Session

How are clean air policies benefitting multi-unit housing residents?

Bob Vollinger, DrPH, MSPH, Tobacco Control Research Branch, National Cancer Institute, Bethesda, MD

APHA's 2019 Annual Meeting and Expo (Nov. 2 - Nov. 6)

Abstract

Impact of the HUD Smokefree Policy on PA Tobacco Cessation Programming among Residents in Public Housing

Livia Greenbacker, MS1, Duane Barksdale1, Jennifer Keith, MPH, CPH1, Katherine Land, MPH1, Barbara Caboot2, Lyn Becker, MBA, RMA2, Sue McLain, MPH2 and Judy Ochs2
(1)Public Health Management Corporation, Philadelphia, PA, (2)Pennsylvania Department of Health, Harrisburg, PA

APHA's 2019 Annual Meeting and Expo (Nov. 2 - Nov. 6)

Background: Starting July 30, 2018, the U.S. Department of Housing and Urban Development (HUD) required all Public Housing Agencies/Authorities (PHA) to implement a smokefree policy. One-third of adults living in public or assisted housing are current cigarette smokers and thus vulnerable to smoking-related outcomes. The Pennsylvania Tobacco Prevention and Control Program (PA-TPC) delivers local tobacco cessation services across the Commonwealth through eight Regional Primary Contractors and the PA Free Quitline. Services are free and informed by best practices, including provision of nicotine replacement therapy (NRT). At intake, Quitline callers and local program enrollees answer the question, “Do you currently live in public housing (sometimes called subsidized housing)?”

This presentation will describe the policy’s impact on PA-TPC enrollment and effectiveness among Pennsylvania residents of public housing.

Method: Quitline intake and service use data was provided by PA Free Quitline’s vendor, National Jewish Health. At six months, a third party conducted follow-up with participants who completed intake. PA-TPC Regional Primary Contractors collect local cessation program participant data at intake and six months post-program completion.

Results: In state fiscal year 2017/2018, 15.4% of Quitline callers and 20.1% of local cessation class enrollees reported living in PHAs. Quitline enrollees living in PHAs complete significantly more counseling calls than enrollees living elsewhere (p<.001), but receive significantly less NRT (p<.001). Six-month follow-up data reveal a significantly lower proportion of callers living in PHAs had quit successfully compared to callers living elsewhere (p=.003); however, local cessation program enrollees show no significant difference in quit rates (p=.06).

Conclusion: PA-TPC will continue outreach to PHA residents for cessation support and continue to examine service use and outcomes for residents seeking quit support through the Quitline and local programming. There are opportunities to maximize service delivery for clients living in public housing, such as targeted outreach and education.

Conduct evaluation related to programs, research, and other areas of practice Public health or related public policy

Abstract

Smoking and Cessation Behavior of Public Housing Residents Enrolled in Tobacco Dependence Treatment

Allison Adams1, Jeffrey Turner, MPH1, Salini Inaganti, MPH1, Sean McCormick, PhD, CTTS-M2, Jamie Magee, MSW, MSPH2, Kathleen O'Connor-Jenkins, MPH2 and Sue McLain, MPH3
(1)Public Health Management Corporation, Philadelphia, PA, (2)Health Promotion Council, Philadelphia, PA, (3)Pennsylvania Department of Health, Harrisburg, PA

APHA's 2019 Annual Meeting and Expo (Nov. 2 - Nov. 6)

Background: Starting July 30, 2018, the U.S. Department of Housing and Urban Development (HUD) required all Public Housing Authorities (PHA) to implement smokefree policies. Research indicates that residents of multi-unit housing (MUH) sites have higher rates of tobacco use and are more at risk for tobacco-related illnesses. Additionally, research demonstrates that quit desire, motivation, and self-efficacy influence cessation success, all of which may be impacted negatively by perceived loss of autonomy in choosing to quit. This presentation examines outcomes of public housing residents enrolled in tobacco dependence treatment (TDT) in the Southeastern Pennsylvania Tobacco Control Program (SEPA TCP) and identifies potential barriers to success.

Methods: We examined intake and follow-up data from 3,241 clients enrolled in TDT through providers contracted by Health Promotion Council, primary contractor for the SEPA TCP, from 2015 to 2019. We used chi-square analyses and independent samples t-tests to compare outcomes of clients who live in public housing and non-public housing clients to assess differences in smoking cessation behaviors. To identify barriers, we asked providers how clientele at MUH sites differ from traditional clients.

Results: Public housing clients had significantly lower quit rates at one month (p=.001) and six months (p=.001) after treatment, indicating that public housing clients were more likely to resume smoking one (68.7%) and six (70.7%) months following treatment, compared to non-public housing clients. Providers cited barriers in providing treatment at MUH sites, including resentment of having to quit and staff members continuing to smoke on site.

Conclusion: Initial findings suggest that public housing clients differ from non-public housing clients, displaying significantly lower quit rates and less motivation to quit. Perceived lack of autonomy in quit behaviors may contribute to poorer outcomes at the end of treatment, which points to the necessity of cessation programming that better facilitates desire and motivation to quit.

Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Program planning

Abstract

Smoke is Smoke: Addressing Smoking & Vaping in Multi-Unit Housing Complexes

Craig Wingate, MPH, MSc1, Francesca Lomotan, MPH1, Edith Cabuslay, MPH1 and Lisa Smusz, MS, LPCC2
(1)San Mateo County Health, Belmont, CA, (2)The Social Changery, Sacramento, CA

APHA's 2019 Annual Meeting and Expo (Nov. 2 - Nov. 6)

Issue:

Establishing tobacco control policies on a local level continues to be an effective strategy to reduce the negative impact of tobacco products. San Mateo County (SMC) in California is a great example of how adopting effective tobacco control policies can lead to positive health outcomes. Currently, the smoking rate in SMC is 6.7%, which is the lowest in the state and one of the lowest in the nation. This would not be possible without the adoption of local smoke-free multi-unit housing (SF-MUH) and other tobacco control policies. However, recently the City of Half Moon Bay (HMB) adopted a SF-MUH policy exempting medical cannabis vaping. This exemption could potentially undermine the effectiveness of the policy, and inadvertently support the idea that vaping is a safe practice.

Description:

In an effort to reduce the likelihood that other SMC jurisdictions will include similar exemptions in their MUH policies, the SMC Tobacco Prevention Program (TPP) is implementing a social marketing campaign tentatively titled, Smoke is Smoke. The goals of the campaign are to raise awareness about SF-MUH policies, and educate SMC residents about the dangers of secondhand smoke, whether it’s cigarette smoke, vape aerosol, or smoke from other substances.

The campaign will be developed in partnership with a social marketing firm, and will focus on the City of San Bruno since a SF-MUH policy was recently implemented there. However, some of the selected media channels will reach other jurisdictions that may be planning to adopt a SF-MUH policy or amend their existing policy. The campaign concepts will be vetted via focus groups with San Bruno residents.

Lessons Learned & Recommendations:

The campaign is expected to launch in late spring 2019. The final campaign concept will be evaluated and include lessons learned, recommendations, and data regarding the campaign’s effectiveness.

Communication and informatics Public health or related education Public health or related public policy

Abstract

HUD's Final Rule: Health and Housing Partnerships for Smoking Cessation

Emily Kane, MPA1 and Heather Batson, MA2
(1)National Nurse-Led Care Consortium, Philadelphia, PA, (2)Public Health Management Corporation, Philadelphia, PA

APHA's 2019 Annual Meeting and Expo (Nov. 2 - Nov. 6)

In December of 2016, the U.S. Department of Housing and Urban Development (HUD) released a final rule mandating that all federally-subsidized public housing be smoke-free within eighteen months. This ban affects close to two million individuals who reside in traditional public housing developments; recent estimates of smoking in public housing suggest that up to one third of residents may be current smokers. To complicate this issue, residents of public housing are more likely to experience restricted access to primary care and other healthcare services like smoking cessation counseling. Federally qualified health centers (FQHCs) are located in communities of need and are well-positioned to provide patient-centered, holistic care to residents of public housing. By partnering with health centers and other healthcare providers, housing authorities can assist residents in quitting smoking, maintain their access to affordable housing, and comply with HUD's smoke-free mandate. This presentation will provide an overview of HUD's final rule, discuss the social determinants of health that residents of public housing may experience, and outline strategies for housing and health partnerships.

Planning of health education strategies, interventions, and programs Provision of health care to the public

Abstract

Promoting Smoking Cessation in Public Housing Communities

Saqi Cho, DrPH, MSPH
National Center for Health in Public Housing, Alexandria, VA

APHA's 2019 Annual Meeting and Expo (Nov. 2 - Nov. 6)

Public housing residents are more likely to smoke and suffer from health conditions that are exacerbated by smoking and secondhand smoke exposure, such as asthma, diabetes, and COPD, compared to the general adult population. Currently, around 34% of public housing residents smoke compared to 22% of other adults. Given HUD’s new requirement that all public housing developments implement a smoke-free policy, many public housing residents may attempt to quit smoking and/or seek smoking cessation counseling and services from their local Health Centers. As a result, the National Center for Health in Public Housing, in collaboration with the CDC Office on Smoking and Health, developed a pilot project to increase access to smoking cessation services and resources for patients served at Health Centers located in or accessible to public housing. Through a competitive process, a total of four Health Centers were selected to participate. The objectives of the pilot were to educate health care providers on the CDC Tips® From Former Smokers resources; to increase access to smoking cessation materials for public housing residents and the health care providers that serve them; and to conduct an evaluation of the pilot. Over a 3-month period, the Health Centers received training about the CDC Tips® campaign and how its free resources could be used to prompt discussions about quitting smoking. The impact and success of the pilot project was measured by comparing two clinical quality indicators before and after project implementation: 1.) number of patients receiving tobacco and smoking cessation counseling provided per month and 2.) the percent of smokers that receive appropriate tobacco cessation follow-up services. Evaluation results show a 44%-2000% increase in the number of patients receiving tobacco cessation counseling and a 5%-10% increase in the percent of smokers receiving appropriate follow-up cessation services after project implementation. Pilot participants expressed a continued interest in utilizing Tips® resources, guaranteeing the continued success of the pilot.

Administer health education strategies, interventions and programs Conduct evaluation related to programs, research, and other areas of practice Implementation of health education strategies, interventions and programs Planning of health education strategies, interventions, and programs Public health or related public policy