Study: Banning smoking in subsidized housing could save millions in health care costs

by Kim Krisberg

Another day, another study that shows investing in public health interventions can make a serious dent in health care spending.

A new study recently published in the American Journal of Preventive Medicine found that banning smoking in all U.S. subsidized housing could yield cost savings of about $521 million every year. That total includes $341 million in secondhand smoke-related health care expenditures, $108 million in renovation expenses and $72 million in smoking-attributable fire losses. In fact, just prohibiting smoking in public housing alone would result in a savings of about $154 million annually, of which $101 million would be in health care cost savings.

To reach the estimates, researchers Brian King, Richard Peck and Stephen Babb analyzed previously estimated national and state cost data. They noted that about 7.1 million Americans lived in subsidized housing in 2009–2010, including 2.1 million people who lived in housing either owned or operated by a public housing authority. In 2009, nearly 33 percent of adults living in subsidized housing smoked cigarettes — a rate more than 10 percentage points higher than the general U.S. adult population. The study noted that secondhand smoke may pose a particularly harmful risk within subsidized housing settings, as many residents are elderly, disabled or are children. Study authors wrote:

With the increasing number of U.S. states prohibiting tobacco smoking in indoor public places, private settings are becoming relatively larger contributors to total (secondhand smoke) burden. This may be particularly true for residents of multiunit housing, where (secondhand smoke) can infiltrate smoke-free living units from units that permit smoking and shared areas.

In a news release from the Centers for Disease Control and Prevention on the study results, researcher King noted that "opening windows and installing ventilation systems will not fully eliminate exposure to secondhand smoke. Implementing smoke-free policies in all areas is the most effective way to fully protect all residents, visitors and employees from the harmful effects of secondhand smoke."

And implementing such smoke-free policies wouldn't necessarily come up against much resistance — according to the study, a majority of subsidized housing tenants favor such rules. As of 2012, more than 250 public housing authorities had instituted smoke-free policies, however the study noted that the prevalence of such policies still remains low nationwide.

The U.S. Department of Housing and Urban Development (HUD) encourages public housing authorities to voluntarily go smoke-free and provides resources to residents and housing managers to help them do so. In January 2013, more than a dozen health organizations, including the American Public Health Association, American Lung Association and American Academy of Pediatrics, sent a letter to HUD Secretary Shaun Donovan stating that "we strongly believe that the only way to protect all residents of federally assisted multi-family housing is to adopt a nationwide smoke-free policy covering all multi-family housing under HUD’s control."

The letter cited a Boston study released in 2009 that examined nicotine levels in 40 low-income housing units in multi-unit buildings. The study found detectable nicotine levels in 94 percent of the units, including 89 percent of units in which no one in the household smoked. The letter also noted that children living in multi-unit housing experience significantly more exposure to secondhand smoke than children who live in detached housing. The authors went on to write:

U.S. law supports many restrictions on the conduct of individuals that affect their neighbors, including prohibitions on nuisances such as excessive noise levels. Smoke-free air policies in multi-family buildings do not prohibit residents from smoking altogether; they only prohibit residents from smoking in locations that can cause harm to their neighbors. ...Building-wide smoke-free air policies, therefore, do not infringe on any protected liberties or freedoms afforded to a person who smokes. Rather, such policies protect the right of all the children and nonsmokers who reside in shared indoor environments.

In addition, authors of the American Journal of Preventive Medicine study addressed concerns that smoke-free policies could "exacerbate socioeconomic disparities" by displacing low-income people who don't want to abide by smoking bans. They reminded readers that such policies don't prohibit smokers from living in subsidized housing and can actually help encourage smokers to quit.

According to CDC, 443,000 U.S. deaths happen every year due to cigarette smoking and exposure to secondhand smoke.

To read the full study on the cost-savings of smoke-free housing policies, click here.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.