Yerger, Valerie B

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UC Office of the PresidentRecent WorkTitleEvaluating the Implementation Process of a Citywide Smokefree Multiunit Housing Ordinance: Insights from Community StakeholdersPermalinkhttps://escholarship.org/uc/item/68m3900kJournalAmerican Journal of Public Health, 104(10)AuthorYerger, Valerie BPublication Date2014-08-14 Peer reviewedeScholarship.org Powered by the California Digital LibraryUniversity of CaliforniaEvaluating theImplementation Processof a Citywide Smoke-FreeMultiunit HousingOrdinance: Insights fromCommunity StakeholdersValerie B. Yerger, ND, Robynn S. Battle, EdD,MPH, and Roland S. Moore, PhDWe evaluated the implementationprocess of Richmond, California’scitywide smoke-free multiunit hous-ing ordinance. We conducted semi-structured focus groups withmultiunit housing tenants, owners,and managers. Residents understoodthe harms of secondhand smoke butlacked accurate information about theordinance and questioned its enforce-ability. They shared concerns that thecity lacked cessation resources forsmokers wishing to quit because ofthe ordinance. To increase compli-ance with the ordinance, tenants,owners, andmanagers need accurateinformation. (Am J Public Health.2014;104:1889–1891. doi:10.2105/AJPH.2014.302075)Implementing smoke-free multiunit hous-ing (MUH) policies is the most effective wayto protect MUH residents from secondhandsmoke exposure.1,2 We have discussedhow MUH tenants, owners, and managersview the implementation of Richmond,California’s citywide smoke-free MUHordinance and potential barriers to itsequitable implementation across the city’sdiverse neighborhoods.The majority (78%) of Richmond’s 106 516residents are ethnic minorities; 38% ofRichmond’s population live in MUH resi-dences.3,4 In 2009, Richmond passed anordinance to prohibit the smoking of anytobacco product or marijuana in residentialdwellings containing 2 or more units; it wasfully implemented in 2011.5METHODSDuring the first year of this 3-year (from2011 to 2014) project, we conducted 7hour-long focus groups among 50 partici-pants who were MUH tenants, owners, ormanagers to assess knowledge of the imple-mentation of Richmond’s smoke-free MUHordinance and to elicit suggestions for im-proving community understanding and ac-ceptance of the ordinance. We compensatedparticipants $40. Table 1 presents focusgroup demographics.We checked focus group transcripts foraccuracy and uploaded them into NVivo9 tofacilitate data management and analysis.6 Wegenerated an a priori codebook predicated onthe overarching research questions and topicsoutlined in the focus group guide. Our quali-tative content analysis identified specific topicsor themes in the transcript data.7RESULTSContent analysis of focus group data identi-fied recurring themes that we grouped as eitherpreimplementation or postimplementation(Table 2).PreimplementationParticipants disclosing the most accurateknowledge of the ordinance were morelikely to live in homeowner association com-munities or in subsidized housing. Landlords,apartment managers, and homeowner associ-ations often communicated with MUH resi-dents via newsletters or community meetings.Although they were in favor of the ordinance,several participants felt the implementationhappened too quickly and did not allowresidents time to figure out how they wouldquit smoking.There were concerns about notifying resi-dents about the ordinance; similarly, severalparticipants, smoker and nonsmoker alike,felt that such a simple yet rigorous ordinancerequired time if compliance was expected.Several participants, in particular smokers,voiced their concern about the strong addictivenature of smoking, noting the importanceof helping individuals who wanted to quit.In general, tenants felt management wasinformed about the ordinance. Additionally,most resident participants with leases men-tioned signing an addendum or completinga new lease in which the clause about theRichmond MUH ordinance was visible. Resi-dent compliance with the ordinance when allwas in place for people to observe the compo-nents of the ordinance was challenging for bothresidents and management.The smoke-free MUH ordinance is codifiedas a nuisance law; thus one must be caught inthe act of smoking in a protected area of anMUH to be cited by a Regulatory Unit officer.Such a stipulation gives rise to challenges inenforcing the ordinance, a sentiment that mostparticipants held. Although many were unsureof the