Comment Clustering.ipynb

{
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   "cell_type": "code",
   "execution_count": 1,
   "metadata": {
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   "source": [
    "def get_document_text(raw_text):\n",
    "    \"\"\" This function takes in raw document text as input which we receive from the API and returns a clean text \n",
    "    of the associated document. It cleans up any HTML code in the text, newline characters, and extracts supplemental\n",
    "    information part of the document.\n",
    "    \n",
    "    INPUT: string\n",
    "    OUTPUT: string\n",
    "    \"\"\"\n",
    "    raw_text = raw_text.replace('\\n',' ')\n",
    "    raw_text = raw_text.replace('*','') # added\n",
    "    raw_text = raw_text.replace('\\r',' ') # added\n",
    "    supp_info_idx = raw_text.find(\"SUPPLEMENTARY INFORMATION:\")\n",
    "    summary_idx = raw_text.find(\"SUMMARY:\")\n",
    "    dates_idx = supp_info_idx = raw_text.find(\"DATES:\")\n",
    "    suppl_info = raw_text[supp_info_idx+26:] # To leave out the string 'Supplementary Information'\n",
    "    summary = raw_text[summary_idx:dates_idx]\n",
    "    # Remove any residual HTML tags in text\n",
    "    cleanr = re.compile('<.*?>')\n",
    "    cleantext = re.sub(cleanr, '', suppl_info)\n",
    "    cleansummary = re.sub(cleanr, '', summary)\n",
    "    return cleantext, cleansummary\n",
    "\n",
    "def get_keywords(clean_corpus):\n",
    "    \"\"\" This function takes in a clean corpus as input and extracts most important keywords and top 10% of relevant \n",
    "    sentences from the text.\n",
    "    \n",
    "    INPUT: string\n",
    "    OUTPUT: List of tuples: [(list_of_keywords,list_of_sentences)]\n",
    "    \"\"\"\n",
    "    \n",
    "    tagged_tokens = tag_my_text(tokenize_text_sent(clean_corpus))\n",
    "    grand_list = get_top_np(noun_phrase_finder(tagged_tokens))\n",
    "    \n",
    "    return grand_list\n",
    "\n",
    "def tokenize_text(corpus):\n",
    "    pattern = r'''(?x)    # set flag to allow verbose regexps\n",
    "    (([A-Z]\\.)+)       # abbreviations, e.g. B.C.\n",
    "    |(\\w+([-']\\w+)*)       # words with optional internal hyphens e.g. after-ages or author's\n",
    "    '''\n",
    "    tokens = nltk.regexp_tokenize(corpus,pattern)\n",
    "    all_token = [word.lower() for token in tokens for word in token if word != \"\" \n",
    "                 and word[0] != \"'\" and word[0] != \"-\"]\n",
    "    return all_token\n",
    "\n",
    "def tokenize_text_sent(corpus):\n",
    "    sent_tokenizer = nltk.data.load('tokenizers/punkt/english.pickle')\n",
    "    raw_sents = sent_tokenizer.tokenize(corpus) # Split text into sentences    \n",
    "    return [tokenize_text(sent) for sent in raw_sents]\n",
    "\n",
    "def tag_my_text(sents):\n",
    "    return [nltk.pos_tag(sent) for sent in sents]\n",
    "\n",
    "#Chunk noun phrases in tree \n",
    "def noun_phrase_chunker():\n",
    "    grammar = r\"\"\"\n",
    "    NP: {<DT|PP\\$>?<JJ>*<NN>}   # chunk determiner/possessive, adjectives and noun\n",
    "    \"\"\"\n",
    "    cp = nltk.RegexpParser(grammar)\n",
    "    return cp\n",
    "\n",
    "#Extract only the NP marked phrases from the parse tree, that is the chunk we defined\n",
    "def noun_phrase_extractor(sentences, chunker):\n",
    "    res = []\n",
    "    for sent in sentences:\n",
    "        tree = chunker.parse(sent)\n",
    "        for subtree in tree.subtrees():\n",
    "            if subtree.label() == 'NP' : \n",
    "                res.append(subtree[0:len(subtree)])\n",
    "                #res.append(subtree[0])\n",
    "                #print(subtree)\n",
    "    return res\n",
    "\n",
    "def noun_phrase_finder(tagged_text):\n",
    "    all_proper_noun = noun_phrase_extractor(tagged_text,noun_phrase_chunker()) \n",
    "    #does not literally mean proper noun. Chunker only extracts common noun\n",
    "    noun_phrase_list = []                                                      \n",
    "    #noun_phrase_string_list =[]\n",
    "    for noun_phrase in all_proper_noun:\n",
    "        if len(noun_phrase) > 0: #this means where the size of the phrase is greater than 1\n",
    "            small_list =[]\n",
    "            for (word,tag) in noun_phrase:\n",
    "                small_list.append(word)\n",
    "            noun_phrase_list.append(small_list)\n",
    "            #noun_phrase_string_list.append(' '.join(small_list))\n",
    "    return noun_phrase_list\n",
    "\n",
    "#get frequency dist of different length in all the noun phrases extracted. \n",
    "#Something of the form {1:45,2:23} - how many 1phrased and 2 phrased chunks I have etc.\n",
    "def get_length_np(nounPhrase):\n",
    "    np_length={}\n",
    "    for inner_np in nounPhrase:\n",
    "        np_length[len(inner_np)] = np_length.get(len(inner_np),0) + 1\n",
    "    return np_length\n",
    "\n",
    "#get freq dist obj for noun phrase of different lengths\n",
    "def find_freq(nested_list,nest_len):\n",
    "    #from nltk.probability import FreqDist\n",
    "    fdist_list =[]\n",
    "    for inner_np in nested_list:\n",
    "        if len(inner_np) == nest_len:\n",
    "            fdist_list.append(' '.join(inner_np))\n",
    "    fdist = FreqDist(fdist_list)\n",
    "    return fdist\n",
    "\n",
    "#make a grand list of top occuring noun phrases of different sizes\n",
    "def get_top_np(np):\n",
    "    master_common_list=[]\n",
    "    len_list =get_length_np(np).keys()\n",
    "    for item in len_list:\n",
    "        fdist_np = find_freq(np,item)\n",
    "        top = fdist_np.most_common(15) \n",
    "        top_list = []\n",
    "        for w,c in top:\n",
    "            if c >= 1: # changed to 1 from 10\n",
    "#                 print (w)\n",
    "                top_list.append((w,c))\n",
    "                #top.remove((w,c))\n",
    "        if len(top_list) > 0:\n",
    "            master_common_list.append(top_list)\n",
    "    return master_common_list"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 3,
   "metadata": {
    "collapsed": true
   },
   "outputs": [],
   "source": [
    "def get_top_sents(corpus,keywords_list):\n",
    "    sentence_list = get_sentences(corpus)\n",
