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Nashville’s public housing joins anti-smoking trend

 The Contributor - USA 24 October 2019

Health is a key concern for many homeless and vulnerably housed, but does banning smoking in all public housing create more tension for an already encumbered community? Or does it reflect a growing trend across the world to outlaw the practice no matter where you live and who you are? (2603 Words) - By Joe Nolan

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The Contributor_Nashville’s public housing joins anti-smoking trend

Raymond Hampton, formerly homeless, smokes a cigarette on 5th Avenue in downtown Nashville Nellida Dela Cruz (Portrait picture - Download to see full image). Photo: Raven Lintu

In a pilot policy that took effect May 1st of this year, the Metropolitan Development and Housing Agency (MDHA) in Nashville cited "an effort to improve the health of all residents" when it declared the Parthenon Towers high rise to be a "smoke-free community housing facility." The towers are currently home to more than 300 elderly and disabled tenants.

Although common areas within the building have been smoke-free for some time, residents were always allowed to smoke in their individual apartments. Under the new policy, however, residents are only allowed to smoke outdoors in a designated smoking area. As MDHA Executive Director Phil Ryan explains, "Research has clearly shown that in high rise residential buildings smoking poses serious health risks not only for the smokers themselves, but also for the people around them who breathe in second-hand smoke."

Health benefits and cost savings are common currency when explaining the reasoning behind a new non-smoking trend that is sweeping across the country's public housing authorities. In Nashville, Parthenon Towers is only the beginning. "Making Parthenon Towers a smoke-free facility is a good common sense policy that will benefit the health of all residents," says Ryan. "We plan to expand this policy to our other community properties in the future."

The health research to which Ryan refers comes from a report that ran last year in the June issue of the New England Journal of Medicine. The report concludes that smoking occupants within a multi-unit residential building put their neighbors at risk. The report explains that cigarette smoke from one unit "can move along air ducts, through cracks in the walls and floors, through elevator shafts, and along plumbing and electrical lines to affect units on other floors."

In addition to the journal's report, secondhand smoke has been identified as a serious health hazard by the Centers for Disease Control, the Surgeon General and the Environmental Protection Agency. In fact, the Surgeon General has concluded that higher concentrations of a number of cancer-causing, toxic chemicals can be found in second-hand smoke as compared to the smoke inhaled by the users. The Surgeon General has also said that exposure to second-hand smoke has negative and immediate consequences on the cardiovascular system of adults.

In Nashville, as in other cities, smoking can be a way of life. But recent numbers from a report by the Metro Nashville Public Health Department show that, for many, it can also be a way of death. In 2008, four of the top five causes of death in Davidson County were conditions that could be directly linked to smoking: heart disease, cancer, chronic lower-respiratory disease and stroke. While smoking rates in the U.S. have been on the decline, a 2010 study from the Centers for Disease Control notes that the smoking population in the country had stabilised around the 20% mark.

Smoking and Poverty

While there are arguments to the contrary, the study also shows clear trends between income, education and smoking. The percentage of smokers below the poverty line was over 10% higher than among populations above the poverty line. In addition, 26% of people with less than a high school education smoked while only 11% of college grads smoked and only 6% of people with graduate degrees felt compelled to light up. Geographically, the Southeastern U.S. is at the top of the list for smoking in the United States.

Steven Samra, Recovery Specialist with the Center for Social Innovation, isn't a smoker himself, but he says cigarettes sometimes serve an important role in his interactions with homeless people. "I describe it as a matter of priorities," he says. "If tobacco gets me engaged and builds a sense of immediate trust during an outreach encounter-the chance that I could provide resources, including SOAR [SSI/SSDI, Outreach, Access and Recovery] and potentially at some point housing-then I feel it's more a matter of harm reduction. I've used a resource (cigarettes) that, while certainly unhealthy, is in demand to provide a potentially bigger-and much healthier-resource."

As for the attitude many non-homeless people express toward homeless smokers-that they shouldn't spend what little money they have on cigarettes-Samra believes people need to learn to mind their own business.

"I have to say that there's something that really rubs me the wrong way about anyone telling another adult what they can and cannot do," he says. "Granted, I believe that this courtesy only extends to the point where their right to do as they choose does not interfere with my own, or cause risk to me or another individual. But if tobacco is a legally obtained product and an adult chooses to use that product, people ought to butt out of someone else's right to choose unless that person is somehow infringing on another's right to do the same without fear of harm from that choice."

