Assessment of Residents' Attitudes and Satisfaction Before and After Implementation of a Smoke-Free Policy in Boston Multiunit Housing.
BACKGROUND
In 2012, the Boston Housing Authority (BHA) in Massachusetts implemented a smoke-free policy prohibiting smoking within its residences. We sought to characterize BHA resident experiences before and after the smoke-free policy implementation, and compare them to that of nearby residents of the Cambridge Housing Authority, which had no such policy.


METHODS
We recruited a convenience sample of nonsmoking residents from the BHA and Cambridge Housing Authority. We measured residents' awareness and support of their local smoking policies before and 9-12 months after the BHA's policy implementation, as well as BHA respondents' attitudes towards the smoke-free policy. We assessed tobacco smoke exposure via saliva cotinine, airborne apartment nicotine, and self-reported number of days smelling smoke in the home. We evaluated predictors of general satisfaction at follow-up using linear regression.


RESULTS
At follow-up, 91% of BHA respondents knew that smoking was not allowed in apartments and 82% were supportive of such a policy in their building. BHA residents believed enforcement of the smoke-free policy was low. Fifty-one percent of BHA respondents indicated that other residents "never" or "rarely" followed the new smoke-free rule and 41% of respondents were dissatisfied with policy enforcement. Dissatisfaction with enforcement was the strongest predictor of general housing satisfaction, while objective and self-reported measures of tobacco smoke exposure were not predictive of satisfaction. At follow-up, 24% of BHA participants had complained to someone in charge about policy violations.


CONCLUSIONS
Resident support for smoke-free policies is high. However, lack of enforcement of smoke-free policies may cause frustration and resentment among residents, potentially leading to a decrease in housing satisfaction.


CONCLUSIONS
Smoke-free housing laws are becoming increasingly prevalent, yet little is known about satisfaction and compliance with such policies post-implementation. We evaluated nonsmoking residents' attitudes about smoke-free rules and their satisfaction with enforcement 1 year after the BHA implemented its comprehensive smoke-free policy. We found that while residents were supportive of the policy, they believed enforcement was low, a perception that was associated with a drop in housing satisfaction. Our findings point to a desire for smoke-free housing among public housing residents, and the importance of establishing systems and guidelines to help landlords monitor and enforce these policies effectively.
Interfaculty Initiative in Health Policy, Harvard University , Cambridge, MA.
Slawa
S
Rokicki
Department of Environmental Health, Harvard T.H. Chan School of Public Health , Boston, MA.
Gary
G
Adamkiewicz
Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA.|New England Research Institutes, Inc, Watertown, MA.
Shona C
SC
Fang
Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA.|Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA.|Department of Medicine, Harvard Medical School, Boston, MA.
Nancy A
NA
Rigotti
Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA.|Department of Medicine, Harvard Medical School, Boston, MA.|Division of General Academic Pediatrics and Center for Child and Adolescent Health Research and Policy, Massachusetts General Hospital, Boston, MA.
Jonathan P
JP
Winickoff
Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA.|Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA.|Department of Medicine, Harvard Medical School, Boston, MA.
Douglas E
DE
Levy
D000328:Adult; D001294:Attitude to Health; D001900:Boston / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006798:Housing / Q000331:legislation & jurisprudence*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010465:Perception; D010549:Personal Satisfaction; D012463:Saliva / Q000737:chemistry; D061845:Smoke-Free Policy / Q000331:legislation & jurisprudence* / Q000639:trends; D012907:Smoking / Q000453:epidemiology / Q000331:legislation & jurisprudence* / Q000523:psychology; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000032:analysis / Q000331:legislation & jurisprudence*
D014028:Tobacco Smoke Pollution