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LESSONS learned from the N.C. Smoke-free Affordable Housing Survey

LESSONS learned from the N.C. Smoke-free Affordable Housing Survey. How is this survey different from previous surveys?. Survey of properties, not individual operators Statewide census Asked questions that operators wanted to know answers to. Previous surveys. Previous surveys.

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LESSONS learned from the N.C. Smoke-free Affordable Housing Survey

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  1. LESSONS learned from the N.C. Smoke-free Affordable Housing Survey

  2. How is this survey different from previous surveys? • Survey of properties, not individual operators • Statewide census • Asked questions that operators wanted to know answers to

  3. Previous surveys

  4. Previous surveys

  5. Survey Methods

  6. Funding and Partners • Funding from CDC’s Community Transformation Grant • Carolina Survey Research Lab at UNC-Chapel Hill contracted to: • Clean sampling frame • Field survey • Analyze data

  7. SurveyDevelopment • Drafted survey questions using: • Past surveys of housing operators • Advice from smoke-free housing researchers • Input from housing industry professionals • Tested survey questions with small group of regional property managers • Finalized survey questions based on feedback

  8. Final Survey • Three sections • Questions about property and unit characteristics completed by all properties • Questions about interest in smoke-free policies and resident experiences completed only by smoking-allowed properties • Questions about implementation and enforcement of policies and resident experiences completed only by smoke-free properties

  9. Sampling • Sampling frame created with lists from: • U.S. Department of Agriculture (Rural Development) • U.S. Department of Housing and Urban Development • North Carolina Housing Finance Agency • Identified 1,865 affordable multi-unit housing properties • All properties surveyed

  10. Recruitment • CSRL called all properties to identify best survey respondent and verify contact information • Reached out to company executive contacts at medium and large companies with reminder emails • Company executives contacted property managers and encouraged them to participate

  11. Data Collection • June to October, 2013 • Online survey or mailed questionnaire • $25 incentive for respondents • 1063 properties completed survey • Overall response rate: 57% • Online: 665 completed survey online (62.6%) • Paper: 398 completed paper survey (37.4%)

  12. Recommended Practices • Obtain input from housing industry professionals for instrument • Ask questions that operators are interested in knowing the answers to • Get buy-in from housing industry professionals to participate • Have an adequate budget for respondent outreach and incentives if possible

  13. SURVEY RESULTS: Policy prevalence

  14. Smoke-Free Policy Prevalence in NC

  15. Smoke-free Policy Implementation • 58.3% of properties had converted to smoke-free; 41.7% opened smoke-free • Median year of smoke-free policy implementation was 2010 • Only 2.4% of properties allowed smoking in some residential units (vs. in none or all) • 73.6% of those properties had “grandfathered” smoking residents

  16. Variables Associated with Smoke-Free Policies • Properties that were smoke-free were more likely to: • Be built after 2001 (p=0.01) • Not receive subsidies designated for families (p=0.01) • Be managed by medium-sized companies (vs. small or large) (p=0.01) • Have residential units accessed by an interior hallway (vs. accessed from outside) (p<0.001)

  17. How do these results compare to previous surveys? • Previous studies in NY, Virginia, and Nebraska have found similar prevalence of smoke-free policies (9%-16.2%) • Study in 2 counties in New York also found that older buildings were less likely to have smoke-free policies • No other studies have looked at company size or type of access to residential units

  18. Children disproportionately live in smoking-allowed properties • 10.49% of children live in smoke-free properties; 95% CI [5.6%-15.37%] • 15.06% of adults live in smoke-free properties; 95% CI [10.54%-19.58%] • Additional regression analysis indicated that, at most properties, the odds of having a smoke-free policy decreased as the number of children per unit increased

  19. Implications for Practice • Overall policy prevalence is low, and more smoke-free policies needed to protect vulnerable populations, including children • Operators need examples of older properties being successfully converted to smoke-free • Outreach to smaller companies • Housing operators may have misperceptions about the ability of secondhand smoke to transfer between units that open to the outdoors

  20. SURVEY RESULTS: Smoking Costs and Policy Outcomes

  21. Smoke-Free Policy Enforcement Staff time Majority (84.8%) of smoke-free properties reported equal or decreased staff time devoted to smoking-related issues Violations 49.8% of smoke-free properties reported violations within the previous 12 months, mostly (80.9%) detected during routine inspections

