Insecticide Cadmium Batteries  SHS can worsen pre-existing conditions such as heart Arsenic Toluene Poison disease and respiratory problems. 4 Industrial solvent  Because children breathe faster than adults, have smaller Carbon monoxide Ammonia Exhaust gas Detergent#
This publication is available at .

# II. INTRODUCTION
This manual is designed for state and local Healthy Homes programs that are working to reduce secondhand smoke exposure in multiunit housing. The manual provides field-tested strategies, recom mendations, best practices, and tools. The content draws on peer-reviewed research and interviews with practitioners. The manual is intended to frame issues and provide guidance for programs. Read ers should feel free to pick and choose among the strategies described-but should also understand that the strategies are interconnected and mutually supportive.
General disclaimer: This manual contains general information about legal matters; the information is not advice, and should not be treated as such.

# III. SECONDHAND SMOKE: WHAT IS IT AND WHY IS IT A PROBLEM?
Secondhand smoke (SHS), also known as environmental tobacco smoke, is defined as a mixture of sidestream smoke from the tip of the cigarette and mainstream smoke exhaled by the smoker. 1, SHS contains more than 4,000 chemicals (Figure 1), 5 of which at least 250 are known to be harmful, and more than 50 are known to cause cancer. 2,3,6 Major medical and scientific organizations agree that SHS exposure can cause disease and premature death in nonsmok ers. These include heart disease and lung cancer in nonsmoking bodies and lungs, and are still developing, they are espe cially vulnerable to the health effects of SHS. 4,15  Exposure to secondhand smoke increases the risk for FIGURE 1: SHS COMPONENTS Sudden Infant Death Syndrome. 4 In response to growing evidence that SHS poses serious health risks to nonsmokers and that only eliminating smoking in indoor settings fully protect nonsmokers 4,16 a growing number of states, communities, and businesses have adopted smoke-free laws and policies that eliminate smoking in workplaces and in public places, including restaurants and bars, to protect nonsmokers from SHS. 31 Smoke-free laws have been shown to reduce SHS exposure among nonsmokers, to reduce heart attack hospitalizations, and to help smokers quit. 4,7,22 Several recent studies have also suggested that smokefree laws may reduce asthma hospitalizations and emergency room visits.  Smoke-free laws typically receive high levels of public support and compliance, with the level of support increasing over time after the laws are implemented, especially among smokers. 4,22 Smoke-free policies also educate the public about the health effects of SHS and change social norms. 4,22 This leads to a number of second ary options, including increased adoption of voluntary smoke-free home rules. 2,4,22,23 However, nonsmoking residents of multiunit housing complexes who choose to make their units smoke-free may still be exposed to SHS that infiltrates their units from other units or common areas, potentially endangering their health. 24

# "The connection between the health and the dwelling of the population is one of the most important that exists." -Florence Nightingale

