A Qualitative Analysis of Resident Experiences with Smoke-Free Policies in North Carolina and Georgia Multiunit Housing Open Access

Ivy, Michelle (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/gb19f583j?locale=en


Second-hand smoke (SHS) exposure is a serious problem for millions of people in the United States. Studies have shown that smoke-free policies in low-income housing can not only reduce SHS exposure to non-smokers but can also reduce smoking in low-income individuals. However, there is limited literature surrounding low-income housing residents’ participation and experiences with implementation of smoke-free policies. Additionally, the Consolidated Framework for Implementation Research has never been used to investigate smoke-free policy adoption and implementation in multiunit housing (MUH).

Qualitative resident interviews with twenty-three residents asked about their personal experiences with the smoke-free policy initial decision-making process, implementation, enforcement, and organizational and community context. Thematic analysis was utilized to organize the relevant responses residents of public housing agencies (PHA) and privately-owned affordable housing properties provided in regard to their experiences with smoke-free policy implementation and enforcement.

The study found that the majority of residents did not have a problem with the policy, regardless of smoking status. When residents were asked about their concerns and opinions toward smoke-free policy implementation and impact they answered by providing concerns about the enforcement process, providing smoking cessation programing, and security. The residents felt the policy was favorable because it aided in the reduction or stopping of smoking in smokers, children not being exposed to smoking as a model at home, and all residents were able to breathe easier inside their homes. Residents stated that they were involved in the implementation of the policy by asking questions and coming up with their own reasons why they should support the policy. Most of the residents stated that they believed the policy was being put into place for multiple reasons such as resident health concerns, cleanliness, and safety. This study asked about residential culture and the perceived role it plays in policy implementation. Regardless of the community’s culture, close or distant, all residents felt that the culture of their community affected policy implementation, enforcement, and support.

Most of the CFIR related resident responses fell into the constructs: Networks & Communications, Culture, Implementation Climate, Learning Climate, and Engaging. The CFIR constructs highlight specific things that PHAs and MUH management should take into account when they implement a policy. By asking residents to describe aspects of the implementation process, this study was able to get a better idea about how residents of low-income housing may react to the implementation and enforcement of a smoke-free policy.

Table of Contents

Chapter I. Introduction and Review of Literature... 1

Problem Definition... 1

Burden of Secondhand Smoke Exposure... 2

Those Effected... 3

Smoke-free Policies... 4

Low-income Multiunit Housing... 4

Smoke-free Policies in MUH... 5

US Department of Urban Housing and Development Smoke-free Policy... 8

Landlord Concerns... 10

Resident Factors Influencing Preference for Smoke-free Policies... 11

Resident Implementation Experiences... 13

Gaps in Literature... 13

Qualitative Research... 14

The Consolidated Framework for Implementation Research... 15

CFIR Utilization in Prevention Oriented Interventions... 19

Limitations of CFIR... 20

CFIR Usage in Tobacco Studies... 22

Summary... 23

Formal Statement of Problem... 24

Purpose... 25

Research Questions... 25


Chapter II. Methodology... 26

Study Participants... 27

Types of Public and Affordable Housing... 27

Recruitment... 27

Research Design and Procedures... 28

Description of Data Collection... 31

Participant Pretection... 31

Data Analysis... 32

Summary... 33


Chapter III. Results... 35

Description of Participants... 35

Resident Interview Results... 37

Personal Opinions About Policy Adoption... 37

Opinions of Other Residents About Policy Adoption... 38

Resident Concerns About Policy Implementation... 39

General Opinions Toward Smoke-free Policy Impact... 41

Reasons for Smoke-free Policy Adoption... 43

Lease Renewal... 44

Community Culture... 45

CFIR Constructs... 48

Networks & Communications... 48

Culture... 49

Learning Climate... 49

Implementation Culture... 50

Access to Knowledge and Information... 50    

Engaging... 51

Summary... 52


Chapter IV. Discussion... 54

Findings... 54

Conclusions... 60

Strengths and Limitations... 62

Implecations... 64


References... 66


Appendices... 77

Appendix A: Recruitment Form... 78

Appendix B: Institutional Review Board Exemption... 80

Appendix C: Interview Guide... 82

Appendix D: Informed Consent Form... 91

Appendix E: Cross-Walk... 94

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