Skip directly to search Skip directly to A to Z list Skip directly to page options Skip directly to site content

Characteristics and Correlates of Cigarette Smoking Status Among US Adults Receiving Federal Housing Assistance

Teresa W. Wang, PhD, MS1,2; Veronica E. Helms, MPH3; Peter J. Ashley, DrPH4; Brian A. King, PhD, MPH1 (View author affiliations)

Suggested citation for this article: Wang TW, Helms VE, Ashley PJ, King BA. Characteristics and Correlates of Cigarette Smoking Status Among US Adults Receiving Federal Housing Assistance. Prev Chronic Dis 2018;15:170395. DOI: http://dx.doi.org/10.5888/pcd15.170395.

PEER REVIEWED

Abstract

This study describes patterns of cigarette smoking (current, former, never) by sociodemographic, household, and chronic disease characteristics and correlates among US adults receiving housing assistance from the US Department of Housing and Urban Development (HUD) during 2007–2012. Estimates were generated from 4,771 adults by using National Health Interview Survey and HUD-linked data. Overall, 48.4% of HUD-assisted adults were never smokers, 33.0% were current smokers, and 18.6% were former smokers; smoking status varied by sex, age, race/ethnicity, whether children were living in the household, and chronic disease status. These estimates could inform tobacco control interventions to improve the health and well-being of HUD-assisted residents.

Top

Objective

Assisted housing is an important platform for improving the health and well-being of residents through evidence-based tobacco control interventions (1). Nearly 10 million people, including 4 million children, receive housing assistance from the US Department of Housing and Urban Development (HUD); approximately 2 million of these people reside in public housing (2). Effective February 2017, HUD finalized a rule requiring all public housing agencies to prohibit the use of lit tobacco products in and around their properties within 18 months (3). To provide data for informing policy implementation, the objective of this study was to describe characteristics and correlates of cigarette smoking status (current, former, never) among HUD-assisted adults.

Top

Methods

The National Center for Health Statistics (NCHS) linked HUD administrative data to data from respondents of the National Health Interview Survey (NHIS), a cross-sectional household survey conducted by using multistage area probability design to capture a statistically representative sample of the civilian, noninstitutionalized US population (1,4). The NCHS Research Ethics Review Board approved the linkage of the data. During 2007–2012, 4,771 of 4,788 total linked respondents aged 18 or older completed the NHIS sample adult module, reported information about their smoking status, and resided in HUD-assisted rental housing (multifamily, housing choice voucher, or public housing) at the time of the NHIS interview.

Smoking status was assessed by asking, “Have you smoked at least 100 cigarettes in your entire life?” and “Do you now smoke cigarettes every day, some days, or not at all?” Current smokers reported smoking at least 100 lifetime cigarettes and now smoking every day or some days; former smokers reported smoking at least 100 lifetime cigarettes and now smoking not at all; never smokers reported not smoking at least 100 lifetime cigarettes.

Data were weighted to account for the complex survey design, and weights were adjusted for linkage eligibility by using a model-based calibration approach (4). The percentage distribution of HUD-assisted current, former, and never smokers was stratified by sex (male or female), age (18–44 y, 45–64 y, or ≥65 y), race/ethnicity (Hispanic, non-Hispanic white, non-Hispanic black, or other non-Hispanic racial/ethnic minority groups), presence of other people living in the household (yes or no), presence of children aged 17 years or younger living in the household (yes or no), and number of diagnosed chronic conditions (0, 1, or ≥2). Estimates from sample sizes less than 30 were suppressed. All potential pairwise comparisons were conducted for each demographic construct by using 2-sided t tests, with P < .05 indicating significance. For constructs with more than 2 comparisons (ie, age, race/ethnicity, chronic conditions), Bonferroni adjustments were implemented to account for multiple hypothesis testing.

