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Implementation Activities in Smoke-Free Public Housing: The Massachusetts Experience

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  • Boram Lee

    (Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
    Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA
    Harvard Medical School, Boston, MA 02115, USA)

  • Vicki Fung

    (Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
    Harvard Medical School, Boston, MA 02115, USA)

  • David Cheng

    (Harvard Medical School, Boston, MA 02115, USA
    Biostatistics Center, Massachusetts General Hospital, Boston, MA 02114, USA)

  • Jonathan P. Winickoff

    (Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA
    Harvard Medical School, Boston, MA 02115, USA
    Division of General Academic Pediatrics, Massachusetts General for Children, Boston, MA 02114, USA)

  • Nancy A. Rigotti

    (Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
    Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA
    Harvard Medical School, Boston, MA 02115, USA
    Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA 02114, USA)

  • Radhika Shah

    (Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA)

  • Claire McGlave

    (School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA)

  • Sydney Goldberg

    (Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA)

  • Glory Song

    (Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA 02108, USA)

  • Jacqueline Doane

    (Massachusetts Tobacco Cessation and Prevention Program, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA 02108, USA)

  • Melody Kingsley

    (Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA 02108, USA)

  • Patricia Henley

    (Massachusetts Tobacco Cessation and Prevention Program, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA 02108, USA)

  • Sanouri Ursprung

    (Office of Statistics and Evaluation, Bureau of Community Health and Prevention, Massachusetts Department of Public Health, Boston, MA 02108, USA)

  • Christopher Banthin

    (Public Health Advocacy Institute, Northeastern University, Boston, MA 02115, USA)

  • Douglas E. Levy

    (Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA 02114, USA
    Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA 02114, USA
    Harvard Medical School, Boston, MA 02115, USA)

Abstract

A 2018 rule requiring federally-subsidized public housing authorities (PHAs) in the United States to adopt smoke-free policies (SFPs) has sparked interest in how housing agencies can best implement SFPs. However, to date, there is little quantitative data on the implementation of SFPs in public housing. Massachusetts PHAs were among the pioneers of SFPs in public housing, and many had instituted SFPs voluntarily prior to the federal rule. The aim of this study was to examine the adoption, implementation, and outcomes of SFPs instituted in Massachusetts PHAs prior to 2018 using a survey conducted that year. The survey asked if PHAs had SFPs and, if so, what activities were used to implement them: providing information sessions, offering treatment or referral for smoking cessation, soliciting resident input, training staff, partnering with outside groups, using a toolkit, and/or providing outdoor smoking areas. We used multivariable regression to investigate associations between implementation activities and respondent-reported policy outcomes (resident support, complaints about neighbors’ smoking, and the number of violations reported per year). Of 238 Massachusetts PHAs, 218 (91%) completed the survey and 161 had an SFP prior to 2018. Common implementation activities were offering smoking cessation treatment/referral (89%) and information sessions for residents (85%). Information sessions for residents were associated with higher resident support (adjusted odds ratio [AOR] 4.3; 95%CI 1.2–15.3). Training staff (AOR 6.3, 95%CI 1.2–31.8) and engaging in ≥5 implementation activities (AOR 4.1, 95%CI 1.2–14.1) were associated with fewer smoking-related complaints. Utilization of multiple implementation activities, especially ones that informed residents and trained PHA staff, was associated with more favorable policy outcomes. We identified five groups of PHAs that shared distinct patterns of SFP implementation activities. Our findings, documenting implementation activities and their associations with SFP outcomes among the early adopters of SPFs in Massachusetts public housing, can help inform best practices for the future implementation of SFPs in multiunit housing.

Suggested Citation

  • Boram Lee & Vicki Fung & David Cheng & Jonathan P. Winickoff & Nancy A. Rigotti & Radhika Shah & Claire McGlave & Sydney Goldberg & Glory Song & Jacqueline Doane & Melody Kingsley & Patricia Henley & , 2022. "Implementation Activities in Smoke-Free Public Housing: The Massachusetts Experience," IJERPH, MDPI, vol. 20(1), pages 1-12, December.
    • Handle: RePEc:gam:jijerp:v:20:y:2022:i:1:p:78-:d:1010089
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    References listed on IDEAS

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    1. repec:aph:ajpbhl:10.2105/ajph.2016.303606_9 is not listed on IDEAS
    2. Nan Jiang & Lorna Thorpe & Sue Kaplan & Donna Shelley, 2018. "Perceptions about the Federally Mandated Smoke-Free Housing Policy among Residents Living in Public Housing in New York City," IJERPH, MDPI, vol. 15(10), pages 1-8, September.
    3. Levy, D.E. & Adams, I.F. & Adamkiewicz, G., 2017. "Delivering on the promise of smoke-free public housing," American Journal of Public Health, American Public Health Association, vol. 107(3), pages 380-383.
    4. Nan Jiang & Emily Gill & Lorna E. Thorpe & Erin S. Rogers & Cora de Leon & Elle Anastasiou & Sue A. Kaplan & Donna Shelley, 2021. "Implementing the Federal Smoke-Free Public Housing Policy in New York City: Understanding Challenges and Opportunities for Improving Policy Impact," IJERPH, MDPI, vol. 18(23), pages 1-13, November.
    5. Wilson, K.M. & Torok, M. & McMillen, R. & Tanski, S. & Klein, J.D. & Winickoff, J.P., 2014. "Tobacco smoke incursions in multiunit housing," American Journal of Public Health, American Public Health Association, vol. 104(8), pages 1445-1453.
    6. Ellen Childs & Alan C. Geller & Daniel R. Brooks & Jessica Davine & John Kane & Robyn Keske & Jodi Anthony & Vaughan W. Rees, 2022. "Assessing Smoke-Free Housing Implementation Approaches to Inform Best Practices: A National Survey of Early-Adopting Public Housing Authorities," IJERPH, MDPI, vol. 19(7), pages 1-15, March.
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