Centers for Disease Control and Prevention
Smoke-free Multi-Unit Housing
National Center for Chronic Disease Prevention and Health Promotion:
Paul Hunting, MPH - Division of Community Health
Stephen Babb, MPH – Office on Smoking and Health
December 5, 2012
CDC Commitment to State and
Community Health
 Office on Smoking and
Health (OSH)
 Division of Community
Health (DCH)
2
DCH
 Core Principles
– Maximize health impact
– Achieve health equity
– Use and expand the evidence
base for sustainable systems and
environmental change
3
OSH
 Lead federal agency for
comprehensive tobacco
control
 Goals:
– Prevent tobacco use initiation
– Promote tobacco use cessation
– Eliminate secondhand smoke
(SHS) exposure
– Identify and eliminate tobaccorelated disparities
4
The DCH Portfolio…
Racial and Ethnic Approaches to Community Health
 Serves as the cornerstone of CDC 's efforts to eliminate health disparities.
Healthy Communities Program

Mobilizes 306 communities and 50 states to prevent chronic diseases in
multiple community sectors.
Communities Putting Prevention to Work

Drives local initiatives that will make healthy living easier, for more than
50M people, through sustainable strategies and environmental changes.
Community Transformation Grants

Develops and implements initiatives to reduce chronic disease risk factors
creating healthier communities where people live, work, play, and go to school
for both large jurisdictions, tribes and smaller communities.
6
Advancing health equity in a
population-wide approach
In theory, policy and environmental
improvements should affect all
equally. In practice, this may not be
the case.
Because of:
 Patchwork adoption in states, Counties and
Communities
 Differential enforcement
 Selection factors
 Community relationships
 Implementation challenges
7
Why Population-wide?
 State action paves the way for local innovation
 Establishes precedent
 Broad stroke approaches to prevention
 Local action
 Can be highly impactful
 Frequently informs the next phase of state and national
level policy
 Can be highly targeted
 Strengthens linkages between local and state public health
 Increases local level capacity to support statelevel strategic direction
Reaching 1 in 3 U.S. Citizens Through
Community Transformation Grants
Goal of CDC’s Community Transformation Grants (CTG) Create a healthier America by:
 Building capacity to implement evidence- and practice-based
policy, environmental, programmatic, and infrastructure
changes to prevent chronic disease
 Supporting implementation of interventions across five broad
areas:





