title: Changes in Tobacco Smoke Exposure following the Institution of a Smoke-Free Policy in the Boston Housing Authority.
abstract: BACKGROUND
  To protect residents from tobacco smoke exposure (TSE), the Boston Housing Authority (BHA) prohibited smoking in BHA-owned apartments beginning in 2012. Our goal was to determine if the smoke-free policy reduced TSE for non-smoking BHA residents.
  
  
  METHODS
  We compared TSE before the smoke-free policy (2012) and one year later among BHA residents as well as residents of the neighboring Cambridge Housing Authority (CHA) where no such policy was in place. Participants were a convenience sample of adult non-smoking BHA and CHA residents cohabitating with only non-smokers. Main outcomes were 7-day airborne nicotine in participants' apartments; residents' saliva cotinine; and residents' self-reported TSE.
  
  
  RESULTS
  We enrolled 287 confirmed non-smokers (192 BHA, 95 CHA). Seventy-nine percent (229) were assessed at follow-up. At baseline, apartment and resident TSE were high in both housing authorities (detectable airborne nicotine: 46% BHA, 48% CHA; detectable saliva cotinine: 49% BHA, 70% CHA). At follow-up there were significant but similar declines in nicotine in both sites (detectable: -33% BHA, -39% CHA, p = 0.40). Detectable cotinine rose among BHA residents while declining among CHA participants (+17% BHA vs. -13% CHA, p = 0.002). Resident self-reported TSE within and outside of the housing environment decreased similarly for both BHA and CHA residents.
  
  
  CONCLUSIONS
  Apartment air nicotine decreased after the introduction of the smoke-free policy, though the decline may not have resulted from the policy. The BHA policy did not result in reduced individual-level TSE. Unmeasured sources of non-residential TSE may have contributed to BHA residents' cotinine levels.
authors.affiliation: Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America; Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Douglas E
authors.initials: DE
authors.lastname: Levy
authors.affiliation: Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Gary
authors.initials: G
authors.lastname: Adamkiewicz
authors.affiliation: Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, Massachusetts, United States of America; Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America; Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Rigotti
authors.affiliation: Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America; New England Research Institutes, Watertown, Massachusetts, United States of America.
authors.forename: Shona C
authors.initials: SC
authors.lastname: Fang
authors.affiliation: Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, Massachusetts, United States of America; Harvard Medical School, Boston, Massachusetts, United States of America; Division of General Pediatrics, Massachusetts General Hospital for Children, Boston, Massachusetts, United States of America.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Winickoff
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston; D005260:Female; D006798:Housing; D006801:Humans; D008297:Male; D008875:Middle Aged; D061845:Smoke-Free Policy; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution
chemical_list: D014028:Tobacco Smoke Pollution