1. Making No-Smoking Rules WORK in Tribal Housing

2. Oregon Smokefree Housing Project Diane Laughter, MPH, Health In Sight LLC diane.laughter@comcast.net

3. Smoking: The world has changed At work On airplanes In stores In hospitals and clinics Inside school buildings In restaurants, bars and theaters In their homes and in their beds In 1965, 1/2 of adult men and 1/3 of women in the U.S. smoked and they did it:

4. Present Day Most workplaces and public places are smokefree. 85% of Oregon homes and 87% of Washington homes have a no-smoking rule. People expect smoke-free air where they work and where they live.

5. Native American Trends in Oregon 38% of adults smoke 90% think secondhand smoke (SHS) is harmful 80% do not allow smoking inside their homes 68% of smokers don’t allow smoking inside their homes * Oregon BRFSS Race Oversample 2004-2005 Population-based survey of American Indians & Alaska Natives found:

6. Northwest Indian Housing Association Members 92% think secondhand smoke is a health hazard 64% think no-smoking policies are “desirable for tribal housing 21% say the program they manage currently has no- smoking rules 15% have or are conducting resident survey and 15% are thinking about moving ahead Preliminary survey results* found: *Recent NWIHA member survey – based on 14 responses; 39% of members

7. What we know about SECONDHAND SMOKE There is no safe level of exposure to SHS: “The scientific evidence is now indisputable: secondhand smoke is not a mere annoyance. It is a serious health hazard that can lead to disease and premature death in children and nonsmoking adults.” U.S. Surgeon General, 2006

8. Thirdhand Smoke – New Info SHS can seep into apartments where no one smokes through shared walls, ventilation systems, ductwork. SHS is absorbed into furniture, carpets, curtains, clothing, toys, etc that children come into contact with and put in their mouths. Children living in buildings where smoking allowed were found with higher blood levels of nicotine markers.* * Wilson KM, et al "Tobacco-smoke exposure in children who live in multiunit housing" Pediatrics 2011;127:85-92

9. Secondhand Smoke cannot be Controlled “At present the only means of effectively eliminating the health risks associated with indoor exposure is to ban smoking activity.” American Society of Heating, Refrigerating & Air-Conditioning Engineers (ASHRAE)

10. “Treatments” can make it worse More from ASHRAE: Separating smokers from non-smokers, using air cleaning technologies, or ventilating buildings does not eliminate SHS exposure. Heating, ventilation and air conditioning systems can actually distribute SHS throughout a building.

11. Look familiar? Clean-up after a smoker; nicotine coats everything Portland Tribune photos

12. Prohibiting smoking is legal… Fair housing laws do not protect smoking behavior. In fact, NONSMOKERS may be eligible for protection from SHS under Fair Housing laws.

13. The Office of Public and Indian Housing & Office of Healthy Homes and Lead Hazard Control issued a statement encouraging: “Public housing authorities to implement Non- Smoking policies for some or all of the units they own or manage.” HUD Notice PIH-2009-21(HA) HUD Weighs In

14. A no-smoking rule doesn’t mean “no smokers”

15. Safe and healthy housing should not be a luxury for those who can afford it

16. Safe & Healthy Housing for ALL Safe & healthy housing is key to a person’s physical safety and well-being. Homes should not pose a serious health hazard to the people who live there.

17. Safe & Healthy Housing for ALL Residents in tribal housing may not be likely to complain or move out if they experience unwanted SHS at home.

18. Safe & Healthy Housing for ALL Native Americans have higher rates of chronic disease and disability. Exposure to SHS and tobacco use make this problem worse.

19. How YOU Can Provide Safe & Healthy Housing Improve indoor air quality Improve resident health A No-Smoking policy is a relatively simple and affordable way to:

20. Tlingit-Haida Regional Housing Authority Who are we? Located in Juneau, AK The largest housing provider in SE Alaska Total of 640 units in 12 communities Total of 461 units adopting a no- smoking policy Anne Weske, Tax Credit- HOME Program Manager

21. Why No-Smoking Policies Our mission… “To provide safe, affordable housing to SE Alaska.” Financial reasons Neighbor “peace” Future rent-ups

22. Where did we begin? Invitation of a smoke-free advocate…got the facts! Began the dialogue -- Figured out where our administration sat on the topic Did it because it’s right! Gained support from all enforcers of the rules Set a date

23. How did we implement it? Treated it as a celebration Informed tenants in a positive, exciting manner Surveyed tenants to find out their feelings on the matter On the “Smoke-Free Initiation” date, made it a big deal. Congratulated the tenants on becoming a smoke-free housing project.