Top

Results

During 2007–2012, 48.4% of HUD-assisted adults were never smokers, 33.0% were current smokers, and 18.6% were former smokers (Table 1). The percentage of never smokers was significantly higher among adults aged 18 to 44 (54.0%) or 65 years or older (49.9%) than among adults aged 45 to 64 (37.6%); women (51.1%) than men (41.0%); Hispanic adults (58.8%) and non-Hispanic black adults (54.6%) than non-Hispanic white adults (36.8%); those who did not live alone (51.5%) than those who lived alone (43.3%); and those who lived with at least 1 child (51.2%) than those who did not live with children (46.0%). The percentage of former smokers was significantly higher among adults aged 65 years or older (35.0%) than among the other 2 age groups; men (23.9%) than women (16.7%); non-Hispanic white adults (24.5%) than Hispanic adults (16.8%) or non-Hispanic black adults (13.6%); those who lived alone (26.9%) than those who did not live alone (13.5%); and those who did not live with children (24.2%) than those who lived with at least 1 child (12.0%). The percentage of current smokers was significantly higher among those aged 45 to 64 years (41.1%) than among the other 2 age groups; non-Hispanic white adults (38.7%) than non-Hispanic black adults (31.8%) and Hispanic adults (20.0%); those who did not live alone (35.0%) than among those who lived alone (29.9%); and those who lived with at least 1 child (36.8%) than among those who did not live with children (29.8%).

Smoking status also varied by the number of chronic conditions among HUD-assisted adults (Table 2). Overall, the percentage of never smokers was significantly higher among those without chronic conditions (59.6%) than among those with 1 chronic condition (49.1%) or 2 or more chronic conditions (39.2%). In contrast, the percentage of former smokers was higher among those with 2 or more chronic conditions (27.2%) than among those with 1 chronic condition (15.4%) or no chronic conditions (9.9%). After stratification by age, chronic disease status significantly differed by current, former, and never smokers aged 18 to 44 years and never smokers aged 65 or older.

Top

Discussion

Before release of the linked NHIS–HUD data, no data sources existed to provide national estimates of smoking status among HUD-assisted residents. This study complements a previous report on current smoking and health outcomes among HUD-assisted adults (1) by providing more nuanced data on smoking status among this population, most notably data on former and never smokers. During 2007–2012, nearly half of HUD-assisted residents were never smokers, while approximately one-fifth were former smokers. These data along with variations observed by sociodemographic, household, and chronic disease characteristics can help inform educational efforts and shifts in social norms that prevent the initiation of tobacco product use, promote cessation, and reduce the likelihood of relapse.

This study indicates that former and never smokers comprise the majority (67%) of HUD-assisted residents. These people are susceptible to secondhand smoke exposure in their homes; approximately one-third of multiunit housing residents who prohibit smoking in their personal living units experience secondhand smoke incursions from elsewhere in their building (5–7). These incursions are a public health concern because there is no risk-free level of second-hand smoke exposure (8). Moreover, smoking in multiunit housing imposes considerable financial costs. The implementation of smoke-free US-subsidized housing has been projected to yield annual cost savings of nearly $500 million from averted health care costs, reduced renovation costs in units where smoking has occurred, and reduced smoking-attributable fire losses (9).

Our study has limitations. First, approximately 60% of 2007–2012 NHIS adults were linkage eligible, which may introduce selection bias if those who were linkage-eligible differed from those who were not linkage-eligible. However, linkage-adjusted weights were used to account for differences between these groups by sex, age, and race/ethnicity (4). Second, all data were based on self-report. Third, these cross-sectional data did not capture data on smoking status for the same cohort as they aged. Finally, this analysis assumed that the composition of HUD-assisted adults has not significantly changed over time.

These data can help inform the development, implementation, and sustainment of evidence-based strategies (10), including smoke-free policies, to reduce the burden of tobacco use–related death and disease among HUD-assisted children and adults. Continued surveillance of smoking and health behaviors among populations living in HUD-assisted housing is important to further evaluate the impact and outcome of these strategies.

Top

Acknowledgments

The authors thank Dr Patricia Lloyd, PhD, National Center for Health Statistics for her valuable assistance with reviewing early drafts of the manuscript. This research was conducted via interagency collaboration and no funding was received. The authors have no financial disclosures or conflicts of interest to report. No copyrighted materials, surveys, instruments, or tools were used in this study. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Top

Author Information

Corresponding Author: Teresa W. Wang, PhD, MS, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy, MS F-79, Atlanta, GA 30341. Telephone: 404-498-1502. E-mail: yxn7@cdc.gov.

Author Affiliations: 1Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia. 2Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia. 3Office of Research, Evaluation, and Monitoring, Office of Policy Development and Research, US Department of Housing and Urban Development, Washington, DC. 4Office of Lead Hazard Control and Healthy Homes, US Department of Housing and Urban Development, Washington, DC.

