[Insert Name] Housing: Smoke-Free Housing Staff/Vendor Training Insert Date Here] [Presenters Names]

WHAT IS SMOKE-FREE HOUSING?

Definition No smoking rules means “No Smoking”, not “No Smokers.” The policy refers to no smoking anywhere in buildings, including individual units Policies may apply to outdoor common areas and entrances, a designated perimeter around buildings or entire campuses. Indicate the level of change or focus area/define community -Community policy change is defined, in this instance, as an entire multi-unit building, a cluster of buildings (developments in public housing) or a portfolio (all housing owned or managed by a landlord/management company) No smoking policies are the best way make multi-unit buildings smoke-free

WHY GO SMOKE-FREE? Health Benefits Fire Safety Cost Savings

Health benefits Secondhand smoke drifts between units in multi-unit housing “Home is the place where children are most exposed to secondhand smoke” and “a major source of exposure for adults.” (U.S. Surgeon General 2006) Secondhand Smoke is a US EPA Class A Carcinogen. There is no risk-free level of exposure to secondhand smoke. Boston Housing Authority Smoke-Free - Sept. 2012 Smoke drifts between units, by design – in order to have healthy air, we need flow between units Ventilation and other mechanical changes are costly and rarely prevent smoke incursion. “[Other than complete separation and isolation] no other engineering approaches, including current and advanced dilution ventilation or air cleaning technologies, have been demonstrated or should be relied upon to control the health risk from SHS exposure.” (ASHRAE 2010) Once it seeps into a unit, secondhand smoke can remain in the air for hours, exposing occupants. Large number of calls to toll-free numbers and local health departments about exposure to smoke in the home setting.

Health benefits Secondhand causes severe health problems and death in nonsmokers. And secondhand smoke exposure is now known to increase the risk of strokes in nonsmokers by up to 30%. Exposure to secondhand smoke leads to stroke, nasal irritation, lung cancer, coronary heart disease and reproductive issues in adults. (Surgeon General 2014) The impact is huge on babies and children. Children face middle ear disease, respiratory illnesses and impaired lung function from exposure to secondhand smoke. (Surgeon General 2014) Children residing in multiunit residential buildings experience higher levels of exposure to secondhand smoke compared children in single-detached dwellings. (Tobacco-Smoke Exposure in Children Who Live in Multiunit Housing, PEDIATRICS, Dec. 2010) Smoke-Free as of Oct. 2011    FACTS from 2014 Surgeon General’s report - More than 100,000 babies have died in the last 50 years from complications from prematurity, complications from low birth weight, Sudden Infant Death Syndrome (SIDS), and other problems resulting from parental smoking. Since 1964, 2.5 million nonsmokers have died from diseases caused by exposure to secondhand smoke.

Fire safety benefits Cigarette started fires are the leading cause of residential fire death in MA Eliminating smoking from buildings greatly reduces risk of fire Some properties have negotiated reduced insurance premiums after going smoke-free

Room of origin – Apartment # 104 located on first floor Side ‘C’ of the South Wing

Cost Benefits

HOW TO GO SMOKE-FREE Process Policy Decisions Resident Engagement

STEPS TOWARD A SMOKE-FREE BUILDING STEP 1: Step 1: Getting Started. Why Go Smoke-Free; Who Else is Going Smoke-Free; Meet with Board or Governing Body STEP 2: Resident Engagement. Initial Resident Survey; Schedule and promote resident meetings; Provide fire safety education; Provide cessation resources. STEP 3: Make a Plan Create Your Smoke-Free Lease Addendum; Be clear about new rules; Set your implementation date; Involve all staff in the planning. STEP 4: Get the Word Out in the Community Inform all contractors and other service providers; Inform health care providers; Work with local media. Clean up STEP 5: Put your Plan into Action Provide notice of the lease change; Promote your no smoking; Promote cessation resources; Celebrate; Enforce. Residents and resident-serving organizations Property managers / landlords Resident Service Coordinators Maintenance staff Fire department Hospitals and health centers Other service providers Home health aides / Personal care attendants Case workers

Policy Decisions Grandfathering Not recommended. Very rarely used. Makes enforcement difficult. Doesn’t address ongoing complaints. Do not get benefits of being 100% smoke-free. Designated Smoking Area v. Buffer Zone v. Property-wide Various from property to property. Considerations: Use temporarily? Access and safety? Keep smoke away from the building and entrances. Neighbors All Buildings or Some Phase in policy across buildings. Allows time for management to learn how to implement. The vase majority of landlords make all their buildings smoke-free. Timeline for implementation Medical marijuana E-Cigarettes These are at least six important decisions that need to be considered when developing a strong policy. Use these as a basis for the interactive exercise.

