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With smoking increasingly prohibited in public places, a Fielding School-led coalition is bringing together Los Angeles apartment owners and their tenants in an effort to address the harmful effects of secondhand tobacco smoke exposure where people live.
PUBLIC HEALTH EFFORTS in California over the last two decades have succeeded in clearing the air of tobacco smoke in the workplace, in restaurants and bars, and in most other public places. But for those who reside in multi-unit apartment complexes, the home is not always a smoke-free zone – even if they want it to be, and even if their health suffers as a result.
With a $3 million federal grant from the U.S. Centers for Disease Control and Prevention (CDC), the Fielding School’s UCLA Center for Health Policy Research is leading an initiative to change that reality for low-income Latino and African-American families living in the City of Los Angeles. The Fielding School team, in partnership with the grassroots group Smokefree Air for Everyone (S.A.F.E.) and a host of other public- and private-sector organizations, is spearheading a comprehensive community action plan to reduce exposure to smoking in Los Angeles apartment buildings where there is a high density of low-income Latino and African-American families – two groups at particularly high risk of suffering the effects of secondhand smoke exposure.
The effort, which works with landlords and tenants to facilitate voluntary non-smoking policies while increasing the opportunities for smokers to access smoking-cessation services, is part of the federal Racial and Ethnic Approaches to Community Health (REACH) initiative in support of public health efforts to reduce chronic diseases, promote healthier lifestyles, reduce health disparities, and control health care spending.
“You shouldn’t be exposed to a known health risk just by virtue of where you live,” says Dr. Steven P. Wallace, professor and chair of the Fielding School’s Department of Community Health Sciences, associate director of the UCLA Center for Health Policy Research and principal investigator on the REACH grant. “This project is designed to make the home a safe and healthy place for some of the most vulnerable populations in Los Angeles.”
The Fielding School-led initiative is focused on parts of the city with the greatest need. “These are areas with high rates of chronic diseases and respiratory conditions, and where options for housing are limited,” says Peggy Toy, director of the UCLA Center for Health Policy Research’s Health DATA (Data, Advocacy, Training, Assistance) program and director of the REACH project. Toy notes that in Los Angeles, 56 percent of Latino households and 54 percent of African-Americans reside in multi-unit buildings.
The CDC estimates that 2.5 million nonsmokers have died from health problems caused by exposure to secondhand smoke since 1964, the year of the U.S. Surgeon General’s landmark report on smoking and health. For adults who have never smoked, secondhand smoke can cause heart disease, lung cancer and stroke. For children, exposure has been linked with ear infections; more frequent and severe asthma attacks; and respiratory symptoms such as coughing and sneezing, shortness of breath, bronchitis, and pneumonia. Secondhand smoke exposure has decreased over time in the U.S. population amid declining smoking rates, more states and communities enacting laws banning smoking in public places, and changing social norms around the acceptability of lighting up around nonsmokers. But tenants of apartment complexes and other multi-unit housing remain vulnerable to tobacco smoke traveling through walls, windows and electrical fixtures.
In children, secondhand tobacco smoke exposure has been linked with ear infections; more frequent and severe asthma attacks; and respiratory symptoms such as coughing and sneezing, shortness of breath, bronchitis, and pneumonia.
IN HER WORK as associate director of S.A.F.E. from 2004 to 2013 and now as REACH project manager, Marlene Gomez (MPH ’11) has encountered the frustration of tenants who are bothered by the smoke drifting into their unit but feel powerless to do anything about it. “Often, they don’t know how best to address the issue with their landlords or they are concerned about whether they have a right to complain,” she says. In other instances, Gomez notes, tenants find they cannot obtain protection from drifting secondhand smoke because they live in properties that are under rent control in the City of Los Angeles. The rent control law prohibits landlords from making changes to existing leases, so if the non-smoking provision isn’t already included in the lease, the landlord may be unable to protect the tenant from the secondhand smoke infiltrating the unit. “It can become a nightmare for those who can’t afford to live in a single-family home and find that it’s not feasible to just get up and move,” Gomez says.
In addition to engaging tenants, the REACH project makes the case to apartment owners about the economic advantages of going smoke free – including potential discounts on insurance and reduced maintenance costs. While many are aware of these benefits, they are concerned with protecting tenants who do smoke and uncertain about how to implement smoke-free policies without violating existing lease agreements, Gomez says.
Rather than promoting a combative environment, the REACH project seeks to bring together tenants and landlords. “Our aim is to educate and facilitate the adoption of smoke-free housing practices and policies in a way that preserves tenancy and enables people who do smoke to access the services they need to quit,” Toy explains.
Following the approach of the UCLA Center for Health Policy Research’s Health DATA program, the Fielding School team provides the resources, expertise and training to build the capacity of partner organizations to successfully carry out the initiative. For example, CD Tech Community Development Corporation, a nonprofit organization based in South Los Angeles, is assisting with tenant education. The Los Angeles Unified School District’s Student Health and Human Services division is conducting home visits to families of students vulnerable to secondhand smoke because of asthma and other conditions. The Apartment Association of Greater Los Angeles offers technical assistance and outreach to landlords who want to go smoke free, while the Oakland-based law and policy group ChangeLab Solutions is tailoring educational seminars for apartment owners on implementing smoke-free practices within the law. Other partners working with FSPH include the Los Angeles County Department of Public Health, David Geffen School of Medicine at UCLA, USC Tobacco Center for Regulatory Sciences in Vulnerable Populations, and American Lung Association in California.
ESTHER SCHILLER was a middle school teacher in the Los Angeles Unified School District in the late 1980s when she began to realize that the asthma attacks she was experiencing on the job were related to the tobacco smoke she was inhaling. At the time, the district had no policy against teachers smoking; some smoked in their classrooms, others used a bathroom on the first floor, sending smoke wafting up the stairs and into Schiller’s classroom directly above. “I was breathing tobacco smoke, and at first I didn’t know it,” Schiller says. By the time she did, Schiller was on her way to being diagnosed with chronic obstructive pulmonary disease.
After receiving a settlement from the Los Angeles Unified School District in 1992 in a well-publicized workers’ compensation case stemming from her exposure to secondhand tobacco smoke as a middle school teacher, Schiller founded S.A.F.E. as a community-based effort to ban smoking from California workplaces. But following the passage of laws that made the state’s restaurants and bars, as well as all workplaces, smoke free, S.A.F.E. began getting calls from people who lived in apartment and condominium complexes. “They were now breathing clean air at work and in restaurants, then returning to their own homes and having to breathe their neighbor’s tobacco smoke,” Schiller says.
When S.A.F.E. began to focus on promoting smoke-free environments for people living in multi-unit buildings more than a decade ago, the effort was met with skepticism. “We were told you couldn’t tell people they couldn’t smoke in their homes,” Schiller recalls. “But we were hearing from residents whose health was affected by the smoke drifts, and we knew this needed to be addressed.”
Now Schiller is serving as lead strategic consultant to the Fielding School’s REACH project, an effort that’s larger than anything she could have imagined when she first took up the cause. Marlene Gomez, the FSPH alum who once worked with Schiller at S.A.F.E., and has reunited with her as project manager for the REACH initiative, believes the time is right. “Communities across the nation are taking this on,” she says. “The momentum is on the side of protecting the health of people where they live.” •