Residential satisfaction amid the smoke-free policy in New York City public housing

Background

Tobacco use remains a critical public health concern, contributing to over 480,000 deaths annually in the United States and affecting 16 million individuals with smoking-related illnesses (1). In public housing specifically, smoking rates are disproportionately higher than in the general population (2–4). Residents of multiunit housing, particularly public housing, face increased risks of secondhand smoke (SHS) exposure (5, 6). Smoke can infiltrate individual units from neighboring apartments and shared areas due to inadequate ventilation systems and the close proximity of units (7, 8). This issue is further exacerbated by social vulnerabilities among public housing residents, including low-income status, racial and ethnic minority backgrounds, and lower levels of educational attainment (9). As a result, public housing residents face an elevated risk of chronic diseases, including cancers, coronary artery disease, stroke, and severe respiratory problems associated with smoking and SHS exposure (3).

In 2016, the U.S. Department of Housing and Urban Development (HUD) issued a rule requiring all public housing agencies to comply with a smoke-free policy within 18 months of the effective date (10). Specially, this regulation mandates that housing authorities prohibit the use of tobacco products—including cigarettes, cigars, or pipes, in all living units and indoor common areas in public housing, as well as all outdoor areas within 25 feet of public housing. This mandate provided an opportunity to introduce innovative smoking cessation services to help public housing authorities comply with HUD initiatives (11–13). Several studies have examined theoretical support for multiunit housing smoke-free policies, demonstrating that smoking bans can be effective but are influenced by a complex set of challenges, including enforcement issues and numerous barriers to cessation programs (14–17). The lack of strict enforcement may cause nonsmoking residents frustration and resentment, potentially leading to a decrease in housing satisfaction (18, 19). However, there is limited research on residential satisfaction following the full implementation of the smoke-free policy in public housing.

Residential satisfaction is a critical metric in evaluating housing policies, as it reflects residents’ perceptions of their living environment, quality of life, and overall well-being (20). Factors influencing residential satisfaction include safety, housing conditions, neighborhood environment, social cohesion, and governance, all of which may be impacted by the implementation and enforcement of smoke-free policies (21, 22). Previous research has shown that both smoking and nonsmoking residents who experience high SHS exposure often report dissatisfaction with their housing conditions (23–25), which can lead to reduced trust in housing authorities and decreased overall well-being, including lower resident satisfaction, reduced compliance with housing policies, and decreased engagement in the community. Conversely, well-enforced smoke-free policies have the potential to improve air quality, health outcomes, and overall housing satisfaction (24).

The New York City Housing Authority (NYCHA) is the largest public housing provider in the U.S., housing more than 500,000 people across 302 developments spanning over 2,200 buildings citywide (26). NYCHA residents have reported higher smoking prevalence (4) and greater SHS exposure from a source outside of their apartments compared to the general New York City population before the implementation of smoke-free policy in 2018 (27). Additionally, NYCHA housing developments are located in areas with some of the highest number of tobacco retail outlets in NYC (28). As of August 2018, NYCHA implemented the smoke-free policy (29), requiring compliance with NYC Local Law 2017/147, which enforces smoke-free policies across public housing. Despite the smoke free policy's implementation, concerns remain about its enforcement, resident adherence, and overall impact on the residential experience.

To explore NYCHA housing satisfaction in the context of the recent smoke-free policy, this study surveyed over 400 residents from NYCHA developments in the Bronx and Manhattan. This survey was part of the baseline assessment for a randomized controlled trial aimed at enhancing smoking cessation and improving compliance with the smoke-free policy in public housing (30). This study aims to provide insights into resident perceptions and experiences with the policy, highlighting the complexities of residential satisfaction in relation to smoking and SHS exposure in public housing. It provides a more comprehensive understanding of how the smoke-free policy affects all residents, including both residents who smoke and those who do not smoke and reveals the broader context of housing conditions, including home maintenance needs, that may undermine the policy and impact the resident experience.

Materials and methods

Buildings and participants

As part of a larger randomized controlled trial to support smoke-free policy compliance in public housing funded by the National Cancer Institute of the National Institutes of Health (30), we conducted baseline surveys from February 2022 through May 2024 of all the participants recruited in the trial.

