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TIPS AND TECHNIQUES TO SUPPORT RESIDENTS ADAPTING TO THE
SMOKING BAN IN PUBLIC HOUSING
Wednesday, February 28, 2018
2-3 pm (Central)
Disclaimer
This activity is made possible by the Health Resources and Services Administration, Bureau of
Primary Health Care. Its contents are solely the responsibility of the presenters and do not
necessarily represent the official views of HRSA.
Presenters
Thomas CarrDirector, National Policy
American Lung Association
Kristine GonnellaDirector, Training and Technical
AssistanceNational Nurse-Led Care Consortium
Philadelphia, PA
Elizabeth ByrneDirector, Clinical Implementation
Treatment Research InstitutePhiladelphia, PA
Robin SenssDirector of Supportive Services,
Housing Authority of Chester County
Learning Objectives
1. Discuss HUD smoking ban in public housing and the response of a public housing authority.
2. Demonstrate impact of smoking ban on residents of public housing.
3. Illustrate evidence based practices for engaging residents of public housing in smoking cessation programming.
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SMOKE FREE PUBLIC HOUSING: POLICY AND PROSPECTIVE
Thomas CarrDirector, National Policy
American Lung Association
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• 2006 Surgeon General’s report on secondhand smokeapplies to all indoor environments – i.e. there is no safe level of exposure
• SHS-exposed children twice as likely to miss 6 or more school days per year
• Even low levels of SHS exposure associated with decreased reading and math scores
• Smoking materials are one of the largest causes of injuries, deaths and direct property damage from fires
• Secondhand smoke can travel through an entire complex including ventilation systems, electrical outlets, cracks in foundation walls, pipes, plumbing and doorways.
Secondhand Smoke A Significant Problem for Low Income Housing
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Smokefree HUD Rule History
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HUD Smokefree Public Housing Rule - Timeline
HUD Rule Timeline• November 2015 – HUD Issues Proposed Rule
• January 2016 - HUD Holds Stakeholder Convening and Comment Period on Proposed Rule Closes
• December 5, 2016 – HUD Issues Final Rule; only change from proposed rule was the addition of hookah smoking
• February 3, 2017 – Rule Officially Takes Effect; 18-Month Implementation Period for PHAs Starts
• July 31, 2018 – 18-Month Implementation Period Ends and New Smokefree Policy is Supposed to be in Place
FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 99
HUD Smokefree Multi-Unit Housing Rule – Key Provisions
Key Provisions• Applies to all Section 9 public housing, other than dwelling units in mixed-finance buildings
• Prohibits smoking in the interior of buildings, including individual units, plus a 25 foot zone outside buildings
• All lit tobacco products includedo E-cigarettes were not included, but can be added by individual PHAs
• PHAs would also be required to:o Document their smoke-free policies in their PHA plans, a process that requires resident
engagement and public meetings o Smokefree policy would be included in a tenant's lease
FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 1010
HUD Smokefree Multi-Unit Housing Rule
Why Include E-Cigarettes in SmokefreePolicies?
