Home, Sweet-Smelling Home

Vol. 21 • Issue 24 • Page 12

It’s the bane of many a non-smoking apartment dweller: that unmistakable whiff of cigarettes leaching up from the unit below.

“I’ve had some renters ask me if cigarette smoke can really flow from unit to unit,” said Jim Bergman, JD, co-director of the Center for Social Gerontology, Ann Arbor, Mich. “I say to them, cook with curry some night.”

Bergman’s group is leading a crusade made all the more significant in these perilous financial times as many former homeowners return to apartment living: the smoke-free housing movement. Apartment renters, especially the elderly and those with respiratory problems, deserve to live in homes free of toxic nicotine fumes, public health advocates say.

“In Michigan in 2004, it was virtually impossible to find smoke-free apartment buildings anywhere,” Bergman said. “Today, there are literally hundreds of thousands of smoke-free apartment units across this state. In 2004, no public housing authorities in Michigan had smoke-free policies. Today, 27 have them. They oversee between 3,500 and 4,000 smoke-free public housing units.”

Nationally, 95 public housing authorities offer smoke-free housing units, he said, along with another 15,000 smoke-free Section 8 housing units.

“It’s gaining a lot of momentum,” said Colleen Hermann-Franzen, smokefree housing manager for the American Lung Association of Oregon. At the upcoming Smoke-Free California conference, half of the lectures “will be dedicated to smoke-free housing topics,” she noted.

Financially Beneficial

About six years ago “we began receiving increasing calls from individuals who complained about tobacco smoke infiltrating their apartments or condos,” Bergman explained.

But what could he tell them? Filing a lawsuit against a landlord is iffy, not to mention costly and slow-moving. And legislators would never forbid a person to smoke in his own “castle.” Eventually, Bergman and other anti-tobacco activists hit on a winning strategy: approach landlords themselves.

First, they convinced landlords it is within their legal right to ban smoking on their properties. So long as a smoking ban is not discriminatory, that is, it doesn’t target a protected class or minority, it is legal.

Second, they convinced apartment owners of the economic benefits to be gained from going smoke-free. A 2006 survey of renters in the Portland/Vancouver area found that 75 percent wanted smoke-free rental properties and that more than half would be willing to pay more for them, Hermann-Franzen explained.

What’s more, landlords can spend an extra $500 to $10,000 cleansing a unit of the nicotine residue left behind by one or more smokers who lived there. “They not only rip up the carpeting, but often they must take up floor tiles in the kitchen where tar has infiltrated,” Bergman said. “Apartment owners may have to wash walls down three times, using increasingly toxic products, and paint them twice. With materials and labor, it’s easy to see how it can add up.

“Folks will say they’re doing it for health reasons,” he said. “But the reality is, running housing is a business. This is an economic decision.”

Enforcement Tips

For landlords wanting more information on going smoke-free, the ALA of Oregon is only too happy to oblige.

The ALA has created a Web site for renters and landlords (www.smokefreehousingnw.com) and released a guide to no-smoking properties that takes landlords through every step of the process.

Landlords should put up smoke-free building and property signs (also available through the ALA) and perform regular inspections around their properties, Hermann-Franzen advised.

She listed these tips to help landlords implement their smoke-free policies:

“Treat this rule like any other rule you enforce,” Hermann-Franzen said. “Say a landlord has a no-pets policy. Follow the same steps with a smoker as you would with a tenant walking a dog on the property.”

Also, make sure the smoking ban is written into the lease agreement. “If a tenant breaks the rule, the landlord would simply refer them back to the lease,” she said.

Hermann-Franzen has another key message for landlords: It’s not about the person; it’s about the behavior. “Smokers can still live on site,” she said. “They just must take their smoking behavior elsewhere.”

No smoke-free policy has ever been reversed, nor has a single legal challenge come up against them, Bergman said.

Smoke-free condos and smoke-free real estate are next in the ALA’s sights; however, those policies will be “trickier,” Hermann-Franzen acknowledged. Condo associations can include no-smoking policies in their covenants and restrictions or pass a new rule on it “but 75 percent of condo owners in the development must approve it,” she said.

Michael Gibbons, senior associate editor, can be reached at [email protected].

‘Biting Into the Whole Bird’

Earlier this year, New York became the first state to ban smoking at all state-accredited drug and alcohol addiction recovery centers.