Top

References

  1. Helms VE, King BA, Ashley PJ. Cigarette smoking and adverse health outcomes among adults receiving federal housing assistance. Prev Med 2017;99:171–7. CrossRef PubMed
  2. US Department of Housing and Urban Development. Picture of subsidized housing. https://www.huduser.gov/portal/datasets/picture/yearlydata.html. Published January 2016. Accessed May 1, 2017.
  3. Federal Register. US Department of Housing and Urban Development. Instituting smoke-free public housing. 81 FR 87430. December 5, 2016. www.federalregister.gov/documents/2016/12/05/2016-28986/instituting-smoke-freepublic-housing. Accessed February 6, 2017.
  4. Lloyd PC, Helms HV. NCHS-HUD linked data: analytic considerations and guidelines. Release date January 19, 2016. https://www.cdc.gov/nchs/data/datalinkage/nchs_hud_analytic_considerations.pdf. Accessed April 14, 2017.
  5. Nguyen KH, Gomez Y, Homa DM, King BA. Tobacco use, secondhand smoke, and smoke-free home rules in multiunit housing. Am J Prev Med 2016;51(5):682–92. CrossRef PubMed
  6. Licht AS, King BA, Travers MJ, Rivard C, Hyland AJ. Attitudes, experiences, and acceptance of smoke-free policies among US multiunit housing residents. Am J Public Health 2012;102(10):1868–71. CrossRef PubMed
  7. King BA, Babb SD, Tynan MA, Gerzoff RB. National and state estimates of secondhand smoke infiltration among U.S. multiunit housing residents. Nicotine Tob Res 2013;15(7):1316–21. CrossRef PubMed
  8. US Department of Health and Human Services. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta (GA): US Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2006. https://www.ncbi.nlm.nih.gov/books/NBK44324/pdf/Bookshelf_NBK44324.pdf. Accessed May 10, 2017.
  9. King BA, Peck RM, Babb SD. National and state cost savings associated with prohibiting smoking in subsidized and public housing in the United States. Prev Chronic Dis 2014;11(1):E171. PubMed
  10. Centers for Disease Control and Prevention. Best practices for comprehensive tobacco control programs — 2014. Atlanta (GA): US Department of Health and Human Services, CDC; 2014. http://www.cdc.gov/tobacco/stateandcommunity/best_practices/index.htm. Accessed May 10, 2017.

Top

Tables

Return to your place in the textTable 1. Cigarette Smoking Status Among HUD-Assisted Adults, by Sociodemographic and Housing Characteristics, NHIS-HUD Linked Data, 2007–2012
Characteristic Never Smokersa Former Smokersb Current Smokersc
n % (95% CI) n % (95% CI) n % (95% CI)
Overall 2,292 48.4 (46.0–50.8) 944 18.6 (17.1–20.2) 1,535 33.0 (30.8–35.3)
Sex
Male 417 41.0 (36.5–45.7) 309 23.9 (20.8–27.4) 398 35.1 (30.9–39.6)
Female 1,875 51.1 (48.6–53.6) 635 16.7 (15.1–18.4) 1,137 32.3 (29.9–34.8)
Age, y
18–44 1,183 54.0 (50.7–57.3) 204 10.2 (8.6–12.0) 773 35.8 (32.8–38.9)
45–64 546 37.6 (34.3–41.1) 315 21.3 (18.5–24.3) 588 41.1 (37.7–44.5)
≥65 563 49.9 (45.8–54.0) 425 35.0 (31.4–38.6) 174 15.1 (12.3–18.3)
Race/ethnicity
Hispanic 536 58.8 (54.6–62.8) 150 16.8 (13.8–20.0) 206 20.0 (20.7–28.6)
Non-Hispanic white 575 36.8 (33.1–40.6) 419 24.5 (21.7–27.6) 597 38.7 (34.9–42.6)
Non-Hispanic black 1,080 54.6 (51.7–57.6) 335 13.6 (11.9–15.4) 675 31.8 (29.0–34.7)
Non-Hispanic otherd 101 47.7 (31.3–64.5) 40 19.6 (13.0–27.7) 57 32.7 (21.3–45.9)
Presence of others in householde
Lives alone 977 43.3 (40.5–46.0) 631 26.9 (24.8–29.1) 659 29.9 (27.0–32.8)
Does not live alone 1,315 51.5 (48.2–54.8) 313 13.5 (11.7–15.5) 876 35.0 (32.1–37.9)
Living with childrene
≥1 Child aged 0–17 y 1,071 51.2 (47.6–54.7) 219 12.0 (9.9–14.4) 740 36.8 (33.6–40.1)
No children aged 0–17 y 1,221 46.0 (43.3–48.7) 725 24.2 (22.3–26.2) 795 29.8 (27.3–32.4)