# IV. SMOKE-FREE POLICIES IN MULTIUNIT HOMES
The proportion of U.S. households with smoke-free home rules increased from 43 percent in 1992-93 to 77.6 percent in 2006-2007. 16 The proportion of households with at least one smoker which had adopted smoke-free home rules increased from 10 percent in 1992-93 to 32 percent in 2003, while the proportion of households with no smokers with such rules in place increased from 57 percent to 84 percent over this period. 17 Smoke-free homes were defined as homes where no one is allowed to smoke inside. 17 Additionally, smoke-free home policies are associated with greater use of medications that assist in cessation among current smokers and lower rates of relapse among former smokers. 18,19 However, smoking still occurs in many households. 16 For this reason, and because people spend much of their time in their homes, the home remains a major source of SHS exposure. 4 This is especially true for young children, who tend to spend espe cially large amounts of time in the home and who have little control over their exposure to SHS. 4,17 More than half of U.S. children are exposed to SHS 20 Almost all children and nonsmoking adults who live with smokers who smoke in the home are exposed to SHS. 17,20 Because private single-family homes cannot be re quired to go smoke-free, clinical and educational ini tiatives are typically the only viable direct approach for reducing SHS exposure in this setting. 21 As noted above, laws making workplaces and public places smoke-free can contribute indirectly to increased adoption of smoke-free home rules by private house holds. 22,23 These initiatives can encourage households to adopt voluntary smoke-free home rules, motivate smokers to quit, and guide smokers who want to quit to proven cessation treatments and services. 4,22 However, in multiunit housing facilities, smoke-free policies can potentially play an important role in protecting residents from SHS. SHS can infiltrate from units where smoking occurs into common areas and other units where residents have adopted voluntary smoke-free home rules. SHS can infil trate into these areas through air ducts, cracks in floors and walls, stairwells, hallways, elevator shafts, plumbing, electrical lines, and open windows, among other routes. 24 In fact, as much as 60 percent of airflow in multi-unit housing facilities can come from other units. 20,24 Nearly 50 percent of multiunit housing residents report that they have experienced SHS infiltrating their unit.  Smoke-free policies in multiunit housing can protect all occupants from SHS infiltration in individual units and common areas. Smoke-free policies can apply to indoor common areas (e.g., lobbies, laundry rooms, corridors), outdoor common areas (e.g., swimming pools and picnic and barbecue areas), and individual units, and to some or all buildings. Whatever areas such policies cover, they should apply to all residents and visitors at all times. This is necessary for the policies to be effective in protecting multiunit hous ing residents from SHS, since SHS constituents can linger in indoor settings long after smoking has ceased. 28 In some cases, management may need or choose to grandfather existing tenants who smoke for a certain period, such as the time until next lease renewal.
Apartment owners, managers, condominium associations, and public housing authority boards may all adopt policies eliminating or restricting smoking in multiunit housing facilities under their control. 29 A number of communities in California have adopted ordinances restricting smoking in multiunit housing, including several ordinances that eliminate smoking in individual units in certain types of multiunit housing. 30 Several communities in California and a number of states have enacted laws eliminating smoking in common areas, requiring disclosure of smoking policies and status, or establishing that SHS is a nuisance.  As with smoke-free policies in workplaces, public places, and other settings, smoke-free policies in multi-unit housing do not ban smokers from using the smokefree facilities, but simply prevent smokers from smoking in settings where SHS affects others-in this case, primarily through SHS infiltration. In other words, smokers are not precluded from living in smoke-free multiunit housing, as long as they adhere to the smoke-free policy.
Although there is limited information available, surveys and focus groups indicate that, while many multiunit housing owners and managers are interested in adopting smoke-free policies, some ex press concerns about doing so. 36 These concerns typically fall into three major categories. First, many multiunit housing proprietors believe that it is illegal for them to bar tenants from smoking in their units. 36 Second, they fear that a smoke-free policy would make it difficult to attract new tenants or retain current tenants. 36 Finally, they are concerned that enforcing the policy could prove difficult, time-consuming, and expensive. 36 However, with regard to the first concern, no legal barrier prevents owners or managers of multiunit housing complexes from adopting smoke-free policies, including policies that apply to individual units. 29,37 The second concern is also unwarranted, with surveys finding that most tenants prefer smokefree policies. 32 Finally, in terms of the third concern, no evidence exists that smoke-free multiunit housing policies would be difficult to implement and enforce. In fact, operators of multiunit housing with existing smoke-free policies indicated that they are more likely to keep the polices in place. 36 Smoke-free-policies in multiunit housing may also potentially have significant economic benefits for owners. Most important, preparing a smoker's unit for occupancy by a new tenant often requires substantially greater time and money than readying a nonsmoker's unit. For example, smokers' units may require extensive repainting, repair of burn damage, and replacement of carpeting, draperies, and upholstered furniture.  Secondly, smoking is also a major cause of residential fires and the lead ing cause of fatal residential fires. 40 Finally, owners and managers could potentially be subject to legal action by tenants who experience health problems as a result of SHS infiltration. 29 Multiunit housing residents in several states have brought such legal action in recent years, with mixed results. 29,33 Educational outreach can provide multiunit housing operators with this information. In recent years, as more multiunit housing operators have become aware of the benefits of smoke-free policies and rec ognized that they can be implemented successfully, an increasing number of private multiunit com plexes and public housing authorities have opted to go smoke-free. The U.S. Department of Housing and Urban Development has issued notices encouraging housing authorities and Section 8 housing facilities to adopt smoke-free policies voluntarily, including in individual units.  Smoke-free policies in multiunit housing are a win-win -protecting tenants' health while also helping protect owners' investment. r

# V. FRAMEWORK FOR IMPLEMENTATION WITH HEALTHY HOMES PROGRAMS
Initiatives to reduce SHS exposure in multiunit housing offer an attractive opportunity for newly created or transitioning Healthy Homes programs. These initiatives offer Healthy Homes programs a chance to address a potential residential source of indoor air pollution and poor health (See Figure 2). 4,22,43 Unlike some other home health hazards, SHS exposure is preventable; adopting and enforcing a 100 percent smoke-free policy should eliminate most SHS exposure in the home. In addition, because of the growing interest in and demand for smoke-free multiunit housing policies, work in this area may open partnership and funding opportunities. Moreover, because smoke-free multiunit housing policies are relatively simple to adopt, addressing this issue could potentially yield early victories, generating further momentum.

