Evaluation of Smoke-Free Housing Policy Impacts on Tobacco Smoke Exposure and Health Outcomes

摘要。烟草使用仍然是美国可预防死亡的主要原因，负责更多 每年有超过440，000人死亡，其中41，000人可归因于环境烟草烟雾（ETS）。的 联邦住房和城市发展部（HUD）最近通过了一项规定，要求所有公众 房屋署在其发展项目内推行无烟政策。有一个很强的理由 新的住房政策。与一般市民相比，公屋居民在以下方面的风险更大： 暴露于ETS有两个原因：（1）尽管随着时间的推移，吸烟人数总体下降，但主要差异仍然存在， 收入水平、教育和种族/民族。因此，公屋居民的吸烟率， 主要是少数族裔、低收入人口的死亡率往往高于一般人口。(2)最 公共住房居民住在多单元住房（MUH）中，这种环境将所有居民置于高架 与居住在独立社区的居民相比， 住房虽然禁止在家中吸烟对改善健康有着积极的影响， 强制性无烟住房仍处于初期阶段。没有任何实证研究客观地评估了 居民的健康状况。这些政策对健康的影响目前是基于 数学模型，只有少数研究测量了居民ETS暴露的变化， 在实施全面禁房令后。这些研究大多规模较小，随访时间较短 这些国家在这一时期没有采取任何行动，它们对研究执行进程只给予了有限的注意。为了填补这一空白，我们 提出一个大规模的自然实验，以检查HUD政策对减少ETS暴露的影响 改善健康状况。纽约市住房管理局（NYCHA）是最大的住房 在美国，有超过40万居民。使用准实验纵向 在设计上，我们计划在政策实施前后对ETS进行监测（每6个月跟踪一次，持续2.5年 政策后）在200个非吸烟公寓和10个选定的高层NYCHA建筑的公共区域， 并与ETS在另一个人口统计学上匹配的10座高层建筑中的200套公寓的变化进行比较， 住房计划，不受无烟政策的限制。使用地理编码的行政数据，全市NYCHA 居民健康结果将与相应的低收入人口普查区的居民进行比较。最后我们将 使用调查数据，定性访谈和焦点小组，探讨影响的多层次因素， 执行过程和结果。这项研究利用了学术界和 市政府调查人员包括纽约大学医学院的专家、高级职员 以及纽约市卫生和心理卫生部的领导。调查结果将用于 制定在全国公共或私人MUH环境中实施SFH政策的指南。

ABSTRACT. Tobacco use remains the leading cause of preventable death in the U.S., responsible for more than 440,000 deaths annually, of which 41,000 are attributable to environmental tobacco smoke (ETS). The federal Department of Housing and Urban Development (HUD) recently passed a rule that will require all public housing agencies (PHAs) to implement smoke free policies in their developments. There is a strong rationale for the new housing policy. Compared to the general public, residents in public housing are at excess risk for ETS exposure for two reasons: (1) Despite overall declines in smoking over time, major disparities persist by income level, education and race/ethnicity. Thus smoking rates among residents living in public housing, a predominantly minority, lower income population, tend to be higher than in the general population. (2) Most public housing residents live in multiunit housing (MUH), an environment that places all residents at elevated risk for involuntary ETS exposure due to smoke accumulation compared to residents living in detached housing. While prohibition of smoking in homes has promising implications for improving health, initiatives to mandate smoke-free housing are still nascent. No empirical studies have objectively evaluated the impact on health outcomes among residents. Estimated health consequences of such policies are currently based on mathematical models, and only a few studies have measured change in resident ETS exposure before and after implementation of housing-wide bans. These studies have mostly been small, with short follow-up periods, and they have given only limited attention to studying the implementation process. To fill this gap, we propose a large-scale natural experiment to examine the impact of the HUD policy on reducing ETS exposure and improving health outcomes. The New York City Housing Authority (NYCHA) is the largest housing authority in the United States, with more than 400,000 residents. Using a quasi-experimental longitudinal design, we plan to monitor ETS before and after policy implementation (tracking every 6 months for 2.5 years post-policy) in 200 apartments of non-smokers and common areas of 10 select high-rise NYCHA buildings, and compare to ETS changes in 200 apartments in 10 demographically matched high-rise buildings in another housing program, not subject to the smoke-free policy. Using geocoded administrative data, citywide NYCHA resident health outcomes will be compared to residents in matched low-income census blocks. Finally we will use survey data, qualitative interviews and focus groups to explore multilevel factors that influence the implementation process and outcomes. This study leverages a strong, ongoing partnership of academic and municipal government investigators, including experts at New York University School of Medicine, senior staff at NYCHA, and leaders from the NYC Department of Health and Mental Hygiene. Findings will be used to develop guidance for implementing SFH policies in public or private MUH settings nationally.