Sampling

The sampling involved a two-stage enrollment process, including both building and resident levels, as previously described (30). NYCHA oversees 328 developments, including 178,000 apartments across more than 2,000 buildings (26). For feasibility, this study was conducted in the boroughs of Manhattan and the Bronx which include a total of 93,012 current dwelling apartments from 159 developments. Eligible buildings were randomly selected to be randomized for an intervention assignment from these 159 NYCHA sites based on the following criteria: 1) having more than 50 units, 2) not undergoing major renovations. The eligible buildings were randomly sorted by borough. Upon randomization, resident leaders were informed of the study and invited to participate on a rolling basis. If they declined or were unable to be reached, the building was removed from the pool of eligible buildings and the next one on the list was contacted and following the same procedure until we reached our targeted number of buildings in each borough.

The second stage of enrollment was at the resident level. We enrolled participants at sites only after receiving resident approval. NYCHA residents were recruited to participate through door-to-door knocking and lobby interceptions over a two-year period until the targeted number per group meeting the enrollment criteria at the resident level was reached. Criteria at the resident level included: 1) be able and willing to provide verbal informed consent, 2) be at least 18 years old, 3) be able to communicate in English or Spanish, 4) residing in the building at least 5 days per week and 9 months per year, and 5) not planning to move from the building in the next 2 years. This study initially aimed to enroll four current smokers and four non-smokers from each building. However, a greater number of non-smokers agreed to participate. As a result, a total of 405 participants were enrolled, including 176 current smokers and 229 non-smokers. Figure 1 illustrates the study flow diagram, including development, building and participant selections and inclusion in the final analysis.

Survey

The questionnaire was developed using prior iterations from a previous research study and supplemented with questions from standardized national surveys on health and tobacco (24). To facilitate participation from Spanish-speaking residents, a Spanish version was developed through a process of forward translation from English by a bilingual team member, and then independently reviewed by another bilingual researcher to ensure semantic and conceptual equivalence. Any discrepancies were discussed and resolved by consensus. To collect data, Research Assistants went to participant homes and/or conducted the surveys over the phone to ensure responses were collected efficiently. The survey included screening questions to determine residents’ smoking status. Current smoking was defined as reporting, at the time of recruitment, currently smoking a tobacco product, such as cigarettes, cigarillo, e-cigarettes, or other nicotine vaping products, marijuana, hash grass, pot or weed, or hookah. Non-smoking was defined as reporting not currently smoke any combusted tobacco products. To assess SHS exposure in the building, participants were asked whether they had experienced exposure to cigarettes, cigarillo, marijuana, or nicotine vape smoke from other people's units or common areas in the past 12 months.

The primary outcome of interest for this study was participants’ responses to the questions about housing quality and residential satisfaction with building and apartment conditions. Housing quality was assessed through questions about physical conditions and housing hazards, such as the presence of cockroaches, mice or rats, black mold, and lead hazards. Residential satisfaction was defined as participants’ overall satisfaction with their building and apartment environments. Building satisfaction captured perceptions of shared structural, environmental, and management-related conditions, including neighborhood safety, common areas, NYCHA management, and building maintenance. Apartment satisfaction referred to the individual residential unit occupied by the participant and encompassed indoor temperature, ventilation and overall satisfaction with the home. The outcome variables were overall building or apartment satisfaction scores, calculated as continuous variables based on the average responses to seven building-related and four apartment-related satisfaction questions. Satisfaction responses were assigned numerically as follows: “1” for “Very dissatisfied”, “2” for “Dissatisfied”, “3” for “Satisfied”, and “4” for “Very satisfied”, with higher scores indicating greater satisfaction. Detailed descriptions of the specific survey questions (Supplementary Material S1) and response distributions are provided in Table 1.

Table 1. The statements and options of questions related to housing quality and residential satisfaction in this study.

