A Smoke-Free Nation One Step at a Time

Eighty-two percent of Los Angelenos would prefer to live in smoke-free housing, and those who live in publicly funded housing just got their wish.


Under a new federal rule, smoking in public housing will be banned nationwide as of early 2017. The Housing Authority of the City of Los Angeles will be required to ban smoking in apartments, indoor common areas and outside areas within 25 feet of the building. They will have up to a year and a half to put smoke-free policies into place. These new policies will put Los Angeles on par with other nearby areas, such as Santa Monica, which previously passed similar ordinances.


Smoking can have many harmful health effects, including asthma and lung cancer. Although you often hear about the harms of tobacco for the smoker, you hear less often about second or third-hand smoke. However, these can be of real concern when living in close proximity to a smoker or living in the former space of a smoker. Smoke can travel through open windows or through shared wall vents. Third-hand smoke inhalation can come from carpet, rugs, walls, and furniture, because the smoke and its harmful compounds can linger there for months. Neighbors of a smoker can experience irritation of the throat, mouth and eyes, and experience nausea and dizziness.


Los Angeles has one of the largest public housing markets in the nation, with 47,804 units and 114,442 residents, although even this is small compared to New York, which has 631,749 public housing residents. According to the National Center for Health in Public Housing, there are 8.7 million residents in public housing nationwide, which includes residents that use housing vouchers. Of these, 28% of residents smoke compared to about 17% of the general population.


Smoking can be the result of stress related to poverty, which may explain some of the higher rates we see in low-income populations. However, the cost of cigarettes can have a significant financial impact on smokers. The average cost of a pack of cigarettes in the U.S. is $5.51, but the cost varies by state, reaching as much as $12.85 in New York. The ban on smoking in public housing could help to decrease smoking among residents, which in turn would result in financial savings of around $2,250 for a household that smokes a pack a day. That is a significant amount for low-income residents living below the poverty threshold.


Savings are also estimated for taxpayers. U.S. Department of Housing and Urban Development officials estimate that the ban on smoking in public housing sites nationally will save $153 million annually, about $94 million in secondhand smoke- related health care, $43 million in renovation expenses and $16 million in smoking- related fire losses.


Some residents are upset that their choices are being governed while they are inside their homes. But the policy is not intended to lead to numerous evictions, which would be costly anyway, but to improve the health of the residents and the community. Sanctions for policy violations will need to be determined by each jurisdiction, but could allow for some leniency for a small number of violations. In San Antonio, where the policy was passed in 2012, up to 3 violations are allowed before lease termination. Education and resources to help residents quit smoking will also be necessary to help make the ban successful in improving public health.


The new policy has some sharp elbows. The sanction of lease termination could lead to evictions and ultimately homelessness, which could be too high a price to pay to reduce smoking rates in this population. In addition, some people use cigarette smoking to help them cope with cravings for other drugs. Researchers will have to keep a close eye on the consequences of this policy change. If it succeeds in bringing down smoking rates without triggering any increase in homelessness or substance abuse it will be a welcome success, but the public health community must be vigilant and realistic about the potential for adverse effects.


Overall, eliminating smoking from public housing will cut down on the effects of second and third-hand smoking. It may also prevent people from becoming smokers due to the inconvenience of having to leave their building property to smoke. It will be worth keeping an eye on the sale and use of electronic cigarettes, though, which is not included in the ban. Next up, I hope smoking will be banned in all multi-unit apartment buildings.

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