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Predictors of Smoke-Free Policies in Affordable Multiunit Housing, North Carolina, 2013

Predictors of Smoke-Free Policies in Affordable Multiunit Housing, North Carolina, 2013

ORIGINAL RESEARCH — Volume 12 — May 14, 2015

Anna Stein, JD, MPH; Janet Suttie, MA; Laura Baker, MPH; Robert Agans, PhD; Wei Xue, MS, MPH; J. Michael Bowling, PhD

Suggested citation for this article: Stein A, Suttie J, Baker L, Agans R, Xue W, Bowling JM. Predictors of Smoke-Free Policies in Affordable Multiunit Housing, North Carolina, 2013. Prev Chronic Dis 2015;12:140506. DOI: http://dx.doi.org/10.5888/pcd12.140506.

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On this Page

• Abstract
• Introduction
• Methods
• Results
• Discussion
• Acknowledgments
• Author Information
• References
• Tables

Abstract

Introduction
Smoke-free policies can effectively protect nonsmokers from secondhand smoke (SHS) exposure in multiunit housing. We surveyed all affordable multiunit housing properties in North Carolina to determine the statewide prevalence of smoke-free policies and to identify predictors of smoke-free policies.

Methods
Representatives of affordable housing properties in North Carolina completed a mailed or online survey during June through October 2013. The primary outcome measure was presence of a smoke-free policy, defined as prohibiting smoking in all residential units. We used χ2 analysis and multivariate logistic regression to identify correlates of smoke-free policies.

Results
Of 1,865 eligible properties, responses were received for 1,063 (57%). A total of 16.5% of properties had policies that prohibited smoking in all residential units, while 69.6% prohibited smoking in indoor common areas. In multivariate analysis, an increase in the number of children per unit was associated with a decrease in the odds of having a smoke-free policy at most properties. Newer properties across all company sizes were more likely to have smoke-free policies. Accessing units from interior hallways predicted smoke-free policies among medium-sized companies.

Conclusion
More smoke-free policies in affordable multiunit housing are needed to protect vulnerable populations, particularly children, from SHS exposure. Public health professionals should continue to educate housing operators about SHS and the benefits of smoke-free policies at all properties, including older ones and ones where units are accessed from outside rather than from an interior hallway.

Acknowledgments

This article was supported in part by a cooperative agreement with the Centers for Disease Control and Prevention (FOA CDC-RFA-DP11-1115PPHF11). Portions of this project’s work involve the Community Transformation Grants initiative supported by Centers for Disease Control and Prevention funding. Users of this document should be aware that every funding source has different requirements governing the appropriate use of those funds. Under US law, no federal funds are permitted to be used for lobbying or to influence, directly or indirectly, specific pieces of pending or proposed legislation at the federal, state, or local levels. Organizations should consult appropriate legal counsel to ensure compliance with all rules, regulations, and restriction of any funding sources. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

The authors thank Ruth Petersen, Sally Herndon, Jim Martin, Sharon Nelson, and Jill Rushing from the North Carolina Division of Public Health for their leadership and assistance in making this survey possible. We also thank Brian King of the Office on Smoking and Health at the Centers for Disease Control and Prevention and Andrea Licht and Mark Travers of the Roswell Park Cancer Institute for providing expert advice on the design of the survey instrument; Anna Hoffmeyer and the Carolina Survey Research Laboratory team for their dedication in implementing this survey; and Nina Collins for providing assistance with reviewing literature and editing manuscript drafts. Finally, we acknowledge the following individuals and organizations for partnering on this study: Scott Alderman of Landura Management Associates; Rick Allen and Becky Stevens of Partnership Property Management; Leah Lyerly and Jeff Gagnon of Westminster Company; Tim Morgan of Evergreen Construction Company; Debbie Honeycutt of GEM Management; Rita Blackmon of Excel Property Management; and Nicole Kiefer of The Arc of North Carolina.

