MACDC October 8, 2015 Presenters: Kathleen McCabe, Health - - PowerPoint PPT Presentation

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Smoke-Free Housing Training MACDC

October 8, 2015 Presenters: Kathleen McCabe, Health Resources in Action Chris Banthin, Public Health Advocacy Institute Lynne Sales, Peabody Properties Marianne McLaughlin, Jamaica Plain NDC

Agenda

October 8, 2015

1. Welcome and Introductions 2. Why go smoke-free? 3. How to go smoke-free? 4. Compliance and Enforcement 5. Resources, Close and Feedback form

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Training Objectives

May 13, 2015

• Participants will be able to:
• Articulate why smoke-free housing are important
• Identify that smoking contributes to asthma rates
• Explain that smoke drifts between units and cannot be

contained

• Explain the focus on affordable housing as a social justice

issue

• Identify that properties are smoke-free, not smoker free

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CDC Smoke-Free Housing Video - Boston

October 8, 2015

• https://www.youtube.com/watch?v=BDUHWcI48EU

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What is Smoke-Free Housing?

Definition

• Smoke-free housing policies mean

that smoking is prohibited, not people who smoke (“No Smoking”, not “No Smokers”)

• Smoking is prohibited anywhere in buildings, including

individual units.

• Policies may apply to outdoor common areas and entrances, a

designated perimeter around buildings or entire campuses.

No smoking policies are the best way make multi-unit buildings smoke-free

October 8, 2015 | Smoke-Free Housing

Boston Housing Authority Smoke-Free - Sept. 2012

Part 1: Why Go Smoke-Free?

Health Benefits Fire Safety Cost Savings Market Demand

October 8, 2015 | Smoke-Free Housing

There is no risk-free level of exposure to secondhand smoke.

October 8, 2015

• Secondhand smoke drifts between

units in multi-unit housing

• “Home is the place where children

are most exposed to secondhand smoke” and “a major source of exposure for adults.” (U.S. Surgeon General 2006)

• Children residing in multiunit residential

buildings experience higher levels of exposure to secondhand smoke compared children in single- detached dwellings.

Pediatrics, 12/2010

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Who is exposed?

October 8, 2015 | Smoke-Free Housing

Image from the Centers of Disease Control and Prevention (CDC

May 13, 2015 | Smoke-Free Housing

Why is it so bad ?

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Secondhand smoke causes severe health problems and death in nonsmokers. Increased risk of strokes (30%) and heart disease (25%) in nonsmokers Adults: nasal irritation, lung cancer, and reproductive issues Children: SIDS, middle ear disease, respiratory illnesses and impaired lung function

Surgeon General 2014

Fire Safety Benefits

• Eliminating smoking from

buildings greatly reduces risk of fire

• Some properties have

negotiated reduced insurance premiums after going smoke-free

• Cigarette started fires are the

leading cause of residential fire death in MA

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

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Cost Benefits

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Cost of smoking in public housing

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Market Demand

– RESEARCH OBJECTIVES:  Gauge market demand for no smoking rules residential rental and condominium buildings.  Measure the percentage of such buildings.  Assess the experiences with implementation. – RESEARCH METHODOLOGY:  Telephonic survey: 1,304 responses  Mail survey : 372 responses  In Massachusetts  Statistically significant

October 8, 2015 | Smoke-Free Housing

Market Demand:

68% 11.5% 20.5% Effect of No Smoking Rule Included in a Property Listing More Interested Less Interested No Difference

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Market Demand

10 20 30 40 50 60 70 Willing to Pay 10% More Willing to Pay 20% More 41 % of Prospective Residents are Willing to Pay More for a No Smoking Rule

October 8, 2015 | Smoke-Free Housing

Market Demand

81% 5% 14% Effect of Prospective Resident Smelling Tobacco Smoke Less Interested More Interested No Difference

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Part 2: How to Go Smoke-Free

Process Resident Engagement and Education Policy Decisions Cessation Communicating key messages Lease Renewal