Statistical analysis

Data analyses started with descriptive analysis, assessing frequencies of demographic factors, housing quality characteristics, and individual residential satisfaction variables, including building or apartment satisfaction (Table 1). Next, Chi-square test was used to examine the associations between housing quality characteristics, residential satisfaction, smoking status, and SHS exposure. Because some expected cell counts were small, p-values were obtained using Monte Carlo simulation with 10,000 replicates. Internal consistency of the building and apartment satisfaction scales was assessed using Cronbach's alpha. The 7-item building satisfaction scale included items on building quality, common areas, outdoor space, NYCHA management, building upkeep, building safety, and neighborhood safety, while the 4-item apartment satisfaction scale included items on overall apartment quality, winter temperature, summer temperature, and ventilation. A Cronbach's alpha value of 0.70 or higher was considered acceptable. The distribution of overall building or home satisfaction scores within each group was assessed using the Shapiro–Wilk test. As the scores were not normally distributed, differences across groups were evaluated using the Kruskal–Wallis test. Post hoc pairwise comparisons were conducted using Dunn's test with Bonferroni correction to adjust for multiple comparisons. A generalized linear mixed-effects model was then applied to explore factors associated with building and apartment satisfaction, accounting for sampling clustered within the building level. Potential predictors included age (continuous), gender, housing repair status, education level, smoking behavior and SHS exposure, selected based on previous literature and the availability of relevant data in our study. All data were analyzed using R version 4.3.2. The lme4 package was used to fit the generalized linear mixed-effect model (31).

Results

Demographic characteristics

This study included 405 households, with 211 from 16 developments in Manhattan and 194 from 14 developments in the Bronx. One participant was selected from each household. The median age of participants was 49 years, with 70% identifying as female. In terms of race and ethnicity, 51% identified as Latino, and 41% as Black non-Latino. Among the participants who reported their monthly income, 73% reported earning $2,000 or less per month. Additionally, 35% were employed, while 17% were unable to work due to a disability. Overall, 176 participants (43%) reported currently smoking, while 229 (57%) reported not currently smoking. Notably, 277 participants (68%) reported exposure to SHS from cigarettes, cigarillos, e-cigarettes, marijuana or nicotine vapes in the building. When combining smoking status and SHS exposure, 113 participants were current smokers reporting SHS exposure, 63 participants were current smokers without SHS exposure, 164 participants were non-smokers reporting SHS exposure, and 65 participants were non-smokers without SHS exposure. For further details, see Table 2.

Table 2. Characteristics of participants in the survey.

Housing quality

Housing quality encompasses apartment physical repairs and housing hazards, such as the presence of cockroaches, mice, rats, black mold, lead hazards, as well as strong odors from cleaning products, garbage, or cooking originating from other units or common areas in the building. Of the 380 responses to this question, only 16% reported their apartment did not need repairs, while 64% reported incomplete repairs—with a significantly higher proportion of incomplete repairs among current smokers compared to nonsmokers (70% vs. 60%). In the 12 months prior to the assessment, 76% of participants reported seeing cockroaches, 22% observed dead or live mice or rats, and around 50% experienced black mold, lead hazards or strong odors. Stratifications by smoking behavior and SHS exposure revealed that housing conditions were better among those who reported not currently smoking and no SHS exposure. Current smokers exposed to SHS reported the highest incidence of black mold (68%), lead hazard (59%), and strong odors (69%) (Table 3).

Table 3. Residential satisfaction by smoking status and secondhand smoke exposure (SHS).

Pearson's Chi-squared test.

Residential satisfaction

Residential satisfaction pertains to satisfaction with the conditions of both the building and apartment unit. The building satisfaction scale demonstrated excellent internal consistency (α = 0.88, 95% CI: 0.86–0.90), and the apartment satisfaction scale demonstrated acceptable internal consistency (α = 0.70, 95% CI: 0.64–0.74). These results indicate that the items were reliable and showed good internal consistency.

About half of the participants reported being dissatisfied or very dissatisfied with the building environment, with the lowest ratings directed at NYCHA management. Smokers, in particular, expressed significantly greater dissatisfaction with NYCHA management and neighborhood safety compared to nonsmokers (p < 0.05). When further stratified by SHS exposure, both smokers and nonsmokers exposed to SHS reported lower satisfaction across all measures compared to their counterparts who were not exposed (Table 4).

Table 4. Building satisfaction by smoking status and secondhand smoke exposure (SHS).

Pearson's Chi-squared test.

More than one-third of residents reported being dissatisfied or very dissatisfied with the condition of their apartment including indoor temperature and ventilation. As shown in Table 5, satisfaction varied by smoking status and SHS exposure, with smokers exposed to SHS showing the highest rates of dissatisfaction with their apartment conditions and ventilation. Figure 1 presents a summary of the results on residential satisfaction.

Table 5. Apartment satisfaction by smoking status and secondhand smoke exposure (SHS).

P-values were obstained using Pearson's Chi-squared test,with Monte Carlo simulation (10,000 replicates).

