Health departments participating in housing industry organizations – 5/24/12

Q: A state tobacco control program is working with local contractors to start a smoke-free low-income housing initiative, and they hope to become members of housing industry organizations so that they can participate in meetings and build relationships with decision-makers. They are facing resistance from within the health department, and are being told that participating in these groups is not an appropriate activity for state programs.

Has your state health department participated in housing industry organizations to promote smoke-free housing policies? If you faced resistance from within your health department, describe how you were able to overcome that challenge. Also, please share any tips for getting buy-in and support for smoke-free low-income housing.

A:

1. Colorado: We have been successful in establishing partnerships with public housing authorities and associations by recognizing that there are many different levels to establish those partnerships and by:
    
   Continuing to educate them using e-mail or direct mail (establish good database contacts). Accepting the fact that these are very busy people that have a lot of demands and requirements to meet (audits, etc.) is important. This means finding other ways than meetings to partner with them: Asking for advice/peer-reviewing materials, endorsements, attending or presenting at conferences, obtaining a booth at a conference, becoming a paid member, conducting conference calls/webinars, e-mail communication, going to them rather than asking them to come to you, etc. You can see how we involved housing providers on p 1 and 2 of our landlord guide.
    
   After our Colorado Clean Indoor Air Act passed in 2006 there was a lot of focus on that and smoke-free housing was not a high priority for the state till about 2008 so a lot of the ground work was done by local health departments and GASP.
    
   GASP has various password protected tools for our local partners on housing. The password is available to state tobacco program staff from the TCN upon email request.
    
2. Michigan: Our agency was a “business member” to a regional housing association and we found the relationship to be beneficial.
    
   Our local public health agency, the state health department, and the Center for Social Gerontology were all part of this partnership and we cooperated in attending meetings. We found that by discussing the smoke-free housing goals, offering free services to apartments, and getting to know housing representatives, we were able to have informal conversations and provide targeted support that helped to create more interest and action on smoke-free housing.
    
   If we were not at these meetings, the myths and fears around smoke-free housing would still stand in the minds of apartment management companies and owners. Our relationship, support and help within the rental housing community was a benefit and now apartments have gone smoke-free and these are now the natural “thought-leaders” on this topic in our region. We are no longer at the table, but the apartment community is comfortable enough to call their natural mentors or local public health if they have questions or need our support.
    
   Two side issues were also addressed during our membership were bed bugs and the Michigan Medical Marijuana Law. During our membership, our agency was able to quickly navigate the public/private and governmental landscapes on the issue of bed bugs, and clarify the responsibility of apartment owners and managers as this became a growing concern for the apartment industry. We were also able to advise apartment owners on the rules and rights related to medical marijuana. During our membership the Michigan Attorney General advised that apartment owners could ban the growing and smoking of medical marijuana in the buildings that they owned. After the position paper was written by the Michigan Attorney General, there was no promotion of this fact to the apartment industry. Therefore, local public health was able to advocate for more healthy space and support the housing industry in accessing smoke-free policies and expert documents on the issue of both bed bugs and medical marijuana in Michigan.
    
3. Montana: The programmatic decisions made here in the Chronic Disease Bureau must be evidence-based. This program exists because the evidence base is more than sufficient to say that secondhand smoke is toxic, and policies which reduce exposure to secondhand smoke reduce hospitalizations due to heart attacks and other health problems, in addition to promoting tobacco cessation. We have a statewide clean indoor air law, and it seemed rational to extend this to multi-unit housing, especially publicly funded multi-unit housing, to the extent that we could. In addition, grant monies have been made available for this activity, and it seems to be a national trend from CDC and Association for Nonsmokers Rights, and we didn’t want our program to be left behind.
    
   If there is a healthy homes program in that state, smoke free housing can fit very neatly in with those activities. For the same reasons that people should be informed, and ideally prevented, from living in homes with lead paint and loose asbestos, they should be informed about the dangers of exposing themselves, their children or elderly parents to secondhand smoke in multi-unit housing. Sometimes framing the issue the same way as other public health issues helps people to see the value and importance of it.
    
