A New Lease on Life in Public Housing: Assessing the Impact of the Rental Assistance Demonstration Program on Smoking in Buildings and Resident Satisfaction

Diana Hernández
Erin Harned
Maiko Yomogida
Dionna Attinson
Daniel P. Giovenco
Angela Aidala
Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, USA

Chunrong Jia
School of Public Health, The University of Memphis, Tennessee, USA

Paola Martinez
Catholic Charities of the Archdiocese of New York, New York, USA

Susan Camerata
The Wavecrest Management Team, Ltd, New York, USA

Joyce Moon Howard
School of Global Public Health, New York University, New York, USA

Approximately 28 million U.S. residents in multi-unit housing experience frequent secondhand smoke exposure despite having smoke-free home rules in their individual units. People living in low-income residential settings have among the highest rates of smoking and secondhand smoke exposure. Nationally, public housing has been at the forefront of the smoke-free housing policy movement. In 2018, all public housing sites became subject to a federal ban on indoor smoking so as to reduce smoking-related hazards in properties owned and operated by the U.S. Department of Housing and Urban Development (HUD). At the same time, public housing authorities nationwide have increasingly implemented the Rental Assistance Demonstration (RAD) program to address outstanding capital needs in public housing. The present study is unique in that it examines indoor smoking behaviors, exposure to secondhand smoke, and residential satisfaction in the context of HUD’s smoking ban and the RAD program. This study is the first known study to assess indoor smoking and secondhand exposure before and after the construction phases of the RAD conversion. The authors’ findings indicate a significant reduction in secondhand smoke exposure and improvements in individual smoking behaviors, which included reduced daily smoking, less indoor smoking, and some successful quit attempts between baseline and followup assessment periods. Furthermore, respondents were significantly more satisfied with their housing units and building conditions, except those who remained bothered by secondhand smoke. The latter result suggests that secondhand smoke exposure may detract from satisfaction with housing improvements and marks a critical opportunity for continued efforts at addressing quality of life concerns. The discussion focuses on strategies used to improve housing conditions and ways in which that may have impacted study results.