1. Massachusetts Department of Public Health, Tobacco Cessation and Prevention Program A Smoke-Free [insert name] Housing Authority: What, Why and How [Name] [Date]

2. Definition Smoke-Free Housing Rules mean “No Smoking”, not “No Smokers.”

3. Benefits of a Smoke-Free Policy  Reduce SHS smoke exposure and improve air quality for residents, staff and visitors  Reduce smoking among residents and staff  Reduce and prevent the occurrence of fires caused by cigarettes  Increase the number of smoke-free buildings and units  Creates a positive social norm  Lower operating costs associated with unit turnovers, painting, fires and water damage  May reduce insurance premiums

4. Air Movement: Temperature, Wind, Mechanical Forces

5. Pathways

6. Health & Safety  Ventilation and other mechanical changes are costly and rarely prevent smoke incursion. “[Other than complete separation and isolation] no other engineering approaches, including current and advanced dilution ventilation or air cleaning technologies, have been demonstrated or should be relied upon to control the health risk from SHS exposure.” (ASHRAE 2010)  Once it seeps into a unit, secondhand smoke can remain in the air for hours, exposing occupants.  Secondhand Smoke is a US EPA Class A Carcinogen, which means there is no safe level of exposure. Smoke-Free as of Sept. 2012

7. Health & Safety  Once it seeps into a unit, secondhand smoke can remain in the air for hours, exposing occupants.  Secondhand Smoke is a US EPA Class A Carcinogen, which means there is no safe level of exposure.  More deaths are caused each year by tobacco use than by human immunodeficiency virus (HIV), illegal drug use, alcohol use, motor vehicle injuries, suicides, and murders combined.  Secondhand smoke is now known to cause strokes in nonsmokers. Exposure to secondhand smoke increases the risk of stroke by 20-30%.  Massachusetts’ Smoke-Free Workplace Law prevents hundreds of heart attack deaths each year. However, nonsmokers continue to report exposure to secondhand smoke, especially in homes, private vehicles, and other places.

8. Health & Safety  “Home is the place where children are most exposed to secondhand smoke” and “a major source of exposure for adults.” (1)  Nonsmokers who are exposed to secondhand smoke at home increase their risk of developing lung cancer by 20% to 30% and their risk of heart disease by 25% to 30%. (1)  Children exposed to secondhand smoke are more likely to develop bronchitis, pneumonia, asthma and ear infections. (1)  Children residing in multiunit residential buildings experience higher levels of exposure to secondhand smoke compared children in single-detached dwellings. (2) Smoke-Free as of Oct. 2011 1.U.S. Surgeon General 2006 2.Tobacco-Smoke Exposure in Children Who Live in Multiunit Housing, PEDIATRICS, Dec. 2010

9. Support those who want to quit  Creating a smoke-free environment for everyone does not require residents to quit smoking, but does help them quit if they try. (1)  Support quit attempts and utilization of cessation services.  The higher rates of smoking in affordable housing magnify the problems of involuntary exposure. Smoke-Free as of June 2011 1.Implementation of a Smoke-Policy in Multiunit Housing, NICOTINE & TOBACCO RESEARCH, Feb. 2012

10. Fire Safety Unattended cigarettes Southfield Senior Housing Plymouth Housing Authority # 105 South Street – 8/06 19 Penny Lane, Plymouth – 4/12

11. Room of origin – Apartment # 104 located on first floor Side ‘ C ’ of the South Wing

14. Benefit of a Smoke-Free Policy

15. Brookline Housing Authority Survey Results – Elderly Units Demographic and Health Information Primary Language Chinese: 5.74% English: 76.08% Russian: 13.88% Spanish: 4.31% Conditions & Illnesses in Household: YesNo Asthma16.75%83.25% Cancer7.11%92.89% Chronic Bronchitis6.09%93.91% Diabetes26.90%73.10% Heart Disease15.23%84.77%

16. Brookline Housing Authority Survey Results – Elderly Units

17. Brookline Housing Authority Survey Results – Family Units Demographic and Health Information

18. Brookline Housing Authority Survey Results – Family Units

19. STEPS TOWARD A SMOKE-FREE BUILDING STEP 1: Gain Support & Form a Work Group Gather information about SHS, the environment (litter, safety, location of receptacles), sample policies, connect with peers that have a policy and gain agency consensus to move toward implementation. Form an inclusive implementation team for the project. STEP 2: Develop an Implementation Plan Develop a Plan that includes communication strategies with time lines. Understand the internal decision and ruling making process, present the plan to decision makers and staff for approval and support. Survey staff and residents, collect information about available cessation services. Set a tentative date for the policy. STEP 3: Promote Cessation Services Promote cessation services and post resources where residents can see them. Track cessation participation and the number of smokers who quit as a result of the policy. Continue to promote the benefits of a policy. STEP 4: Educate Residents, Staff and Partners Host a meeting to share survey results and policy provisions. Finalize policy draft with clear enforcement provisions, set the policy effective date, follow house rule change process, continue to promote cessation services, communicate policy effective date in multiple ways (newsletter, flyer and meetings). STEP 5: Implement the Policy & Post Signs Post “No Smoking” and designated smoking signs. Ensure designated areas are maintained and well lit. Post the policy on your agency website and on all collateral materials. STEP 6: Enforce The Policy Enforce the policy and document violations. Evaluate the policy effectiveness (survey staff and residents 6 months - 1 year post policy). Track all complaints and smoking violations. Continue to promote cessation.

20. The Role of Education  A complete understanding of the health & safety issues promotes compliance. Just notifying residents of the rule change does not work!  Educate before, during and after implementation. And educate during enforcement.  Educate everyone playing a role in the policy Staff & board members Residents & guests Attorneys and other service providers Courts

21. Cessation Services and Benefits Massachusetts’ smokers want to quit—and need help to succeed. Massachusetts residents want to quit smoking. 77% of adult smokers in Massachusetts want to quit; 60% have tried to quit in the past year; 44% report they plan to quit in the next thirty days. When a smoking cessation benefit was added to MassHealth, over 40% of MassHealth smokers took advantage of it.

24. Enforcement: Hold residents financially responsible Respond quickly and consistently to potential violations Eviction No smoking signs Educate residents about why the building is smoke-free Don’t designate a Smoking area (or keep it away from building and entrances) Ask residents to inform their guests Educate management Document enforcement Clean up butts Cessation education

25. Enforcement:  Establish a smoke-free environment.  Enforce this policy like you do other rules and regulations.  If you don’t smell it, there is no violation.  Send warning letters. Have sit-down meetings.  Continue education and promotion of cessation resources.

26. Disability Law Smoke-free policies are not discriminatory under state and federal fair housing laws. Smoking is not a disability, nor a reasonable accommodation for a disability. Addiction to nicotine, while powerful, does not fit within the definition of “handicap” under fair housing laws.  Clinical guidelines for healthcare providers instruct provider to promote cessation, not smoking.  Waiving the no-smoking rule is a “fundamental alteration” that is unreasonable. Also, a waiver would cause an “undue administrative burden” on staff.  However, always accept and objectively review any reasonable accommodation request, even if you suspect it has no merit.

27. Trends in the Market:  The number of non-smoking properties in New England and across the country is increasing.  In Rhode Island, 20+ housing authorities have adopted at smoke-free policy. Nationally, hundreds of housing authorities are smoke-free.  More landlords and housing authorities are making their entire properties smoke-free, not just the buildings.  Smoke-free housing policies are being implemented in all types of multi-unit properties, across the market spectrum.

28. Massachusetts Department of Public Health, Tobacco Cessation and Prevention Program