# HEALTHY HOMES
- Secondhand smoke
- Radon - Fire hazards - Fall hazards - Allergens - Lead - Pesticides - Moisture - Volatile

# FIGURE 2: COMPONENTS OF A HEALTHY HOME
Moreover, Healthy Homes programs enjoy ready access to multiunit managers and tenants that state tobacco control programs, typically do not possess. Thus, Healthy Homes programs are therefore in a uniquely favorable position to build relationships with key stakeholders in order to lay the ground work for policy change.
The only way to fully protect nonsmokers from SHS is to eliminate smoking in indoor settings. 4 In a single-family home, this can be accomplished through a voluntary household rule which prohibits anyone from smoking inside the home at any time. However, residents of multiunit housing facilities who adopt such household rules can still be exposed to SHS through infiltration from other units or common areas. 24 Therefore, only a policy making, at a minimum, all units and indoor common areas in a building smoke-free, can effectively protect tenants from SHS. Thus Healthy Homes programs' educational and outreach activities will be most effective if they are directed to ultimately achieving implementation of such policies by convincing owners, managers, and tenants of their importance and benefits. In addition to informing managers and tenants about the health effects of SHS, it is also important to provide managers and tenants who smoke with support and assistance in their efforts to quit, including information on available cessation resources.
It is important for smoke-free policies in multiunit housing to be implemented in a nonpunitive man ner that does not stigmatize residents who smoke or refuse housing to applicants who smoke. Poli cies should be written and implemented in a way that minimizes the chances that multiunit housing residents are evicted for violations. Efforts should also be made to ensure that residents who do smoke have access to smoking cessation resources should they choose to take this opportunity to quit.
The following table provides a menu of resources that Healthy Homes programs can draw on to promote smoke-free policies in multiunit housing facilities. The table is based on a review of current best practices by state and local health departments, tobacco control agencies, public housing authori ties, nonprofit organizations, and community organizations. The framework is structured around four broad strategic activity areas: coordination, communication, collaboration, and capacity building. The table also includes a list of tools and resources for each activity. The goal of this framework is to enable Healthy Homes programs to select and implement strategies to effectively reduce SHS exposure in multiunit housing. The specific approach a program selects will depend on its organizational capacity, resources, existing projects, and the characteristics and circumstances of the community in question.

# Coordination
Research and analyze current smokefree programs and policies.
Review state and local demographics.
Use information to target initial efforts and highlight existing efforts.
Identify key gaps in resources that need to be addressed to support current efforts and develop a work plan.
Conduct a community assessment to identify community needs, characteristics, and cultural identity, and target outreach accordingly.

# VI. ADDENDUM
In addition to the resources listed above, a number of other helpful materials are available for Healthy Homes programs that are interested in working to reduce SHS exposure in multiunit housing. The following addendum provides an in-depth listing of research findings, best practices, web sites, and other information, including both online and print resources. Many resources were identified through interviews with smoke-free practitioners. Healthy Homes programs are free to use or adapt any of these materials.

# AddEndum conTEnTS
 Toolkits
-   Multiunit housing operators' concerns about the legality of requiring individual units to go smokefree can pose a major barrier to adoption of smoke-free multiunit housing policies. A number of nongovernmental legal organizations have responded to these concerns by providing analyses of the relevant legal issues. While these resources provide an overview of these issues, they do not consti tute legal advice. The language of all smoke-free policies should be based on model language that has withstood legal scrutiny, and should be reviewed by an attorney knowledgeable about local and state ordinances before the policy is adopted.
Corresponding URL's for this table are listed in the Reference section of this manual.

# Federal Law
Federal Statutes: American with Disabilities Act Federal Statutes: Fair Housing Act

# State Statute Designation
There is no constitutional right to smoke, and no law precludes adoption of smoke-free policies in multiunit housing, including policies that make individual units smoke-free. Smoke-free policies are not discriminatory, since smoking is not a protected act and smokers are not a protected class. In some cases, it may be necessary to grandfather for a limited amount of time (e.g., until their leases come up for renewal). For analysis, see Tobacco Control Legal Consortium's There is No Constitutional Right to Smoke. a
The Americans with Disabilities Act permits smoke-free policies. Because smoking is not considered a disability, smokers are not protected under the Fair Housing Act or the Rehabilitation Act. 44 Some health conditions affected by SHS could be considered a disability (e.g., emphysema, heart conditions, asthma, COPD). Multiunit housing facilities may be required to provide some nonsmoking tenants who are affected by SHS infiltration some accommodation for these conditions on a case-by-case basis. Most state smoking restrictions focus on workplaces and public places rather than multiunit housing. Some state laws restrict smoking in common areas in multiunit housing complexes. Utah e law establishes SHS as a potential nuisance, giving tenants grounds for legal action. 46 In addition, Utah law also specifically allows condominium associations to restrict smoking in units, common areas, and facilities. 34 In Oregon, f a disclosure law requires a property owner to notify prospective tenants of a multiunit housing facility's smoking policy and the areas where smoking is permitted. 47