Factors related to overall building and apartment satisfaction

The score of residents’ satisfaction was calculated based on seven questions about the building environment and four questions about the apartment environment, with scores ranging from 1 (least dissatisfied) to 4 (very satisfied). As shown in Table 6, the average scores were 2.38 for the building level and 2.62 at the apartment scale. The smokers exposed to SHS reported the lowest satisfaction score for both their building (mean = 2.19) and apartment environment (mean = 2.44). Nonsmokers not exposed to secondhand smoke (SHS) reported the highest satisfaction for both building (mean = 2.71) and apartment (mean = 2.91). Pairwise comparisons showed no significant differences in either building or apartment satisfaction between smokers and nonsmokers when exposed to SHS. These results are presented in Figure 2.

Table 6. Building or apartment satisfaction score by smoking status and secondhand smoke exposure (SHS).

P values from Kruskal–Wallis rank sum test were used to assess the differences in satisfaction scores across the four smoking and SHS exposure groups.

A generalized linear mixed effect model was used to examine factors associated with satisfaction with the building and apartment environment, accounting for random intercepts for building level. Home condition, age, education, smoking status and SHS exposure were significantly and independently correlated with satisfaction scores for either the building or the apartment. Older age was significantly associated with higher apartment satisfaction (β = 0.004, P = 0.02), but not with building satisfaction. Residents who reported incomplete home repairs had significantly lower satisfaction scores for both building (β = −0.41, P < 0.001) and apartment conditions (β = −0.32, P < 0.001), compared to those whose homes did not require repairs. Higher educational attainment was also significantly associated with lower building satisfaction, although the effect was small. Specially, participants with a high school diploma or GED (β = −0.30, P < 0.001) or at least some college education (β = −0.23, P = 0.01) reported lower satisfaction compared to those with less than a high school education; however, education was not significantly associated with apartment satisfaction. In terms of smoking and SHS exposure, compared to non-smokers not exposed to SHS both non-smokers exposed to SHS (building: β = −0.31, P < 0.001; apartment: β = −0.25, P = 0.01) and smokers exposed to SHS (building: β = −0.40, P < 0.001; apartment: β = −0.38, P < 0.001) reported significantly lower satisfaction. Current smokers not exposed to SHS did not differ significantly in satisfaction levels from non-smokers not exposed to SHS. We also conducted additional GLMM analyses to examine the separate effects of smoking and SHS exposure. The results indicate that SHS exposure is significantly associated with lower satisfaction scores for both building and apartment levels. Smoking status was also associated with lower satisfaction, reaching statistical significance only for apartment satisfaction (β = −0.14, P = 0.02). In contrast, gender, race and ethinicity were not significantly associated with residential satisfaction in this study. Details see Table 7.

Table 7. Generalized linear model of the factors associated with residential satisfaction.

Bold values indicate statistical significance at p < 0.05.

Discussion

Based on the results of this study, the residents who reported current smoking and exposure to SHS experienced the most severe housing hazards and reported the lowest satisfaction, compared to the residents reporting non-smoking and no SHS exposure. Lower residential satisfaction was independently associated with younger age, higher education, incomplete repairs and SHS exposure in NYCHA housing.

A 2020 report from the Community Service Society found that 60% of NYCHA residents reported serious problems with heating, leaks, mold, and the need for major repairs (32). We found poor housing quality, including incomplete repairs, ventilation, and pest infestations contributed to widespread resident dissatisfaction. In this study, 70% of smokers reported unresolved repairs in their units, and 53% reported exposure to black mold or lead, highlighting a disproportionate burden on smoking households. This finding suggests that smokers in public housing may be doubly disadvantaged—facing both poor living conditions (33) and heightened health risks from personal smoking behavior and SHS exposure, which exacerbates dissatisfaction with living environments. The co-occurrence of these disadvantages could also be related to more upstream factors, including economic challenges and psychosocial aspects. The compounding effect of these challenges may reinforce existing disparities between public housing residents and other city residents (34). Smoking and SHS exposure not only harm health but can also contribute to a perception of neglect and dissatisfaction with housing conditions (23). Residents reporting higher exposure to secondhand smoke also reported lower satisfaction with building and apartment conditions, consistent with prior findings, without implying attitudes toward the smoke-free policy, as posited by the smokefree social contract theory (35). Among smokers, the accumulation of negative experiences, such as SHS exposure, lead hazards, and poor housing conditions, impedes compliance and results in limited individual and group-level motivation to improve conditions. It creates a vicious circle, where these challenges reinforce one another, making it difficult to break the pattern without a substantial, coordinated intervention. When residents perceive that housing management does not maintain expected standards of service or are neglecting maintenance responsibilities they may feel less obligated to comply with policies, including smoke-free regulation (36). This may come in the form of smoking in prohibited locations, and/or not reporting instances of smoking. We also found both smokers and nonsmokers exposed to SHS reported lower satisfaction compared to those not exposed (37). Public housing residents, particularly nonsmokers, face a disproportionate burden of involuntary SHS exposure (38). Reducing SHS exposure is essential not only for improving health outcomes but also for enhancing residential satisfaction (39).

