# Health outcomes and health care spending among residents of smoke-free public housing

> **NIH NIH R01** · MASSACHUSETTS GENERAL HOSPITAL · 2020 · $817,206

## Abstract

ABSTRACT
Tobacco is the leading preventable cause of death in the United States, affecting both tobacco users and those
exposed to second- and third hand smoke. Residents of low-income, multiunit housing are particularly
vulnerable to tobacco smoke exposure. Low-income individuals are more likely to smoke, which in turn
increases the tobacco smoke exposure of people sharing their environments. In November of 2015, the U.S.
Department of Housing and Urban Development (HUD) proposed a rule requiring federally-funded public
housing authorities (PHAs) to establish smoke-free policies for their residences, potentially reducing the
morbidity associated with smoking and tobacco smoke exposure. Massachusetts PHAs have been at the
forefront of smoke-free housing policies and their experience provides an early opportunity to assess the
health benefits of HUD's proposed smoke-free policy, as well as smoke-free policies in other low-income
housing. The principal investigator and colleagues have shown that public housing developments with smoke-
free policies have lower levels of tobacco smoke pollution in the air (fine particle matter [PM2.5], nicotine) than
those without smoke-free policies. In addition, they found that after the Boston Housing Authority introduced its
smoke-free policy in 2012, airborne nicotine in residents' apartments went down by 70%. While the evidence
that smoke-free housing policies reduce tobacco smoke pollution in PHAs is promising, the existing research
has notable limitations. Furthermore, no studies have yet examined changes in health outcomes for residents
following the introduction of smoke-free housing policies. Smokers and non-smokers alike are expected to
benefit from the prohibition of smoking in multiunit housing. We propose assessing the potential health impact
of smoke-free public housing policies on tobacco treatment use, signal adverse clinical events, and health care
spending for all public housing residents in Massachusetts. Our study will use a strong quasi-experimental
design to evaluate a series of natural experiments arising from the staggered introduction of smoke-free
policies in ≥27% of the state's 241 PHAs. Residents in PHAs that do not adopt smoke-free policies will serve
as concurrent controls. We will measure outcomes for PHA residents using 2008-2018 data from the
Massachusetts All Payer Claims Database (APCD), a uniquely comprehensive resource that includes health
care claims for all insured residents from nearly all health insurers in the state. In addition, we will include data
on tobacco treatment use from the Massachusetts state quit line. Findings from this study will have policy-
relevant implications for smoke-free housing in state-funded PHAs (not covered by HUD's policy), other
subsidized and low-income housing, and private housing markets nationally.

## Key facts

- **NIH application ID:** 9981772
- **Project number:** 5R01HL112212-07
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Douglas Levy
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $817,206
- **Award type:** 5
- **Project period:** 2012-03-01 → 2023-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9981772

## Citation

> US National Institutes of Health, RePORTER application 9981772, Health outcomes and health care spending among residents of smoke-free public housing (5R01HL112212-07). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/9981772. Licensed CC0.

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