Creating Smoke-Free Multi-Unit Housing as a Strategy to Improve Health Outcomes Among Vulnerable Populations.

Despite decades of progress in tobacco control, exposure to secondhand smoke (SHS) remains a persistent public health issue. Low-income communities and communities of color continue to experience high smoking rates and limited protection from smoke-free policies, contributing to disproportionate rates of disease. Guided by the Health Equity Framework, this study examined SHS exposure and support for smoke-free housing among households with vulnerable members, such as young children, older adults, and individuals with chronic conditions. Youth were trained in data collection methods and administered door-to-door surveys (n = 309) at multi-unit housing (MUH) to assess tenants' SHS exposure, attitudes toward smoke-free housing, and household vulnerability. Findings revealed that 36.6% of respondents experienced smoke drifting into their homes, yet few complained to building management or to the smoker. Households with vulnerable members were significantly more likely to prevent smoke from entering individual units (p = .007) and support comprehensive smoke-free MUH policies (p = .031). The study also found a statistically significant relationship between SHS exposure and support of eviction for repeat violators. These findings underscore the need for and potential impact of smoke-free MUH policies in historically marginalized communities. They also highlight the value of youth-led research in building capacity to engage in tobacco control advocacy. Future research should explore systemic barriers to implementing and enforcing smoke-free housing policies, and advocate for their integration into broader housing equity efforts.