    "    indexed_sents = sentence_indexing(sentence_list) # This is so that we can re-order most relevant sentences later\n",
    "    \n",
    "    sentence_length_scores = get_sentence_lengths(sentence_list)\n",
    "    keyphrase_scores = get_keyphrase_scores(corpus,sentence_list, keywords_list)\n",
    "    \n",
    "    sent_scores = [s+c for s,c in zip(sentence_length_scores,keyphrase_scores)]\n",
    "    idx_sent_scores = [(s,c) for s,c in zip(indexed_sents,sent_scores)]\n",
    "    sorted_sents = sorted(idx_sent_scores,key=lambda sent: sent[1],reverse=True)\n",
    "    \n",
    "    # Keep top 10% of the sentences, or top 10 whichever is less\n",
    "    top_10 = int(len(sorted_sents) * 0.1)\n",
    "    if top_10 > 10:\n",
    "        top_10 = 10\n",
    "    x = sorted_sents[:top_10]\n",
    "    top_list = [item[0] for item in x]\n",
    "    sorted_top_list = sorted(top_list,key=lambda sent:sent[1],reverse=False)\n",
    "    sorted_top_list = [sent[0] for sent in sorted_top_list]\n",
    "    \n",
    "    return sorted_top_list\n",
    "    \n",
    "def get_sentences(corpus):\n",
    "    # First, tokenize the corpus into sentences\n",
    "    sent_tokenizer = nltk.data.load('tokenizers/punkt/english.pickle')\n",
    "    raw_sents = sent_tokenizer.tokenize(corpus)\n",
    "    \n",
    "    return raw_sents\n",
    "\n",
    "def sentence_indexing(sent_list):\n",
    "    indexed_sents = []\n",
    "    for idx,sent in enumerate(sent_list):\n",
    "        indexed_sents.append((sent,idx))\n",
    "    return indexed_sents    \n",
    "\n",
    "def get_sentence_lengths(sent_list):\n",
    "    sent_length = []\n",
    "    for s in sent_list:\n",
    "        sent_length.append(len(s.split(' ')))\n",
    "    \n",
    "    return sent_length\n",
    "\n",
    "def get_keyphrase_scores(corpus,sent_list, keywords):\n",
    "    #keywords = get_keywords(corpus) # This gives us a list containing unigrams at index 0 and bigrams at index 1,etc\n",
    "    \n",
    "    unigrams = [item[0] for item in keywords[0]]\n",
    "    bigrams = [item[0] for item in keywords[1]]\n",
    "\n",
    "    unigram_scores = get_unigram_scores(unigrams,sent_list)\n",
    "    bigram_scores = get_bigram_scores(bigrams,sent_list)\n",
    "\n",
    "    sent_feature_import = [a+b for a,b in zip(unigram_scores,bigram_scores)]\n",
    "    \n",
    "    return sent_feature_import\n",
    "\n",
    "def get_unigram_scores(unigram_list,sent_list):\n",
    "    occurence_list = []\n",
    "    for s in sent_list:\n",
    "        words = s.split(' ')\n",
    "        occurence_count = 0\n",
    "        for w in words:\n",
    "            if w.lower() in unigram_list or w.lower() in ['complaint','concern','documented','evidence','warn']:\n",
    "                occurence_count += 1\n",
    "        occurence_list.append(occurence_count)\n",
    "        \n",
    "    return occurence_list\n",
    "\n",
    "def get_bigram_scores(bigram_list,sent_list):\n",
    "    occurence_list = []\n",
    "    for s in sent_list:\n",
    "        # create bigrams\n",
    "        token=nltk.word_tokenize(s)\n",
    "        bigram_phrases = ngrams(token,2)\n",
    "        occurence_count = 0\n",
    "        for w in bigram_phrases:\n",
    "            w = [word.lower() for word in w]\n",
    "            if ' '.join(w) in bigram_list:\n",
    "                occurence_count += 1\n",
    "        occurence_list.append(occurence_count)\n",
    "        \n",
    "    return occurence_list"
   ]
  },
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   "cell_type": "code",
   "execution_count": 4,
   "metadata": {
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   "outputs": [],
   "source": [
    "def extract_summary(text):\n",
    "    clean_text, clean_summary = get_document_text(text)\n",
    "    keywords = get_keywords(clean_text)\n",
    "    top = get_top_sents(clean_text,keywords)\n",
    "    \n",
    "    return keywords[0],top, clean_summary"
   ]
  },
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  {
   "cell_type": "code",
   "execution_count": 1,
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   "outputs": [],
   "source": [
    "# Imports\n",
    "from pickle import dump, load\n",
    "import nltk\n",
    "from nltk import word_tokenize,FreqDist\n",
    "import re\n",
    "from nltk.corpus import wordnet as wn\n",
    "from nltk.util import ngrams"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 2,
   "metadata": {
    "collapsed": false
   },
   "outputs": [
    {
     "data": {
      "text/plain": [
       "6"
      ]
     },
     "execution_count": 2,
     "metadata": {},
     "output_type": "execute_result"
    }
   ],
   "source": [
    "doc_list =load(open(\"data/Master2_doc_content\",'rb'))\n",
    "len(doc_list)"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 3,
   "metadata": {
    "collapsed": false
   },
   "outputs": [
    {
     "data": {
      "text/plain": [
       "dict_keys(['comment_list', 'text'])"
      ]
     },
     "execution_count": 3,
     "metadata": {},
     "output_type": "execute_result"
    }
   ],
   "source": [
    "# Start working on one document and associated comments\n",
    "document = doc_list[0]\n",
    "document.keys()"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 4,
   "metadata": {
    "collapsed": false
   },
   "outputs": [],
   "source": [
    "# Convert bs4 ResultSet to a list of strings\n",
    "comments = []\n",
    "for c in document['comment_list']:\n",
    "    c = c.replace('\\n',' ')\n",
    "    comments.append(str(c))"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 5,
   "metadata": {
    "collapsed": false
   },
   "outputs": [
    {
     "data": {
      "text/plain": [
       "1290"
      ]
     },
     "execution_count": 5,
     "metadata": {},
     "output_type": "execute_result"
    }
   ],
   "source": [
    "len(comments)"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 6,
   "metadata": {
    "collapsed": true
   },
   "outputs": [],
   "source": [
    "# Modified from Brandon Rose:\n",
    "def tokenize_text(text):\n",
    "    tokens = [word.lower() for sent in nltk.sent_tokenize(text) for word in nltk.word_tokenize(sent)]\n",
    "    filtered_tokens = []\n",
    "    for token in tokens:\n",
    "        if re.search('[a-zA-Z]', token):\n",
