Cost Savings Associated with Prohibiting Smoking in U.S. Subsidized Housing

https://doi.org/10.1016/j.amepre.2013.01.024Get rights and content

Background

Tobacco smoking in multiunit housing can lead to secondhand-smoke (SHS) exposure among nonsmokers, increased maintenance costs for units where smoking is permitted, and fire risks. During 2009–2010, approximately 7.1 million individuals lived in subsidized housing in the U.S., a large proportion of which were children, elderly, or disabled.

Purpose

This study calculated the annual economic costs to society that could be averted by prohibiting smoking in all U.S. subsidized housing.

Methods

Estimated annual cost savings associated with SHS-related health care, renovation of units that permit smoking, and smoking-attributable fires in U.S. subsidized housing were calculated using residency estimates from the U.S. Department of Housing and Urban Development and previously reported national and state cost estimates for these indicators. When state estimates were used, a price deflator was applied to account for differential costs of living or pricing across states. Estimates were calculated overall and by cost type for all U.S. subsidized housing, as well as for public housing only. Data were obtained and analyzed between January and March 2011.

Results

Prohibiting smoking in all U.S. subsidized housing would yield cost savings of approximately $521 million per year, including $341 million in SHS-related healthcare expenditures, $108 million in renovation expenses, and $72 million in smoking-attributable fire losses. Prohibiting smoking in U.S. public housing alone would yield cost savings of approximately $154 million per year.

Conclusions

Efforts to prohibit smoking in all U.S. subsidized housing would protect health and generate substantial cost savings to society.

Introduction

Exposure to secondhand smoke (SHS) from burning tobacco products causes disease and premature death among nonsmokers.1 With the increasing number of U.S. states prohibiting tobacco smoking in indoor public places, private settings are becoming relatively larger contributors to total SHS burden.1, 2 This may be particularly true for residents of multiunit housing, where SHS can infiltrate smokefree living units from units that permit smoking and shared areas.3, 4, 5, 6 In addition to SHS-related healthcare costs, smoking in multiunit housing can lead to excess expenses from property renovation and smoking-attributable fires.7, 8

Approximately 7.1 million Americans lived in subsidized housing during 2009–2010.9 Among these individuals, 2.1 million lived in public housing, which is housing either owned or operated by a Housing Authority.9 In 2009, approximately 32.7% of adult subsidized-housing residents were current cigarette smokers,10 compared with 20.6% of U.S. adults.11 This high smoking prevalence is a concern, considering that a large proportion of subsidized housing is occupied by individuals who are particularly sensitive to SHS, including children, the elderly, and the disabled.1, 9 The current study calculated the costs associated with SHS-related health care, renovation of units where smoking is permitted, and smoking-attributable fires that could be averted by prohibiting smoking in U.S. subsidized housing.

Section snippets

Healthcare Costs Related to Secondhand Smoke

Expenditures for health care related to secondhand smoke were calculated using previously published cost estimates among all nonsmoking Minnesota residents that were derived using claims data from the state’s largest health insurer.12 Because Minnesota’s smoking prevalence (16.8%) is approximately half that of subsidized housing residents (32.7%),10, 11 the annual per capita savings reported for Minnesota ($44.00) was adjusted to $85.00 (32.7/16.8 multiplied by $44). To account for differences

Results

The estimated cost savings from prohibiting smoking in all U.S. subsidized housing would be $521 million (range: $270–$892) per year, including $341 million (range: $169–$611) in SHS-related health care; $108 million (range: $61–$169) in renovation expenses; and $72 million (range: $41–$113) in smoking-attributable fire losses (Table 1). The estimated cost savings from prohibiting smoking in U.S. public housing alone would be $154 million (range: $80–$265) per year, including $101 million

Discussion

Smokefree policies are favored by a majority of tenants and legally permissible in subsidized and market-rate housing.19, 20, 21, 22 The U.S. Department of Housing and Urban Development has encouraged Public Housing Authorities, and owners and managers of multifamily housing rental assistance programs such as Section 8, to implement smokefree policies in their properties.23, 24 As of January 2012, more than 250 Public Housing Authorities across the U.S. have instituted such policies, including

Acknowledgements

There were no sources of funding, direct or indirect, for the reported research. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the CDC.

No financial disclosures were reported by the authors of this paper.

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