in the room,” says Margaret Reid, RN MPA, Director; Office of Health Equity, Boston Public Health Commission “It changes from the right to smoke to the health of your neighbors and your community.”  

Employees who will be on the front lines need to be trained and understand the policy and the health environmental and economic reasons for it.   

For public housing, the BPHC partnered with the Boston Housing Authority and BHA transitioned their portfolio to smoke free in 2012. From 2014-2017 BPHC received funding through the CDC’s REACH and PICH funding streams and was able to expand their smoke-free housing work to Section 8 housing in Boston and other affordable housing options, as well as develop a landlord tool kit and public awareness campaign.

The BPHC administers the Boston Behavioral Risk Factor Surveillance System survey, a survey usually administered at the state level that measures various health data such as smoking rates, emergency room visits, chronic disease rates and more. The team credits data for helping to obtain buy-in from landlords and tenants, especially in the early days. The BPHC added a checkmark for “housing type” to drill down into that data to evaluate health data by housing type. 

“The data by housing type is eye opening, and helps us prioritize our work,” says Reid. “For example, if we see that Section 8 housing has higher rates of emergency department visits, we will focus on training staff and holding community meetings in those housing areas. We might administer a resident survey to detect issues with the smoke-free policy.”

The 2013 survey showed that second-hand smoke exposure was higher among people with low incomes: 27 percent of Boston residents in subsidized housing were smokers, compared to 16 percent in market rate housing.

To date, the BPHC has helped 50,000 low-income units become smoke-free. This impacts approximately 125,000 tenants in Boston.

Enforcing the smoke-free policy
Enforcing the smoking ban is the next step after implementing a no-smoking policy, communicating it to tenants and making it a part of their lease. The BPHC team believes strongly in educating all staff on the policy and the process for following up on incidences where the policy is broken.

“A maintenance person is more likely than administration to see where smoking is happening,” says Barros. “All frontline staff members need to understand the benefits of smoke free housing for these policies, as they may be responsible for enforcement.  .”

Smokers who do not follow the policy are offered education on their health risks, and support in finding places to smoke outside of the smoke-free area. “However, we have found that when residents are engaged, the policy is self-enforcing,” says Barros.

BPHC encourages landlords to market the fact that their housing is smoke-free. This can be as easy as checking it off under the “amenities” section of the description. Over the years, smoke-free housing has become a market demand.

“From a public health perspective, the policy is very effective,” says Reid. “It is one intervention, yet it helps thousands of people.”

These actions and similar efforts should help ease the challenges underserved populations face when searching for dental care. Oral health is a key component of a person’s overall health, so resolving these inequities will be one step in ensuring that every child has an opportunity to achieve their optimal health. 

Share:

Add your comment

 
 

 

Archive

Tagcloud

qi collaboration engagement partnerships larc im coiin nichq nashp breastfeeding new york wic quality improvement onboarding new york state hospitals mom mother partners epilepsy data AAP early childhood eccs coiin pdsas texas community support learning session infant mortality children's health new technology engineering transgender collaborative learning planning PDSA planning paralysis underplanning analysis paralysis vision eye health smoking smoke-free housing second-hand smoke toolkit e-module infant health dental care oral health underserved populations health inequity public health Maternal and Child Health Journal tips leadership engagement Sickle cell disease indiana SCD medicaid perinatal regionalization safe sleep sudden infant death syndrome national birth defects prevention month birth defects pregnancy planning one key question prepregnancy health preconception health public breastfeeding support family engagement families patients experts insights CHOPT childhood obesity innovation food desert telemedicine TBLC breastfeeding supporting preterm birth prematurity racial disparities audiology ehdi follow-up illinois talana hughes vulnerable populations sports asthma soccer basketball obesity football SIDS Pokemon Go gamification smartphones interconception care birth spacing issue brief contraceptive use postpartum care CoIN HRSA early childhood trauma NHSA community health consumer advocacy womens health interconception health teenage health PATCH wisconsin missouri risk appropriate care community health workers SCD< infographic infant mortality awareness month inspirations childrens health national breastfeeding month maternal health patient engagement hearing loss hearing treatment pediatric vision vision screening eyesight pre-term birth early-term birth SCD clinic los angeles LOCATe CDC levels of care neonatal care maternal care smoking cessation project safe sleep practices neonatal abstinence syndrome NAS opioids maternal and child health MCH Family voices quality care mental health hydroxyurea SCDTDP men dads testing change data sharing state government city government apps sleep AJPM preconception care senior leadership breastfeeding support video series health equity health disparities access BQIH exclusive breastfeeding long-acting reversible contraception unplanned pregnancies social determinants of health health innovations Best Babies Zone CoIIN baby boxes Rhode Island progesterone rooming-in Baby-Friendly parent partner patient and family engagement healthy weight healthy lifestyles primary care telementoring ECHO video conferencing socioemotional health childhood development pediatric Tennessee interview National Coordinating and Evaluation Center medical-legal partnerships mobile app disparities perinatal care overweight obese healthy weight clinic wellness pilot sites data collection education resources paternal engagement risk-appropriate care preterm infants high-risk babies Ten Steps public relations social movement reversible contraceptives medical home pediatric medical home patient transformation facilitator PTF skin-to-skin rooming in prenatal smoking information visualization charts SUID postpartum new mother webinar AMCHP QI Tips ongoing improvement fourth trimester partnership quality and safety coaching PDSA Cycle leadership support year end holiday message reflections gratitute Medicaid data doctor relationship PQC perinatal quality collaboratives vision care vision health evidence-based guidelines ASH health and wellness healthy living healthy eating home visitors home visiting programs March of Dimes APHA results evaluation supplementation formula reduction video infant loss social media advocacy leadership Berns Best Fed Beginnings Ten Steps to Successful Breastfeeding sustainability stress prenatal care data capacity epidemiologists surveillance data PFAC community partners preconception and interconception care motivational interviewing Native Americans ADHD NICHQ Vanderbilt Assessment Scale ADHD Toolkit system design care coordination skin to skin newborn screening ASTHO reduce smoking aim statement safe birth Texas Ten Step skin-to-skin contact 10 Steps staff training small tests acute care mother-baby couplet collective impact population health preconception Newborn Screening Program substance abuse breast milk formula milk bank crisis Huffington Post fundraising campaign first responders NYC improvement healthcare health system sickle cell diease treatment protocol family health partner maternity care Collaborative Improvement and Innovation Network Health Outcomes Cross-Sector Collaboration Knowledge Sharing Child Health