1. Makes enforcement easier and less subject to confusion and discretion
2. U.S. Surgeon General: Secondhand e-cigarette emissions are not safe.
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HUD Rule Implementation
Lots on the Plates of Housing Authorities• Help needed
Don’t Reinvent the Wheel• Resources Exist • Lung.org/Smokefreehousing
Working in Coalition Will Help• Organizations that serve disparate populations in the
community• Community Health Centers/Medical Organizations• Firefighters groups/organizations• Asthma coalitions/groups
Involve and Empower Residents• Will be more effective and successful
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American Lung Association – HUD Rule Implementation/Cessation Projects
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Please Keep in Mind
Reduced exposure to secondhand smoke is the main goal of the HUD Rule
Smoking cessation an important butsecondary objective
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Major Points to Remember about the HUD Rule
Smokefree policies are about smoking, not smokers.• Residents may be afraid they’ll be forced to quit or move out• Property managers may be afraid they’ll have to evict residents who smoke
Many tobacco users may decide to make a quit attempt when a property goes smokefree.• Smoking cessation services and medications if possible should be available to residents.• Smokers on Medicaid, Medicare and other types of insurance often have access to no or low-cost
medications• State phone counseling services for smokers (1-800-QUIT-NOW) sometimes provide no cost
medications to uninsured persons
Not every tobacco user will decide to make a quit attempt when a property goes smokefree.• Some may be angry about the new policy and some just aren’t ready to make a quit attempt• Everyone needs to comply with the smokefree policy, even if they don’t stop using tobacco• Reasonable accommodations for some residents such as moving people nearer entrances or
elevators can be considered
FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 1515
Major Points to Remember about the HUD Rule
Start Early• Providing ample time between announcement and implementation of the new policy gives
residents time to understand the policy and adjust to it
It’s impossible to communicate too much about the new policy.• Announce the forthcoming policy change as early as and in as many ways as possible• Hold resident meetings to discuss the new policy• Get residents involved in planning the launch of the policy, where signage is located, how the
policy is enforced, etc
Starting a smokefree multi-unit housing policy doesn’t have to be expensive or lonely.• Many willing partners are available in the public health community, including state and local
health departments, tobacco control coalitions, voluntary health organizations and more• Community partners may be able to help provide signage, cessation resources and even
people to speak at resident meetings and staff events
FOR INTERNAL USE ONLY DO NOT DISTRIBUTE. Confidential and proprietary property of the American Lung Association, all rights reserved. 1616
Community Health Centers Will Be on the Front Lines
Community Health Centers Provide Extensive Primary Care Services to Public Housing Residents• Close to 300 health centers operate clinical delivery sites in or immediately accessible to
public housing, according to the National Association of Community Health Centers
Health Centers can be important partners in implementation of HUD’s smokefree housing rule• Because many health centers directly serve public housing residents, they can assist with
providing smoking cessation services and access to medications in particular• The Lung Association has worked closely with the National Center for Health in Public
Housing, which provides TA to a subset of the 300 health centers above & ALA also hopes to work with individual health centers on state-level implementation/cessation projects
Health Centers should be prepared for higher demand for smoking cessation assistance when HUD’s final rule takes effect• While smoking cessation assistance should be offered prior to implementation, when the
policy changes is when demand is most likely to surge
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• HUD Website Page with Implementation Resources: https://www.hud.gov/program_offices/public_indian_housing/programs/ph/phecc/smokefree
• Lung Association Resources: www.lung.org/smokefreehousing• Free Smokefree Multi-Unit Housing Online Course – Helpful training for people new to the
issue
• Smokefree Multi-Unit Housing Issue Brief – versions in both English and Spanish
• National Center for Health in Public Housing Resource Page: https://nchph.org/smoke-free-public-housing-everything-need-know/
HUD Rule Implementation - Resources
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• Voluntary, interactive and supportive
• Addiction-based model with behavior change focus
• Supports use of cessation medications
• Multiple options available:
• Freedom From Smoking in-person group clinic *
• Freedom From Smoking Plus
• Lung HelpLine *
• Freedom From Smoking self-help guide *
* Available in Spanish
FreedomFromSmoking.org
Freedom From Smoking®
1919
Finding American Lung Association Resources/Reaching Us
To find our smoking cessation resources:
• Lung.org/ffs
• FreedomFromSmoking.org
To find our smokefree multi-unit housing resources:
• Lung.org/smokefreehousing
To reach your local American Lung Association office:
• Lung.org
• 1-800-LUNG-USA
National Nurse-Led Care Consortium
Mission: Advance nurse-led health care through policy, consultation, and programs to reduce health disparities and meet people’s primary care and wellness needs.
Supported via a National Cooperative Agreement with HRSA to provide training and technical assistance to health centers in order to strengthen healthcare for residents of public housing.
Health Centers and Public Housing
Health centers across the country provide primary care services to thousands of public housing residents, offering an extensive access point for smoking prevention education and cessation treatment for patients from these communities.
Partnerships to Support Implementation
Housing Authority
Operate health centers serving neighborhoods with dense public housing and facing disparities in access and outcomes.
Provide comprehensive health care and health promotion on-site and through housing authority events.
Provide enrollment assistance
Provides space for smoking cessation programming.
