Kicking the Habit One Community at a Time: Going Smoke-Free Takes a Concerted Effort

By Diane Sears

Turning a whole apartment community into a tobacco-free zone is not a simple task. Like the personal battle of kicking the smoking habit, it takes determination, dedication, and sometimes a bit of outside help.

In Florida, that assistance comes from the Florida Department of Health, which has placed advocates of the smoke-free lifestyle all over the state. As champions of Tobacco Free Florida, they educate managers of multifamily and public housing communities about the dangers of secondhand smoke, helping guide them toward banning the use of tobacco products on their property. They also conduct educational sessions for residents to help them make the transition to smoke-free — in their apartment homes, initially, and sometimes even in their lives.

One of those is Susan Jenkins, the tobacco policy coordinator in Pinellas County, which covers St. Petersburg and surrounding areas. "I feel so strongly about the mission of Tobacco Free Florida," she says. "It’s helping children and adults and saving lives."

Jenkins often cites statistics that make people raise their eyebrows. One of her favorites is this: A full 82.4 percent of Florida residents do not smoke. "We’re not talking about a small majority," she says. "That’s important because it helps us understand how many people are being adversely affected by secondhand smoke. It’s also important to know the trend as it’s going, that more and more people are smoking less, and more and more are complaining about secondhand smoke. ... This is serious. There is no risk-free level of exposure to secondhand smoke. We need to wake up and realize that secondhand smoke is deadly."

Her region receives more complaints about secondhand smoke than any other parts of the state, Jenkins says. That means people take time to pick up the phone or log into their computers and file their displeasure to the Health Department either locally or at its headquarters or through the Florida Clean Indoor Air Act (FCIAA) office in Tallahassee. She has seen complaints go up substantially even in the two years she’s been in her position. Jenkins sees complaints as "golden." Not only do they identify individuals who need help, but they open the door for a conversation with the decision-maker — whether it be the owner or the regional property manager.

The term secondhand smoke has been around for decades, but people today are becoming more educated about its effects on nonsmokers. "It used to be that nonsmokers would complain about how secondhand smoke made them nauseous and gave them headaches," Jenkins says. "Now people are aware it can cause disease, disability, and death."

Jenkins and her coworkers throughout the state have a cure for that. They are contacting property managers to share information and persuade them to convert their communities to smoke-free. More and more are receptive as their complaints regarding secondhand smoke increase. In fact, the newer properties come on the market as smoke-free. But some property owners are still nervous about offending longtime residents who have been allowed to smoke inside their homes for years. Those are the tougher cases.

Start with the ‘Why’

Jenkins has a procedure she uses to approach the issue. It works something like this:  

1. Schedule an initial meeting. She requests a meeting with the property manager — or, in some cases, a decision-maker on a higher level, like the person who oversees a whole collection of apartment communities. She also contacts decision-makers based on complaints. Jenkins frequently takes a tobacco cessation specialist from the Area Health Education Center (AHEC) with her to meetings with management. "I’m very fortunate to work closely with AHEC here in Pinellas. We each have a different focus, but our close relationship and teamwork has had wonderful results."
2. Start with the "why." During the meetings, both with management and later with the residents, she cites all the reasons it makes sense for the community to go smoke-free. Those include the facts and statistics she likes to gather.
3. Hold a town hall-type forum. After sharing the "why" with management, they share information with residents about why the community will go smoke-free, when it will happen, and what community rules will be instituted around the new policy. This is when some of the smokers complain and criticize. Jenkins answers their concerns and restates the facts (the "why"). It’s cathartic and important that they get it out, she says. "You’d be surprised how many are angry at first and then they come up afterward and sign up for a class and even apologize. I always emphasize that this is not about the smoker, but about the smoke." Jenkins typically recommends communities schedule the transition for three months or six months out and give people time to adjust and attend cessation classes if they choose.
4. Help residents quit smoking. At the town hall meetings, residents can ask questions and smokers can sign up for free classes to help them quit. AHEC often conducts the classes right on the premises so residents don’t have to leave their community. The cessation classes are free, and residents can receive complimentary nicotine gum, patches, and lozenges.
5. Follow up. Jenkins and her colleagues stay in touch with the community managers to be sure they feel supported during and after the transition. "It’s a partnership, and we continue to follow up in any way we can to assist their community," Jenkins says. "I love to hear the feedback from the residents too. Many have suffered for years from secondhand smoke, prior to going smoke-free. They are so grateful!" 

"It makes sense to go smoke-free," Jenkins says. "When you explain it to people, it gives them a better understanding. They understand the property management or the public housing authority is doing this for sound, common-sense reasons. It’s about the safety, health, and welfare of not only the residents but the employees as well."

