Smoke-Free Policies in Multiunit Housing: Smoking Behavior and Reactions to Messaging Strategies in Support or in Opposition
Smoke-Free Policies in Multiunit Housing: Smoking Behavior and Reactions to Messaging Strategies in Support or in Opposition
ORIGINAL RESEARCH — Volume 12 — June 25, 2015
Carla J. Berg, PhD; Regine Haardörfer, PhD; Michael Windle, PhD; Madeleine Solomon, MPH; Michelle C. Kegler, DrPH
Suggested citation for this article: Berg CJ, Haardörfer R, Windle M, Solomon M, Kegler MC. Smoke-Free Policies in Multiunit Housing: Smoking Behavior and Reactions to Messaging Strategies in Support or in Opposition. Prev Chronic Dis 2015;12:140479. DOI: http://dx.doi.org/10.5888/pcd12.140479.
Given the high proportion of US adults living in multiunit housing (MUH) and the related risks of secondhand smoke, we examined correlates of having smoke-free MUH policies, level of support for such policies, and reactions to related messaging among a quota-based nonprobability sample of US adults.
In 2013, 752 adult MUH residents were recruited through an online survey panel to complete a cross-sectional survey assessing tobacco use, personal smoke-free policies in homes and cars, smoke-free MUH policies, and reactions to messaging on smoke-free MUH policies. We sought sufficient representation of smokers, racial/ethnic minorities, and residents of the Southeast.
Overall, 56.3% had no smoke-free MUH policies and 16.2% had complete policies; 62.8% favored living in smoke-free MUH, and 28.9% said they would move if their building became smoke-free. Multivariate regression indicated that correlates of living in MUH with partial or no policies included younger age, less education, lower income, and current smoking (P’s ≤ .01); more restrictive smoke-free MUH policies were associated with lower cigarette consumption and recent quit attempts among current smokers (P’s < .05); and correlates of support for MUH policies included greater education, nonsmoker status, and having complete MUH policies (P’s < .05). Of 9 messages opposing smoke-free MUH policies, the most persuasive was “People have the right to smoke in their own homes”; the most persuasive message of 11 in support was “You have the right to breathe clean air in your home.”
Smoke-free MUH policies may reduce smoking. Messaging in favor of smoke-free MUH policies was more persuasive than messaging opposing such policies, indicating the potential for using these approaches.
The home is a significant source of secondhand smoke exposure (SHSe) (1,2). Despite support for smoke-free public policies (3,4), research documenting support for policies in personal living areas is limited (5). Because smoke can penetrate building cracks and move through doorways and stairwells easily (6–8), people in multiunit housing (MUH) complexes are vulnerable to SHSe from neighboring units and common areas (9). One-third of American housing units are rented; 65% are in MUH complexes (10). Thus, MUH complexes are important settings for addressing the risks of SHSe. One study detected nicotine in 89% of nonsmoking homes among 49 low-income multiunit residences (9); another estimated that SHS infiltrated the homes of 27.6 to 28.9 million MUH residents with smoke-free home rules in the previous year (11). Those in affordable MUH are at higher risk of SHSe than those in other types of MUH and the general population (9). Women and people living below the poverty line are more likely to live in MUH (11). Additionally, children and the elderly are more likely to live in affordable MUH, and a substantial proportion of MUH residents have a chronic condition exacerbated by SHSe (eg, asthma) (9).
Research suggests that smokers living in MUH with smoking restrictions may be more likely to reduce or quit smoking, particularly indoors, resulting in less SHSe (12). Moreover, most MUH residents support a smoke-free MUH policy (13–16). However, much of this research has focused on certain cities (13,17,18) or states (13–16). One national survey of US adults living in MUH (19) reported that 29% lived in a smoke-free building and of those with personal smoke-free home policies, 56% supported a complete smoke-free MUH policy. Efforts to support or oppose tobacco control policies use arguments related to the impact of such policies on health, economic issues, prevention of youth tobacco use, individual rights, hospitality, and morality (20–22). However, to our knowledge, no research has examined the most persuasive messaging strategies that support or oppose MUH smoking policies or examined these issues in a nationwide sample.
This study drew from a socioecologic framework (23) and examined 1) sociodemographics in relation to level of smoke-free MUH policies, 2) sociodemographics and level of smoke-free MUH policies in relation to level of cigarette consumption and past year quit attempts among current smokers, and 3) sociodemographics, smoking status, and level of smoke-free MUH policies in relation to support for smoke-free MUH policies in a sample of US adults living in MUH with representation from key groups such as smokers and racial/ethnic minorities. We also examined the persuasiveness of messaging strategies in support of and in opposition to smoke-free MUH policies. A primary aim was to compare reactions to tobacco control policies in the southeastern United States (where tobacco control is lagging) with reactions in other regions.
We thank Global Market Insite, Inc. for preparing and administering this assessment. This work was supported by the Centers for Disease Control and Prevention (no. 3 U48 DP001909-04S1 [principal investigator, C.J.B.]), the National Cancer Institute (no. U01CA154282-01 [principal investigator, M.C.K.] and no. 1K07CA139114-01A1 [principal investigator, C.J.B.]), and the Georgia Cancer Coalition (principal investigator, C.J.B.]). The funders had no role in the analyses or interpretation of the study or its results.
Corresponding Author: Carla J. Berg, PhD, Department of Behavioral Sciences and Health Education, Emory University School of Public Health, 1518 Clifton Rd NE, Room 524, Atlanta, GA 30322. Telephone: 404-727-7589. Email: email@example.com.
Author Affiliations: Regine Haardörfer, Michael Windle, Madeleine Solomon, Michelle C. Kegler, Emory University Rollins School of Public Health, Atlanta, Georgia.
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