    "            filtered_tokens.append(token)\n",
    "    return filtered_tokens\n",
    "\n",
    "def stem_text(text):\n",
    "    tokens = tokenize_text(text)\n",
    "    stems = [stemmer.stem(t) for t in tokens]\n",
    "    return stems"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 7,
   "metadata": {
    "collapsed": true
   },
   "outputs": [],
   "source": [
    "from nltk.stem.snowball import SnowballStemmer\n",
    "stemmer = SnowballStemmer('english')"
   ]
  },
  {
   "cell_type": "markdown",
   "metadata": {},
   "source": [
    "Switched from stemming to just tokenizing due to sentiment analysis needs."
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 8,
   "metadata": {
    "collapsed": true
   },
   "outputs": [],
   "source": [
    "from sklearn.feature_extraction.text import TfidfVectorizer\n",
    "\n",
    "tfidf_vec = TfidfVectorizer(tokenizer=tokenize_text,\n",
    "                            stop_words='english',\n",
    "                            ngram_range=(1,3),\n",
    "                            min_df=0.2, max_df=0.8,\n",
    "                            max_features=200000)"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 9,
   "metadata": {
    "collapsed": false
   },
   "outputs": [],
   "source": [
    "tfidf_matrix = tfidf_vec.fit_transform(comments)"
   ]
  },
  {
   "cell_type": "markdown",
   "metadata": {},
   "source": [
    "### Latent Semantic Analysis"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 10,
   "metadata": {
    "collapsed": false
   },
   "outputs": [],
   "source": [
    "# Adapated from http://scikit-learn.org/stable/auto_examples/text/document_clustering.html#sphx-glr-auto-examples-text-document-clustering-py\n",
    "from sklearn.decomposition import TruncatedSVD\n",
    "from sklearn.preprocessing import Normalizer\n",
    "from sklearn.pipeline import make_pipeline\n",
    "\n",
    "num_components = 20\n",
    "svd = TruncatedSVD(num_components)\n",
    "normalizer = Normalizer(copy=False)\n",
    "lsa = make_pipeline(svd, normalizer)\n",
    "\n",
    "lsa_tfidf_matrix = lsa.fit_transform(tfidf_matrix)"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 12,
   "metadata": {
    "collapsed": false
   },
   "outputs": [
    {
     "data": {
      "text/plain": [
       "0.94984019555042065"
      ]
     },
     "execution_count": 12,
     "metadata": {},
     "output_type": "execute_result"
    }
   ],
   "source": [
    "svd.explained_variance_ratio_.sum()"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 13,
   "metadata": {
    "collapsed": true
   },
   "outputs": [],
   "source": [
    "from sklearn.cluster import KMeans\n",
    "\n",
    "num_clusters = 12\n",
    "km = KMeans(n_clusters=num_clusters)\n",
    "km.fit(lsa_tfidf_matrix)\n",
    "clusters = km.labels_.tolist()"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 21,
   "metadata": {
    "collapsed": false
   },
   "outputs": [
    {
     "name": "stdout",
     "output_type": "stream",
     "text": [
      " health live children smokers policy public rule smoke-free support free\n",
      " tobacco smoke health housing smoking public use public housing children free\n",
      " housing residents hud policy smoke smoking public rule public housing health\n",
      " rule proposed proposed rule housing public hud public housing smoking smoke-free health\n",
      " smoke-free housing public public housing rule health policy proposed hud proposed rule\n",
      " smoke smoking smokers live 's housing health people units hud\n",
      " people smoke smoking smokers housing live 's health hud public\n",
      " 's smoking people smoke smokers live rule tobacco public health\n",
      " smoking smoke policy housing rule health hud support 's residents\n",
      " public housing public housing smoking health smoke rule smokers people live\n",
      " smoke free smoke free housing public public housing health smoking policy rule\n",
      " smoke secondhand secondhand smoke housing health public smoking children rule hud\n"
     ]
    }
   ],
   "source": [
    "terms = tfidf_vec.get_feature_names()\n",
    "original_space_centroids = svd.inverse_transform(km.cluster_centers_)\n",
    "order_centroids = original_space_centroids.argsort()[:, ::-1]\n",
    "for i in range(num_clusters):\n",
    "    for ind in order_centroids[i, :10]:\n",
    "        print(' %s' % terms[ind], end='')\n",
    "    print('')"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 16,
   "metadata": {
    "collapsed": false
   },
   "outputs": [],
   "source": [
    "from sklearn.metrics.pairwise import paired_distances\n",
    "\n",
    "cluster_center_list = []\n",
    "for c in clusters:\n",
    "    cluster_center_list.append(km.cluster_centers_[c])\n",
    "\n",
    "center_distances = paired_distances(lsa_tfidf_matrix, cluster_center_list)"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 17,
   "metadata": {
    "collapsed": true
   },
   "outputs": [],
   "source": [
    "import pandas as pd\n",
    "comment_clusters = {'comment': comments, 'cluster': clusters, 'dist': center_distances}\n",
    "comment_frame = pd.DataFrame(comment_clusters, index = [clusters] , columns = ['comment', 'cluster', 'dist'])"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 18,
   "metadata": {
    "collapsed": false
   },
   "outputs": [
    {
     "data": {
      "text/plain": [
       "1     296\n",
       "0     130\n",
       "4     126\n",
       "5     107\n",
       "3     107\n",
       "7      97\n",
       "2      85\n",
       "8      83\n",
       "11     76\n",
       "6      72\n",
       "10     62\n",
       "9      49\n",
       "Name: cluster, dtype: int64"
      ]
     },
     "execution_count": 18,
     "metadata": {},
     "output_type": "execute_result"
    }
   ],
   "source": [
    "comment_frame['cluster'].value_counts()"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 19,
   "metadata": {
    "collapsed": false
   },
   "outputs": [
    {
     "name": "stdout",
     "output_type": "stream",
     "text": [
      "comment    u PublicHealth Pre.ent. Promale. ProŠt. Health...\n",
      "cluster                                                    3\n",
      "dist                                                0.850071\n",
      "dtype: object\n",
      "\n",