Sharon is a Contributor vendor who fits the profile of the financially struggling smoker. A familiar face to customers who pick up the paper at her post in Green Hills, Sharon is currently homeless, although she sometimes earns enough selling papers to stay in an affordable hotel at night. When I ask Sharon if she is a smoker, she laughs. "Actually, I was hoping I could quit," she says. As she lights a cigarette, she tells me about her struggles with giving up smoking.

Sharon has smoked for over 40 years, and is not aware of having any smoking-related health issues. Over those years, her efforts at quitting have proved successful, to a point. "I was doing good," she enthuses. "I just threw 'em down. I think I was free for 30 days." During that particular attempt at smoke-free living, Sharon was teased by smoking co-workers and her then-son-in-law who "smoked like a chimney stack." Eventually, it all proved too much and Sharon went back to cigarettes.

Sharon could be a good candidate for public housing, but with the new non-smoking trend in Nashville's MDHA residences, the transition from the streets just got a lot tougher, and it doesn't seem fair to Sharon. "I think they [should] have the right to whether they smoke or not in there," she says. "You pay rent. You have your own right to do what you want to in your own place."

Non-Smoking Neighbors

A formerly homeless man now living in public housing in Nashville couldn't disagree more. Kevin Barbieux is a local writer, whose The Homeless Guy blog recorded the day-to-day reality of his life on the streets, bringing him-and the homeless experience-to the attention of the national media. Barbieux's blog is slowly developing into a video platform that finds him continuing to speak about homelessness even though he now has a place to live.

While Barbieux is not in a MDHA residence, the authority provides the Section 8 voucher that pays the rent on the Urban Housing Solutions residence that he secured through the assistance of the Metro Homelessness Commission. "It's a convoluted arrangement, but I'm just happy to have the place," he says.

Although he admits to walking outdoors to enjoy the occasional cigar, Barbieux is a non-smoker who welcomes the recent wave of smoking bans in public housing. "The smell of cigarette smoke really does penetrate from one apartment to another," says Barbieux. "I'm not so worried about risks of second hand smoke as much as I'm annoyed at the putrid smell of stale smoke permeating my own living space."

Experiences like Barbieux's underscore the research about second-hand smoke in multi-unit residences, and while some smokers might argue that they should have the right to smoke in their own apartments, Barbieux argues that it's only fair that non-smoking residents should be able to enjoy fresh air in theirs.  "It really shouldn't matter if it's public housing or any other kind," Barbieux says. "People shouldn't be forced to tolerate it. In fact, I'd rather smoking be banned from the entire property. It's disgusting having to walk through a cloud of cigarette smoke just to get to your apartment," He complains. "If smokers cannot contain their smoke so that it does not affect other people, then they should lose their right to smoke."

Like Barbieux, many residents at Parthenon Towers have come out in favor of the ban, including the facility's Resident Association. Peach Ella Whitfield, president of the association, sees the change as part of an even wider vision for a healthier community in the residence. "Secondhand smoke is harmful to everyone and we would like for all residents to be healthier, by not only cutting back or quitting smoking altogether, but by also watching our diets and exercising more," she says.

Counting the Health Costs

Bill Friskics-Warren is the director of homeless services for United Neighborhood Health Services (UNHS) in Nashville. His data regarding smoking among homeless populations provides a snapshot of the connections between poverty and smoking. As in Barbieux's case, public housing is a crucial option for homeless people attempting to get off the street, but those with the smoking habit will soon find that smoking is a liability when reaching out for this lifeline.

"According to SAMHSA, the Substance Abuse and Mental Health Services Administration of the federal government, the smoking prevalence rate for people who are homeless in the U.S. could be as high as 70%," explains Friskics-Warren. Like all studies of homelessness, exact numbers are hard to come by, but it's clear that the percentage of smokers among these likely candidates for public housing verges on the astronomical.

Friskics-Warren also cites smoking-and second hand smoke-as contributing to some of the major health issues facing homeless people. "Cardiovascular disease, which in many cases is linked to smoking, is one of the big killers of homeless and low income people," he explains. "Exposure to secondhand smoke can cause cancer, asthma and other serious health problems." Friskics-Warren also notes that the health complications of a life on the street often make smoking even more difficult to quit for the extremely poor.