4. North Carolina: The North Carolina Tobacco Prevention and Control Branch has been working with a number of housing industry organizations, including the NC Housing Coalition, the Southeastern Affordable Housing Management Association (SAHMA), the NC Housing Finance Agency, and the Apartment Association of NC. We have had productive phone conversations or in-person meetings with representatives of all of these groups and they have expressed willingness to send out communications by email on our behalf, send our surveys on our behalf, and otherwise facilitate our relationship with their members. We presented on smoke-free multi-unit housing at the NC Affordable Housing Conference in November 2011 and the NC SAHMA conference in May 2012, and we had a booth at the 2011 NC SAHMA conference and will have one at the Apartment Association of NC’s 2012 Legislative Days event.
    
5. Oregon: In our experience, becoming a member and working closely with the trade associations serving the market rate, public housing (NAHRO), affordable housing (AHMA), and condo associations (CAI) has been absolutely key to our success. These folks are the opinion leaders in their communities of professionals and it is to them that members turn to make their business decisions. We were told in our landlord focus groups that Lung Association, public health departments are "paid to say that," and thus not really trusted sources (see report here).
    
   We pulled our partners in from the very outset, had them help us determine baseline questions; we exhibited at their trade shows (can be spendy but where else do you reach the exact target audience?); worked with them to do trainings in THEIR venues; we gave them a small grant to reprint their lease forms to include smoking policy info, develop a special addendum and to post info to their websites and develop their own materials. When we had the smoking policy disclosure law on our Governor's legislative agenda, because of the trusted relationship we had built over three years, they actually put their paid lobbyist on our bill and it sailed through and went into effect Jan 2010. Then they helped us communicate about it through every means they had. These folks all know each other -- when you get in the door with one group, it opens doors for others. Because of our great relationship with Metro Multifamily Housing Association, they opened the door for us at CAI and we have been working within their organization to promote no-smoking in condos (next chapter after the rentals).
    
6. South Dakota: Since most chronic disease programs share low income folks as a priority population, housing industry organizations are actually an obvious and necessary group to work with. Any local community efforts focused on health improvement should always include such organizations because of the populations they serve and thus impact. The benefits of working with them and policy/ system/ environmental changes resulting from those relationships can include the following and many more:
    
   • Smoke-free housing with comprehensive SF policy to include not only all buildings but all grounds as well. We know that tobacco use and second hand smoke exposure impacts Heart disease and stroke, cancer, diabetes complications, and COPD.
      
   • Housing built to maximize opportunities for increasing the physical activity of residents: walking paths fitness trails, fitness centers, etc. We know that increased physical activity, results in: lower blood pressure, lower heart rates, lower stress levels, lower cholesterol, better control of blood sugars, lowered risk of many cancers, etc.
      
   • Buildings with garden space for residents, thereby increasing access to fresh vegetables, increased physical activity and reduced stress.
      
7. Utah: The Smoke-free Multiple Unit Housing Coordinator for the State of Utah has been a member of the Utah Apartment Association for at least the past five years.  Being a member of this organization is very beneficial as we are able to participate every year in the annual Utah Fair Housing Conference and Education Trade Show, and use the membership directory and newsletters to promote smoke-free housing here in Utah. There are many property management companies (public and Section 8 housing) and housing authorities that are members of this of this organization, and the continued presence has helped with many to implement a smoke-free policy.
    
8. West Virginia: West Virginia is working with local, regional, State, and Federal housing authorities regarding the need for smoke-free, tobacco free policies, especially to help ensure any new construction or awards for low income housing has a smoke-free policy for entire building.
    
   Even though all 55 county clean indoor air regulations provide for smoke free air in all the commons areas of multi-unit housing, through our Smoke-Free Initiative of West Virginia, we are working directly with local housing authorities to educate them on adopting voluntary smoke-free polices. Visit the Smoke-Free Initiative of West Virginia’s Smoke-Free Housing website to learn more.
    
   At the same time, we are still moving our local health departments along by educating them on how to deal with drifting SHS complaints from inside housing units and how to resolve them. For now, we have determined that the most suitable regulatory agency to adopt these policies is city councils and county commissions who typically have authority over multi-unit housing.
    
   We are able to support smoke-free housing in many ways here. Our key person who does this is our Smoke-Free Initiative of West Virginia Coordinator, who has built relationships with various housing authorities. We also have had our Regional Coordinators (ten of them across the state) and our local coalitions engage local housing directors and others in some areas.
    
9. Washington: We contract with appropriate organizations to make most of these connections. The Department of Health is not a member of any housing organization, but we have offered assistance to several of them in the private and public sector, mostly through our contracted entities.

Back to Table of Contents