Public health experts support federally mandated smoke-free public housing

In response to a new federal rule mandating smoke-free policies in federally funded public housing authorities (PHAs), three public health experts applaud the efforts of the U.S. Department of Housing and Urban Development (HUD) to protect nonsmoking residents from the harmful effects of tobacco exposure. In a commentary published online today in the American Journal of Public Health, authors from Massachusetts General Hospital (MGH) and the Harvard T.H. Chan School of Public Health discuss both implementation challenges and possible solutions to ease the burden of transition.

"For decades we've seen the shift to smoke-free policies in places like restaurants, bars, office buildings, workplaces and even parks," says Douglas Levy, PhD, of the Mongan Institute Health Policy Center at MGH. "This next step is a new frontier in clean indoor air policies and will be critically important for nonsmoking public housing residents because it will limit harmful exposure to tobacco from those who smoke indoors in their apartments. Public housing residents in particular haven't got the luxury of simply moving away from neighbors who smoke."

Challenges faced by PHAs implementing the new policy include physical infrastructure, demographics, community support, weather, staffing and other concerns. It is critical, the authors say, to address problems in a manner that makes it easier for residents to smoke in acceptable areas or even begin a smoking cessation program.

"Because smoking is highly addictive, it can be really difficult for smokers to change their behavior. Public housing officials need to think beyond simply setting the policy and put careful thought into implementation," says Levy. "For example, implementing these policies for the first time in warmer months can make it easier for smokers to take their cigarettes outside, while placing structures for people to smoke at approved locations may help encourage compliance."

Ultimately, the authors say, PHAs will see the greatest impact by enlisting all members of the community, smokers and non-smokers alike, to create a culture which values the health of its members, especially the young and elderly.

"When residents within the community feel like they have a stake in their own health, their family's health, and their neighbor's health, we'll see the greatest change and the most benefit," says Levy, who is an assistant professor of Medicine at Harvard Medical School. "These efforts, combined with strong support and resources for smokers looking to quit, support a strong strategy toward combating an avoidable public health risk.