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Mass General West
Wednesday, June 16, 2010
Researchers examine risks and consequences of cigarette smoking to all inhabitants of multiple-unit housing; challenge status quo
"Research shows that those
living in multiple-unit housing are being exposed to toxins from tobacco smoke,"
says Jonathan Winickoff, MD, MPH, lead author and pediatrician at MassGeneral Hospital for Children (MGHfC). "Even if you are not a smoker and don't
smoke inside of your own apartment, if you have a neighbor who is smoking
inside of his, the entire building is contaminated."
Over 7 million people are served by
public housing in the U.S.,
with 4 in 10 units occupied by families with children. On July 17, 2009, the U.S. Department of
Housing and Urban Development (HUD) issued a memorandum that strongly
encouraged local Public Housing Authorities (PHAs) to implement no-smoking
policies in some or all of their public housing units. While surveys indicate that 4 in 5 nonsmokers
prefer smoke-free building policies and many private landlords throughout the
country have made their housing units smoke-free, only about 4 percent of PHAs
have banned smoking in the units they manage.
The article gives specific guidance
on policy options for PHAs and HUD to protect all residents from tobacco smoke
exposure and clarifies that there are no legal barriers to banning smoking in
public housing. "HUD has taken an important step," says coauthor
Michelle Mello, JD, PhD, of the Harvard School of Public Health, "but it
could do more to prod lagging PHAs to take action."
The National Toxicology Program has
identified more than 250 poisonous gases, chemicals and metals in tobacco
smoke, 11 of which are class A carcinogens. Numerous epidemiologic studies show
that exposure to tobacco smoke can cause lung cancer and cardiac disease in
nonsmokers, and the Surgeon General's report on involuntary smoking concluded
that there is no safe level of exposure. Studies have shown that even brief exposures
to tobacco smoke can adversely affect nonsmokers, especially children, who
experience increased rates and severity of asthma and other respiratory illnesses,
as well as higher risk of sudden infant death syndrome.
The report details how smoking in a
single unit within a multiunit residential building puts other residents of the
building at risk. Tobacco smoke can move
along air ducts, through cracks in the walls and floors, through elevator
shafts, and along plumbing and electrical lines to affect units on other
floors. Mitigation measures like fans
and air filters are not effective in preventing exposure. High levels of
tobacco toxins can persist in the indoor environment long after the period of
active smoking â€” a phenomenon known as third-hand smoke. Tobacco toxins from smoke are deposited on
indoor surfaces and reemitted in the air over a period of days to years, and
are found on rugs, furniture, clothing, and floors â€“ all surfaces that children
crawl and play on.
While it is clear that second- and
third-hand smoke are inimical to the health of nonsmokers in multiple housing
units, the authors note, there are challenges facing public housing authorities,
landlords and nonsmokers. Any addiction
is difficult to overcome and a ban would put pressure on tenants addicted to
nicotine, and could raise concern over how to deal with tenants who continued
to smoke inside their building.
"Any no-smoking policies
within PHAs would need to be accompanied by clear instructions on how residents
can access evidence-based smoking-cessation resources," says coauthor Mark
Gottlieb, JD, executive director of the Public Health Advocacy Institute at
School of Law. Currently most state Medicaid programs do not
cover comprehensive tobacco-dependence treatments, a situation that may change
with an increased emphasis on tobacco control in healthcare reform. However,
right now, free smoking cessation services are available in all 50 states
though their smoking quitlines.
"Rather than prohibiting smokers
from inhabiting public housing units, prohibiting the act of smoking on the
premises would minimize the ethical concerns relating to a smoking ban,"
says Mello. "This type of policy
would encourage smokers to quit, since only those who continued to smoke on the
premises would be required to move out."
Creating and maintaining smoke-free
living space that encourages smoking cessation not only provides a healthy
environment for children as they grow, it discourages them from picking up the
habit, Mello explains. "When
children see smoking in and around their homes, it normalizes the behavior for
them. Research shows that no-smoking
policies in the home lead to lower smoking initiation rates by teens." Americans living below the poverty level are
1.6 times more likely to smoke; adopting a smoke-free policy in public housing
units encourages inhabitants to "fight back" against the intense
tobacco marketing that exists in low-income neighborhoods.
"As we move forward and
further explore public housing policy, it is important to remember that the
status quo is not acceptable for America's children," says
Winickoff. "Each child deserves a
healthy start, and we can help provide this by encouraging smoke-free home
General Hospital Founded in 1811, Massachusetts
General Hospital is
the third oldest general hospital in the United
States and the oldest and largest in New
England. The 900-bed medical center offers sophisticated
diagnostic and therapeutic care in virtually every specialty and subspecialty
of medicine and surgery. Each year the MGH admits more than 47,500 inpatients
and handles nearly 1.4 million outpatient visits at its main campus and health
centers. Its Emergency Department records more than 88,000 visits annually. The
surgical staff performs approximately 38,000 and the MGH Vincent Obstetrics
Service delivers more than 3,500 babies each year. The MGH conducts the largest
hospital-based research program in the country, with an annual research budget
of more than $600 million. It is the oldest and largest teaching hospital of Harvard Medical School,
where nearly all MGH staff physicians serve on the faculty. The MGH is
consistently ranked among the nation's top hospitals by US News and World Report.
About Harvard School of Public HealthHarvard School of Public Health is
dedicated to advancing the public's health through learning, discovery, and
communication. More than 400 faculty members are engaged in teaching and
training the 1,000-plus student body in a broad spectrum of disciplines crucial
to the health and well being of individuals and populations around the world.
Programs and projects range from the molecular biology of AIDS vaccines to the
epidemiology of cancer; from risk analysis to violence prevention; from
maternal and children's health to quality of care measurement; from health care
management to international health and human rights.
About The Public Health
Advocacy InstituteThe Public Health Advocacy Institute is a legal research center at Northeastern University School of Law that
focuses on public health law. PHAI's goal is to support and enhance a commitment
to public health in individuals and institutes who shape public policy through
law. PHAI is committed to research in public health law, public health
policy development; to legal technical assistance; and to collaborative work at
the intersection of law and public health.
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