smoke-free housing training macdc - mel king housing...there is no risk-free level of exposure to...

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Smoke-Free Housing Training

MACDCOctober 8, 2015

Presenters:

Kathleen McCabe, Health Resources in Action

Chris Banthin, Public Health Advocacy Institute

Lynne Sales, Peabody Properties

Marianne McLaughlin, Jamaica Plain NDC

Agenda

October 8, 2015

1. Welcome and Introductions

2. Why go smoke-free?

3. How to go smoke-free?

4. Compliance and Enforcement

5. Resources, Close and Feedback form

| Smoke-Free Housing

Training Objectives

May 13, 2015

Participants will be able to: Articulate why smoke-free housing are important

Identify that smoking contributes to asthma rates

Explain that smoke drifts between units and cannot be contained

Explain the focus on affordable housing as a social justice issue

Identify that properties are smoke-free, not smoker free


CDC Smoke-Free Housing Video - Boston

October 8, 2015

https://www.youtube.com/watch?v=BDUHWcI48EU


https://www.youtube.com/watch?v=BDUHWcI48EU

What is Smoke-Free Housing?

Definition

Smoke-free housing policies mean

that smoking is prohibited, not people

who smoke (“No Smoking”, not “No Smokers”)

Smoking is prohibited anywhere in buildings, including individual units.

Policies may apply to outdoor common areas and entrances, a designated perimeter around buildings or entire campuses.

No smoking policies are the best way make multi-unit buildings smoke-free

October 8, 2015 | Smoke-Free Housing

Boston Housing Authority Smoke-Free - Sept. 2012

Part 1: Why Go Smoke-Free?

Health Benefits

Fire Safety

Cost Savings

Market Demand


There is no risk-free level of exposure

to secondhand smoke.

October 8, 2015

Secondhand smoke drifts between

units in multi-unit housing

“Home is the place where children

are most exposed to secondhand smoke”

and “a major source of exposure for

adults.” (U.S. Surgeon General 2006)

Children residing in multiunit residential

buildings experience higher levels of exposure to secondhand smoke compared children in single-detached dwellings. Pediatrics, 12/2010


Who is exposed?


Image from the Centers of Disease Control and Prevention (CDC

May 13, 2015 | Smoke-Free Housing

Why

is it

so

ba

d ?


Secondhand smoke causes severe health problems and death in nonsmokers.

Increased risk of strokes (30%) and heart disease (25%) in nonsmokers

Adults: nasal irritation, lung cancer, and reproductive issues

Children: SIDS, middle ear disease, respiratory illnesses and impaired lung functionSurgeon General 2014

Fire Safety Benefits

Eliminating smoking from buildings greatly reduces risk of fire

Some properties have negotiated reduced insurance premiums after going smoke-free

Cigarette started fires are the leading cause of residential fire death in MA


Room of origin: Apartment # 104

located on first floor

Side ‘C’ of theSouth Wing

Cost Benefits


Cost of smoking in public housing


Market Demand

– RESEARCH OBJECTIVES:

Gauge market demand for no smoking rules residential rental and condominium buildings.

Measure the percentage of such buildings.

Assess the experiences with implementation.

– RESEARCH METHODOLOGY:

Telephonic survey: 1,304 responses

Mail survey : 372 responses

In Massachusetts

Statistically significant


Market Demand:

68%

11.5%

20.5%

Effect of No Smoking Rule Included in a Property Listing

More Interested

Less Interested

No Difference


Market Demand

0

10

20

30

40

50

60

70

Willing to Pay 10% More

Willing to Pay 20% More

41 % of Prospective Residents are Willing to Pay More for a No Smoking Rule


Market Demand

81%

5% 14%

Effect of Prospective Resident SmellingTobacco Smoke

Less Interested

More Interested

No Difference


Part 2: How to Go Smoke-Free

Process

Resident Engagement and Education

Policy Decisions

Cessation

Communicating key messages

Lease Renewal


Process: How to Achieve a Smoke-Free Building

October 8, 2015

STEP 1: Getting Started

STEP 2: Resident Engagement

STEP 3: Make a Plan

STEP 4: Get the Word Out in the Community

STEP 5: Put your Plan into Action


Getting Started

May 13, 2015

Landlord / Board or Governing Body

Residents

Educate decision-makers• Why Go Smoke-Free• How to go smoke-free

Understand the resources available


STEP 2: Resident Engagement - WHY


Boston Housing Authority Smoke-Free Housing Murals

Engaging residents encourages compliance

Residents who understand WHY the building is going smoke-free are more likely to comply with the rule and encourage others to as well. Just notifying residents of the rule change does not work!

