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. 


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