October 8, 2015 | Smoke-Free Housing

Process: How to Achieve a Smoke-Free Building

October 8, 2015

• STEP 1: Getting Started
• STEP 2: Resident Engagement
• STEP 3: Make a Plan
• STEP 4: Get the Word Out in the Community
• STEP 5: Put your Plan into Action

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Getting Started

May 13, 2015

• Landlord / Board or Governing Body
• Residents
• Educate decision-makers
• Why Go Smoke-Free
• How to go smoke-free
• Understand the resources available

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STEP 2: Resident Engagement - WHY

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Boston Housing Authority Smoke-Free Housing Murals Engaging residents encourages compliance Residents who understand WHY the building is going smoke-free are more likely to comply with the rule and encourage others to as

• well. Just notifying residents of the rule change does not work!

What can residents do?

May 13, 2015 | Smoke-Free Housing

• Survey
• Schedule, promote and attend resident meetings
• Conduct outreach /education
• Provide input as policy is developed
• Resident engagement should happen before, during and after

implementation

Make a Plan

October 8, 2015

• Create your lease addendum
• Ask residents to sign lease addendum
• Be clear about new rules
• Set implementation date
• 6 months – 1 year out
• Involve staff in the planning. Provide staff training.

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Policy Decisions

Policy Decisions:

• Grandfathering
• Designated Smoking Area /

Buffer Zone / Property-wide

• All Buildings or Some?
• Timeline for Implementation

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• E-Cigarettes
• Medical Marijuana

E-Cigarettes - background

• They produce a nicotine infused vapor, which is often
• flavored. They are less harmful than traditional

cigarettes.

• E-cigarettes are completely unregulated. There are no

standards for health, addictiveness, safety and even lethality.

• They are not cessation products. Manufacturers include

Philip Morris, Lorillard, R.J. Reynolds, and others.

• Use is increasing, including among youth. Dual use with

traditional tobacco products is increasing.

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Impacts of Smoke-Free Housing Policies

E-Cigarettes – policy decisions

October 8, 2015

• Ban use property-wide
• Ban use everywhere that traditional tobacco

products are banned, except individual units

• Do not mention in smoke-free housing policy

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Medical Marijuana

• Smoking marijuana is not a reasonable accommodation under

the law.

• The various federal statutes and cases that tell us which

accommodations are reasonable all preclude “ongoing illegal drug use.”

• Marijuana is an illegal drug under Schedule I of the Controlled

Substance Act, which means that it “has no currently accepted medical use in treatment in the United States.”

• It is not legally reasonable to allow marijuana use in

contravention to a no-smoking rule.

October 8, 2015 | Smoke-Free Housing

Cessation – BPHC video

October 8, 2015

• https://www.youtube.com/watch?v=hHCque2z9qI&f

eature=youtu.be

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Support Smokers Who Want to Quit

• Why is this important?
• Creating a smoke-free environment for

everyone does not require residents to quit smoking, but does help them quit if they try. 1

• Many people might want to try to quit and

will be looking for resources to help them

Smoke-Free as of June 2011

1 Implementation of a Smoke-Policy in Multiunit Housing, NICOTINE & TOBACCO RESEARCH, Feb. 2012

• What can you do?
• Understand the resources available to help smokers quit. Contact your

local health department to understand what resources are available

• Support quit attempts and utilization of cessation services. If possible,

host a cessation group on site

October 8, 2015 | Smoke-Free Housing

Cessation Services and Benefits

October 8, 2015

• 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.

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October 8, 2015 | Smoke-Free Housing

October 8, 2015 | Smoke-Free Housing

Support Smokers Who Want to Comply

October 8, 2015

• Why is this important?
• Not everybody is interested in – or ready to – quit smoking
• We don’t want anybody to lose their housing over this rule
• What can you do?
• Work with people on a plan for modifying their behaviors (e.g. go

for a walk after a meal to smoke, smoke while walking to/from the car)

• Speak with family members and service providers about how to

help some residents comply

• Encourage residents to speak with a cessation counselor or attend

group meetings even if they don’t want to quit. They may get some tips for going longer stretches without a cigarette.

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Communicating the Key Messages

• 1. Making properties smoke-free is good for health. It also prevents

fires and saves money.