What can residents do?


Survey

Schedule, promote and attend resident meetings

Conduct outreach /education

Provide input as policy is developed

Resident engagement should happen before, during and after implementation

Make a Plan

October 8, 2015

Create your lease addendum

Ask residents to sign lease addendum

Be clear about new rules

Set implementation date

6 months – 1 year out

Involve staff in the planning. Provide staff training.


Policy Decisions

Policy Decisions: Grandfathering

Designated Smoking Area /Buffer Zone / Property-wide

All Buildings or Some?

Timeline for Implementation


E-Cigarettes

Medical Marijuana

E-Cigarettes - background

They produce a nicotine infused vapor, which is often flavored. They are less harmful than traditional cigarettes.

E-cigarettes are completely unregulated. There are no standards for health, addictiveness, safety and even lethality.

They are not cessation products. Manufacturers include Philip Morris, Lorillard, R.J. Reynolds, and others.

Use is increasing, including among youth. Dual use with traditional tobacco products is increasing.


Impacts of Smoke-Free Housing Policies

E-Cigarettes – policy decisions

October 8, 2015

Ban use property-wide

Ban use everywhere that traditional tobacco products are banned, except individual units

Do not mention in smoke-free housing policy


Medical Marijuana

• Smoking marijuana is not a reasonable accommodation under the law.

• The various federal statutes and cases that tell us which accommodations are reasonable all preclude “ongoing illegal drug use.”

• Marijuana is an illegal drug under Schedule I of the Controlled Substance Act, which means that it “has no currently accepted medical use in treatment in the United States.”

• It is not legally reasonable to allow marijuana use in contravention to a no-smoking rule.


Cessation – BPHC video

October 8, 2015

https://www.youtube.com/watch?v=hHCque2z9qI&feature=youtu.be


https://www.youtube.com/watch?v=hHCque2z9qI&feature=youtu.be

Support Smokers Who Want to Quit

Why is this important? Creating a smoke-free environment for

everyone does not require residents to quit smoking, but does help them quit if they try. 1

Many people might want to try to quit and will be looking for resources to help them

Smoke-Free as of June 2011

1 Implementation of a Smoke-Policy in Multiunit Housing, NICOTINE & TOBACCO RESEARCH, Feb. 2012

What can you do? Understand the resources available to help smokers quit. Contact your

local health department to understand what resources are available

Support quit attempts and utilization of cessation services. If possible, host a cessation group on site


Cessation Services and Benefits

October 8, 2015

Massachusetts’ smokers want to quit—and need help to succeed. Massachusetts residents want to quit smoking.

77% of adult smokers in Massachusetts want to quit;

60% have tried to quit in the past year;

44% report they plan to quit in the next thirty days.

When a smoking cessation benefit was added to MassHealth, over 40% of MassHealth smokers took advantage of it.


Support Smokers Who Want to Comply

October 8, 2015

Why is this important? Not everybody is interested in – or ready to – quit smoking

We don’t want anybody to lose their housing over this rule

What can you do? Work with people on a plan for modifying their behaviors (e.g. go

for a walk after a meal to smoke, smoke while walking to/from the car)

Speak with family members and service providers about how to help some residents comply

Encourage residents to speak with a cessation counselor or attend group meetings even if they don’t want to quit. They may get some tips for going longer stretches without a cigarette.


Communicating the Key Messages

1. Making properties smoke-free is good for health. It also prevents fires and saves money.

2. Secondhand smoke drifts between units and cannot be contained in one unit.

3. Smoke-free housing rules are legal.

4. Properties with these rules are smoke-free, NOT smoker-free.

5. There is strong support among residents and property owners for smoke-free housing rules.

6. Multi-unit housing across the market spectrum is going smoke-free


Communicating the Key Messages

October 8, 2015

Share your process for going smoke-free! Timeline

Resident engagement and education

Who might you share these messages with?


