Smoking inside public housing is particularly troubling because of its effect on disadvantaged and vulnerable residents such as the elderly,  the disabled and young children. 

According to an article entitled, “Regulation of Smoking in Public Housing” written by Jonathan P. Winickoff, M.D., M.P.H., Mark Gottlieb, J.D., and Michelle M. Mello, J.D., Ph.D. in the New England Journal of Medicine, more than 7 million people live in public housing in the United States.  In 2008–2009, 32% of households in public housing included elderly persons, 35% included disabled persons, and 41% included children.  The mean annual income of households in public housing during this period was $13,289.” It is also believed that adolescents who live in public housing are considered to be at high risk for early experimentation with cigarettes.

Health Implications of Second-hand Smoke

The National Toxicology Program identified more than 250 poisonous gases, chemicals, and metals in tobacco smoke, 11 of which are class A carcinogens.  Numerous epidemiologic studies show that exposure to smoking can cause lung cancer and cardiac disease in nonsmokers (Institute of Medicine, Committee on Secondhand Smoke Exposure). 

The Surgeon General's report on secondary smoke concluded that “there is no safe level of exposure.  Even brief exposures to tobacco smoke can adversely affect nonsmokers, primarily elderly or disabled persons with compromised cardiac or pulmonary function.   Asthma and other respiratory illnesses, as well as the rate of sudden infant death syndrome, are increased among children exposed to tobacco smoke.”

Poisonous Journey from smoker to non-smoker residence

Tobacco smoke and its related carcinogenic gasses move along air ducts, through cracks in the walls and floors, through elevator shafts, and along plumbing and electrical lines to affect units on other floors. These toxins are deposited on indoor surfaces and re-emitted in the air over a period of days to years. Evidence has been found on rugs, furniture, clothing, and floors - all surfaces that children crawl and play on.

Benefits of non-smoking housing

Non-smoking homes have been associated with substantially reduced levels of biochemical markers of tobacco exposure and lower health risks among nonsmokers. Such policies can also encourage smoking cessation among household members, discourage the initiation of smoking by adolescents, and decrease the incidence of house fires.

Many private landlords have met public demand by enacting a no-smoking, and have reaped the benefits as entrepreneurs of reduced fire hazard, lower insurance costs and decreased cleaning costs.

It is reasonable to conclude that if such a smoking ban is implemented, Public Housing Authorities  will also reap long-term cost savings through reductions in cleaning costs and the risk of fire, as well as other smoke-related costs.

Is it Feasible?

“Perhaps the greatest hurdle for the Public Housing Administration to implement smoke-free policies is the challenge of enforcement. Effectiveness in monitoring and for reporting noncompliance would need to be established, along with sanctions for residents who do not comply. The threat of eviction cannot be wielded lightly, both because the process is legally onerous and because eviction undermines the purpose of public-housing programs — that is, protecting vulnerable populations from homelessness,”  Winickoff states.

While the question of eviction is daunting, the groundwork has been laid by the department of Housing and Urban Development (HUD) in the inclusion of a Tenancy Addendum for Section 8 leases that permits property owners to evict tenants who engage in drug use, crime, or alcohol abuse in the dwelling. 

Initial decontamination costs would have to be considered as well for the Public Health Administration to get on board.  Complete decontamination of a two-bedroom unit can exceed $15,000; the simple cleaning of one unit in which one or more residents have smoked costs 2-3 times as much as the cleaning of a non-smoking unit. 

Final words

The report concludes, “The use of federal regulatory or contractual mechanisms to ensure that PHAs implement no-smoking policies in public housing raises ethical concerns and practical challenges; however, it is justified in light of the harms resulting from exposure to tobacco smoke.”