Introduction
Smoke-free policies (SFP) in multi-unit housing are a promising tool for reducing
exposure to tobacco smoke among residents. Concerns about increased housing instability
due to voluntary or involuntary transitions induced by SFPs have been a primary barrier
to greater widespread adoption. The impact of SFP implementation on transitions out
of public housing in federally funded public housing authorities in Massachusetts
was evaluated.
Methods
Tenancy data from the Department of Housing and Urban Development were used to determine
the time from admission to transitioning out of public housing based on a cohort study
design. Periods of exposure to SFPs were defined based on dates of SFP implementation
at each PHA. Multi-level Cox regression models were fit to estimate the effects of
SFPs on the hazard of transitioning, adjusting for household- and PHA-level characteristics.
Analyses were conducted in 2021‒2022.
Results
There were 44,705 households with a record of residence in Massachusetts PHAs over
2009‒2018. Over this period, despite increasing adoption of SFPs among the PHAs, rates
of transition remained steady at around 5‒8 transitions per 1,000 household-months.
There was no overall association between exposure to SFPs and transitions among the
full sample (adjusted HR=0.99, 95% CI=0.95, 1.04, p=0.794). However, the association varied significantly by age group, race/ethnicity,
timing of SFP adoption, and era of admission.
Conclusions
Adoption of SFPs in public housing had a minimal overall impact on turnover for households
in Massachusetts, though disparities in the impact were observed between different
demographic and PHA-level subgroups.
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Published online: January 10, 2023
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© 2022 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