She recalls one community meeting where the room was packed with residents, including five smokers who were very opposed to the proposed change. She gave the "whys" and at the end, one of the smokers stood up and said, "You know, I’ve listened to this and I’m going to keep on smoking, but what she says makes sense. It’s not fair for a few people to hurt other people with their smoking. I’m going to keep smoking, but I’m going to go off-property to do it."

Sell policy change

Donna Noel Stayton is one of Tobacco Free Florida’s champions in South Florida. At the Florida Department of Health’s Office in Monroe County, she turns to a scientific behavioral change model, Stages of Change, to persuade property managers to go smoke-free. According to the U.S. Centers for Disease Control, health policy is one of the 10 essential public health services.

"I’m very methodical about the way I do it," Stayton says. "I am a sales person. I might as well have a black briefcase that has my wares in it. I am selling policy change. ... It’s really important to me. I am an ex-smoker. I quit in 1986. I know it’s really hard. And my dad was a lifelong smoker who passed away way too young from emphysema."

Stayton, who has been with the Department of Health for 10 years, has created her own procedures for working with communities to go smoke-free. It looks like this:  

1. Relationship development. She visits property managers to see what their needs are and how she can help them from a health promotion standpoint — oh, and by the way, she tells them, here are some brochures about smoke-free housing. She tries to get a sense of how they feel about the topic and follows up on a regular basis.
2. Properties considering policy. The community might be receiving complaints from nonsmoking residents about their smoking neighbors, or about people smoking at the pool or in other common areas. The managers don’t know what to do, so Stayton begins coaching them. She advises them to do a survey to assess the residents to find out what they really think. She also suggests setting up an AHEC cessation class to get folks starting down the road to quitting.
3. Properties going smoke-free. Managers who want to implement a smoke-free program often are intimidated by the process, so Stayton will provide them with assistance for success. Her tools include a sample lease (such as the FAA lease), presentations, access to cessation classes, and educational materials for the residents.
4. Implementation. Once the policy is implemented, it is important to ensure success. Stayton will provide press releases and media, signage, and continued access to cessation classes and educational programs that will bring awareness to the policy not only at the property, but in the community.
5. Maintenance of the policy. The community supports the effort by writing about it in its newsletter, working out the finer points of enforcing the new rules, and scheduling smoking cessation classes. Stayton follows up periodically to ensure success. 

Like her colleagues, she works with public housing as well as privately owned and subsidized communities. One particularly challenging case involved a community of 50 apartment homes for people with HIV, AIDS, and other disabilities. The community’s board of directors was hesitant to impose strict rules and take smoking away from people who were so sick. But that was exactly the point, Stayton said. She did some digging and found phrasing in their funding that said the community was obligated to provide its residents with clean air. That did the trick, and the community went smoke-free with a clean conscience.

But her passion is protecting children from the dangers of smoking and secondhand smoke. Like Jenkins, Stayton also has some favorite statistics she cites when she’s working to persuade communities to go smoke-free. These come from the Florida Youth Tobacco Survey:

• In 2008, when Monroe County first started its anti-smoking efforts, 19 percent of high school youths said they had smoked on one or more of the past 30 days. In 2014, that number was 8.7 percent.
• In 2012, 21.4 percent of high school students said they had tried cigarettes. In 2016, that number was 12.7 percent.
• In 2012, 6.1 percent said they were current smokers. In 2016, that number was 3 percent.
• In 2008, 61.4 percent said they had been exposed to secondhand smoke in the past seven days. In 2014, that number was 47.1 percent.
• In 2008, 13.5 percent said smoking was allowed in their homes. In 2014, that number was 8.7 percent. 

"I’m interested in youth prevention," she says. "It’s important for children not to see this as normal. We need to get rid of secondhand smoke and be better role models for kids. When I see kids in their early teens smoking, I think, ‘Oh, you’re going to spend the rest of your life trying to quit. It’s going to be such a struggle.’ I don’t want that for them."

Tout the Amenity

With the growing interest in smoke-free housing, health department workers say communities should treat it as an amenity. Advertise the property as smoke-free, and celebrate it as a healthy community. One community in south St. Petersburg hung a sign at its gate that said it was proud to be a smoke-free community.

"We share that when an apartment is going smoke-free, it’s a positive," Jenkins says. "It’s an amenity.

"Generally what happens is when a facility goes smoke-free, it’s more positive than people anticipate," she says. "Sometimes they think it’s going to be hard. One facility said that to me, and they were shocked how positively it was accepted."

To help communities market their smoke-free amenity, FAA offers a certification that includes an acrylic display piece for the leasing office or clubhouse, window decals, logos for print and online marketing materials, and listing in FAA communications and on the FAA website. As of March 2017, about 40 communities are FAA Smoke-Free Certified. For more information, visit faahq.org/smoke-free-housing or email smokefree@faahq.org.