Provides outreach to bring in new patients through public events, distribution of materials
Tenant council representatives serve on HC Board
FQHC
STEPS FOR IMPLEMENTING A TOBACCO/SMOKE FREE POLICY
• Meet with key management personnel• Survey residents • Establish a timeframe for change• Make policy choices – gain Board approval• Educate residents of the benefits of a smoke-free environment • Provide Quitline information and cessation services to residents who would
like to quit• Adopt new policies for leases and house rules • Promote and enforce tobacco/smoke free policies
BENEFITS OF TOBACCO/SMOKE FREE POLICY
• Protection from secondhand and “thirdhand” smoke
Protect employees
Protect tenants
Especially elderly and vulnerable youth
Protect visitors, family, friends and contractors
• Market Advantage – housing that smells of tobacco smoke are harder to sell and rent
• Reduced Costs
• Reduced Fire Risks
• Positive Modeling
• Legal Liability
Additional Thoughts Before & After Implementation
• Third Party Management
• Reduction in turnover costs
• Smoke free community vs. smoking area
• Grandfathering current residents
• Reasonable Accommodations
• Managing the change and positive results
©Treatment Research Institute, 2012
3/19/2018
Smoking CessationHow your entire team can effectively serve
residents of public housing
Elizabeth Byrne, MA, LPC, Clinical Implementation Manager
©Treatment Research Institute, 2013
©Treatment Research Institute, 2012
3/19/2018
Who provides the help?
Patient Centered Medical Homes are the ideal partners to support smoke-free living in public housing.
Cessation Support can (and should) come from everyone on the clinic team:
Primary Care & Behavioral Health Clinicians
Nurses & Social Workers
Medical Assistants & Front Desk staff
The unified message should be:
“When you’re ready, we can help.”
“Cutting back is an EXCELLENT start.”
©Treatment Research Institute, 2012
3/19/2018
What are patients seeing?
Display CDC TIPS and Quitlineposters in the waiting room and treatment rooms
Include questions about smoking behaviors on any check-in paperwork
©Treatment Research Institute, 2012
3/19/2018
What are practitioners saying?
How are the questions about smoking being asked?
What types of side conversations can patients overhear?
Ensure ALL medical staff are using encouraging words and are able to offer specific suggestions on how patients can cut down or quit.
©Treatment Research Institute, 2012
3/19/2018
Are you enforcing the no-smoking
ordinances in your city around
entrances?
Do your patients have to walk through smoke to enter your building?
Can patients smell smoke on your employees?
©Treatment Research Institute, 2012
3/19/2018
Are there hands-on activities
for patients to get involved in?
Do you have a peer-support model in place where patients can strive to become leaders in their community?
©Treatment Research Institute, 2012
3/19/2018
Are you offering additional support
and programming for weight
management?
Do you have a registered dietician on staff to work with patients who are trying to quit?
Provide handouts to encourage healthy eating choices.
©Treatment Research Institute, 2012
3/19/2018
Collaboration
Collaboration is excellent for community building.
Look for opportunities to expand partnerships.
Work with gate keepers to help you navigate incredibly large systems.
Think outside the box!
Keep moving when you’ve been blocked.
Be clear and transparent about your agenda.
Don’t give up!
©Treatment Research Institute, 2012
3/19/2018
Health Centers & PHA Working Together
Strengths:
Direct access to all residents
Possibility for location of programming in house, no travel needed
Challenges:
Multiple layers of bureaucracy
Lack of privacy for patients
Competing agendas
©Treatment Research Institute, 2012
3/19/2018
How Do We Do This Sustainably?
Work it into the primary care visit (3-5min)
Utilize your Behavioral Health Consultant (10-20min)
Train interns to run small cessation groups (45-90 min)
Possible groups: Public Health, Nursing, Social Work, Counseling, Psychology, Adult Education
There are plenty of open access curriculums available to use for free
The CDC TIPS campaign has multiple free resources
Reach out to your local health department for potential community partnerships
©Treatment Research Institute, 2012
3/19/2018
Do What You Can!
Every bit of psychoeducation and reinforcement you can provide patients is helpful and makes a difference.
This includes harm reduction, stages of change, NRT options, patient literature
Start with something simple and make it happen this month—don’t wait for the perfect solution.
Posters
Ask staff if anyone is interested in getting involved
Distribute questionnaire for patient interest in a class
CDC Tips From Former Smokers Campaign
©Treatment Research Institute, 2012
3/19/2018
CDC Tips From Former Smokers
Free materials to download like: low-res TV, print, radio, online, and out of home ads
Continuous loop videos
PSAs in Spanish and English about quitting smoking and secondhand smoke
Print ads with stories from real people your patients can relate to
www.cdc.gov/tobacco/campaign/tips/
©Treatment Research Institute, 2012
3/19/2018
Questions?Thank you!
Elizabeth Byrne
Clinical Implementation Manager
ebyrne@tresearch.org
215-399-0980 ext 107
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