enforceability, they were resigned tocomplying with the ordinance.TABLE 1—Participant Demographics:Focus Groups on Smoke-Free MultiunitHousing (MUH) Ordinance; Richmond,CA; 2011–2014CharacteristicFocus Group (n = 50),No. or RangeParticipantResident of federalhousing19Resident of affordablehousing6Resident of private MUH 7Resident of community-based organization12Owner or manager 6GenderWoman 34Man 16Age, y 32–79Ethnicity/raceAsian 7African American/Black 22American Indian 2Hispanic 6White 11Other 2Smoking statusCurrent smoker 14Former smoker 19Nonsmoker 17RESEARCH AND PRACTICEOctober 2014, Vol 104, No. 10 | American Journal of Public Health Yerger et al. | Peer Reviewed | Research and Practice | 1889The topic of marijuana smoking inside MUHunits stimulated heated discussions, with sev-eral participants, particularly those living insubsidized housing, noting they were moreagitated by marijuana smoke than by tobaccosmoke. However, the marijuana provision ofthe ordinance may have a disproportionateburden on disabled and low-income residentsliving in subsidized housing who smoke mari-juana for medical purposes.PostimplementationOverall, focus group results suggested thatseveral of the participants felt that their man-agement group, landlord, or homeowners as-sociation was attempting to comply with theordinance’s designated smoking area. One prob-lem, however, proved to be the need to identifydesignated smoking areas that were convenientlylocated for smoking residents. This problem wasmore common among residents from public orsubsidized housing located in areas with highcrime and illegal drug activity.Overall, even with the challenges related todissemination of information and with theimplementation and enforcement of the ordi-nance, focus group participants felt that theordinance was having some intended effects.Perceived effectiveness translated to how resi-dents, landlords, management companies,and law enforcement tried best to implementand comply with the ordinance.DISCUSSIONRichmond MUH residents, regardless ofwhether they lived in subsidized, public housingor privately owned MUH homes, favored theordinance. Our analysis suggests that providingaccurate information about the ordinance toresidents, involving residents in decisions relatedto designated smoking areas, and directinginterested smokers to cessation resources arecrucial to successful implementation.Because smoke-free policies in MUH com-prise a growing area of interest in tobaccocontrol, it is important to understand howcommunity residents and other stakeholdersadopt and carry out these policies. jAbout the AuthorsValerie B. Yerger is with the Department of Social andBehavioral Sciences, School of Nursing, University ofCalifornia, San Francisco. Robynn S. Battle and RolandS. Moore are with the Prevention Research Center, PacificInstitute for Research and Evaluation, Oakland, CA.Correspondence should be sent to Valerie Yerger, Box0612, University of California, San Francisco, San Fran-cisco, CA 94143-0612 (e-mail: valerie.yerger@ucsf.edu).Reprints can be ordered at http://www.ajph.org by clickingthe “Reprints” link.This article was accepted May 2, 2014.ContributorsV. B. Yerger wrote the first draft of the article. V. B. Yergerand R. S. Battle collected data from the focus groups.TABLE 2—Themes and Illustrative Quotes: Focus Groups on Smoke-Free Multiunit Housing (MUH)Ordinance; Richmond, California; 2011–2014Theme Illustrative QuotesPreimplementationPreparation of residents I really wish there was more support as far as our stress, because they’re stressing us out now, with this ordinance . . . the way they went aboutit was just all wrong . . . whatever we’re stressing about before, now we’ve got a little more. (MUH tenant, African American woman)At least have some type of forum, some type of discussion, some type of something—opposed to you waking up and you’re on your way to workand they’ve got something slapped on your door saying, “If I catch you smoking, you’re getting out.” (MUH tenant, African American woman)Sensitivity to needs of smokers whomight wish to quitDon’t get me wrong, I love my kids more than I love myself. . . . I would never ever see no harm come to them. But as I explained to my18-year-old, these cigarettes go way back before you, and it’s not personal, and I don’t mean to hurt you, I don’t mean to offend you, but prayfor me. (MUH tenant, African American woman)I think that before they begin the penalty phase of this ordinance, there should’ve been some