Evaluation of Federally Mandated Smoke-Free Housing Policy and Health Outcomes among Adults Over the

Anastasiou E, Thorpe LE, Wyka K, Elbel B, Shelley D, Kaplan S, Burke J, Kim B, Newman J, Titus AR.
Evaluation of Federally Mandated Smoke-Free Housing Policy and Health Outcomes among Adults Over the Age of 50 in Low-Income, Public Housing in New York City, 2015-2022
Nicotine Tob Res. 2025 Apr 8:ntaf046. doi: 10.1093/ntr/ntaf046. Epub ahead of print. PMID: 40195027.

Introduction: Effective July 2018, the U.S. Department of Housing and Urban Development issued a rule requiring all public housing authorities to implement smoke-free housing (SFH) policies in their developments. We examined the differential impacts of SFH policy on hospitalizations for myocardial infarction (MI) and stroke among adults aged ≥50 years old living in New York City (NYC) Housing Authority (NYCHA) versus a matched-comparison population in NYC.

Aims and methods: We identified census block groups (CBGs) comprised solely of 100% NYCHA units (N = 160) and compared NYCHA CBGs to a selected subset of CBGs from all CBGs with no NYCHA units (N = 5646). We employed propensity score matching on distributions of key CBG-level sociodemographic and housing covariates. We constructed incident rates per 1000 persons by aggregating 3-month "quarterly" counts of New York State all-payer hospitalization data from October 2015 to December 2022 and dividing by the population aged ≥50 in selected CBGs, ascertained from 2016 American Community Survey 5-year estimates. We selected a difference-in-differences (DID) analytic approach to examine pre- and post-policy differences in incident hospitalizations between the intervention and matched-comparison groups.

Results: Matching results indicated a balanced match for all covariates, with standardized mean differences <0.10. In DID analyses, we observed small declines in both MI (DID = -0.26, p = .02) and stroke (DID = -0.28, p = .06) hospitalization rates for NYCHA CBGs compared to non-NYCHA CBGs from pre-to post-54 months' policy.

Conclusions: SFH policies in NYC were associated with small reductions in CVD-related hospitalizations among older adults living in housing subject to the policy.

Implications: Housing remains a key focal setting for interventions to reduce SHS exposure and associated morbidities. Ongoing monitoring is warranted to understand the long-term impacts of SFH policies in public housing developments.