Centers for Disease Control and Prevention Smoke-free Multi-Unit Housing

1. Centers for Disease Control and PreventionSmoke-free Multi-Unit Housing National Center for Chronic Disease Prevention and Health Promotion: Paul Hunting, MPH - Division of Community Health Stephen Babb, MPH – Office on Smoking and Health December 5, 2012

2. CDC Commitment to State and Community Health • Office on Smoking and Health (OSH) • Division of Community Health (DCH) 2

3. DCH • Core Principles • Maximize health impact • Achieve health equity • Use and expand the evidence base for sustainable systems and environmental change 3

4. OSH • Lead federal agency for comprehensive tobacco control • Goals: • Prevent tobacco use initiation • Promote tobacco use cessation • Eliminate secondhand smoke (SHS) exposure • Identify and eliminate tobacco-related disparities 4

5. The DCH Portfolio… • Racial and Ethnic Approaches to Community Health • Serves as the cornerstone of CDC 's efforts to eliminate health disparities. • Healthy Communities Program • Mobilizes 306 communities and 50 states to prevent chronic diseases in • multiple community sectors. • Communities Putting Prevention to Work • Drives local initiatives that will make healthy living easier, for more than • 50M people, through sustainable strategies and environmental changes. • Community Transformation Grants • Develops and implements initiatives to reduce chronic disease risk factors • creating healthier communities where people live, work, play, and go to school • for both large jurisdictions, tribes and smaller communities.

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7. Advancing health equity in a population-wide approach In theory, policy and environmental improvements should affect all equally. In practice, this may not be the case. • Because of: • Patchwork adoption in states, Counties and Communities • Differential enforcement • Selection factors • Community relationships • Implementation challenges 7

8. Why Population-wide? • State action paves the way for local innovation • Establishes precedent • Broad stroke approaches to prevention • Local action • Can be highly impactful • Frequently informs the next phase of state and national level policy • Can be highly targeted • Strengthens linkages between local and state public health • Increases local level capacity to support state-level strategic direction

9. Reaching 1 in 3 U.S. Citizens ThroughCommunity Transformation Grants • Goal of CDC’s Community Transformation Grants (CTG) - Create a healthier America by: • Building capacity to implement evidence- and practice-based policy, environmental, programmatic, and infrastructure changes to prevent chronic disease • Supporting implementation of interventions across five broad areas: • Tobacco–Free Living • Active Living and Healthy Eating • Community-Clinical and Other Preventive Services • Social and Emotional Wellness • Healthy and Safe Physical Environment

11. Tobacco Control and DCH • In DCH, CTG is just part of the Picture • CPPW Communities are funded for Tobacco Control • Counter advertising • SHS/Tobacco use restrictions (Comprehensive CIA, MUH, Outdoor Areas, etc.) • Pricing and Promotions • Healthy Communities Program • SHS/Tobacco use restrictions (Comprehensive CIA, MUH, Outdoor Areas, etc.) • Cessation referral • Regulation of retail outlets • REACH • Identification of promising practices in Indian Country • Culturally appropriate approaches to smoke-free and tobacco- free policy • Enhance community infrastructure and cessation services

12. State-level Tobacco Control Efforts • Fund state tobacco control programs • Also fund: • 8 Territories • 7 National Networks • 8 Tribal Support Centers • Evidence-based, comprehensive approaches • Develop and disseminate best practices • Work closely with: • other federal agencies • e.g., FDA Center for Tobacco Products • national nongovernmental partners

13. Smoke-free MUH and CTG • CTG programs working in MUH settings are building off experiences and learnings from CPPW and other community level programs. • For the next several years, 27 CTG funded communities are working to create smoke-free MUH. For Example: • Increase the number of Rochester (NY) Housing Authority (RHA) units with established prohibitive exposure to tobacco smoke practices from 0 to 1100 by December 2014. • Increase the number of cities in LA County that implement evidence-based jurisdiction-wide strategies that will reduce exposure to SHS in multi-unit housing and associated outdoor areas from 0 to 12 by September 2016. • Increase the number of families living in smoke-/tobacco-free multiunit housing to 126000 by September 2016 in the City of Austin. • Increase the number of smoke-free buildings with multi-unit housing in rural and/or low SES areas of Vermont from 0 to 13,000 by September 2013.