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Author Information

Corresponding Author: Anna Stein, JD, MPH, 1932 Mail Service Center, Raleigh, NC 27699-1932. Telephone: 919-707-5406. Email: anna.stein@dhhs.nc.gov.

Author Affiliations: Anna Stein, Janet Suttie, Laura Baker, North Carolina Division of Public Health, Raleigh, North Carolina; Robert Agans, Wei Xue, J. Michael Bowling, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.

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References

1. US Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. 2006. Atlanta (GA): US Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006. http://www.ncbi.nlm.nih.gov/books/NBK44324/. Accessed February 13, 2014.
2. Kraev TA, Adamkiewicz G, Hammond SK, Spengler JD. Indoor concentrations of nicotine in low-income, multi-unit housing: associations with smoking behaviours and housing characteristics. Tob Control 2009;18(6):438–44. CrossRef PubMed
3. King BA, Babb SD, Tynan MA, Gerzoff RB. National and state estimates of secondhand smoke infiltration among U.S. multiunit housing residents. Nicotine Tob Res 2013;15(7):1316–21.CrossRef PubMed
4. Agaku IT, King BA, Dube SR; Centers for Disease Control and Prevention (CDC). Current cigarette smoking among adults — United States, 2005–2012. MMWR Morb Mortal Wkly Rep 2014;63(2):29–34. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6302a2.htm?s_cid=mmmm6302a2_w. Accessed April 2, 2014. PubMed
5. Drach LL, Pizacani BA, Rohde KL, Schubert S. The acceptability of comprehensive smoke-free policies to low-income tenants in subsidized housing. Prev Chronic Dis 2010;7(3):A66. http://www.cdc.gov/pcd/issues/2010/may/09_0209.htm. Accessed February 12, 2014. PubMed
6. US Department of Health and Human Services. The health consequences of smoking — 50 years of progress: a report of the Surgeon General. Atlanta (GA): US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2014. http://www.surgeongeneral.gov/library/reports/50-years-of-progress/full-report.pdf. Accessed March 28, 2014.
7. King BA, Travers MJ, Cummings KM, Mahoney MC, Hyland AJ. Secondhand smoke transfer in multiunit housing. Nicotine Tob Res 2010;12(11):1133–41. CrossRef PubMed
8. King BA, Travers MJ, Cummings KM, Mahoney MC, Hyland AJ. Prevalence and predictors of smoke-free policy implementation and support among owners and managers of multiunit housing. Nicotine Tob Res 2010;12(2):159–63. CrossRef PubMed
9. Cramer ME, Roberts S, Stevens E. Landlord attitudes and behaviors regarding smoke-free policies: implications for voluntary policy change. Public Health Nurs 2011;28(1):3–12. CrossRefPubMed
10. Jackson SL, Bonnie RJ. A systematic examination of smoke-free policies in multiunit dwellings in Virginia as reported by property managers: implications for prevention. Am J Health Promot 2011;26(1):37–44. CrossRef PubMed
11. Burdette LK, Rowe GC, Johansen L, Kerkvliet JL, Nagelhout E, Lewis K, et al. A statewide assessment of smoke-free policy in multiunit housing settings. Nicotine Tob Res 2014;16(12):1593–8.CrossRef PubMed
12. Hewett MJ, Sandell SD, Anderson J, Niebuhr M. Secondhand smoke in apartment buildings: renter and owner or manager perspectives. Nicotine Tob Res 2007;9(Suppl 1):S39–47. CrossRefPubMed
13. Ong MK, Diamant AL, Zhou Q, Park H-Y, Kaplan RM. Estimates of smoking-related property costs in California multiunit housing. Am J Public Health 2012;102(3):490–3. CrossRefPubMed
