Getting residents on board with proposed smoking ban in public housing

Howard Koh at HUD smoke-free housing meeting
Harvard Chan School's Howard Koh said he was "thrilled" with HUD's proposal to ban smoking in public housing.

December 14, 2015 — Under a new federal proposal, smoking would be banned in all public housing in the United States within several years. On December 3, 2015, about 35 experts from around the country—federal officials, representatives from major nongovernmental organizations, tobacco cessation experts, and experts in public health and public housing—gathered at Harvard to discuss how best to help implement, evaluate, and enforce the plan, and how to ensure its success.

The U.S. Department of Housing and Urban Development (HUD) announced the proposed rule in November. After a public comment period ends in mid-January, HUD will design a final rule, which public housing authorities will then have up to 18 months to implement.

“This is too big a public health opportunity to miss,” said Michelle Williams, chair of the Department of Epidemiology at Harvard T.H. Chan School of Public Health, and program lead for the Harvard Catalyst Population Health Research Program, which sponsored the day-long event at Countway Library. Co-hosts for the event were Alan Geller, senior lecturer on social and behavioral sciences, and Vaughan Rees, lecturer on social and behavioral sciences and director of the Center for Global Tobacco Control.

Howard Koh, Harvey V. Fineberg Professor Professor of the Practice of Public Health Leadership at Harvard Chan School and former Assistant Secretary for Health for the U.S. Department of Health and Human Services, called tobacco control “the overriding public health issue of our time,” and said he was “thrilled and astonished” when the HUD proposal was announced in mid-November.

In spite of major efforts in recent years to limit indoor smoking—in workplaces, bars and restaurants, colleges and universities, and public buildings—58 million Americans are still exposed to toxic secondhand smoke. Many of them are low-income, living in public housing apartment buildings where smoke can drift in hallways and between units, affecting households with no smokers. By banning lit tobacco products in all 4,000 U.S. public housing authorities, the HUD proposal could benefit the health of nearly 2 million residents, including many who are poor, elderly, disabled, or children. The new rule is also expected to reduce the risk of fires and lower smoking-related maintenance costs.

Success stories

Representatives from public housing authorities in three cities that have already implemented smoke-free policies—Boston, Providence, and Duluth—said that, for the most part, the effort has gone smoothly and that most residents have been in favor of the change.

Duluth’s 1,200 public housing units, home to roughly 86,000 residents, went smoke-free in 2010. Pam Benson of the Duluth Housing and Redevelopment Authority said there were numerous meetings with residents to discuss ways to ease the transition for smokers who weren’t going to quit, but who would no longer be able to smoke in their apartments. Their solution was to create outdoor gazebos with motion sensors that activate heaters automatically on cold winter days.

“People want to follow the rules,” Benson said. “They like the cleaner environment and they want to do what they can to be part of it.”

Melissa Sanzaro of the Providence Housing Authority—who initially thought people would be upset at losing the right to smoke in their homes—said she “was really surprised at the support.”

Experts at the meeting agreed that good communication about the HUD proposal— the scientific and health rationale for it, and how it will affect public housing residents and staff—is key to its success.

Issues of fairness

Some expressed concern about the plan’s impact on longtime smokers who would have trouble quitting. Smokers “are addicted,” said Rosie Henson of the American Cancer Society. “They should not become the victims in all of this. We’ve really got to pay attention to cessation efforts, or it’s going to look like we just took away tobacco products from people who are already suffering from lots of other issues in their lives.”

Others said the plan could place an additional burden on people who are already struggling—the poor, minorities, the elderly, and people with disabilities and mental health issues. Having to smoke outside could be particularly difficult for those with impaired mobility, they said.

John Kane of the Boston Housing Authority noted that, after public housing in Boston went smoke-free in 2012, he and his staff were able to accommodate some impaired residents who were smokers by either moving them closer to elevators, or from an upper floor to the first floor, or closer to the front door.

Bob Vollinger of the National Cancer Institute acknowledged concern about “telling people what to do in their homes,” but added that “our whole business in public health is about changing social norms and changing people’s expectations. Really, I think the time is right for this.”

Karen Feldscher

photo: Noah Leavitt