The move has split public health advocates down the middle, since it’s well-known that drug addicts have much higher smoking rates than the general public.

Some cheer the move, citing a 2004 study in the Journal of Consulting and Clinical Psychology that found smoking cessation during addiction treatment gave addicts a 25 percent better chance of maintaining long-term abstinence from alcohol and drugs.

Critics, however, say many addicts rely on cigarettes to help them through treatment to kick other, more immediately dangerous drugs like heroin or crack cocaine. “This policy is saying that if someone wants to quit heroin but is not ready to give up cigs, well, sorry, but you can’t get treatment,” Tony Newman, of the Drug Policy Alliance, told Newsweek.

The argument that addicts who otherwise would enter rehab will stay away if they can’t smoke “I find a little specious,” Jim Bergman, JD, co-director for the Center for Social Gerontology, told ADVANCE. “We all like crutches. No question about it. But I think if a person is ready totake the step to get off illegal drugs, that’s pretty huge all by itself. My guess is they are probably also prepared to deal with cigarettes. You might as well try to fight them all at once. If you’re going cold turkey, try to bite into the whole bird.”

-Michael Gibbons

Smoking Cessation: Update from CHEST Conference

Smoking cessation experts must face a disquieting truth: All the low-hanging fruit’s been picked.

More than 40 years after the U.S. Surgeon General first warned about the dangers of cigarettes, most moderate smokers intending to quit-social smokers-have managed to do so. Going forward, the vast majority of smokers asking their doctors how to quit will be of the hardcore variety, those with a true physical addiction who light up within a half-hour of getting out of bed in the morning.

So concludes a study presented at the recent conference of the American College of Chest Physicians.

Researchers administered a sophisticated questionnaire to more than 600 smokers undergoing treatment for nicotine addiction. Their results suggest that nearly 75 percent of smokers currently undergoing smoking cessation treatment are severely nicotine dependent.

Treating hardcore smokers requires fluency in the latest cessation tools and strategies. Unfortunately, most physicians sorely lack this training, two prominent experts declared at CHEST ’08.

“This is a paradoxical time,” said David Sachs, MD, a clinician who for 25 years has weaned-or tried to-20,000 nicotine addicts. “It’s the best of times because never have physicians had more effective tools to treat tobacco dependence. It’s the worst of times because few know how to use them.”

Little Training

Most physicians (87 percent) receive fewer than five hours of training on tobacco dependence and fewer than 6 percent know the Agency for Healthcare Research and Quality treatment guidelines for tobacco dependence, said Virginia Reichert, NP.

She queried 600 health care providers on tobacco control issues while at the North Shore-LIJ Health System Center for Tobacco Control, Great Neck, N.Y., and was less than impressed with the scope of their knowledge of the issue. “I knew they wouldn’t know much about the symptoms of withdrawal, but I was shocked they didn’t know the prevalence,” she said. “I was getting surveys that said 75 percent of the public smokes, or 2 percent. It was all over the map.”

Since 70 percent of smokers report a desire to quit and 30 percent are more likely to quit with assistance from a health care provider, it’s a pity more doctors don’t know the basics, Reichert said.

“Physicians are very good at advising patients to quit, but they don’t know enough,” she said. “If you don’t know a nicotine patch is over-the-counter, how are you going to help these people?”

Withdrawal Symptoms

The higher the nicotine dependence score, the more severe the withdrawal symptoms if they try to quit cold turkey, explained Sachs, of the Palo Alto Center for Pulmonary Disease Prevention, Palo Alto, Calif.

Withdrawal symptoms include dizziness, depression, constipation and weight gain, to name a few, noted Reichert, who said about 30 percent of smokers make at least one quit attempt per year.

Females exhibit more withdrawal symptoms than males, and their symptoms can continue up to eight weeks after quitting, added Mary Anne McCaffree, MD, a pediatrician for the Oklahoma State Department of Health.

Typical nicotine replacement therapy for women includes a 21 mg patch plus a 14 mg patch and nicotine gum, Reichert said. But these tools take 20 minutes to deliver nicotine to the brain’s thalamus section, she said, as opposed to a cigarette, a remarkable delivery device that does the job in just seven seconds-one more obstacle in the way of successful quitting.

-Michael Gibbons