Residents Board member Property managers Resident service coordinators/

resident serving organizations Maintenance staff Local fire officials Hospitals/health centers Guests

Attorneys Service providers including

home health agencies, personal care attendants, other vendors regularly on site

Courts and partners (clerk magistrates, mediators, TPP, judges)

Others?

Put your Plan into Action

October 8, 2015

Finalize a policy and integrate language into a lease addendum; Send official notice of policy change to all residents and waiting lists

Have a sit-down meeting with each resident (at lease-up or separately) to review the policy; Residents sign lease addendum, which becomes effective on x date

Promote the smoke-free policy; promote cessation resources

Celebrate

Enforce


Part 3: Compliance and Enforcement

Understanding Why and How

Tools

Disability Law


Encourage Compliance

May 13, 2015

Clean up property

Remove ashtrays and

visible signs of smoking

Put up appropriate signage


Enforcement 101


Why is enforcement important?• It helps to establish a smoke-free environment. • Residents/guests will know that management is serious about

maintaining a smoke-free environment.

How do we enforce this rule?• Enforce this policy like other rules and regulations.• Be consistent. Follow-up with and document every complaint. • Send warning letters. Have sit-down meetings.• Work with resident service coordinators, mediators, other

providers, family and others to help residents comply with the rule.• Educate, and promote of cessation resources.

Enforcement Tools

How do we collect evidence of a violation? Complaints by residents and inspection reports by staff should be

written. Management should verify, use 2 staff on an inspection or different

staff for different inspections. Smell and look for smoke in complainant’s unit and in hallway outside

smoker’s door. DO NOT enter unit without permission. There are a variety of secondhand equipment used for secondhand

smoke measurements, but they are not needed. Keep a comprehensive, written evidence log, throughout

enforcement. Document condition of unit before renting, and look and smell for

signs of smoking during authorized inspection of unit after complaint.


Sample Notice of Smoking Incident


Disability Law

Smoke-free policies are not discriminatory under state and federal fair housing laws. Smoking is not a disability, nor a reasonable accommodation for a disability. Addiction to nicotine, while powerful, does not fit within the definition of “handicap” under fair housing laws.

Clinical guidelines for healthcare providers instruct provider to promote cessation, not smoking.

Waiving the smoke-free policy is a “fundamental alteration” that is unreasonable. Also, a waiver would cause an “undue administrative burden” on staff.

However, always accept and objectively review any reasonable accommodation request, even if you suspect it has no merit.


Trends in the Market

The number of smoke-free properties in New England and across the country is increasing. Over 80 housing authorities in MA will be smoke-free by the end

of 2015.

11 MA CDCs have smoke-free housing policies

Nationally, hundreds of housing authorities are smoke-free.

HUD / DHCD / MA Housing strongly encourage smoke-free rules

Many landlords are making entire properties smoke-free, not just the buildings.

Smoke-free housing policies are being implemented in all types of multi-unit properties, across the market spectrum.


October 8, 2015

Part 4: Tools and Resources

Make Smoking History toolkit

www.makesmokinghistory.org

BPHC website

http://www.bphc.org/whatwedo/tobacco-free-living/smoke-free-homes/Pages/Smoke-Free-Homes.aspx

HUD toolkit & DHCD guidance

Technical Assistance providers


http://www.makesmokinghistory.org/

http://www.bphc.org/whatwedo/tobacco-free-living/smoke-free-homes/Pages/Smoke-Free-Homes.aspx

You’re doing a GREAT thing!

What are the impacts of smoke-free housing policies? Reduce SHS smoke exposure and improve

air quality for residents, staff, visitors and pets

Reduce smoking among residents and staff

Reduce and prevent the occurrence of fires caused by cigarettes

Increase the number of smoke-free buildings and units

Creates a positive social norm

Lower operating costs associated with unit turnovers, painting, fires and water damage

May reduce insurance premiums

May increase physical activity among residents


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r 22, 2011

Kathleen McCabe, Director, Policy and Practice

Health Resources in Action, Inc.

[email protected]

(617) 279-2240, ext 512

Chris Banthin, Program Director

Public Health Advocacy Institute

Northeastern University School of Law

[email protected]

(617) 373-8502

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