      "comment                                          January ...\n",
      "cluster                                                    3\n",
      "dist                                                0.368073\n",
      "dtype: object\n",
      "\n",
      "comment                                                  ...\n",
      "cluster                                                    5\n",
      "dist                                                0.345464\n",
      "dtype: object\n",
      "\n",
      "                                              comment  cluster      dist\n",
      "3   I strongly encourage all public housing agency...        3  0.460829\n",
      "3   RE: Docket number is FR 5597-P-02.  Title \"Ins...        3  0.585358\n",
      "3   Thank you for considering than ban of smoking ...        3  0.678159\n",
      "3   As an employee of a local hospital and a coord...        3  0.472842\n",
      "3   As an apartment dweller and nonsmoker who is s...        3  0.547512\n",
      "3   I am a pediatrician and a member of the Americ...        3  0.643567\n",
      "3   Countless decades' worth of research has shown...        3  0.457262\n",
      "3   While I do not disagree with the health proble...        3  0.736956\n",
      "3   The American Lung Association in Montana stron...        3  0.617645\n",
      "3   The Chemistry of Secondary Smoke About 94% of ...        3  0.644471\n",
      "3   even brief exposure to secondhand smoke can be...        3  0.660632\n",
      "3   As a Solano County Supervisor Representing Dis...        3  0.850071\n",
      "3   Please implement this No-Smoking Housing Rule!...        3  0.603342\n",
      "3   Please see attached file. The American Lung As...        3  0.771110\n",
      "3   As a public health professional and lifetime a...        3  0.422789\n",
      "3   I feel that smoking in housing should be banne...        3  0.620895\n",
      "3   I am a Community Health Advocate in Florida an...        3  0.597078\n",
      "3   As a pediatrician, I have seen many young stud...        3  0.765876\n",
      "3   Our agency (the Champaign-Urbana Public Health...        3  0.614391\n",
      "3   Prohibiting public housing residents from smok...        3  0.700095\n",
      "3   As a tobacco education and prevention educator...        3  0.495135\n",
      "3   I am in support of Docket Number HUD-2015-0101...        3  0.529848\n",
      "3   Template Messages: HUD Smokefree Housing Propo...        3  0.562377\n",
      "3   Re: Docket No. FR 5597-P-02 Instituting Smoke-...        3  0.503190\n",
      "3   The need for smoke-free housing and no smoking...        3  0.622857\n",
      "3   Please extend this long overdue rule to includ...        3  0.564468\n",
      "3   The North Carolina Justus-Warren Heart Disease...        3  0.626282\n",
      "3   To Whom It May Concern, I am writing in on beh...        3  0.521486\n",
      "3   I say yes to the proposed no smoking policy in...        3  0.635700\n",
      "3   As a pediatrician and a member of the American...        3  0.624384\n",
      "..                                                ...      ...       ...\n",
      "3                                         January ...        3  0.504798\n",
      "3   1RuleName :InstitutingSmokeFreePublicHousingDo...        3  0.581863\n",
      "3     BOARD OF SUP ERVISORS  Office of the  First ...        3  0.482377\n",
      "3   T:ECH --------520 West 23rd Street Ł Los Angel...        3  0.446772\n",
      "3       ChangeLab Solutions is a nonprofit organiz...        3  0.467188\n",
      "3         2530 San Pablo Avenue, Suite J     Berke...        3  0.502623\n",
      "3   1  Comment on  Regulatory Impact Analysis for ...        3  0.459870\n",
      "3   !!  January  19, 2016   Regulations Division, ...        3  0.523149\n",
      "3    www.healthpolicy.ucla.edu  10960 Wilshire Bou...        3  0.516060\n",
      "3   APARTMENT ASSOCIATION OF GREATER LOS ANGELES R...        3  0.511022\n",
      "3      Smokefree Housing Facts  What residents sho...        3  0.511687\n",
      "3    1 Comments of James L. Repace, 6701 Felicia L...        3  0.401183\n",
      "3         2530 San Pablo Avenue, Suite J     Berke...        3  0.564085\n",
      "3    PROTECTING, MAINTAINING AND IMPROVING THE HEA...        3  0.479769\n",
      "3   FR 5597-P-02 Instituting Smoke-Free Public Hou...        3  0.471665\n",
      "3   HUD SMOKE-FREE RULE COMMENTS Posted on 11/17/1...        3  0.450967\n",
      "3   1  Comments on HUD™s proposed rule Instituting...        3  0.501890\n",
      "3         January  4 ,   2016     The Honorable Ju...        3  0.464428\n",
      "3   n Ł' Ł ~ n: ~ Ł MMUR Ł 03431 s 'Ł n,~ Ł Decemb...        3  0.531212\n",
      "3               January 1 9 , 2016     The Honorab...        3  0.564265\n",
      "3   January 11,2016 U.S. Department 451 71h Street...        3  0.504442\n",
      "3      4300 Cherry Creek Drive S.,  Denver, CO 802...        3  0.472526\n",
      "3   u PublicHealth Pre.ent. Promale. ProŠt. Health...        3  0.559098\n",
      "3   January 18, 2016   Secretary Juli⁄n Castro  c/...        3  0.576410\n",
      "3      December  16, 2015   Regulations Di vision ...        3  0.569414\n",
      "3   FAME Corporations 1968 W Adams Blvd. Los Angel...        3  0.477728\n",
      "3    1 Comment  on HUD™s proposed rule   Instituti...        3  0.368073\n",
      "3                          Our vision is to transf...        3  0.446784\n",
      "3   520 West 23rd Street Ł Los Angeles, CA 90007 T...        3  0.446772\n",
      "3   COUNTY  OF  Rich Fitzgerald  County Executive ...        3  0.463586\n",
      "\n",
      "[107 rows x 3 columns]\n"
     ]
    }
   ],
   "source": [
    "print(comment_frame[comment_frame.cluster==3].max())\n",
    "print()\n",
    "print(comment_frame[comment_frame.cluster==3].min())\n",
    "print()\n",
    "print(comment_frame[comment_frame.cluster==5].min())\n",
    "print()\n",
    "print(comment_frame[comment_frame.cluster==3])"
   ]
  },
  {
   "cell_type": "markdown",
   "metadata": {},
   "source": [
    "Not going to summarize long comments as, while some comments are very long, understanding the comment as a whole is necessary for officials to take it into account when assessing the relevance to the regulation."
