Developing Tobacco Control Interventions in Permanent Supportive Housing for Formerly Homeless Adults

Abstract

Smoke-free policies are effective population-based strategies to reduce tobacco use yet are uncommon in permanent supportive housing (PSH) for formerly homeless individuals who have high rates of smoking. In this study, we partnered with six supportive housing agencies in the San Francisco Bay Area to examine the implementation of smoke-free policies and cessation services. We administered a questionnaire and conducted in-depth, semistructured interviews with agency directors (n = 6), property management staff (n = 23), and services staff (n = 24) from 23 PSH sites on the barriers to implementing tobacco control interventions. All properties restricted smoking in indoor shared areas, but only two had policies restricting smoking in living areas. While there was staff consensus that smoke-free policies were important to reduce tobacco-related harm, participants disagreed on whether smoke-free policies were aligned with PSH’s harm reduction framework. Residents’ comorbid mental illness and substance use and the lack of appropriate enforcement tools were barriers to implementation. Using these formative findings, we present a framework for a toolkit of strategies to increase implementation of smoke-free policies and cessation interventions in PSH. Successful implementation of indoor smoke-free policies in PSH will require concurrent cessation services to support smoking cessation efforts and address the mental health and substance use needs of residents.

Smoke-Free or Not: Attitudes Toward Indoor Smoke-Free Policies Among Permanent Supportive Housing Residents

“…Discussions between PSH staff and residents concerning rent evasions may be opportunities to discuss smoking cessation and could be aligned with the harm reduction framework, as smoking poses a serious threat to financial stability. 20 This study further extends the findings from other studies conducted among residents in shelters 14,[27][28][29][30] and low-income subsidized housing 31 that have outlined the potential for smoke-free policies to reduce smoking behaviors. Acquiring housing is associated with an enhanced sense of stability, a decrease in stress and boredom, and for some, even a decrease in smoking behaviors.…”

“…This article presents the perspectives of residents living in PSH, while the staff perspective is reported elsewhere. 20…”

“…Detailed demographic characteristics and smoke-free policies of the collaborating PSH agencies have been reported elsewhere. 20 One agency exclusively served veterans, and 2 agencies operated properties that were required to be smoke-free because of county-level smoke-free ordinances. All but one of the agencies had written policies in the lease, and 4 of the 6 allowed smoking in individual living area.…”

Advancing Housing and Health: Promoting Smoking Cessation in Permanent Supportive Housing

“…In a mixed-methods study that included a survey of 23 permanent supportive housing sites in the San Francisco Bay Area, 17 sites did not offer on-site cessation services or discuss the effect of smoking on housing stability. 16 Service staff members at these sites reported rent evasion and the resulting threat of eviction as some of the most common reasons for case management interventions in permanent supportive housing. 16 Despite the potential effect of smoking on financial and/or housing instability, service staff members in these sites rarely engaged in discussion on the potential for smoking cessation to help alleviate the health or financial burden caused by smoking.…”

“…16 Service staff members at these sites reported rent evasion and the resulting threat of eviction as some of the most common reasons for case management interventions in permanent supportive housing. 16 Despite the potential effect of smoking on financial and/or housing instability, service staff members in these sites rarely engaged in discussion on the potential for smoking cessation to help alleviate the health or financial burden caused by smoking. 16…”