1. Enabling tenants to live comfortably in a smokefree environment.
Insert your logo here
Smokefree Housing
Enabling tenants to live comfortably in a smokefree environment.

2. We will cover issues so you will…
Have a greater understanding of smoking and nicotine addiction
Know the support available to help people quit or manage their smoking
Feel confident in talking with clients/tenants about the smokefree housing policy
Know your organisation's systems and the day-to-day tasks that support a smokefree environment
Introduction
What we aim to get out of this session
Greater understanding of nicotine addiction, smoking, support available
May show NRT options etc for handing around group.
Some suggestions of how to talk with tenants/ potential tenants about this – prepare them to manage this
This is for everyone regardless of their own smoking status.
Recommend a process of documentation to record that this has been covered.

3. The problem
Tobacco smoking continues to be a major public health problem in New Zealand.
People of lower socioeconomic status continue to have high smoking prevalence
Need to overcome the contextual factors that promote smoking and the barriers to successful cessation.
There is considerable potential to target a difficult-to-reach population with stop-smoking support in smokefree social housing.
Only about 3% of smokers stay quit with no support.
• Long-term abstinence rates refer to periods of abstinence of six months or more.
• ‘Support’ refers to behavioural support
“Contextual factors” include the physical environment and ‘social norms’. i.e. overall, are the contextual factors more pro-smoking or are they pro-quitting? Implementing smoke-free policies shift social norms from the status quo and make smoking ‘less normal’.
There is considerable potential to target a difficult-to-reach population with stop-smoking support in conjunction with this policy.
The establishment of smokefree policies in subsidised social housing in New Zealand, is a potentially useful and viable strategy to reduce the tobacco burden among low socioeconomic status populations. However, for smoking to be eliminated entirely (or to reach the ≤5% level), then at least moderate levels of resources need to be devoted to staff training and the systematic delivery of stop-smoking support, follow-up, and perhaps enforcement.

4. Insert housing provider logo here
Our intent ….
Insert a statement here describing what your organisation intends to do with regard to smokefree policy and implementation.
Outline policy…e.g.
- not requiring them to quit (might like to have a go) but they must not smoke inside
Hopefully, incentives for all existing tenants to make the change voluntarily as well.
Expectation – process will be established for all tenants – expect to have discussion with smokers and non- smokers - guests

5. Smokefree Aotearoa/NZ 2025
Our children and grandchildren will be free from tobacco and enjoy tobacco free lives.
That almost no-one will smoke (less than 5%).
It will be very difficult to sell or supply tobacco.
The national context – we have a government goal for a smokefree nation where less than 5% of population smoke.
Smokefree will become the norm, increase in SF environments and reduced supply of cigarettes.
There is a risk that our most vulnerable will be left behind and increasingly marginalized.
This is a strategy to work towards addressing this issue.
Disadvantaged people want to quit as much as others but are less successful because they often lack supportive environments and adequate resources.

6. Smoking by neighbourhood deprivation
Socioeconomically disadvantaged and otherwise vulnerable people typically bear a greater burden of smoking related harm than people with more resources.
Quitting smoking is one of the biggest contributors to reducing health inequalities
As you can see in the graph, generally, the most ‘well off’ people tend not to be smokers …… but ….people who live in the most deprived neighborhoods have the highest rates of smoking …. and these are the people who can least afford it! They also tend to have poor access to health care …. so the negative health effects of smoking can hit these people especially hard.
-less access to cigarettes, higher prices – potential financial hardship, increase in smokefree environments in public spaces.
Need to increase access to support
The most ‘well-off’ people
‘Poor’ people

7. People who smoke … 80% or more regret ever starting
Only 3% remain quit after an unsupported attempt!
80% or more regret ever starting
70% trying to quit at any one time
 May increase to 20+% with support, NRT and smokefree environments
Only 3% remain quit after an unsupported attempt … this may increase to over 20% with support and NRT…… but it is still hard for people to stay quit …. Smokefree environments help!
Regardless of age, ethnicity
Smoking is a chronic and relapsing condition; it takes the average person 20 serious quit attempts to successfully stop smoking
13 people die a day (5000 a year)
People of lower socioeconomic status continue to have higher smoking prevalence than those in more socioeconomically advantaged groups (Prevalence :All – 15%, Low SES 30%, Mental Health 47%, AOD 84%)
No lack of intention to quit , just harder for them and relapse more likely.
Need to increase access to support – supported quit attempts are far more successful.
Return to smoking (97%)  Stay quit (3%)

8. People who smoke … Smokers (15%) Smokers (80%) General population
Alcohol and other drugs
Smokers (15%)
 Non-smokers (85%)
Smoking is often a “gateway” to other drugs so it is not surprising to see this relationship. There are chemical synergies that increase the effect of smoking and other drugs. Smokefree setting help break the association between smoking and alcohol and other drugs.
Research shows that addressing nicotine addiction at the same time as other addictions is effective (rather than one at a time).
Smokers (80%)
 Non-smokers (20%)