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 20,
   "metadata": {
    "collapsed": false
   },
   "outputs": [
    {
     "name": "stdout",
     "output_type": "stream",
     "text": [
      "Most Central Comments by Cluster\n",
      "\n",
      "Cluster 0\n",
      "\n",
      "Long Comment, Extracted Summary Below:\n",
      "([('smoking', 8), ('http', 7), ('tobacco', 6), ('smoke', 5), ('research', 4), ('exposure', 4), ('health', 4), ('support', 3), ('disease', 3), ('housing', 3), ('prevention', 3), ('cessation', 3), ('asthma', 3), ('directorate', 3), ('control', 2)], [\"t, NE         Washington, DC 20002 - 4242       (202) 336 - 5500           Web: www.apa.org   (202) 336 - 6123 TDD     January 19, 2016     The Honorable Julián Castro   Secretary   Department of Housing and Urban Development   451 Seventh Street SW   Washington, DC 20410     Dear Secretary Castro:     The American Psychological Association (APA), the largest association of psychologists in the  U.S., works  to benefit society and improve people's lives through research, education, practice,  and advocacy.\", 'We have a l ong - standing commitment   to supporting programs and policies to  improve the health and well - being of vulnerable and underserved populations across the lifespan,  which includes low - income, racial/ethnic minority, and other populations (taking into account  ge nder, gender identity, culture, national origin, religion, sexual orientation, disability, and  language)   at high risk for disease and other adverse health conditions 1 .', 'Vulnerable populations, however,  such as the poor, mentally  ill, racial/ethnic minority groups, persons living with HIV, LGBT persons,  and substance  abusing individuals are at increased ri sk for smoking - related illnesses because of higher exposure  to risks associated with smoking and lower availability of resources to combat smoking 5 .', 'African Americans are 20% more likely to have asthma and African American  children are 7 times more likely than non - Hispanic whites to die from asthma - related                                                                1   Public Interest Directorate, American Psychological Association.'], '')\n",
      "\n",
      "\n",
      "Cluster 1\n",
      "\n",
      "\n",
      "\n",
      "\n",
      "Cluster 2\n",
      "\n",
      "A Veteran should be able to decide whether to smoke in his/her own home.\n",
      "\n",
      "\n",
      "Cluster 3\n",
      "\n",
      "Long Comment, Extracted Summary Below:\n",
      "([('smoke', 9), ('rule', 5), ('massachusetts', 4), ('housing', 4), ('//www.mass.gov/eohhs/docs/dph/tobacco', 4), ('cancer', 3), ('hud', 3), ('secondhand', 3), ('heart', 3), ('dph', 3), ('respiratory', 2), ('department', 2), ('disease', 2), ('income', 2), ('risk', 2)], ['1   http://www.mass.gov/eohhs/docs/dph/tobacco - control/adults - health - consequences.pdf   2   http://www.mass.gov/eohhs/docs/dph/tobacco - control/adults - who - smoke.pdf   11 Beacon Street, Suite 710   Boston, MA  02108   Phone:  617 - 723 - 6100   Fax:  617 - 723 - 6111   www.cobth.org      Faulkner Hospital     -          In  a second   report , 3   DPH estimated  that  16.4% of  Massachusetts households allow ed   smoking in their  homes   thereby exposing a potential   456,000 adult  nonsmokers   to  secondhand   smoke for   more than one  hour per week.', 'Sincerely,          John Erw in   Executive Director, Conference of Boston Teaching Hospitals                                                         3   http://www.mass.gov/eohhs/docs/dph/tobacco - control/adults - exposed - to - secondhand - smoke.pdf   4   http://www.mass.gov/eohhs/docs/dph/tobacco - control/secondhand - smoke - factsheet.pdf   5   http:/ /www.mass.gov/eohhs/docs/dph/tobacco - control/smoke - free - law - factsheet - 5year.pdf   '], '')\n",
      "\n",
      "\n",
      "Cluster 4\n",
      "\n",
