Smoke-Free Multi-Unit Housing: Design of a Mixed-Method Economic Impact Evaluation in North Carolina

Background: With the reduced but persistent rate of smoking in the US, second-hand smoke exposure continues to be a pressing public health issue. According to the U.S. Department of Health and Human Services, there is no safe level of exposure to second-hand smoke (SHS). Exposure to SHS can cause lung cancer, coronary heart disease, and is especially dangerous for pregnant women, babies and children. Multi-unit housing (MUH) properties create particular challenges related to SHS exposure, as residents have no control over the smoking status of adjacent tenants. In MUH, tenants may be exposed to neighbors' SHS through multiple routes, including through doors, air vents, building cracks, hallways and patios. Methods: The 2012-2013 Tobacco Prevention Control Branch (TPCB) Capstone team conducted formative research on the barriers to smoke-free housing policies in North Carolina and created an informational campaign to raise awareness about the risks of tobacco and SHS among MUH property owners/managers (O/M) and tenants. The 2013-2014 TPCB Capstone team built on the foundation laid by previous teams and TPCB research to strengthen the case for going smoke-free from the perspective of MUH O/M. The project included formative research on the financial impact and perceptions of smoke-free policies as reported by MUH O/M and a review of the literature on cost analyses of smoke-free policies in MUH and other settings. We collaborated with experts to refine the constructs identified in our research and developed a quantitative survey instrument and a qualitative interview guide to be used to assess costs at a large North Carolina-based property management company. Results: Our formative research revealed six key constructs that capture the economic impact of smoking in MUH. Based on these, we produced a Quantitative Study Protocol that captures maintenance and turnover costs from financial documents and a Qualitative Study Protocol that captures maintenance workers' experience during the transition to smoke-free policies. We piloted the qualitative Interview Guide with maintenance workers from an MUH property and produced a Suggested Finalized Interview Guide. Discussion: Our deliverables represent the first step in building a compelling financial case for MUH to go smoke-free. This is especially important work as little research has been conducted at the intersection of smoke-free policies and MUH with regard to cost. Next year's TPCB Capstone team will sustain this year's work and be able to collect and analyze data efficiently using the tools and protocols developed this year.Master of Public Healt