9. People who smoke … Smokers (15%) Smokers (47%) General population
Mental health consumers
Smokers (15%)
 Non-smokers (85%)
There is significant variation in prevalence dependent on the mental health condition. Those with schizophrenia have far higher smoking prevalence.
Tobacco is the single largest contributor to premature death of those with mental health conditions (25 years earlier)
Quitting smoking reduces anxiety, stress and depression. (Smoking can cause depression).
For some, it can reduce the level of medications required. See Mental Health Foundation – Policy on Smoking for more detail.
Those with mental health conditions want to quit as much as anyone else.
Smokers (47%)
 Non-smokers (53%)

10. Barriers to quitting – personal and social circumstances
Nicotine addiction
Smoking as normal- being ‘surrounded’ by smokers
Continuing difficult circumstances
Lack of personal support to quit
Lack of confidence in quitting

11. Financial burden of smoking
Less money for essentials like food, accommodation etc.
Smokers twice as likely to report severe financial stress (going without meals, no heating).
Children in smoking households more likely to experience food insecurity.
Smokers with serious mental illness spending from one quarter to one third of income on cigarettes.
Cost of smoking pack a day approx. $6000 – research shows that low SES people who smoke will respond to tax increases – more quit attempts and cut down

12. Insert housing provider logo here
Describe staff roles …..
Describe how will implementing the smokefree policy look in terms of day-to-day work and interactions with tenants.
Describe the systems and documentation you will need to have in place
Describe other practical aspects of implementation

13. There is help available
Image of local stop smoking service or Quitline?
Medications
Specialist support services
Friends and whanau
You!
Introduce local service provider who could talk about the range of support available (later)

14. Practical implementation
Working as a part of the social housing provider team, your role includes motivating people to make a quit attempt, and to help them access cessation support. This section provides guidance on how to do this.
Easy as ABC A Ask, B Brief advice, C refer to Cessation support
The following information may be best reconfigured and shared in a handout

15. Ask about and document every person’s smoking status
Ask about and document every person’s smoking status. Definitions: Non- smoker - fewer than 100 cigarettes in their lifetime Ex- smoker - not smoked in the last 28 days Smoker – more than 100 cigarettes and in the last 28 days
Ask.. A requirement that sets the baseline for further action. Non- smokers need to know in order to manage visitors and general expectations.
Smokers – to ensure compliance, offer and engage support and manage compliance.
Ex – smokers …The definition has a short time frame. Relapse is high within 1 year – congratulate and ensure they know support is available .

16. How? Have a conversation.. State the policy
Are you aware that [insert housing provider] policy on smoking means that there is to be no smoking inside the home/unit ?
Ask about their smoking.
How does this policy affect you?
Expectation that all tenants will be advised of the policy and offered support.
Everyone needs clarity on the policy regardless of smoking status
Use of open questions is less confrontational and will usually gather information needed.
(Use of a printed resource to leave behind may be helpful.)

17. rief advice Tailor your advice to the person where possible
“This could be a good time to make a change…”
Could focus on the fresh start/new environment, financial and health benefits.
Try and open the door for the stop smoking service to assist.

18. essation Offer encouragement and support:
Strongly encourage every person who smokes to use cessation support.
“By using services you are much more likely to stop smoking. How would you feel if I connected you with support and information?”
Briefly explain the options available
Leave stop smoking service information.
Strongly encourage every person who smokes to use support available and help them to access it.

19. Resistant response
Clarify their responsibility and consequences of non–compliance
[e.g.
If they smoke on the porch – windows and doors must be closed.
Be considerate to their neighbours as the smoke will drift – encourage them to smoke elsewhere if possible
They are responsible for managing disposable of butts and ash]
“I can see this may be difficult for you.
The reality is that you cannot smoke inside. You may smoke outside as long as the windows and doors are closed. The smoke will drift so we expect you to be considerate of your neighbours and you will be responsible for the safe disposal of ash and butts.
You may find this takes a while to adjust. There are medications you can try as alternatives for cigarettes. They can help you feel more comfortable and save some money. Talk to your pharmacist…(check with your stop smoking provider how to address this).
Outline the consequences of non – compliance?
Compliance management processes – documentation
Recommend leaving stop smoking service information

20. No- I’m not interested in quitting
Substitutes for smoking
Comfort from with withdrawal symptoms
Minimise closet smoking
Reduce fire risk
Free up $$
Gain confidence in ability to quit
Using alternatives may help clients live comfortably and comply with the policy. It may also increase their confidence in their ability to quit in the future.
No additional harm using NRT (nicotine replacement therapy) while continuing to smoke, However, there is no safe level of smoking, people are best to make a complete switch.
Stop smoking service may outline alternative options.

21. Common responses “It helps me manage stress.” “It’s my only pleasure.”
Feelings of stress and nicotine withdrawal are very similar. People have also learned to associate stress management with smoking because of this. (They need to “re-programme” and find other ways to cope.) Stop smoking services can help address this.
People who stop smoking may feel stressed while quitting (NRT helps reduce withdrawal symptoms) but they significantly lower their overall stress levels within a few months.
Pleasure? Or relief from withdrawal. Exploration of other “pleasures” and focus on how more $ saved could allow this to happen. Visit the cost of smoking calculator for those who have more time for this conversation – hyperlink to site could be added to slide.

22. Support services

23. Summarise process. This slide is from the NZ Guidelines to help people stop smoking. It could be adapted to reflect the process that best fits your organisation and local services.