Smoke-free policy in Vermont public housing authorities

Introduction: Millions of adults and children living in public housing face exposure to second hand smoke from adjacent apartments. These tenants are less able to escape smoke exposure by moving, and Housing Authorities are beginning to implement smoke-free policies. We assessed the status of smoke-free policy in Vermont public housing, and explored the experience of tenants and managers in Burlington who recently implemented such a policy. Methods: We contacted Vermont Housing Authorities by telephone to assess the status of smoke-free policy in their multi-unit housing. Tenants living in smoke-free housing completed a survey assessing their opinion about the smoke-free policy. Building managers participated in a structured interview to describe their experience managing a smoke-free building. Results: Seven out of nine Housing Authorities provided data on 2,464 units in multi-unit buildings. Policy to restrict smoking existed in 14.3% of units serving families, and 39.4% of units serving elderly or disabled tenants. 49 tenants completed the survey. 61% believe smoking still occurs inside. 70% of tenants support the smoking ban in their building. Support was strongest among non-smokers (p<0.0001). The managers estimated >90% compliance. Managers reported difficulty proving policy violations, unexpected building expenses, and criticism from mobility impaired residents. Conclusion: Despite dangers to tenants, most public housing in Vermont allows smoking. Most concerning, units housing children and families were least likely to restrict smoking. Although there are significant barriers to implementing smoke-free policy, several agencies reported successful implementation. Adherence to policies may increase if accommodations, such as designated outdoor spaces, are provided.