14. Smoke-free MUH and OSH • One of OSH’s four core goals is eliminating SHS exposure • The home is an important source of SHS exposure • Main place where children are exposed • Increasingly important source for nonsmoking adults • MUH residents with household no-smoking rules can still be exposed to SHS infiltration • Smoke-free homes and smoke-free MUH: • protect nonsmokers from SHS • help smokers quit • address disparities (low-SES, racial/ethnic) • OSH role • Extend science base • Provide technical assistance and training • Work with partners (e.g., HUD)

15. DCH Successes in MUH • Southern Nevada Health District • The Southern Nevada Regional Housing Authority (SNRHA) now requires all public housing to be smoke free including all properties owned and managed by SNRHA, including the apartment rented by the resident, the building in which the dwelling unit is located, and all common areas inside and outside the building up to 15 feet from each building and 50 feet from the buildings entry. • Reach – 12,964 Residences. • Los Angeles County • LA County CPPW program has made significant contributions that have supported seven cities in the implementation of population-wide smoke-free multi-unit housing policies. With approximately 40% of all county residents living in MUH, these improvements have created smoke-free housing for approximately 230,000 residents. 15

16. DCH Successes in MUH • Boston Public Health Commission • Boston Public Health Commission is providing funding and technical assistance to 5 non-profit community development corporations to offer 1,700 new units of smoke-free housing. Further, beginning in September of 2012 Boston Housing Authority began to transition all of its 64 public housing developments to be smoke-free • Reach – 12,000 Residences and over 23,000 residents. • Seattle, WA • Washington’s Seattle Housing Authority is implementing a policy that will make all 6,000 dwelling units owned by the agency smoke-free. The policy covers common areas, all residential apartment units, including Low-Income Public Housing (LIPH) units as well as all units in HOPE VI communities, special portfolio buildings, and privately managed buildings. • Reach - Over 26,000 low-income households in Seattle. 16

17. OSH Successes in MUH • Worked with ALA and HUD to organize ancillary meeting on smoke-free MUH at 2012 National Conference on Tobacco Or Health • Supported CDC Healthy Homes Program in developing manual on this topic • Held webinar and conducted trainings for state and local programs • Working on studies estimating: • # of MUH residents exposed, nationally and by state • Cost savings associated with smoke-free MUH 17

18. Working Together • Community and State CTG Awards can be valuable partners and critical stakeholders in statewide efforts. • Capacity building communities have the opportunity to design pilot implementation projects that align with state level priorities • Implementation awards may be conducting work that aligns and supplements state-level efforts. • Community grantees can help build the evidence base and identify and disseminate best practices. • Following is a list of CTG funded communities working on MUH 18

19. CTG-funded MUH work is going on in… • State of Wisconsin • Broward County, FL • City of Austin, TX • County of Los Angeles, CA • County of San Diego, CA • Denver, CO • Douglas County, NE • New York, NY • Hennepin County, MN • State of Illinois • State of Iowa • Louisville/Jefferson County, KY • State of Maryland • Middlesex County, MA • State of Massachusetts • Kansas City, MO • State of Minnesota • State of North Carolina • Oklahoma City/County, OK • Philadelphia , PA • State of California • San Francisco, CA • State of South Dakota • Tacoma-Pierce County, WA • Rochester, NY • State of Vermont • State of Washington 19

20. CTG-funded MUH work is being furthered by… Three CTG National Networks – Acceleration These are Networks are funded to work across the country and in particular help reach rural and frontier areas with health disparities. MUH is a key element of the work funded through the: • American Lung Association; • The National Reach Coalition; and • YMCA of the USA. • HUD • ANR • Smoke-free environments law project • EPA Indoor environments Division 20

21. Additional Collaborations . • The Centers for Disease Control and Prevention has funded a project being conducted in Los Angeles County California and three other communities to assess the health benefits of MUH interventions and to study the implementation of smoke-free policies in market-based and subsidized MUH, with the goal of understanding how best to implement smoke-free policies that will protect MUH residents from the adverse effects of secondhand smoke (SHS) • The specific research aims of the project are: • To examine the health impact of smoke-free policies in reducing exposure to SHS in MUH facilities through analysis of environmental and biometric data. • To examine the cost-effectiveness of smoke-free policies in reducing SHS exposure in MUH complexes • To examine barriers and facilitators to the implementation of smoke-free policies in reducing SHS exposure in MUH complexes.

22. Thanks! Paul Hunting, MPH, Project Officer Centers for Disease Control and Prevention Division of Community Health Program Implementation and Development Branch 770-488-1165 phunting@cdc.gov Stephen Babb, MPH, Public Health Analyst Centers for Disease Control and Prevention Office on Smoking and Health Policy Branch 770-488-1172 sbabb@cdc.gov