According to the principle of the social contract theory (35), one strategy to enhance compliance may be to invest in apartment repairs and maintenance as crucial roles in shaping residential satisfaction and well-being (40–42). Additionally, this commitment should include stronger enforcement and improved management practices within NYCHA to promote healthier and more satisfactory living conditions. Our study found a general consensus on dissatisfaction with NYCHA management, yet residents whose apartment repairs were completed reported similar satisfaction levels to those living in apartments that did not require repairs. This finding underscores the importance of robust policy enforcement, improved housing maintenance, and enhanced management practices to foster a healthier and more satisfactory living environment in NYCHA and other public housing (43, 44).

This study provides a comprehensive analysis of housing satisfaction among NYCHA residents. It benefits from a large, randomly selected sample from two boroughs in New York City, enhancing the generalizability of findings. Both smokers and nonsmokers are included, with stratified analyses conducted to provide a more nuanced understanding of how the smoke-free policy affects all residents. Research assistants connected in-person, at-home with every participant to complete the surveys, allowing for a deeper exploration of residents’ experiences, perceptions, and challenges related to the smoke-free policy and residential satisfaction.

Several limitations should be considered. First, the cross-sectional design limits our ability to draw causal inferences between the smoke-free policy, personal smoking behavior, SHS exposure, and residential satisfaction. Although we observed associations between poor housing quality and non-compliance with the smoke-free policy, these relationships may be bidirectional and cannot be interpreted as causal due to the cross-sectional design. Secondly, the 12-month recall period for SHS exposure may have introduced recall bias. However, our ongoing RCT includes follow-up assessments, which will allow us to evaluate the impact of the smoke-free policy and proposed intervention on cessation, SHS exposure, and residential satisfaction in future analysis (30). Thirdly, we selected only public housing buildings with more than 50 units that did not experience major renovations. Expanding the sample to include a wider range of buildings could provide a more comprehensive perspective on housing satisfaction and policy compliance. Fourthly, this study relied on survey items that were supplemented with questions from standardized national health and tobacco instruments. The measures did not capture several important architectural and environmental features—such as floor level, building orientation, window characteristics, shading, and facility-related factors—that may also influence housing and building satisfaction. We were limited to the items available in the parent survey. Future research incorporating a more comprehensive set of environmental and architectural attributes is warranted. Additionally, our study population was drawn exclusively from NYCHA housing, with more than 90% identifying as Lationa or Black, and nearly half not reporting their income. The absence of more varied socioeconomic groups limits the generalizability of our findings and precludes direct comparisons across both racial/ethnic and income levels. Future studies should examine residential satisfaction and SHS exposure across socioeconomically diverse housing settings to better understand how smoke-free policies are perceived and experienced in different populations.

Conclusion

This study underscores ongoing challenges in the implementation and enforcement of smoke-free policies in public housing, as evidenced by the high prevalence of SHS exposure reported by residents living in NYCHA housing designated as smoke-free. Despite the policy being in effect, residents reported continued SHS exposure, indicating noncompliance and enforcement barriers that may compromise residential satisfaction. Strengthening smoke-free policy enforcement and addressing housing quality provide crucial opportunities for improving residential satisfaction in public housing.

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Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fenvh.2026.1697920/full#supplementary-material

Supplementary material Supplementary material at the source

Supplementary material Supplementary material at the source

Footnotes

Edited by: Lutchmie Narine, Syracuse University, United States

Reviewed by: Jiangtao Du, University of Liverpool, United Kingdom

Lina Ang, National University of Singapore, Singapore