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

Abstract

Purpose: Interventions for tobacco dependence are most effective when combined with smoke-free policies, yet such policies are rare in permanent supportive housing (PSH) for formerly homeless adults. We aimed to provide in-depth analysis of attitudes and barriers to and facilitators of implementing smoke-free policies in PSH. Approach: Current smokers living in PSH completed a questionnaire and participated in in-depth, semistructured interviews on smoking history, attitudes toward smoke-free policies, and perceived barriers to cessation. Setting: We collaborated with 6 San Francisco Bay Area PSH agencies. Participants: Thirty-six residents in PSH. Methods: Interviews, conducted by trained interviewers, were digitally recorded, transcribed, and analyzed using content analysis methods. Participants were recruited until we reached thematic saturation, or no new themes emerged from the interviews. Results: Over half of participants (52.8%, n = 19) reported depression, and 97.2% (n = 35) reported current substance use. Support for indoor smoking bans in living areas was modest (33.1%), although most residents anticipated cutting down (61%) and reported they would not move because of a smoking ban (77.8%). There was interest in quitting smoking, although co-use of tobacco with other substances was a major barrier. Conclusion: This study is the first to explore attitudes toward smoke-free policies in PSH. We found that residents in PSH support smoke-free policies and consider them feasible if implementation processes are sound. Our findings underscore the need to address barriers to adopting smoke-free policies and accessing smoking cessation services. In particular, interventions must address the co-use of tobacco with other substances and the impact of smoking on financial and housing stability.

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

“…In the present study, the first to our knowledge to describe barriers to implementing tobacco control policies in PSH, we partnered with six PSH agencies in the San Francisco Bay Area to conduct a formative assessment of tobacco control interventions and to provide a framework for a toolkit of strategies to reduce tobacco use among PSH residents. This study reports on the perspectives of staff in PSH, while an accompanying manuscript reports on the perspectives of residents (Petersen, Elser, Nguyen, Alizaga, & Vijayaraghavan, 2018).…”

Policy Support for Smoke-Free and E-Cigarette Free Multiunit Housing

“…1,6,36,37 Less is known about the impact of MUH-specific smoke-free policies; recent studies find mixed evidence that smoke-free MUH policies motivate smokers to change smoking behaviors and are associated with reductions in incursions. 38,39 While these findings—along with our finding of majority support for smoke-free and e-cigarette-free MUH—are promising, some preliminary studies on smoke-free MUH policies document challenges with implementing these policies. 38-41 MUH residents and advocates have expressed concern regarding fair smoke-free MUH policy enforcement, including the need for cessation support and the use of eviction as an enforcement strategy, which need to be further studied and considered in policy implementation.…”

“…[38][39][40][41] MUH residents and advocates have expressed concern regarding fair smoke-free MUH policy enforcement, including the need for cessation support and the use of eviction as an enforcement strategy, which need to be further studied and considered in policy implementation. 38,39,42 Some studies and advocacy tools suggest that MUH resident engagement, graduated enforcement approaches, and increased cessation supports may promote equitable enforcement. 25,39,[41][42][43] If implemented in a just and fair manner, MUH policies can have the potential of changing social norms, such that cigarette smoking and e-cigarette use would become less socially acceptable in homes with shared walls and spaces.…”

“…38,39,42 Some studies and advocacy tools suggest that MUH resident engagement, graduated enforcement approaches, and increased cessation supports may promote equitable enforcement. 25,39,[41][42][43] If implemented in a just and fair manner, MUH policies can have the potential of changing social norms, such that cigarette smoking and e-cigarette use would become less socially acceptable in homes with shared walls and spaces. 1,6,36,37 By including underrepresented groups in formative policy research and policy making, greater support can be gained for MUH cigarette and e-cigarette policies.…”

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

“…13 Among permanent supportive housing residents who smoke, tobacco-related expenditures amount to about 11% of residents' monthly income (range, 6%-26%). 14,15 These smoking-related expenditures could interfere with residents' ability to pay living expenses, including rent, which can place them at risk for eviction. 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.…”