Skip to main content

Advertisement

SpringerLink
Log in

Smoking Policy Change Within Permanent Supportive Housing

  • Original Paper
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

Smoke-free policies effectively reduce secondhand smoke (SHS) exposure among non-smokers, and reduce consumption, encourage quit attempts, and minimize relapse to smoking among smokers. Such policies are uncommon in permanent supportive housing (PSH) for formerly homeless individuals. In this study, we collaborated with a PSH provider in San Diego, California to assess a smoke-free policy that restricted indoor smoking. Between August and November 2015, residents completed a pre-policy questionnaire on attitudes toward smoke-free policies and exposure to secondhand smoke, and then 7–9 months after policy implementation residents were re-surveyed. At follow-up, there was a 59.7% reduction in indoor smoking. The proportion of residents who identified as current smokers reduced by 13% (95% CI: −38, 10.2). The proportion of residents who reported never smelling SHS indoors (apartment 24.2%, 95% CI: 4.2, 44.1; shared areas 17.2%, 95% CI: 1.7, 32.7); in outdoor areas next to the living unit (porches or patio 56.7%, 95% CI: 40.7, 72.8); and in other outdoor areas (parking lot 28.6%, 95% CI: 8.3, 48.9) was lower post-policy compared with pre-policy. Overall, resident support increased by 18.7%; however, the greatest increase in support occurred among current smokers (from 14.8 to 37.5%). Fewer current smokers reported that the policy would enable cessation at post-policy compared to pre-policy. Our findings demonstrate the feasibility of implementing smoke-free policies in PSH for formerly homeless adults. However, policy alone appears insufficient to trigger change in smoking behavior, highlighting the need for additional cessation resources to facilitate quitting.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. HUD Exchange. (2011). Supportive housing program eligibility requirments. Retrieved from https://www.hudexchange.info/programs/shp/shp-eligibility-requirements/.

  2. Clifasefi, S. L., Malone, D. K., & Collins, S. E. (2013). Exposure to project-based housing first is associated with reduced jail time and bookings. International Journal of Drug Policy, 24(4), 291–296. doi:10.1016/j.drugpo.2012.10.002.

    Article  PubMed  Google Scholar 

  3. Larimer, M. E., Malone, D. K., Garner, M. D., Atkins, D. C., Burlingham, B., Lonczak, H. S., ... Marlatt, G. A. (2009). Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA, 301(13), 1349–1357. doi:10.1001/jama.2009.414.

    Article  PubMed  CAS  Google Scholar 

  4. Henwood, B. F., Katz, M. L., & Gilmer, T. P. (2015). Aging in place within permanent supportive housing. International Journal of Geriatric Psychiatry, 30(1), 80–87. doi:10.1002/gps.4120.

    Article  PubMed  Google Scholar 

  5. Collins, S. E., Malone, D. K., Clifasefi, S. L., Ginzler, J. A., Garner, M. D., Burlingham, B., ... Larimer, M. E. (2012). Project-based Housing First for chronically homeless individuals with alcohol problems: Within-subjects analyses of 2-year alcohol trajectories. American Journal of Public Health, 102(3), 511–519. doi:10.2105/AJPH.2011.300403.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Padgett, D. K., Gulcur, L., & Tsemberis, S. (2006). Housing first services for people who are homeless with co-occurring serious mental illness and substance abuse. Research on Social Work Practice, 16(1), 74–83. doi:10.1177/1049731505282593.

    Article  Google Scholar 

  7. Connor, S. E., Cook, R. L., Herbert, M. I., Neal, S. M., & Williams, J. T. (2002). Smoking cessation in a homeless population. Journal of General Internal Medicine, 17(5), 369–372. doi:10.1046/j.1525-1497.2002.10630.x.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Baggett, T. P., & Rigotti, N. A. (2010). Cigarette smoking and advice to quit in a national sample of homeless adults. American Journal of Preventive Medicine, 39(2), 164–172. doi:10.1016/j.amepre.2010.03.024.

    Article  PubMed  Google Scholar 

  9. Gelberg, L., Linn, L. S., Usatine, R. P., & Smith, M. H. (1990). Health, homelessness, and poverty: A study of clinic users. Archives of Internal Medicine, 150(11), 2325–2330. doi:10.1001/archinte.1990.00390220069014.