Abbreviations: CI, confidence interval; HUD, US Department of Housing and Urban Development; NHIS, National Health Interview Survey.
a Participants were classified as never smokers if they responded no to the question, “Have you smoked at least 100 cigarettes in your entire life?” and “not at all” to the question, “Do you now smoke cigarettes every day, some days, or not at all?”
b Participants were classified as former smokers if they responded yes to the question, “Have you smoked at least 100 cigarettes in your entire life?” and responded with “not at all” to the question, “Do you now smoke cigarettes every day, some days or not at all?”
c Participants were classified as current smokers if they responded yes to the question, “Have you smoked at least 100 cigarettes in your entire life?” and responded with “every day,” or “some days” to the question, “Do you now smoke cigarettes every day, some days or not at all?”
d Includes non-Hispanic Asian and all other non-Hispanic racial groups.
e These data were collected in the NHIS family core module.

 

Return to your place in the textTable 2. Cigarette Smoking Status Among HUD-Assisted Adults, by Chronic Conditionsa and Age, NHIS-HUD Linked Data, 2007–2012
No. of Chronic Conditionsa Never Smokersb Former Smokersc Current Smokersd
n % (95% CI) n % (95% CI) n % (95% CI)
Overall
0 856 59.6 (55.9–63.3) 149 9.9 (8.1–11.9) 459 30.5 (27.2–34.0)
1 545 49.1 (44.9–53.3) 196 15.4 (12.9–18.3) 372 35.5 (31.4–39.7)
≥2 891 39.2 (36.2–42.3) 599 27.2 (24.5–29.9) 704 33.6 (30.7–36.6)
18–44 y
0 703 62.7 (58.7–66.5) 84 7.6 (5.7–10.0) 358 29.7 (26.2–33.4)
1 319 49.2 (43.5–55.0) 72 11.5 (8.3–15.2) 238 39.3 (34.0–44.9)
≥2 161 35.6 (28.3–43.6) 48 16.0 (7.0–29.4) 177 48.4 (40.8–56.0)
45–64 y
0 104 44.8 (36.0–53.8) 40 16.4 (11.3–22.6) 88 38.8 (30.4–47.7)
1 113 40.6 (33.7–47.8) 59 17.5 (12.5–23.5) 114 41.9 (35.0–49.1)
≥2 329 34.6 (30.4–39.1) 216 23.9 (19.9–28.3) 386 41.5 (37.3–45.8)
≥65 y
0 49 56.9 (42.9–70.0) 25 e 13 e
1 113 61.9 (53.1–70.1) 65 28.7 (21.5–36.7) 20 e
≥2 401 46.5 (42.1–51.0) 335 37.2 (33.1–41.3) 141 16.3 (13.0–20.2)

Abbreviations: CI, confidence interval; HUD, US Department of Housing and Urban Development; NHIS, National Health Interview Survey.
a Participants were identified as having a chronic condition if they reported in the survey that they had ever been told by a doctor or health care provider that they had hypertension, coronary heart disease, stroke, diabetes, cancer, arthritis, or hepatitis; had experienced weak or failing kidneys during the past 12 months; currently had asthma; or had chronic obstructive pulmonary disease (COPD). COPD was assessed using affirmative responses from 2 survey questions asking adults if they had ever had emphysema or had had chronic bronchitis in the past 12 months; adults who responded yes to either question were identified as having COPD. These data were collected in the sample adult questionnaire.
b Participants were classified as never smokers if they responded no to the question, “Have you smoked at least 100 cigarettes in your entire life?” and “not at all” to the question, “Do you now smoke cigarettes every day, some days, or not at all?”
c Participants were classified as former smokers if they responded yes to the question, “Have you smoked at least 100 cigarettes in your entire life?” and responded with “not at all” to the question, “Do you now smoke cigarettes every day, some days or not at all?”
d Participants were classified as current smokers if they responded yes to the question, “Have you smoked at least 100 cigarettes in your entire life?” and responded with “every day,” or “some days” to the question, “Do you now smoke cigarettes every day, some days or not at all?”
e Estimate suppressed as nominal sample size was less than 30.

Top


The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions.

TOP