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

Background The United States implemented a federal smoke-free mandate across all public housing since 2018. This study explores residential satisfaction following implementation of the smoke-free policy by New York City Housing Authority (NYCHA). Methods We administered a cross-sectional survey in a randomly selected sample from NYCHA housing from February 2022 through May 2024. Data on demographics, smoking and secondhand smoke (SHS) exposure, housing quality, and residential satisfaction were collected through interview-guided questionnaires. A generalized linear mixed-effects model was used to examine factors associated with residential satisfaction. Results A total of 405 participants were included: 176 current smokers (113 exposed to SHS and 63 not exposed) and 229 non-smokers (164 exposed and 65 not exposed). 277 participants (68%) reported exposure to SHS from cigarettes, cigarillos, e-cigarettes, marijuana or nicotine vapes in the building. On a scale from 1 (dissatisfaction) to 4 (satisfaction), current smokers exposed to SHS reported the lowest satisfaction scores for both building (mean = 2.19) and apartment environment (mean = 2.44). Current smokers not exposed to SHS (mean = 2.51 for building and 2.63 for apartment) and non-smokers exposed to SHS (mean = 2.33 for building and 2.62 for apartment) had intermediate scores, while non-smokers not exposed to SHS reported the highest scores (2.71 for building satisfaction; 2.91 for apartment satisfaction). Smokers exposed to SHS reported the highest frequency of black mold (68%), lead hazard (59%), and strong odors (66%) compared to other groups. Lower residential satisfaction was independently associated with younger age, higher education, incomplete repairs and SHS exposure. Conclusions Despite smoke-free housing policy, SHS exposure remains prevalent in NYCHA housing and contributes to lower residential satisfaction, especially among current smokers. Strengthening smoke-free policy enforcement and improving housing quality provide crucial opportunities for enhancing residential satisfaction and promote health in public housing.