Staff Roles For Implementation Cessation Communication with residents Lease renewal Resident education/engagement

Support those who want to quit Why is this important? Creating a smoke-free environment for everyone does not require residents to quit smoking, but does help them quit if they try. (1) Many people might want to try to quit and will be looking for resources to help them What can you do? Understand the resources available to help smokers quit. Contact your local health department to understand what resources are available Support quit attempts and utilization of cessation services. If possible, host a cessation group on site Smoke-Free as of June 2011 1.Implementation of a Smoke-Policy in Multiunit Housing, NICOTINE & TOBACCO RESEARCH, Feb. 2012

Cessation Services and Benefits Massachusetts’ smokers want to quit—and need help to succeed. Massachusetts residents want to quit smoking. 77% of adult smokers in Massachusetts want to quit; 60% have tried to quit in the past year; 44% report they plan to quit in the next thirty days. When a smoking cessation benefit was added to MassHealth, over 40% of MassHealth smokers took advantage of it.

Support those who want to comply Why is this important? Not everybody is interested in – or ready to – quit smoking We don’t want anybody to lose their housing over this rule What can you do? Work with people on a plan for modifying their behaviors (e.g. go for a walk after a meal to smoke, smoke while walking to/from the car) Speak with family members and service providers about how to help some residents comply Encourage residents to speak with a cessation counselor or attend group meetings even if they don’t want to quit. They may get some tips for going longer stretches without a cigarette.

Communicate What are the key messages? 1. Making properties smoke-free is good for health. Smoke-free properties provide many health benefits, including removing a major asthma trigger and eliminating exposure to known carcinogens. Secondhand smoke contains over 4,000 chemicals and poisons, including lead and ammonia. According to the Surgeon General, there is no safe level of exposure to secondhand smoke. Children exposed to secondhand smoke are more likely to suffer acute respiratory infections, ear problems, and more severe asthma. 2. Secondhand smoke drifts between units in multi-unit housing and cannot be contained in one unit. Secondhand smoke travels within buildings. It is nearly impossible and quite impractical to contain secondhand smoke within an individual apartment or unit. Opening a window, sitting in a separate area, or using air filters or a fan does not get rid of secondhand smoke. 3. Smoke-free housing rules are legal. Already 70 municipal housing authorities in Massachusetts and many other landlords and condominiums have gone no-smoking.

Communicate 4. Properties with these rules are smoke-free, NOT smoker-free. Smokers can live in and visit properties with smoke-free rules. These rules prevent smoking, not smokers. No one needs to move or find a new place to live because of a smoke-free rules, as long as they don’t smoke on the property. 5. There is strong support among residents and property owners for smoke-free housing rules. 6. Multi-Unit housing across the market spectrum is going smoke-free in Massachusetts and nationally Public housing developments, private apartment buildings owned by a landlord and rented to tenants, and condominium associations are all adopting smoke-free rules. SHARE YOUR PROCESS FOR GOING SMOKE-FREE! Timeline Resident engagement and education

Communicate Who should you share these messages with? Residents Board member Property managers Resident service coordinators / resident serving organizations Maintenance staff Local fire officials Hospitals/health centers Guests Attorneys Service providers including home health agencies, personal care attendants, other vendors regularly on site Courts and partners (clerk magistrates, mediators, TPP, judges) Others?