      "                                https://www.facebook.com/groups/WP4HE/                           January 15, 2016       Office of the Assistant Secretary for  Public and Indian Housing   U.S. Department of Housing and Urban Development     RE: Docket Number FR 5597 - P - 02   Instituting Smoke - Free Public Housing     To Whom  It   May Concern:     On behalf of the Westlawn Partnership for a Healthier Environment, I am pleased to pr ovide a  letter of support for the proposed rule to require all Public Housing Authorities to implement  smoke - free policies (HUD Docket No. FR 5597 - P - 02).     The Westlawn Partnership for a Healthier Environment  is a group of community stakeholders  that   has met on a regular basis since 2008 to identify, prioritize, and address environmental  health concerns in the Westlawn community.  Located in northwest Milwaukee, Westlawn is   - subsidized housing development.     Milwauke e County ranks as the worst county in the State of Wisconsin for asthma - related  hospitalizations and emergency department visits.  Moreover, specific to  the  Westlawn   community , the rate of hospitalizations for asthma among children is nearly twice that of  Mi l w aukee County, and the rate of asthma - related emergency department visits is 1.5 times  higher in this community compared to the rest of the county.  Thus, smoke - free housing could  help to   reduce asthma triggers, improve indoor air quality ,   and   improve health outcomes   for  children and families in Westlawn and beyond.       Thank  you for proposing this important rule     it  has the potential to reduce health care costs,  save lives, and improve the quality of life for so many Americans.     Sincerely,        Anne Dressel, PhD, CFPH   Project Director   Westlawn Partnership for a Healthier Environment   Email:  banda@uwm.edu   Phone: (414) 229 - 3995   \n",
      "\n",
      "\n",
      "Cluster 5\n",
      "\n",
      "Long Comment, Extracted Summary Below:\n",
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      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "([('smoke', 431), ('exposure', 167), ('secondhand', 161), ('health', 134), ('heart', 132), ('youth', 114), ('tobacco', 114), ('death', 107), ('smoking', 104), ('care', 93), ('cancer', 90), ('housing', 87), ('disease', 80), ('attack', 64), ('control', 61)], ['                                                           MARKET DEMAND FOR SMOKE-FREE RULES   IN MULTI-UNIT RESIDENTIAL PROPERTIES   &   LANDLORDS™ EXPERIENCES   WITH SMOKE-FREE RULES         April 2009     Prepared by:    The Massachusetts Smoke-Free Housing Project   Public Health Advocacy Institute  Northeastern University School of Law  Boston, Massachusetts                2 Massachusetts Smoke-Free Housing Project   Public Health Advocacy Institute, Inc.   Northeastern University School of Law   102 The Fenway, Suite 117   Boston, Massachusetts 02115       (617) 373-2026   www.phaionline.org                                                           3 INDEX                   Introduction .', 'Sample Size  10%  20%  30%  40%  50%  60%  70%  80%  90%             1500 1.5 2.0 2.3 2.5 2.5 2.5 2.3 2.0 1.5  1000 1.9 2.5 2.8 3.0 3.1 3.0 2.8 2.5 1.9  900 2.0 2.6 3.0 3.2 3.3 3.2 3.0 2.6 2.0  750 2.1 2.8 3.3 3.5 3.6 3.5 3.3 2.8 2.1  700 2.2 3.0 3.4 3.6 3.7 3.6 3.4 3.0 2.2  650 2.3 3.1 3.5 3.7 3.8 3.7 3.5 3.1 2.3  600 2.4 3.2 3.7 3.9 4.0 3.9 3.7 3.2 2.4  550 2.5 3.3 3.8 4.1 4.2 4.1 3.8 3.3 2.5  500 2.6 3.5 4.0 4.3 4.4 4.3 4.0 3.5 2.6  450 2.7 3.7 4.2 4.5 4.6 4.5 4.2 3.7 2.7  400 2.9 3.9 4.5 4.8 4.9 4.8 4.5 3.9 2.9  350 3.1 4.2 4.8 5.1 5.2 5.1 4.8 4.2 3.1  300 3.4 4.5 5.2 5.5 5.7 5.5 5.2 4.5 3.4  250 3.8 5.0 5.7 6.1 6.3 6.1 5.7 5.0 3.8  200 4.2 5.5 6.4 6.8 6.9 6.8 6.4 5.5 4.2  150 4.8 6.4 7.3 7.8 8.0 7.8 7.3 6.4 4.8  100 5.9 7.8 9.0 9.6 9.8 9.6 9.0 7.8 5.9    75 6.8 9.0 10.4 11.1 11.3 11.1 10.4 9.0 6.8    50 8.3 11.1 12.7 13.6 13.9 13.6 12.7 11.1 8.3                 TABLE 1A  Gender and Age of Respondents  Gender   N=1304  Age  N=3255  Male Female 18-24 25-34 35-44 45-54 55-64 65+  45.3%  N=591  54.7%  N=713  12.1%  N=158  38.4%  N=502  16.9%  N=220  12.3%  N=160  8.6%  N=111  11.8%  N=152  TABLE 1B  Education and Income of Respondents  Education  N=3200  Income  N=2987  College + College Some College No College $6 0K  53.1%  N=1503  21.7%  N=634  15.2%  N=654  9.9%  N=409  49.6%  N=623  50.4%  N=632   23                                                  TABLE 2A  Smoking-Related Rules  Gender   Age  Income   Male  N=592  Female  N=713  18-24   N=159  25-34   N=501  35-44   N=220  45-54   N=159  55-64   N=112  65-74   N=77  $60K   N=632  100% No Smoking   27.2%  N=161  29.9%  N=213  47.2%  N=75  27.9%  N=140  25%  N=55  23.9%  N=38  25%  N=28  22.1%  N=17  29.5%  N=184  28.3%  N=179  No Smoking in   Common Areas   40.2%  N=238  42.6%  N=304  25.2%  N=40  44.5%  N=223  46.4%  N=102  40.9%  N=65  