    Article  PubMed  CAS  Google Scholar 

  10. Lee, T. C., Hanlon, J. G., Ben-David, J., Booth, G. L., Cantor, W. J., Connelly, P. W., & Hwang, S. W. (2005). Risk factors for cardiovascular disease in homeless adults. Circulation, 111(20), 2629–2635. doi:10.1161/circulationaha.104.510826.

    Article  PubMed  Google Scholar 

  11. Centers for Disease Control and Prevention. (2016). Current cigarette smoking among adults—United States, 2005–2015. Morbidity and Mortality Weekly Report, 65, 1205–1211. doi:10.15585/mmwr.mm6544a2.

    Article  Google Scholar 

  12. Hwang, S. W. (2001). Homelessness and health. Canadian Medical Association Journal, 164(2), 229–233.

    PubMed  PubMed Central  CAS  Google Scholar 

  13. Hwang, S. W., Orav, E. J., O’Connell, J. J., Lebow, J. M., & Brennan, T. A. (1997). Causes of death in homeless adults in Boston. Annals of Internal Medicine, 126(8), 625–628. doi:10.7326/0003-4819-126-8-199704150-00007.

    Article  PubMed  CAS  Google Scholar 

  14. Baggett, T. P., Hwang, S. W., O’Connell, J. J., Porneala, B. C., Stringfellow, E. J., Orav, E. J., ... Rigotti, N. A. (2013). Mortality among homeless adults in Boston: Shifts in causes of death over a 15-year period. JAMA Internal Medicine, 173(3), 189–195. doi:10.1001/jamainternmed.2013.1604.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Hwang, S. W., Wilkins, R., Tjepkema, M., O’Campo, P. J., & Dunn, J. R. (2009). Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study. BMJ (Clinical Research ed.), 339, b4036. doi:10.1136/bmj.b4036.

    Article  Google Scholar 

  16. Culhane, D. P., Metraux, S., & Byrne, T. (2011). A prevention-centered approach to homelessness assistance: A paradigm shift?. Housing Policy Debate, 21(2), 295–315. doi:10.1080/10511482.2010.536246.

    Article  Google Scholar 

  17. Rog, D. J., Marshall, T., Dougherty, R. H., George, P., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Permanent supportive housing: Assessing the evidence. Psychiatric Services, 65(3), 287–294. doi:10.1176/appi/ps.201300261.

    Article  PubMed  Google Scholar 

  18. Tsemberis, S. (2010). Housing First: Ending homelessness, promoting recovery and reducing costs. In B. O'Flaherty & I. G. Ellen (Eds.), How to house the homeless (pp. 37–56). New York, NY: Russell Sage Foundation.

  19. Sadowski, L. S., Kee, R. A., VanderWeele, T. J., & Buchanan, D. (2009). Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: A randomized trial. JAMA, 301(17), 1771–1778. doi:10.1001/jama.2009.561.

    Article  PubMed  CAS  Google Scholar 

  20. International Agency for Research on Cancer & World Health Organization. (2009). Evaluating the effectiveness of smoke-free policies. Lyon, France: IARC Press, International Agency for Research on Cancer.

  21. Mills, A. L., White, M. M., Pierce, J. P., & Messer, K. (2011). Home smoking bans among U.S. households with children and smokers opportunities for intervention. American Journal of Preventive Medicine, 41(6), 559–565. doi:10.1016/j.amepre.2011.08.016.

    Article  PubMed  Google Scholar 

  22. Pizacani, B. A., Maher, J. E., Rohde, K., Drach, L., & Stark, M. J. (2012). Implementation of a smoke-free policy in subsidized multiunit housing: Effects on smoking cessation and secondhand smoke exposure. Nicotine & Tobacco Research, 14(9), 1027–1034. doi:10.1093/ntr/ntr334.

    Article  Google Scholar 

  23. Vijayaraghavan, M., Hurst, S., & Pierce, J. P. (2015). A qualitative examination of smoke-free policies and electronic cigarettes among sheltered homeless adults. American Journal of Health Promotion, 31(3), 243–250. doi:10.4278/ajhp.150318-QUAL-781.

    Article  PubMed  Google Scholar 

  24. Vijayaraghavan, M., & Pierce, J. P. (2015). Interest in smoking cessation related to a smoke-free policy among homeless adults. Journal of Community Health, 40(4), 686–691. doi:10.1007/s10900-014-9985-9.

