Increases in Secondhand Smoke After Going Smoke-Free: An Assessment of the Impact of a Mandated Smoke-Free Housing Policy.

Objective: The 12-month impact of federally mandated smoke-free housing (SFH) policy adoption (July 2018) was assessed using two markers of ambient secondhand smoke (SHS): airborne nicotine and particulate matter at the 2.5-micrometer threshold (PM2.5).

Methods: We measured markers of SHS in Norfolk, VA from December 2017 to December 2018 in six federally subsidized multi-unit public housing buildings. Multi-level regression was used to model the following comparisons: (1) the month immediately before SFH implementation versus the month immediately after, and (2) December 2017 versus December 2018.

Results: There was a 27% reduction in indoor PM2.5 and a 32% reduction in airborne nicotine in the first month after SFH adoption, compared to the month prior to adoption. However, there was a 33% increase in PM2.5 and a 25% increase in airborne nicotine after 12 months.

Conclusions: US Department of Housing and Urban Development (HUD)-mandated SFH can reduce SHS in multi-unit housing. However, SFH could also plausibly increase indoor smoking. Policy approaches adopted by individual properties or housing authorities-for example, property-wide bans versus allowing designated smoking areas-could be driving this potential unintended consequence.

Implications: Successful implementation of SFH by public housing authorities in response to the HUD rule requires ongoing attention to implementation strategies. In this sense, SFH likely differs from other policies that might be seen as less intrusive. Long-term success of SFH will depend on careful policy implementation, including plans to educate and support housing authority staff, inform and engage residents, and build effective partnerships with community agencies.