Evaluation of Federally Mandated Smoke-Free Housing Policy and Health Outcomes Among Adults Over the Age of 50 in Low-Income, Public Housing in New York City, 2015-2022

Introduction Effective July 2018, the U.S. Department of Housing and Urban Development issued a rule requiring all public housing authorities to implement smoke-free housing (SFH) policies in their developments. We examined the differential impacts of SFH policy on hospitalizations for myocardial infarction (MI) and stroke among adults aged >= 50 years old living in New York City (NYC) Housing Authority (NYCHA) versus a matched-comparison population in NYC. Aims and Methods We identified census block groups (CBGs) comprised solely of 100% NYCHA units (N = 160) and compared NYCHA CBGs to a selected subset of CBGs from all CBGs with no NYCHA units (N = 5646). We employed propensity score matching on distributions of key CBG-level sociodemographic and housing covariates. We constructed incident rates per 1000 persons by aggregating 3-month "quarterly" counts of New York State all-payer hospitalization data from October 2015 to December 2022 and dividing by the population aged >= 50 in selected CBGs, ascertained from 2016 American Community Survey 5-year estimates. We selected a difference-in-differences (DID) analytic approach to examine pre- and post-policy differences in incident hospitalizations between the intervention and matched-comparison groups. Results Matching results indicated a balanced match for all covariates, with standardized mean differences <0.10. In DID analyses, we observed small declines in both MI (DID = -0.26, p = .02) and stroke (DID = -0.28, p = .06) hospitalization rates for NYCHA CBGs compared to non-NYCHA CBGs from pre-to post-54 months' policy. Conclusions SFH policies in NYC were associated with small reductions in CVD-related hospitalizations among older adults living in housing subject to the policy. Implications Housing remains a key focal setting for interventions to reduce SHS exposure and associated morbidities. Ongoing monitoring is warranted to understand the long-term impacts of SFH policies in public housing developments.