"Quitting smoking is typically a lower priority among folks who are homeless than managing their diabetes or high blood pressure, to say nothing of securing their next meal or bed for the night," he says. While UNHS medical providers prescribe nicotine patches to patients to assist in smoking cessation, they see very low success rates among homeless people trying to quit.

"Generally speaking, there is a lack of good information about accessible tobacco cessation options for low-income people," he says. "Not only that, but service providers historically haven't seen smoking or tobacco use as an addiction on a par with alcohol and illegal drug abuse. I don't think it's a stretch to say that tobacco use among homeless people is a social problem of epidemic proportions."

Federal Influence on Anti-Smoking Trends

MDHA's policy change is part of a nationwide trend that finds a number of public housing authorities experimenting with various smoking bans following a July 2009 memorandum from the federal department of Housing and Urban Development (HUD). The memorandum strongly encouraged non-smoking policies in public housing units.

Julie Oaks is the Communications Manager for MDHA. She also smoked for 20 years. "I quit a year ago in August," she tells me cautiously. "It was very hard." Oaks confirms that the HUD memorandum is the impetus behind the non-smoking trend in public housing, and as a former smoker, she empathizes with the difficulties it will cause for the approximately 150 smokers currently living in Parthenon Towers. "I'm hesitant to say I quit," she confesses. "It can be so easy to fall back into. It always lingers out there."

Demonstrating some understanding of how hard it can be to quit smoking, supporters of the new policy have called for reasonable measures during the transition. "The decision by MDHA and the Parthenon Towers Resident Association to go tobacco-free is a significant step toward making Nashville a healthier place," says Bill Paul, M.D., Director of Health of Nashville/Davidson County. "I commend each for looking out for the health and well being of residents and also approaching this change with care and respect."

One example of such "care and respect" is the building of a smoking area 30 feet from the Parthenon Towers' rear entrance. The space will be accessible to all residents and their guests. But for many of the elderly residents who call Parthenon Towers home, going outside to smoke might be easier said than done. While new tenants will not be allowed to smoke in their rooms, existing tenants will have until next September to quit smoking, get used to going outside to smoke or to find another place to live. Such rigors might seem unfair or unreasonable to smokers at Parthenon Towers, but similar changes are already taking place elsewhere around the city and the country. And in many cases, the transition is accompanied by a zero-tolerance attitude.

Smoking Bans Across the U.S.

In August of this year, the Zanesville Times Recorder in Ohio reported that the state's Perry County Metropolitan Housing Authority (PCMHA) implemented a smoking ban citing financial savings and the health of their residents. A more draconian measure than MDHA's, the Perry County ban declared all of their residences immediately smoke-free as of August 1.

The Recorder reported that "residents no longer can smoke in their homes, yards or even their cars if they are on housing authority property… Violators will be given a warning…then they'll have to move out." The piece goes on to quote PCMHA Executive Director Sandy Harper who said, "It'll be handled the same as any other lease violation: They'll be asked to leave." The PCMHA decision will impact the residents of more than 100 single unit and family dwellings on two campuses.

In August of this year, KEPR-TV in Washington State reported that the Kennewick Housing Authority (KHA) had declared a non-smoking ban on all KHA properties. However, the authority decided to set-up an outdoor smoking area similar to the one at Parthenon Towers, allowing residents to continue smoking as long as they practiced their habits outside. Again, costs and health concerns were cited as the main motivations behind the decision. The KHA stated that it cost three times as much to clean and turn-over a smoking residence as opposed to a space previously occupied by a non-smoker.

In keeping with the trend, WABI-TV in Bangor, Maine recently reported that the state would become the first in the nation to "protect tenants from secondhand smoke." As of January 1, 2019, all of Maine Public Housing Authority's residences will be smoke-free. As in other cities, officials stated that the savings in turn-over clean-up costs would be significant.

Parthenon Towers is the first smoke-free public housing facility in Tennessee, but it's just the beginning of a more widespread reality throughout Nashville and the rest of the state. In fact, Parthenon Towers is rapidly becoming a mini-experiment in healthy, green living. The building is currently being renovated into "loft style" residences and with the addition of an array of solar panels installed by MDHA on the building's roof.  Parthenon Towers has become the largest solar energy generator in Davidson County.

All of these developments may be signs of the times, but they put us in mind of the old saying: "Most people are in favor of progress, it's the changes they don't like."

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