    Article  PubMed  Google Scholar 

  25. Businelle, M. S., Poonawalla, I. B., Kendzor, D. E., Rios, D. M., Cuate, E. L., Savoy, E. J., ... Reitzel, L. R. (2014). Smoking policy change at a homeless shelter: Attitudes and effects. Addictive Behaviors, 40, 51–56. doi:10.1016/j.addbeh.2014.08.013.

    Article  PubMed  Google Scholar 

  26. Al-Delaimy, W. K. (2015). California Tobacco Survey (CTS). Retrieved from: http://library.ucsd.edu/dc/collection/bb9353145q.

  27. StataCorp. (2015). Stata Statistical Software. College Station, TX: StataCorp LP.

    Google Scholar 

  28. Tsemberis, S., Gulcur, L., & Nakae, M. (2004). Housing First, consumer choice, and harm reduction for homeless individuals with a dual diagnosis. American Journal of Public Health, 94(4), 651–656. doi:10.2105/AJPH.94.4.65.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Tsai, J., & Rosenheck, R. A. (2012). Smoking among chronically homeless adults: Prevalence and correlates. Psychiatric Services, 63(6), 569–576. doi:10.1176/appi.ps.201100398.

    Article  PubMed  Google Scholar 

  30. Henwood, B. F., Cabassa, L. J., Craig, C. M., & Padgett, D. K. (2013). Permanent supportive housing: Addressing homelessness and health disparities?. American Journal of Public Health, 103(S2), S188–S192. doi:10.2105/AJPH.2013.301490.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Ku, L., Bruen, B. K., Steinmetz, E., & Bysshe, T. (2016). Medicaid tobacco cessation: Big gaps remain in efforts to get smokers to quit. Health Affairs, 35(1), 62–70. doi:10.1377/hlthaff.2015.0756.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Vijayaraghavan, M., Schroeder, S. A., & Kushel, M. (2016). The effectiveness of tobacco control policies on vulnerable populations in the USA: A review. Postgraduate Medical Journal, 1–7. doi:10.1136/postgradmedj-2014-133193.

    Article  PubMed  Google Scholar 

  33. Hood, N. E., Ferketich, A. K., Klein, E. G., Wewers, M. E., & Pirie, P. (2013). Individual, social, and environmental factors associated with support for smoke-free housing policies among subsidized multiunit housing tenants. Nicotine & Tobacco Research, 15(6), 1075–1083. doi:10.1093/ntr/nts246.

    Article  Google Scholar 

  34. San Diego County Regional Taskforce on the Homeless. (2015). 2015 WEALLCOUNT Results. Retrieved from http://www.rtfhsd.org/wp-content/uploads/2017/07/2015-PITC-Results-Updated-7.2.15.pdf.

Download references

Acknowledgements

We would like to thank the staff and residents at the supportive housing program that participated in this study.

Funding

This study was funded by the NIH National Cancer Institute [Grant number: T32CA113710; Petersen was a postdoctoral fellow at the UCSF Center for Tobacco Control Research and Education when this work was completed]. Dr. Vijayaraghavan was supported by the Tobacco Related Disease Research Program [Grant number: 25IP-0015]. The funders played no role in the conduct of this research or the preparation of this manuscript.

Author information

Authors and Affiliations

  1. School of Nursing, Loma Linda University, Loma Linda, CA, USA

    Anne Berit Petersen

  2. Department of Epidemiology, UC Berkeley, Berkeley, CA, USA

    Holly C. Stewart

  3. Housing Innovation Partners, San Diego, CA, USA

    Jon Walters

  4. Division of General Internal Medicine/Zuckerberg San Francisco General Hospital, School of Medicine, University of California San Francisco, 1001 Potrero Ave, Box 1364, San Francisco, CA, 94110, USA

    Maya Vijayaraghavan

Authors
  1. Anne Berit Petersen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Holly C. Stewart
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jon Walters
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maya Vijayaraghavan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Maya Vijayaraghavan.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Petersen, A.B., Stewart, H.C., Walters, J. et al. Smoking Policy Change Within Permanent Supportive Housing. J Community Health 43, 312–320 (2018). https://doi.org/10.1007/s10900-017-0423-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-017-0423-7

Keywords

Search

Navigation