# Local City/ County
A number of communities in California have adopted ordinances addressing SHS infiltration in multiunit housing. These ordinances range from requirements that apartment managers disclose units where smoking is occurring to policies making indoor and/or outdoor common areas smoke-free to policies making individual units in some or all buildings smoke-free. These policies may initially apply only to new properties or may cover existing properties as well. Communities and states can also use tax credits, bonus points in competitive grant proposals, and other financial incentives to encourage the adoption of smoke-free multiunit housing policies (California Tax Credits. g Also, local Ordinances are effective (Oakland, CA; Buffalo, NY). For sample ordinance provisions that provide an overview of the available policy options, see the

# Lower Insurance Costs
Surveys of owners find that staff time spent dealing with smoking complaints was reduced following implementation of a smoke-free policy. 25 Maine's Sanford Housing Authority found that the cost of renovating smokers' units ranged from $1,070-1,670 versus $550 for a non-smoking unit. 39 Starting smoke-free home rules in single-family homes leads to reduced SHS exposure, increased smoking cessation, and reduced smoking among adult and adolescent smokers. 22 High preference and demand for smoke-free housing, as documented by renter surveys. 26 See Smoke-Free Environments Law Project p website for more surveys.
New York realtors have reported that smokers' residences are harder to sell than nonsmokers' residences. 67 Nonsmoking restaurants have on average a 16 percent higher resale value. 68 Cigarettes are a major cause of residential fires and the leading cause of fatal residential fires. 40 Some insurance companies offer discounts on fire, life, liability, and property insurance to multi-unit housing complexes that have adopted smoke-free policies. 71

# SAmPLE imPLEmEnTATion guidE For ownErS And mAnAgEr
Adopting a smoke-free policy in new properties should be relatively straightforward becausemanagement can establish a smoke-free norm from the start.
1. Establish a 100 percent smoke-free policy in all buildings, including individual units and common areas.
2. Include smoke-free provisions in lease/rental agreements.
3. Prominently post "No smoking" signs at entrances, on bulletin boards, in stairwells, and in other locations.
4. Highlight the smoke-free policy as an amenity in listings, ads, and other promotions.
5. Continually remind managers, staff, and tenants about the smoke-free policy. Educate them about the reasons for the policy and what to do if they see a violation. Prepare sup porting evidence, FAQs, and other relevant information.
Adopting a smoke-free policy in existing properties may require more intensive planning and educa tion, and could involve a phased-in approach to provide a transition period for tenants who are accustomed to smoking in their units.
1. Decide on the policy's scope and provisions and on the timeline for implementing it. For example, will the policy apply to individual units as well as common areas, and will it apply to some or all buildings? Also explain how the policy will handle existing tenants who smoke in their units (e.g., they may be grandfathered in until their leases come up for renewal, and, then be required to comply). Use building meetings, notices, and signs to let tenants know that the smoke-free policy is coming. This process should begin several months before the policy's effective date. Use this opportunity to educate tenants on the dangers of SHS and the issue of SHS infiltration. Tell tenants when the policy will take effect and explain how it will be enforced. Ask tenants for ideas on how to implement the policy, but do not give them veto power over its provisions. If necessary, conduct a small survey to gauge tenant response to and readiness for the policy. During the policy phasein, consider clustering nonsmokers and smokers in separate buildings. Tenants who smoke can be offered incentives to move to these buildings.
2. Publicize available smoking-cessation services. Provide support and encouragement to smokers who choose to take this opportunity to quit. Make sure to identify SHS and SHS infiltration, not smokers, as the problem. Don't use language or take steps that could make smoking tenants feel stigmatized.
3. Prominently post "No smoking" signs.
4. Remove ashtrays or relocate them to more appropriate locations.
5. Send tenants a letter formally notifying them of the new policy. Require all residents to sign a statement that they agree to comply with the policy. Enforcement of the policy for current tenants can begin on renewal of the tenant/renter lease, updated with the new smoke-free policy addendum.
rEFErEncES For HyPErLinkS :