• 2. Secondhand smoke drifts between units and cannot be contained

in one unit.

• 3. Smoke-free housing rules are legal.
• 4. Properties with these rules are smoke-free, NOT smoker-free.
• 5. There is strong support among residents and property owners for

smoke-free housing rules.

• 6. Multi-unit housing across the market spectrum is going smoke-free

October 8, 2015 | Smoke-Free Housing

Communicating the Key Messages

October 8, 2015

• Share your process for going smoke-free!
• Timeline
• Resident engagement and education
• Who might you share these messages with?

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 Residents  Board member  Property managers  Resident service coordinators/ resident serving organizations  Maintenance staff  Local fire officials  Hospitals/health centers  Guests  Attorneys  Service providers including home health agencies, personal care attendants, other vendors regularly on site  Courts and partners (clerk magistrates, mediators, TPP, judges)  Others?

Put your Plan into Action

October 8, 2015

• Finalize a policy and integrate language into a lease

addendum; Send official notice of policy change to all residents and waiting lists

• Have a sit-down meeting with each resident (at

lease-up or separately) to review the policy; Residents sign lease addendum, which becomes effective on x date

• Promote the smoke-free policy; promote cessation

resources

• Celebrate
• Enforce

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Part 3: Compliance and Enforcement

Understanding Why and How Tools Disability Law

October 8, 2015 | Smoke-Free Housing

Encourage Compliance

May 13, 2015

• Clean up property
• Remove ashtrays and

visible signs of smoking

• Put up appropriate signage

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Enforcement 101

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Why is enforcement important?

• It helps to establish a smoke-free environment.
• Residents/guests will know that management is serious about

maintaining a smoke-free environment.

How do we enforce this rule?

• Enforce this policy like other rules and regulations.
• Be consistent. Follow-up with and document every complaint.
• Send warning letters. Have sit-down meetings.
• Work with resident service coordinators, mediators, other

providers, family and others to help residents comply with the rule.

• Educate, and promote of cessation resources.

Enforcement Tools

How do we collect evidence of a violation?

 Complaints by residents and inspection reports by staff should be written.  Management should verify, use 2 staff on an inspection or different staff for different inspections.  Smell and look for smoke in complainant’s unit and in hallway outside smoker’s door.  DO NOT enter unit without permission.  There are a variety of secondhand equipment used for secondhand smoke measurements, but they are not needed.  Keep a comprehensive, written evidence log, throughout enforcement.  Document condition of unit before renting, and look and smell for signs of smoking during authorized inspection of unit after complaint.

October 8, 2015 | Smoke-Free Housing

Sample Notice of Smoking Incident

October 8, 2015 | Smoke-Free Housing

Sample Notice of Smoking Incident

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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 smoke-free policy 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.

October 8, 2015 | Smoke-Free Housing

Trends in the Market

• The number of smoke-free properties in New England and

across the country is increasing.

• Over 80 housing authorities in MA will be smoke-free by the end
• f 2015.
• 11 MA CDCs have smoke-free housing policies
• Nationally, hundreds of housing authorities are smoke-free.
• HUD / DHCD / MA Housing strongly encourage smoke-free

rules

• Many landlords are making 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.

October 8, 2015 | Smoke-Free Housing

October 8, 2015

Part 4: Tools and Resources

Make Smoking History toolkit www.makesmokinghistory.org BPHC website

http://www.bphc.org/whatwedo/tobacco-free- living/smoke-free-homes/Pages/Smoke-Free- Homes.aspx

 HUD toolkit & DHCD guidance

Technical Assistance providers

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You’re doing a GREAT thing!

• What are the impacts of smoke-free

housing policies?

• Reduce SHS smoke exposure and improve

air quality for residents, staff, visitors and pets

• 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
• May increase physical activity among residents

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Kathleen McCabe, Director, Policy and Practice Health Resources in Action, Inc. kmccabe@hria.org (617) 279-2240, ext 512 Chris Banthin, Program Director Public Health Advocacy Institute Northeastern University School of Law chris@phaionline.org (617) 373-8502