Stakeholder perspectives on smoke free public housing: Formative work to inform policy and planning

Background Whether or not they allow smoking in their own homes, residents of multi-unit housing are exposed to significant second hand smoke (SHS). Exposure may be greater for families living in public housing, due to higher rates of tobacco use in these communities. Since 2009, HUD has supported local public housing authorities to enact policies to reduce SHS exposure, and many PHAs are working to develop and implement smoke-free policies. In Philadelphia, formative work was conducted in partnership with the Philadelphia Housing Authority (PHA) and the Philadelphia Department of Public Health, to better understand stakeholder readiness for smoke-free public housing. Methods During 2012, we conducted in-depth interviews (n=6) with PHA staff, resident leaders and other tobacco control stakeholders and focus groups (n=2) with public housing residents, both smokers and non-smokers. Data were transcribed and analyzed to identify themes related to current tobacco use in public housing communities, and stakeholder views on barriers and facilitators of smoke-free policy implementation. Results Current tobacco use in communities was perceived to be significant. Smoking and non-smoking residents were aware of SHS-related health risks, but less knowledgeable about the properties of SHS. Many used inadequate strategies for controlling SHS in homes (i.e., odor-reducing fragrances, having non-smoking rooms), or common areas (extinguishing cigarettes when children enter elevators) Smokers described motivation to quit. All residents welcomed health education and community forums on policy development. Staff concerns focused on resident attitudes, and resources for enforcement. Overall, stakeholders agreed that ideal processes for implementation relied on investments in resident education on SHS, cessation services tailored to resident needs, and collaborative policy development. Conclusions Implementation of smoke-free public housing policies requires cessation services, and considerable public health education, building on existing awareness of SHS-related health risks.