Secondhand Smoke and Smokefree Policies in Owner-Occupied Multi-Unit Housing

doi:10.1016/j.amepre.2012.07.039

American Journal of Preventive Medicine

Volume 43, Issue 5, Supplement 3, November 2012, Pages S187-S196

https://doi.org/10.1016/j.amepre.2012.07.039 Get rights and content

Background

Studies have documented movement of secondhand smoke (SHS) between units in multi-unit buildings, but none has focused on owner-occupied units in common-interest communities (CICs). In Minnesota, approximately 170,000 households (8%) live in such units. CIC households may experience long-term SHS exposure because owner-occupants typically live in the same unit for many years.

Purpose

This study estimated the prevalence of SHS incursion in CICs and assessed residents' attitudes toward SHS incursions and interest in smokefree policies.

Methods

A stratified sample of Minnesota CIC owner-occupants was surveyed in 2009, with analysis in 2010–2011. Data were weighted to account for differing sampling, response, and coverage rates by stratum, then calibrated to population control totals for housing type, age, and smoking status.

Results

The response rate was 35.6%, with 495 completions. Twenty-eight percent of households reported SHS incursion into their unit in the preceding 6 months; 59% of these said this bothers them a lot. Only 6% report that their CIC has a smokefree policy for residents' units. Forty-two percent would prefer such a policy whereas 26% would prefer smoking-permitted. Sixty-three percent definitely and 17% probably would choose a no-smoking building over a smoking-permitted building if they were buying a new unit, and 46% would be willing to pay more for such a unit.

Conclusions

Secondhand smoke incursion is common in CICs, and interest in smokefree CICs greatly exceeds the supply. Given the known health risks of SHS exposure, tobacco control efforts in multi-housing should address CICs as well as rental households.

Introduction

Exposure to secondhand smoke (SHS) causes numerous adverse health effects,1, 2, 3 with any exposure posing some risk.⁴ Exposure in the home is of particular concern because Americans spend 69% of their time in residences.⁵ People who live in multi-unit buildings may experience incursions of SHS from other units and therefore be exposed even if they do not allow smoking in their own unit: research has documented both bulk air transfer6, 7, 8, 9, 10, 11, 12 and transfer of SHS constituents6, 13, 14, 15 between units.

In surveys of renters or of all residents of multi-housing, 36% to 53% have reported SHS incursion.16, 17, 18, 19, 20, 21 Half to three quarters have expressed a preference for smokefree policies, although only a small minority live in buildings having such policies.

Almost half of the U.S. population is protected by smoking bans in workplaces and restaurants and bars,²² but only a few U.S. communities ban smoking in multi-housing.²³ Efforts to promote voluntary smokefree policies in rental housing have increased over the past 15 years, with 37 U.S. states and five countries now represented on the Smokefree Housing-Talk listserv (J. Bergman, Smokefree Environments Law Project, personal communication, July 19, 2012) and governmental agencies recently encouraging smokefree policies.24, 25, 26, 27, 28 But little work has focused on common-interest communities (CICs).

Common-interest communities include condominiums, cooperatives, and planned communities. Over 5 million U.S. households live in CICs.²⁹ CIC household income is lower than single-family homeowners', but higher than renters'.²⁹ CIC households are more likely than single-family homeowners but less likely than renters to be minorities.²⁹ Approximately 170,000 Minnesota households (8%) are owner-occupants of CICs in multi-housing. These households face different considerations than renters in dealing with SHS incursion. They live in their units—and may be exposed—substantially longer on average. Moving to avoid exposure often entails selling the unit. Implementing smokefree policies requires approval by the homeowners' association or its board.²³

In 2008, there were no available surveys focusing on SHS in CICs in the scientific literature. This research sought to fill that gap. Key objectives were to quantify the frequency and severity of SHS incursions, estimate the percentage of units covered by smokefree policies, and assess interest in and barriers to adoption of smokefree policies. Such information can help to gauge the need for policy initiatives and identify barriers they may face.

Section snippets

Population and Samples

Common-interest community owner-occupants present challenges for survey research both in characterizing the population and in identifying suitable sampling frames. The best available population data come from the U.S. Census Bureau's American Community Survey. The 2008 Integrated Public Use Microdata Series,³⁰ a 1% sample of this survey, was used to estimate the number of owner-occupied CIC households in multi-housing and their distribution by housing subtype and householder age. These data

Results

A total of 495 surveys were completed (319 mail, 176 phone). The response rate⁴⁵ was 35.6% (MFDU 61.5%, SFDU 28.2%). Demographic and housing characteristics are summarized in Table 1.

