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

• Published in: Nicotine & tobacco research Vol. 27; no. 9; p. 1566
• Main Authors: Anastasiou, Elle, Thorpe, Lorna E, Wyka, Katarzyna, Elbel, Brian, Shelley, Donna, Kaplan, Sue, Burke, Jonathan, Kim, Byoungjun, Newman, Jonathan, Titus, Andrea R
• Format: Journal Article
• Language: English
• Published: England 22.08.2025
• Subjects: Aged; Female; Hospitalization - statistics & numerical data; Humans; Male; Middle Aged; Myocardial Infarction - epidemiology; New York City - epidemiology; Poverty; Public Housing - legislation & jurisprudence; Public Housing - statistics & numerical data; Smoke-Free Policy - legislation & jurisprudence; Stroke - epidemiology; Tobacco Smoke Pollution - legislation & jurisprudence; Tobacco Smoke Pollution - prevention & control; New York City
• ISSN: 1469-994X
• DOI: 10.1093/ntr/ntaf046

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