24. Coquille Indian Housing Authority Anne Shane, Executive Director Connie Barton, Tobacco Prevention Coordinator for the Coquille Tribe Located on Coquille Tribal Lands in Coos Bay, Oregon 109 units of assistance including 32 multi-family rentals, 22 single-family rentals, 20 homeownership units, and 35 tenant-based rental assistance units Community-based approach to policy development Applies to all CIHA owned and operated structures and facilities except homebuyer units

25. Coquille Indian Tribe Events Leading to Policy 2009 - Gathered sample policies from colleagues January 2010 Tobacco Prevention and Education Program presentations to Coquille Indian Housing Authority (CIHA) Board and to Residents Association Created and mailed survey to residents March 2010 Stakeholders meeting to discuss survey results Presented survey results to CIHA Board and Residents Association

26. Coquille Resident Survey Methods: Housing Authority sent survey to head of household with SASE Four $50 gift cards were offered as incentives Surveys were returned to Tobacco Prevention Coordinator who tabulated results and drafted report

27. Coquille Survey Results Response rate = 48 out of 87 were returned 100% said they were aware of the dangers of secondhand smoke 89% said they would support (with the provision of designated smoking areas) smokefree Tribal events 71% thought it was important to establish non- smoking areas and/or non-smoking housing on Tribal Lands

28. Coquille Survey Results – cont. Preferences were: 16% - No Tobacco use allowed on Tribal Lands 46% - Tobacco use limited to designated smoking areas (including designated units) 38% - No restrictions on Tobacco use Feelings about efforts to develop Tobacco-Free Zones on Tribal Lands: 6.35 was average on scale with 1= not supportive, 10 = very supportive

29. Coquille Indian Tribe – Policy Implementation Policy development: Drafted policy and presented to CIHA Board It went into effect 30 days after adoption Communication: Published in newsletter Provided copies to residents Posted in office Became part of new resident orientation

30. Coquille No-Smoking Policy Highlights Applies to all tenants, employees, and guests within housing community Applies to all buildings and facilities including office and operations facilities, parks and playgrounds, and rental units (excludes homebuyer units) Grandfathers existing single family tenants’ right to smoke inside and outside unit Grandfathers existing multi-family tenants right to smoke inside and outside on rear deck, porch, or patio Eliminates smoking in all multi-family common areas and within 10 feet of other community facilities and structures

31. Aleutian Housing Authority Patty Paulus, Housing Services Director

32. Tribes Agdaagux Akutan Belkofski Atka Nelson Lagoon Nikolski Qagan Tayagungin Qawalangin Pauloff Harbor St. George St. Paul Unga Representing 12 Tribes, our area of service is comprised of approximately 100,000 square miles. This area of Alaska is often called the “birthplace of the winds.”

33. Rationale for no-smoking policy Help insure the health and safety of tenants as well as staff Reduce cost associated with remodeling of units. The cost of refurbishing an apartment after a smoking tenant moves will be $600 to $3000 – two to three times more than a non- smokers apartment

34. Aftermath of Nicotine Nicotine stains on wall from 10-year smoker Same wall after applying sealants and paint – nicotine still seeps through

35. Tenant Demand Increasingly, tenants are filing complaints about second-hand smoke seepage more than any other complaint The potential base of renters is now largely non-smoking (approximately 73%) St. Paul 10-Plex – St. Paul Island, Alaska

36. Working through Barriers Barriers Policy approval Defiant Tenants Weather Logistics Resolutions Be prepared – present statistics and facts supporting your objective Zero Tolerance Provide an enclosed smoking “shack” Ensure that Resident Managers actively support and implement the policy

37. Step by Step Investigated – Determined the ratio of smoking to non-smoking tenants currently living in our facilities Researched – Compiled information of the benefits of smoke-free living Established a sample policy - Including the consequences for violations Presented information - To Board of Commissioners, Tribe, or Property Management/Agency

38. Implementing the Policy Adopt a Smoke-Free Facility Policy Give tenants ample time to comply with the new policy Require new residents to sign a lease agreement which includes the Smoke-free Policy Require existing tenants to sign a Smoke- free Lease Addendum Post NO-SMOKING signs Provide resources for smokers who want to quit

39. Incentives Painting units Installing new carpet Anniversary recognition Health benefits

40. This webinar is co-hosted by the Oregon Smokefree Housing Project (funded by the Oregon Health Authority) and the Washington State Department of Health In collaboration with the Northwest Indian Housing Association and partners from Alaska and Idaho