Discussion

To our knowledge, this is the first survey focusing in depth on SHS incursion and smokefree policy issues in CICs. The prevalence of SHS incursions in owner-occupied CIC households in Minnesota is lower than rates reported in the literature for renters and for all residents of multi-housing. It is higher than the rate for the condominium subset of a survey of Canadians in multi-housing, 15% of whom have ever experienced SHS incursions into their current residence.²⁰ The fraction of those

References (45)

S.L. Lohr
Multiple frame surveys
D.A. Dillman et al.
Response rate and measurement differences in mixed-mode surveys using mail, telephone, interactive voice response (IVR) and the Internet
Soc Sci Res
(2009)
Proposed identification of environmental tobacco smoke as a toxic air contaminant, Part b: health effects
(2005)
Proposed identification of environmental tobacco smoke as a toxic air contaminant, Part a: exposure assessment
(2005)
Health effects of exposure to environmental tobacco smoke: the report of the California Environmental Protection AgencySmoking and Tobacco Control Monograph No. 10
(1999)
The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General
(2006)
N.E. Klepeis et al.
The National Human Activity Pattern Survey (NHAPS): a resource for assessing exposure to environmental pollutants
J Expo Anal Environ Epidemiol
(2001)
D.L. Bohac et al.
Secondhand smoke transfer and reductions by air sealing and ventilation in multiunit buildings: PFT and nicotine verification
Indoor Air
(2011)
P. Francisco et al.
Infiltration and ventilation measurements on three electrically-heated multifamily buildings
D.T. Harrje et al.
Extended testing of a multifamily building using constant concentration and PFT methods

H.E. Feustel et al.

Diagnostics and measurements of infiltration and ventilation systems in high-rise apartment buildings

M.P. Modera et al.

Improving diagnostics and energy analysis for multifamily buildings: a case study

(1986)

R.C. Diamond et al.

Ventilation and occupant behavior in two apartment buildings

P. Levin

Air leakage between apartments

T.A. Kraev et al.

Indoor concentrations of nicotine in low-income, multi-unit housing: associations with smoking behaviours and housing characteristics

Tob Control

(2009)

Ghaemghami J, Dumyahn T, Shea J, Bethune L. 2006. Tobacco smoke intrusion investigation in Boston: Three case studies....

B.A. King et al.

Secondhand smoke transfer in multiunit housing

Nicotine Tob Res

(2010)

M.J. Hewett et al.

Secondhand smoke in apartment buildings: renter and owner or manager perspectives

Nicotine Tob Res

(2007)

D. Hennrikus et al.

Preferences and practices among renters regarding smoking restrictions in apartment buildings

Tob Control

(2003)

B.A. King et al.

Multiunit housing residents' experiences and attitudes toward smoke-free policies

Nicotine Tob Res

(2010)

Ipsos-Reid. Ontario apartments and second hand smoke. Research conducted for the Ontario Tobacco-Free Network. Public...

Second hand smoke in multiple unit residential buildings

(2007)

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Impact of indoor-air policiesSecondhand Smoke and Smokefree Policies in Owner-Occupied Multi-Unit Housing

Background

Purpose

Methods

Results

Conclusions

Introduction

Section snippets

Population and Samples

Results

Discussion

Soc Sci Res

Proposed identification of environmental tobacco smoke as a toxic air contaminant, Part b: health effects

Proposed identification of environmental tobacco smoke as a toxic air contaminant, Part a: exposure assessment

Health effects of exposure to environmental tobacco smoke: the report of the California Environmental Protection AgencySmoking and Tobacco Control Monograph No. 10

The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General

The National Human Activity Pattern Survey (NHAPS): a resource for assessing exposure to environmental pollutants

J Expo Anal Environ Epidemiol

Secondhand smoke transfer and reductions by air sealing and ventilation in multiunit buildings: PFT and nicotine verification

Indoor Air

Infiltration and ventilation measurements on three electrically-heated multifamily buildings

Extended testing of a multifamily building using constant concentration and PFT methods

Diagnostics and measurements of infiltration and ventilation systems in high-rise apartment buildings

Improving diagnostics and energy analysis for multifamily buildings: a case study

Ventilation and occupant behavior in two apartment buildings

Air leakage between apartments

Indoor concentrations of nicotine in low-income, multi-unit housing: associations with smoking behaviours and housing characteristics

Tob Control

Secondhand smoke transfer in multiunit housing

Nicotine Tob Res

Secondhand smoke in apartment buildings: renter and owner or manager perspectives

Nicotine Tob Res

Preferences and practices among renters regarding smoking restrictions in apartment buildings

Tob Control

Multiunit housing residents' experiences and attitudes toward smoke-free policies

Nicotine Tob Res

Second hand smoke in multiple unit residential buildings

Impact of indoor-air policies
Secondhand Smoke and Smokefree Policies in Owner-Occupied Multi-Unit Housing