Smoke-Free Multi-Unit Housing:
Creating Healthy Environments
Where it Matters Most
Anna Stein, JD, MPH
Legal Specialist
NC Division of Public Health
CAHEC Partners Conference
May 20, 2014
Changing Smoke-Free Norms
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Government buildings and grounds
Parks
Beaches
Restaurants and bars
Retail establishments
Worksites
Schools
Colleges and Universities
Hospitals
Rental housing
Health Reasons for
Smoke-Free Housing
U.S. Surgeon General’s Call to Action
to Promote Healthy Homes
• There is no risk-free level of exposure to secondhand smoke
(SHS)
• In multi-unit housing, SHS moves between units through:
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Ventilation systems
Cracks in walls
Openings for plumbing and electrical systems
Open doors and windows
• Cleaning the air or ventilating buildings does not eliminate
exposure to secondhand smoke
US DHHS, 2006
Dangers of Secondhand Smoke
• Secondhand smoke (SHS) is the smoke that comes from a
lighted cigarette or tobacco product
• SHS contains 11 known cancer-causing poisons and 239
other known toxins
• Exposure to SHS increases the risk of:
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Heart attacks and stroke
Lung cancer and emphysema
Frequency and severity of asthma
Sudden infant death syndrome (SIDS)
• 38,000-65,000 deaths a year in the US are caused by SHS
2006 and 2014 US Surgeon General’s Report on Secondhand Smoke
Thirdhand Smoke
• Thirdhand smoke is the residual nicotine and other
chemicals left by tobacco smoke on a variety of surfaces,
such as carpets, walls, and blinds
• It remains in the environment long after the act of
smoking has stopped
• It reacts with common indoor air compounds to create a
cancer-causing mix that can be breathed in or absorbed
through the skin
• Children are particularly at risk for damage from
thirdhand smoke
Schick et al, 2013; Hang et al, 2013; Mayo Cinic
Smoke-Free Housing:
Legal Issues
Smoke-Free Housing Policies are
Legal
• There is no constitutional protection for smokers
• Smokers are not a protected class
• Smoking is not a fundamental right
• There are no federal legislative or regulatory barriers to the
implementation of smoke-free housing policies
• In fact, HUD has specifically endorsed smoke-free policies
(2009, 2010, 2012 notices)
• There are no state barriers to voluntary implementation of
smoke-free policies by property owners
Potential Liability Issues for
Landlords over Secondhand Smoke
• Violation of the implied warranty of habitability
• Violation of the implied covenant of quiet
enjoyment
• Constructive eviction
• Negligence
• Reasonable accommodations for people with
breathing problems or other health problems
under the Fair Housing Act
Changelabs, 2013; http://changelabsolutions.org/publications/legaloptions-tenants-shs
The Business Case for
Smoke-Free Housing
Cigarette Smoke Causes Costly
Damage to Units
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Nicotine coating on walls, appliances—everything!
