SHARE Study: Smoke-free Housing: Asking about Residents’ Experiences
Project period: December 2014–December 2018
Funding: The Department of Housing and Urban Development (HUD), Healthy Homes grant #MAHHU0025-14
From May 2015 to March 2017, we surveyed residents at a private housing management company adopting a smoke-free policy. Twelve of the company’s 52 housing development sites, located in four states (MA, CT, VA, and MD), were randomized to either an intervention or control group. Because of likely variation in smoking prevalence and prevailing tobacco control activities (existing workplace smoke-free laws, tobacco tax rates), sites were stratified by geography (New England and mid-Atlantic) and size of the development. Study participants in the intervention group received positive messages in support of the smoke-free policy as well as access to a private Facebook group which provided support for the smoke-free policy and smoking cessation resources.
Two hundred thirty-eight (238) residents enrolled in the study and completed three surveys:
- Baseline (prior to smoke-free policy)
- Six-month survey (approximately six months post-smoke-free policy implementation)
- Twelve-month survey (approximately 12 months post-smoke-free policy implementation)
Survey questions assessed support for the smoke-free policy, perceived exposure to secondhand smoke, and policy understanding. Residents completed surveys online, through the mail, or with a trained interviewer over the phone or in person.
Air quality measurement
Air quality was measured to determine secondhand smoke levels in public areas of each of the 12 developments surveyed. Indoor air quality was assessed using a measure of airborne nicotine concentration. Two passive nicotine monitors were placed in separate indoor common areas of each development (such as laundry rooms, community rooms, stairwells) for a period of one week.
Individual interviews (n=28) were conducted with property staff (managers, resident service coordinators, maintenance, security, and administrators) and focus groups were conducted with resident smokers (n=28) and non-smokers (n=47).
A focused ethnography design allowed us to study the complexities surrounding a distinct issue in specific settings, namely the smoke-free policy from resident and staff perspectives in low-income housing. The study design, data collection measures, and analysis were informed by the comprehensive social-ecological model to broadly contextualize implementation efforts and examine the intrapersonal, interpersonal, organizational, and community factors that influence resident compliance. Explicit in our design was the recognition that because this was a policy and population-based intervention, there were likely multiple and interacting factors between residents and their environment that would influence behaviors.
The activities described above were approved by the Harvard T.H. Chan School of Public Health Institutional Review Board.