One year ago, HUD broke it’s own silence on an obvious enemy of air quality – tobacco smoke. For many, this action was long overdue. We’ve known for some time that biomarkers of cigarette smoke are detectable in high levels in children whose parents smoke; that rates of asthma and sudden infant death syndrome are higher; that house fires are more common; and that the children are more likely to become smokers themselves from these households. We also know that the 250 poisons, chemicals and metals in cigarette smoke move easily along air ducts, electrical and plumbing lines, cracks and elevator shafts. Finally, we know that economically disadvantaged persons living below the federal poverty level are 1.6 times as likely to smoke as those above the level, in part due to targeting by marketers from the tobacco industry. (5)

When HUD acted on July 17, 2009 they didn’t ban smoking in public housing units. Rather they issued a memorandum to Public Housing Authorities stating that HUD “strongly encourages Public Housing Authorities (PHAs) to implement non-smoking policies in some or all of their public housing units.”(6) Why didn’t they go farther? Well, ownership and administration of these housing units is decentralized, both public and private, and sensitive to market forces. In addition, an outright ban on smoking would be challenging to enforce, and eviction is an arduous affair. Still health advocates say public health never has come easy – consider sanitation, substance abuse or motor safety.

That’s why, increasingly, experts are saying “get on with it” and clean up the indoor air in these dwellings. Public health experts recently summed it up this way: “The same legal, practical and health issues that have driven successful efforts to make workplaces, private vehicles and private housing smoke-free militate in favor of extending similar protection to the vulnerable public housing population.” (5)

I’m with them.

For Health Commentary, I’m Mike Magee

References:

1. A portrait of public housing residents. Washington, DC: Council of Large Public Housing Authorities, 2004. ( http://www.clpha.org/page.cfm?pageID=126.)
2. Department of Housing and Urban Development. Current statistics, 2010. (https://pic.hud.gov/pic/RCRPublic/rcrmain.asp.)
3. Epstein JA, Botvin GJ, Diaz T, Ifill-Williams M. Psychosocial predictors of cigarette smoking among adolescents living in public housing developments. Tob Control 1999;8:45-52. http://tobaccocontrol.bmj.com/content/8/1/45.abstract
4. Physical condition standards for HUD housing that is decent, safe, sanitary and in good repair, 24 C.F.R. 5.703 (1998). http://www.hud.gov/offices/reac/pdf/uniform_stds.pdf
5.  Winickoff JP, Gottlieb M, Mello MM. Regulation of Smoking in Public Housing. N Engl J Med July 17, 2010; 362:24, 2319-2323. http://www.nejm.org/doi/pdf/10.1056/NEJMhle1000941
6. Department of Housing and Urban Development, Office of Public and Indian Housing. Non-smoking policies in public housing. July 17, 2009 (memorandum). http://www.hud.gov/offices/pih/publications/notices/09/pih2009-21.pdf