44.6%  N=50  42.9%  N=33  39.6%  N=247  43.4%  N=274  No Related Rules  32.6%  N=193  27.5%  N=196  27.7%  N=44  27.5%  N=138  28.6%  N=63  35.2%  N=56  30.4%  N=34  35.1%  N=27  30.8%  N=192  28.3%  N=179                 TABLE 1C  Housing Type of Respondents  House   Divided into   Apartments  Apartment   Building  Condominium   15%  N=196  52%  N= 679  33%  N=430   TABLE 1D  Smoking-Related Health Conditions of Respondents  Child Health Conditions   N=299  Adult Health Conditions  N=1303  Asthma  Chronic Ear   Infection  Frequent   Respiratory   Infections  Asthma  Chronic   Respiratory   Condition  Heart   Disease  Stroke  19%  N=57  7.1%  N=21  5.6%  N=17  19.6%  N=256  10.6%  N=138  8.1%  N=105  4.3%  N=56  TABLE 1E  Smoking Behavior of Respondents  100 Cigarettes in  Respondents™ Life  N=1303  Smoking Frequency  N=470  More   Than  Less Than Every Day Some Days  Never  35.3%  N=461  63.9%  N=833  27.2%  N=128  12.8%  N=60  59.9%  N=282  TABLE 1G  Respondents™ Perception of Secondhand Smoke Exposur e  N=1303  Very   Harmful  Somewhat   Harmful  Minor   Nuisance  Not   Harmful   Not Sure   66.7%  N=869  25.4%  N=330  5%  N=66  1.9%  N=25  1%  N=13   24  TABLE 2B  Smoking-Related Rules  Education  Housing Type   College &      Graduate   School   N=690   College  N=28 1  Some    College   N=197  No College   N=128  House   Divided into   Apartments   N=195  Apartment   Building   N=679  Condominium   N=430  100% No   Smoking   29.7%  N=205  30.6%  N=86  28.9%  N=57  19.5%  N=25  52.3%  N=102  29.5%  N=200  16.7%  N=72  No smoking in   Common Areas   44.2%  N=305  39.5%  N=111  33.5%  N=66  43.8%  N=56  19%  N=37  40.6%  N=276  53.3%  N=229  No Related   Rules  26.1%  N=180  29.9%  N=84  37.6%  N=74  36.7%  N=47  28.7%  N=56  29.9%  N=203  30%  N=129     TABLE 2C  Smoking-Related Rules  Child Health Conditions  N=299  Adult Health Conditions  N=1304   Asthma   N=57  Chronic Ear   Infections   N=22  Frequent    Respiratory   Infections   N=17  Asthma   N=256  Chronic   Respiratory   Condition   N=139  Heart   Disease   N=105  Stroke   N=57  100% No   Smoking   21.1%  N=12  27.3%  N=6  17.6%  N=3  32%  N=82  25.9%  N=36  22.9%  N=24  38.6%  N=22  No Smoking in   Common Areas   42.1%  N=24  31.8%  N=7  11.8%  N=2  42.2%  N=108  36.7%  N=51  47.6%  N=50  49.1%  N=28  No Related   Rules  36.8%  N=21  40.9%  N=9  70.6%  N=12  25.8%  N=66  37.4%  N=52  29.5%  N=31  12.3%  N=7     TABLE 3A  Demand for Smoking-Related Listing Information  Gender Age Income   Male  N=591  Female  N=712  18-24   N=159  25-34   N=502  35-44   N=220  45-54   N=161  55-64   N=111  65-74   N=78  $60K   N=632  More  Interested  70.2%  N=415  68.5%  N=488  54.7%  N=87  71.5%  N=359  74.5%  N=164  65.2%  N=105  68.5%  N=76  70.5%  N=55  67%  N=417  71.8%  N=454  Less  Interested  10.3%  N=61  12.1%  N=86  15.7%  N=25  9.2%  N=46  11.4%  N=25  14.9%  N=24  11.7%  N=13  11.5%  N=9  14.8%  N=92  7.4%  N=47  No   Difference  18.4%  N=109  17.8%  N=127  28.9%  N=46  18.1%  N=91  13.2%  N=29  16.1%  N=26  18.9%  N=21  17.9%  N=14  17.4%  N=108  19.1%  N=121  Not Sure  1%  N=6  1.5%  N=11  .6%  N=1  1.2%  N=6  .9%  N=2  3.7%  N=6  .9%  N=1  0%  N=0  1.6%  N=5  1.2%  N=10     TABLE 3B  Demand for Smoking-Related Listing Information  Education  Housing Type   College &   Graduate   School   N=691    College     N=281  Some    College   N=197  No College   N=128  House   Divided into   Apartments   N=195  Apartment   Building   N=678  Condominium   N=430  More  Interested  77.1%  N=533  67.6%  N=190  59.4%  N=117  47.7%  N=61  67.7%  N=132  67.3%  N=456  73.3%  N=315  Less  Interested  7.8%  N=54  8.5%  N=24  16.87%  N=33  26.6%  N=34  11.3%  N=22  12.7%  N=89  9.1%  N=39  No   Difference  14.3%  N=99  22.1%  N=62  21.8%  N=43  25%  N=32  19.5%  N=38  19.2%  N=130  16%  N=69  Not Sure  .7%  N=5  1.8%  N=5  2%  N=4  .8%  N=1  1.5%  N=3  .9%  N=6  1.6%  N=7   25   TABLE 3C  Willingness to Pay More for Smoke-free Property  Gender Age Income   Male  N=591  Female  N=712  18-24   N=159  25-34   N=502  35-44   N=219  45-54   N=159  55-64   N=111  65-74   N=77  $60K   N=632  Willing to Pay  More   44.3%  N=262  42%  N=299  34.6%  N=55  42.2%  N=212  46.1%  N=101  39%  N=62  46.8%  N=52  48.1%  N=37  36.1%  N=225  49.2%  N=311  20% More  N=304  22.7%  N=69  N=343  28.6%  N=98  N=57  19.3%  N=11  N=247  20.2%  N=50  N=121  29.8%  N=36  N=77  35.1%  N=27  N=56  25%  N=14  N=42  