Burns in carpeting and elsewhere
Creates increased need for outside contractors
One study showed costs for turning over a unit where
smoking had occurred were two to five times greater,
depending on the amount of smoking
Smoke-Free Housing New England, 2009
Cigarette Use and Threat of Fire
• Improperly discarded smoking materials are the #1 cause of
residential fire deaths in the US
• Between 2006 and 2010, smoking materials caused 1 out of
3 fire deaths in multi-unit housing
• Oxygen tanks are highly flammable and commonly found in
elderly housing
National Fire Protection Association, Fire Analysis and Research
Division, 2012; photos courtesy of Scott Alderman and Rick Allen
QAP Incentives
for Smoke-Free Housing
• 8 states include incentives for smoke-free
policies in their QAPs
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Arizona (2-4 points)
California (2 points)
Colorado (1 point)
Maine (threshold requirement)
Minnesota (1 point)
Montana (1 point)
New Hampshire (2 points)
Rhode Island (2 points)
Smoke-Free Housing:
North Carolina Research
2012 Survey of NC Public
Housing Authorities (n=93)
• 36% of PHAs reported having some sort of smoking
restriction in place on one or more of their properties
(e.g., in common areas, community rooms, grounds,
offices or units)
• 4 PHAs had one or more properties with smoke-free
units: Wilmington, Charlotte, Wilson, and Pender County
• In 2013, the Northwest Regional Housing Authority and
Oxford Housing Authority passed smoke-free policies for
all of their properties
NC Tobacco Prevention and Control Branch
2013 NC Affordable
Multi-Unit Housing Survey
• The NC Division of Public Health sent survey to all
properties subsidized by HUD, NC Housing Finance
Agency, and USDA Rural Development
• 1063 properties returned survey (57% response rate)
• Results showed 16.5% of affordable housing units in
North Carolina were covered by a smoke-free policy in
2013
• 2014 update: 28% or greater of NC affordable housing
smoke-free
Smoke-Free Policy Enforcement
Staff time
Majority (84.8%) of
smoke-free properties
reported equal or
decreased staff time
devoted to smokingrelated issues
Violations
Half of smoke-free
properties reported no
violations within the
previous 12 months;
Properties which
reported violations
most commonly
detected them during
routine inspections
Smoke-Free Policy Enforcement
Legal issues Very few properties had
terminated leases or taken legal actions to
enforce their policies in the past 12 months
• Out of 16,168 smoke-free units in the state,
49 leases were terminated (0.3% of units),
and 5 summary ejectment complaints were
filed and all were granted
Comparing Smoke-Free and
Smoking-Allowed Properties
• No difference in:
oAverage annual occupancy rate
oResidents moving away due to
smoking-related issues
NC Affordable Housing Survey:
Suggestions from Managers
Engage and inform residents
“If you discuss and have educational
information sessions in regards to 2nd
hand smoke most persons who smoke will
honor your policies. The more informed
people are the better they react to your
requests for no smoking.”
Provide enough time before policy change
“As long as the tenants
know and have a period of
time to get used to the
idea they will be fine.”
“Ample notice must
be given. Not all
residents are going to
abide by all rules.”
Clearly state policy in lease and at move-in
“It is easier to enforce
the smoke free policy
because it is clearly
stated in the lease
that we are a smokefree unit.”
“The residents are
made aware of the
smoke-free policy
before they move in.”
Provide resources for people
who want to quit smoking
“Involve residents as
much as possible
and offer/ refer
available resources
for quitting.”
Enforce the policy consistently and firmly
“Be consistent with
residents and keep them
informed. Take the policy
serious and make sure [it]
is enforced at all levels.”
“Be consistent and
firm in making the
residents aware of
the smoke-free
policy.”
Remind residents frequently
“Give constant
reminders, such as
smoke free signs
and little blurbs in
the monthly
newsletters.”
Image Credit: DHIC
Smoke-Free Housing:
Resources
www.smokefreehousingnc.com
Smoke Free Multi-Unit Housing
Resident Brochure
Health Departments May Be
Able to Provide Resources
• State and local health
departments in your area may
be able to assist with:
• Providing information
sessions to residents on the
health impacts of smoking
and secondhand smoke
• Providing resources to help
residents quit smoking
• Other health-promoting
services for your residents
Policy Can Motivate Change
Mary L. 77 years old Smoking 62 years
• Mary expressed at a group meeting how she
felt about the policy change
“When we rented here…this was our home, our castle to live in. I
pay my rent, I keep my bills paid. It feels just like when you snatch a
toy away from a child.”
• Mary, 2 weeks later, after she decided to join a smoking
cessation class
“I’ve had 4 heart attacks. My doctors have been talking to me
about quitting smoking. The smoke-free policy has been the push
to get me started.”
For Further Information or Assistance
from the NC Division of Public Health
Anna Stein, JD, MPH
(919) 707-5406
anna.stein@dhhs.nc.gov
Pam Diggs, MPH
(919) 707-5407
pamela.diggs@dhhs.nc.gov