LAUSR

The harms associated with smoking and the benefits of both quitting smoking and limiting exposure to secondhand smoke are clear, yet policies restricting tobacco use in homes are controversial.1,2 Based on the increased risk of involuntary exposure to secondhand smoke in multiunit housing, public health officials have advocated for the implementation of state laws that prohibit smoking in all multiunit housing as part of the visions laid out in Healthy People 2020 and Healthy People 2030.3,4 These goals reflect implicit and explicit ethical assessments that suggest the benefits of protecting nonsmokers from secondhand smoke outweigh the harms to smokers of requiring them to alter a chosen behavior. Still, despite the Healthy People 2020 goal published in 2010, as of February 5, 2022, only 67 municipalities in the United States have enacted smoke-free multiunit housing laws that apply to all private units,5 and no statewide policies have been put in place,6 indicating smoke-free housing rules are not universally prioritized and accepted. In 2017, the US Department of Housing and Urban Development (HUD) announced that all public housing authorities (PHAs) in the United States would be required to adopt smoke-free policies by July 2018.7 This rule applied to federally funded public housing (subsidized housing for low-income renters that is owned and operated by the PHAs) but not to market-rate or other subsidized housing, such as subsidized housing operated through public–private partnerships, voucher programs, or state-funded public housing.8 Although HUD’s smoke-free public housing policy is a step toward the Healthy People goal of universal smoke-free multiunit housing, it affects only a subset of multiunit housing. As a result, the benefits and inconveniences of smoke-free housing are not equitably distributed in the population, and this inequity demands interrogation of the current state of smoke-free policies in multiunit housing. Analyses of social justice and tobacco policies highlight how tobacco policies often disproportionately affect, both positively and negatively, vulnerable populations such as those with low income, poor mental health, substance use disorders, or other disabilities, because tobacco use is concentrated in these populations.9,10 HUD’s smoke-free public housing policy invites scrutiny because the only people affected by the policy are low-income people receiving a particular form of housing assistance. Racial and ethnic minority populations are also disproportionately affected; 48% of public housing households are non-Hispanic Black compared with 19% of renter households overall.11 We assess the extent to which reductions in harm and restrictions to autonomy differ in public housing compared with other types of multiunit housing to help evaluate whether limiting smoke-free policies to public housing is warranted. We will conclude that although the ethical implications of smokefree housing policies in public housing compared with other multiunit housing differ slightly, these differences are not substantial enough to warrant unequal distribution of smokefree policies. Thus, following HUD’s lead, other legislative and regulatory bodies should establish smoke-free multiunit housing rules that cover all multiunit housing.