  22. Smoke-Free Policy Enforcement Legal issuesVery few properties had terminated leases or taken legal actions to enforce their policiesin the past 12 mo. • Out of 16,168 smoke-free units in the state, 49 leases were terminated (0.3% of units), and 5 summary ejectment complaints were filed and granted

  23. Comparing Smoke-Free and Smoking-Allowed Properties • No difference in: • Average annual occupancy rate • Residents moving away due to smoking-related issues • Resident complaints about: • Tobacco smoke in residential units • Tobacco smoke in outdoor common areas

  24. Turnover Costs • 57.5% of smoking-allowed properties reported that average turnover cost per unit was more in units that had been smoked in Average cost more per unit: $347.74 • 41.3% reported the cost was about the same Image: AC Vents from non-smoking and smoking unit Image credit: Mary Gillett

  25. Smoking-Related Fires(in the last 36 months) • Total: 49 fires • 45 at smoking-allowed properties • 4 at smoke-free properties • Range of costs: $0-$513,366 Image credit: Scott Alderman, Landura Management Associates

  26. Implications for Practice: Concerns About Policies Unfounded • Previous surveys have identified concerns about enforcement, costs, and legal issues as the main barriers to smoke-free policy adoption • These concerns countered by our results • Identical occupancy rates • Less time dealing with smoking-related issues • Rare need for legal intervention to enforce • Courts will enforce the policies

  27. QUALITATIVE RESULTS: Operators’ recommendations

  28. Engage and inform residents “If you discuss and have educational information sessions in regards to 2nd hand smoke most persons who smoke will honor your policies. The more informed people are the better they react to your requests for no smoking.”

  29. Provide enough time before policy change “As long as the tenants know and have a period of time to get used to the idea they will be fine.” “Ample notice must be given. Not all residents are going to abide by all rules.”

  30. Clearly state policy in lease and at move-in “It is easier to enforce the smoke free policy because it is clearly stated in the lease that we are a smoke-free unit.” “The residents are made aware of the smoke-free policy before they move in.”

  31. Provide cessation resources “Involve residents as much as possible and offer/ refer available resources for quitting”

  32. Enforce the policy consistently and firmly “To be consistent with residents and keep them informed. Take the policy serious and make sure [it] is enforced at all levels.” “Be consistent and firm in making the residents aware of the smoke-free policy.”

  33. Remind residents frequently “Constant reminders, such as smoke free signs and little blurbs in the monthly newsletters” Image Credit: DHIC

  34. Future research

  35. Directions for future research • Greater exploration of cost savings for operators going smoke-free • North Carolina Division of Public Health beginning case study in the fall • Impact of smoke-free policies on resident health • Difficult to get sufficient sample size of residents with measurable health conditions • Transient populations • May be able to see impact of large-scale policies (e.g. municipality-wide)

  36. References • Cramer ME, Roberts S, Stevens E. Landlord attitudes and behaviors regarding smoke-free policies: implications for voluntary policy change. Public Health Nurs. 2011;28(1):3–12. doi: 10.1111/j.1525-1446.2010.00904.x • Hewett MJ, Sandell SD, Anderson J, Niebuhr M. Secondhand smoke in apartment buildings: renter and owner or manager perspectives. Nicotine Tob Res. 2007;9(suppl 1):S39–47. doi: 10.1080/14622200601083442 • Jackson SL, Bonnie RJ. A systematic examination of smoke-free policies in multiunit dwellings in Virginia as reported by property managers: implications for prevention. Am J Health Promot. 2011;26(1):37–44. doi:10.4278/ajhp.091005-QUAN-329 • King BA, Travers MJ, Cummings KM, Mahoney MC, Hyland AJ. Prevalence and predictors of smoke-free policy implementation and support among owners and managers of multiunit housing. Nicotine Tob Res. 2010;12(2):159–163. doi:10.1093/ntr/ntp175 • Ong MK, Diamant AL, Zhou Q, Park H-Y, Kaplan RM. Estimates of smoking-related property costs in California multiunit housing. Am J Public Health. 2012;102(3):490–493. doi:10.2105/AJPH.2011.300170

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