Integrating smoke-free policies into leases How does the policy become official? Set an implementation date Finalize a policy and integrate language into a lease addendum Send official notice of policy change to all residents and waiting lists Have a sit-down meeting with each resident (at lease-up or separately) to review the policy Residents sign lease addendum, which becomes effective on x date

When should you start the education process? Educate and Engage Why is education important? It encourages compliance Residents who understand WHY you’re going smoke-free, are more likely to comply with the rule. And help you enforce it. Just notifying residents of the rule change does not work! Ample notice and information allows time for residents to modify their smoking behaviors. Opportunity for input helps create a policy that residents believe will work Educating other partners will get buy-in from people that will help you enforce the policy. They’ll help provide necessary supports to those residents that most need them. When should you start the education process? Educate before, during and after implementation. And educate during enforcement!

Impacts of Smoke-Free Housing Policies Resident Engagement Impacts of Smoke-Free Housing Policies How can you engage residents? Surveying Outreach / Education Timeline Policy implementation Health / Safety Cessation Advisory Committee The bullets above outline some broad strategies for engaging residents. We have trained residents to help with administering surveys. Residents have set up tables at events on site to distribute information about the policy. Resident Task Force members have recruited neighbors to attend meetings and to complete surveys. We’ve also trained residents to understand cessation resources so they can speak to their neighbors about what is available to them. Melissa will provide more examples of how they engaged residents in Providence. Boston Housing Authority Smoke-Free Housing Murals

ENFORCEMENT Understanding Why and How Tools Disability Law

Enforcement Why is enforcement important? It helps to establish a smoke-free environment. Clean up butts on the grounds Keep smoke away from entrances and windows Post clear signage Residents/guests will know that management is serious about maintaining a smoke-free environment. How do we enforce this rule? Enforce this policy like you do other rules and regulations. Be consistent. Follow-up with and document every complaint. Send warning letters. Have sit-down meetings. Work with resident service coordinators, mediators, other providers, family and others to help residents comply with the rule. Educate, and promote of cessation resources. Chris

Enforcement Tools How do we collect evidence of a violation? Complaints by residents and inspection reports by staff should be written. Management should verify, use 2 staff on an inspection or different staff for different inspections. Smell and look for smoke in complainant’s unit and in hallway outside smoker’s door. DO NOT enter unit without permission. There are a variety of secondhand equipment used for secondhand smoke measurements, but they are not needed. Keep a comprehensive, written evidence log, throughout enforcement. Document condition of unit before renting, and look and smell for signs of smoking during authorized inspection of unit after complaint.

Chris

Disability Law Smoke-free policies are not discriminatory under state and federal fair housing laws. Smoking is not a disability, nor a reasonable accommodation for a disability. Addiction to nicotine, while powerful, does not fit within the definition of “handicap” under fair housing laws. Clinical guidelines for healthcare providers instruct provider to promote cessation, not smoking. Waiving the no-smoking rule is a “fundamental alteration” that is unreasonable. Also, a waiver would cause an “undue administrative burden” on staff. However, always accept and objectively review any reasonable accommodation request, even if you suspect it has no merit.

Trends in the Market: The number of non-smoking properties in New England and across the country is increasing. Over 70 housing authorities in MA are smoke-free. In RI, 20+ housing authorities have adopted at smoke-free policy. Nationally, hundreds of housing authorities are smoke-free. More landlords and housing authorities are making their entire properties smoke-free, not just the buildings. Smoke-free housing policies are being implemented in all types of multi-unit properties, across the market spectrum.

You’re doing a GREAT thing! What are the impacts of smoke-free housing policies? Reduce SHS smoke exposure and improve air quality for residents, staff, visitors and pets Reduce smoking among residents and staff Reduce and prevent the occurrence of fires caused by cigarettes Increase the number of smoke-free buildings and units Creates a positive social norm Lower operating costs associated with unit turnovers, painting, fires and water damage May reduce insurance premiums May increase physical activity among residents Create a smoke-free environment for everyone, which does not require residents to quit smoking, but does help them quit if they try. (Implementation of a Smoke-Policy in Multiunit Housing, NICOTINE & TOBACCO RESEARCH, Feb. 2012) Cessation is not required Many people will make a QUIT ATTEMPT (Portland example) Understand the local resources available to support those that want to quit