Boston's non-regulatory approach to smoke-free housing

Background Tobacco smoke exposure (TSE) causes or worsens several chronic diseases, including lung cancer, heart disease and asthma. Smoke-free housing policies and regulations are emerging responses to this public health threat. Methods A non-regulatory approach was taken in Boston, with a goal of shifting the local market norm. Boston Public Health Commission's Smoke Free Homes Initiative included incentives, systems changes, and awareness building resulting in the adoption of smoke-free policies in the multi-unit residential housing market. The approach uses several points of interaction between local government and the residential housing industry. We describe facilitating factors, barriers, and lessons learned from the BPHC's initiative to advance smoke-free housing as a market norm through a multi-faceted approach featuring collaborative partnerships with government and housing providers. Results Over 600 Community Development Corporation units were transitioned during the three year initiative. Companies who manage these properties have applied their knowledge in transitioning additional properties. Boston Housing Authority transitioned its 12,000 unit public housing portfolio. Developments representing 6,661 units of non-public affordable, subsidized, and market rate housing in Boston have adopted smoke-free housing policies. Conclusion Local government can be an effective champion for public and private policy changes beyond its own jurisdiction. Boston pursued a non-regulatory approach, encouraging a market transformation toward smoke-free housing, which supported the transition of thousands of units of multi-family housing over a three year period. Strategies and lessons learned from Boston can be applied to other communities.