14. Bulletin No. OMB 13–01. Revised delineations of metropolitan statistical areas, micropolitan statistical areas, and combined statistical areas, and guidance on uses of the delineations of these areas. Washington (DC): Office of Management and Budget; 2013.
15. US Department of Housing and Urban Development. Occupancy requirements for subsidized multifamily housing programs (4350.3). Chapter 3. Eligibility for assistance and occupancy. http://portal.hud.gov/hudportal/documents/huddoc?id=43503c3HSGH.pdf. Accessed February 24, 2015.
16. US Department of Agriculture, Rural Development. MFH asset management handbook (2-3560). Chapter 6: project occupancy. http://www.rd.usda.gov/files/3560-2chapter06.pdf. Accessed February 26, 2015.
17. Wilson KM, Klein JD, Blumkin AK, Gottlieb M, Winickoff JP. Tobacco-smoke exposure in children who live in multiunit housing. Pediatrics 2011;127(1):85–92. CrossRef PubMed
18. Homa DM, Neff LJ, King BA, Caraballo RS, Bunnell RE, Babb SD, et al. Vital signs: disparities in nonsmokers’ exposure to secondhand smoke — United States, 1999–2012. MMWR Morb Mortal Wkly Rep 2015;64(4):103–8. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6404a7.htm?s_cid=mm6404a7_w. Accessed February 24, 2015. PubMed
19. Licht AS, King BA, Travers MJ, Rivard C, Hyland AJ. Attitudes, experiences, and acceptance of smoke-free policies among US multiunit housing residents. Am J Public Health 2012;102(10):1868–71. CrossRef PubMed
20. King BA, Cummings KM, Mahoney MC, Juster HR, Hyland AJ. Multiunit housing residents’ experiences and attitudes toward smoke-free policies. Nicotine Tob Res 2010;12(6):598–605.CrossRef PubMed
21. Wilson KM, Torok M, McMillen R, Tanski S, Klein JD, Winickoff JP. Tobacco smoke incursions in multiunit housing. Am J Public Health 2014;104(8):1445–53. CrossRef PubMed
22. Borland R, Yong H-H, Cummings KM, Hyland A, Anderson S, Fong GT. Determinants and consequences of smoke-free homes: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control 2006;15(Suppl 3):iii42–50. CrossRef PubMed
23. Gilpin EA, White MM, Farkas AJ, Pierce JP. Home smoking restrictions: which smokers have them and how they are associated with smoking behavior. Nicotine Tob Res 1999;1(2):153–62.CrossRef PubMed
24. Pizacani BA, Martin DP, Stark MJ, Koepsell TD, Thompson B, Diehr P. Household smoking bans: which households have them and do they work? Prev Med 2003;36(1):99–107. CrossRefPubMed
25. Hood NE, Wewers ME, Ferketich AK, Klein EG, Pirie P. Predictors of voluntary home-smoking restrictions and associations with an objective measure of in-home smoking among subsidized housing tenants. Am J Health Promot 2013;28(2):97–104. CrossRef PubMed
26. North Carolina Housing Finance Agency. Facts on the Federal Low Income Housing Tax Credit. http://www.nchfa.com/About/facts/lihtcfactsheet.pdf. Accessed August 4, 2014.
27. US Department of Housing and Urban Development. Notice H 2012-22. Further encouragement for O/As to adopt optional smoke-free housing policies. http://portal.hud.gov/hudportal/documents/huddoc?id=12-22hsgn.pdf. Published October 26, 2012. Accessed June 1, 2014.
28. US Department of Housing and Urban Development, Office of Lead Hazard Control and Healthy Homes. Change is in the air: an action guide for establishing smoke-free public housing and multifamily properties. http://portal.hud.gov/hudportal/documents/huddoc?id=smokefreeactionguide.pdf. Accessed November 12, 2014.
29. 2012 BRFSS survey results: North Carolina tobacco use. Raleigh (NC): North Carolina State Center for Health Statistics; 2012. http://www.schs.state.nc.us/schs/brfss/2012/nc/all/_rfsmok3.html. Updated August 2, 2013. Accessed April 7, 2014.