type of help phase . . . we all need some kindof help. It’s just like you didn’t come out walking. You had to learn how to walk. You got to learn how to stop smoking. (MUH tenant, AfricanAmerican woman)Enforceability concerns I don’t think [landlords are enforcing this ordinance]. Not yet. Because [we] are not telling the office, “Oh, yeah, my neighbor issmoking.” . . . [Not until we] start being more concerned about letting them know who does and doesn’t [smoke]. (MUH tenant, Latina)When you have a law that can’t be enforced, then it just tells people that laws are not important. . . . I think it’s harmful to have a law thatcan’t be enforced and yet have the law. (MUH owner, White man)Have a sign posted up on each area . . . put a fine there [on the sign]. I know somebody’s going to quit smoking in front of the house, anywherethere’s a fine. I don’t want to smoke there. (tenant, Laotian man)Concerns about marijuana smoke The doctor is saying that they have a prescription. . . . Then when the police came, they said you have to buy this $600 vaporizer . . . who has$600 for that? If you’re on medical marijuana, that means that you’re getting Section 8, that means you’re on disability, so you don’t havemoney for all this. (MUH tenant, African American woman)PostimplementationIssues with designated smoking areas What the low-income housing thing is, these areas . . . the police call them hot spots. The same areas where they want you . . . to go outsidein the blazing dark, running from raccoons and stray bullets. . . . So, if I’m out there smoking . . . and some dude just happens to comeby . . . and shoot me, now I done got shot following the ordinance. . . . So, how is that helping my children now? (MUH tenant, AfricanAmerican woman)Perceived effectiveness of ordinance I’m on a second floor, and the people downstairs and one over [me] who are smokers have been complying with [the ordinance]. Absolutely.(MUH owner, White woman)RESEARCH AND PRACTICE1890 | Research and Practice | Peer Reviewed | Yerger et al. American Journal of Public Health | October 2014, Vol 104, No. 10V. B. Yerger and R. S. Moore reviewed all transcripts andcoded data categories. R. S. Battle coded data. R. S. Battleand R. S. Moore collected the interview data. All authorsconceptualized the study, refined and contextualized theanalysis, revised all drafts of the article, and approvedthe final draft.AcknowledgmentsSupport for this study was provided by the CaliforniaTobacco-Related Disease Research Program (grants20CA-0105 and 20CA-0105H).We acknowledge Julie M. Waters for providing entréeinto the Richmond bureaucracy and neighborhoodcouncils and for helping with recruitment, data collection,and data entry. We also acknowledge Phoenix Jackson,a recipient of the Cornelius Hopper Diversity Award, forkeeping our project visible on social media. We thankthe members of our community advisory panel: IrmaAnderson, Texanita Bluitt, Cecilia Jauregui, J. G. Larochette,La Trena Robinson, and Vilai Sengpraseuth.Human Participant ProtectionThis study was approved by the institutional reviewboards of the University of California, San Francisco, andthe Pacific Institute for Research and Evaluation. Partic-ipants provided informed written consent before studyparticipation.References1. King BA, Travers MJ, Cummings KM, Mahoney MC,Hyland AJ. Secondhand smoke transfer in multiunithousing. Nicotine Tob Res. 2010;12(11):1133---1141.2. Levy DE, Rigotti NA, Winickoff JP. Tobacco smokeexposure in a sample of Boston public housing residents.Am J Prev Med. 2013;44(1):63---66.3. 2005---2007 American Community Survey (ACS)3-Year Estimates. Suitland, MD: US Census Bureau;2008.4. City of Richmond. City facts. 2009. Available at:http://www.ci.richmond.ca.us/DocumentCenter/Home/View/301. Accessed July 7, 2014.5. City of Richmond, California. Richmond municipalcode. Available at: https://library.municode.com/index.aspx?clientId=16579&stateId=5&stateName=California.Accessed July 7, 2014.6. QSR International. NVivo 9.0 [computer program].Burlington, MA; 2010.7. Hsieh HF, Shannon SE. Three approaches to qual-itative content analysis. Qual Health Res. 2005;15(9):1277---1288.RESEARCH AND PRACTICEOctober 2014, Vol 104, No. 10 | American Journal of Public Health Yerger et al. | Peer Reviewed | Research and Practice | 1891

Evaluating the Implementation Process of a Citywide Smokefree Multiunit Housing Ordinance: Insights from Community Stakeholders

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