Tobacco–Free Living
Active Living and Healthy Eating
Community-Clinical and Other Preventive Services
Social and Emotional Wellness
Healthy and Safe Physical Environment
Tobacco Control and DCH
In DCH, CTG is just part of the Picture
 CPPW Communities are funded for Tobacco Control
 Counter advertising
 SHS/Tobacco use restrictions (Comprehensive CIA, MUH, Outdoor Areas, etc.)
 Pricing and Promotions
 Healthy Communities Program
 SHS/Tobacco use restrictions (Comprehensive CIA, MUH, Outdoor Areas,
etc.)
 Cessation referral
 Regulation of retail outlets
 REACH
 Identification of promising practices in Indian Country
 Culturally appropriate approaches to smoke-free and tobacco- free policy
 Enhance community infrastructure and cessation services
State-level Tobacco Control Efforts
 Fund state tobacco control programs
 Also fund:
• 8 Territories
• 7 National Networks
• 8 Tribal Support Centers
 Evidence-based, comprehensive approaches
 Develop and disseminate best practices
 Work closely with:
• other federal agencies
• e.g., FDA Center for Tobacco Products
• national nongovernmental partners
Smoke-free MUH and CTG
 CTG programs working in MUH settings are building off
experiences and learnings from CPPW and other
community level programs.
 For the next several years, 27 CTG funded communities are
working to create smoke-free MUH. For Example:
 Increase the number of Rochester (NY) Housing Authority (RHA) units with
established prohibitive exposure to tobacco smoke practices from 0 to 1100
by December 2014.
 Increase the number of cities in LA County that implement evidence-based
jurisdiction-wide strategies that will reduce exposure to SHS in multi-unit
housing and associated outdoor areas from 0 to 12 by September 2016.
 Increase the number of families living in smoke-/tobacco-free multiunit
housing to 126000 by September 2016 in the City of Austin.
 Increase the number of smoke-free buildings with multi-unit housing in rural
and/or low SES areas of Vermont from 0 to 13,000 by September 2013.
Smoke-free MUH and OSH
 One of OSH’s four core goals is eliminating SHS exposure
 The home is an important source of SHS exposure
 Main place where children are exposed
 Increasingly important source for nonsmoking adults
 MUH residents with household no-smoking rules can still
be exposed to SHS infiltration
 Smoke-free homes and smoke-free MUH:
 protect nonsmokers from SHS
 help smokers quit
 address disparities (low-SES, racial/ethnic)
 OSH role
 Extend science base
 Provide technical assistance and training
 Work with partners (e.g., HUD)
DCH Successes in MUH
 Southern Nevada Health District
•
The Southern Nevada Regional Housing Authority (SNRHA) now requires all
public housing to be smoke free including all properties owned and managed by
SNRHA, including the apartment rented by the resident, the building in which the
dwelling unit is located, and all common areas inside and outside the building up
to 15 feet from each building and 50 feet from the buildings entry.
o
Reach – 12,964 Residences.
 Los Angeles County
•
LA County CPPW program has made significant contributions that have
supported seven cities in the implementation of population-wide smoke-free
multi-unit housing policies. With approximately 40% of all county residents
living in MUH, these improvements have created smoke-free housing for
approximately 230,000 residents.
15
DCH Successes in MUH
 Boston Public Health Commission
•
Boston Public Health Commission is providing funding and technical assistance
to 5 non-profit community development corporations to offer 1,700 new units of
smoke-free housing. Further, beginning in September of 2012 Boston Housing
Authority began to transition all of its 64 public housing developments to be
smoke-free
o
Reach – 12,000 Residences and over 23,000 residents.
 Seattle, WA
• Washington’s Seattle Housing Authority is implementing a policy that will make
all 6,000 dwelling units owned by the agency smoke-free. The policy covers
common areas, all residential apartment units, including Low-Income Public
Housing (LIPH) units as well as all units in HOPE VI communities, special portfolio
buildings, and privately managed buildings.
o Reach - Over 26,000 low-income households in Seattle.
16
OSH Successes in MUH
 Worked with ALA and HUD to organize ancillary meeting
on smoke-free MUH at 2012 National Conference on
Tobacco Or Health
 Supported CDC Healthy Homes Program in developing
manual on this topic
 Held webinar and conducted trainings for state and local
programs
 Working on studies estimating:
• # of MUH residents exposed, nationally and by state
• Cost savings associated with smoke-free MUH
17
Working Together
 Community and State CTG Awards can be valuable partners and
critical stakeholders in statewide efforts.
 Capacity building communities have the opportunity to design pilot
implementation projects that align with state level priorities
 Implementation awards may be conducting work that aligns and
supplements state-level efforts.
 Community grantees can help build the evidence base and identify
and disseminate best practices.
•
Following is a list of CTG funded communities working on MUH
18
CTG-funded MUH work is going on
in…














State of Wisconsin
Broward County, FL
City of Austin, TX
County of Los Angeles, CA
County of San Diego, CA
Denver, CO
Douglas County, NE
New York, NY
Hennepin County, MN
State of Illinois
State of Iowa
Louisville/Jefferson County, KY
State of Maryland
Middlesex County, MA













State of Massachusetts
Kansas City, MO
State of Minnesota
State of North Carolina
Oklahoma City/County, OK
Philadelphia , PA
State of California
San Francisco, CA
State of South Dakota
Tacoma-Pierce County, WA
Rochester, NY
State of Vermont
State of Washington
19
CTG-funded MUH work is being
furthered by…
Three CTG National Networks – Acceleration
These are Networks are funded to work across the country and in
particular help reach rural and frontier areas with health disparities. MUH
is a key element of the work funded through the:







American Lung Association;
The National Reach Coalition; and
YMCA of the USA.
HUD
ANR
Smoke-free environments law project
EPA Indoor environments Division
20
Additional Collaborations
.
The Centers for Disease Control and Prevention has funded a project being
conducted in Los Angeles County California and three other communities to
assess the health benefits of MUH interventions and to study the
implementation of smoke-free policies in market-based and subsidized MUH,
with the goal of understanding how best to implement smoke-free policies that
will protect MUH residents from the adverse effects of secondhand smoke
(SHS)
The specific research aims of the project are:
• To examine the health impact of smoke-free policies in reducing exposure to
SHS in MUH facilities through analysis of environmental and biometric data.
• To examine the cost-effectiveness of smoke-free policies in reducing SHS
exposure in MUH complexes
• To examine barriers and facilitators to the implementation of smoke-free
policies in reducing SHS exposure in MUH complexes.
Thanks!
Paul Hunting, MPH, Project Officer
Centers for Disease Control and
Prevention
Division of Community Health
Program Implementation and
Development Branch
Stephen Babb, MPH, Public Health
Analyst
Centers for Disease Control and
Prevention
Office on Smoking and Health
Policy Branch
770-488-1165
phunting@cdc.gov
770-488-1172
sbabb@cdc.gov