31%  N=13  N=275  25.1%  N=69  N=343  27.1%  N=93  10% More  59.2%  N=180  65.9%  N=226  80.7%  N=46  61.1%  N=151  58.6%  N=71  61%  N=47  58.9%  N=20  67%  N=28  61.8%  N=170  64.4%  N=221  This question was asked of those who would be will ing to pay more in general or who were not sure if  they would pay  more.', 'TABLE 3E  Effect of Perspective Resident Smelling Tobacco Smo ke   Gender Age Income   Male  N=591  Female  N=712  18-24   N=159  25-34   N=502  35-44   N=220  45-54   N=160  55-64   N=111  65-74   N=77  $60K   N=632  More  Interested  5.4%  N=32  7.2%  N=51  4.4%  N=7  5.2%  N=26  4.5%  N=10  6.9%  N=11  9%  N=10  6.5%  N=5  9.8%  N=61  3%  N=19  Less  Interested  82.2%  N=486  80.8%  N=575  76.7%  N=122  87.3%  N=438  89.1%  N=196  71.2%  N=114  74.8%  N=83  74%  N=57  74.6%  N=465  88.3%  N=558  No   Difference  11.3%  N=67  11.2%  N=80  18.2%  N=29  6.6%  N=33  5.9%  N=13  21.9%  N=35  15.3%  N=17  16.9%  N=13  14.8%  N=92  7.6%  N=48  Not Sure  1%  N=6  .8%  N=6  .6%  N=1  1%  N=5  .5%  N=1  0%  N=0  .9%  N=1  2.6%  N=2  .8%  N=5  1.1%  N=7              26  TABLE 3F  Effect of Perspective Resident Smelling Tobacco Smo ke  Education  Housing Type   College and   Graduate   School   N=691   College   N=282  Some    College   N=197  No College   N=130  House   Divided into   Apartments   N=195  Apartment   Building   N=680  Condominium   N=429  More  Interested  3.8%  N=26  6.4%  N=18  9.1%  N=18  16.2%  N=21  3.1%  N=6  7.9%  N=54  5.4%  N=23  Less  Interested  91.8%  N=634  84.8%  N=239  64%  N=126  45.4%  N=59  84.1%  N=164  76.5%  N=520  88.1%  N=378  No   Difference  4.2%  N=29  8.5%  N=24  23.4%  N=46  36.2%  N=47  12.3%  N=24  14.3%  N=97  6.1%  N=26  Not Sure  .3%  N=2  .4%  N=1  3.6%  N=7  2.3%  N=3  .5%  N=1  1.3%  N=9  .5%  N=2     TABLE 4A  Resident Support for Smoke-free Rule  Gender Age Income   Male  N=159  Female  N=213  18-24   N=75  25-34   N=140  35-44   N=54  45-54   N=38  55-64   N=27  65-74   N=16  $60K   N=179  Strongly  Support  81.8%  N=130  84%  N=179  82.7%  N=62  82.1%  N=115  81.5%  N=44  89.5%  N=34  81.5%  N=22  100%  N=16  81.6%  N=151  83.2  N=149  Somewhat  Support  8.8%  N=14  8%  N=17  17.3%  N=13  5%  N=7  13%  N=7  2.6%  N=1  11.1%  N=3  0%  N=0  11.4%  N=21  4.5%  N=8  Neutral  8.2%  N=13  3.8%  N=8  0%  N=0  10%  N=14  1.9%  N=1  5.3%  N=2  3.7%  N=1  0%  N=0  2.2%  N=4  10.1%  N=18  Somewhat  Oppose  .6%  N=1  1.9%  N=4  0%  N=0  2.1%  N=3  1.9%  N=1  0%  N=0  0%  N=0  0%  N=0  1.6%  N=3  1.7%  N=3  Strongly  Oppose  .6%  N=1  .9%  N=2  0%  N=0  0%  N=0  0%  N=0  2.6%  N=1  3.7 %  N=1  0%  N=0  1.6%  N=3  .6%  N=1   The answers for ﬁNot Sureﬂ are excluded from this  Table.', 'TABLE 4B  Resident Support for Smoke-free Rule  Education  Housing Type   College &   Graduate   School   N=206    College  N=87  Some    College   N=57  No College   N=25  House   Divided into   Apartments   N=103  Apartment   Building   N=198  Condominium   N=72  Strongly  Support  90.8%  N=187  78.2%  N=68  70.2%  N=40  60%  N=15  83.5%  N=86  81.8%  N=162  84.7%  N=61  Somewhat  Support  3.9%  N=8  10.3%  N=9  14%  N=8  24%  N=6  5.83%  N=6  10.6%  N=21  6.9%  N=5  Neutral   2.9%  N=6  9.2%  N=8  12.3%  N=7  0%  N=0  8.7%  N=9  4.5%  N=9  4.2%  N=3  Somewhat  Oppose  1.5%  N=3  0%  N=0  0%  N=0  8%  N=2  0%  N=0  2%  N=4  1.4%  N=1  Strongly  Oppose  1%  N=2  1.1%  N=1  0%  N=0  4%  N=1  0%  N=0  .5%  N=1  2.8%  N=2   The answers for ﬁNot Sureﬂ are excluded from this  Table.', '27  TABLE 4C  Resident Support for Immediate Change to Smoke-free  Property  Gender Age Income   Male  N=430  Female  N=498  18-24   N=84  25-34   N=361  35-44   N=165  45-54   N=121  55-64   N=84  65-74   N=60  $60K   N=454  Strongly  Support  41.2%  N=177  47.8%  N=238  23.8%  N=20  47.9%  N=173  49.1%  N=81  43.8%  N=53  36.9%  N=31  48.3%  N=29  42.8%  N=187  46.7%  N=212  Somewhat  Support  14.7%  N=63  16.9%  N=84  19%  N=16  20.5%  N=74  12.1%  N=20  9.1%  N=11  15.5%  N=13  10%  N=6  13%  N=57  18.1%  N=82  Neutral   16.5%  N=71  11.2%  N=56  26.2%  N=22  8.3%  N=30  15.2%  N=25  10.7%  N=13  21.4%  N=18  18.3%  N=11  14.6%  N=64  12.8%  N=58  Somewhat  Oppose  12.1%  N=52  10.6%  N=53  17.9%  N=15  10.8%  N=39  11.5%  N=19  13.2%  N=16  9.5%  N=8  6.7%  N=4  12.6%  N=55  9.3%  N=42  Strongly  Oppose  14.9%  N=64  13.3%  N=66  13.1%  N=11  12.5%  N=45  10.9%  N=18  22.3%  N=27  15.5%  N=13  16.7%  N=10  16.5%  N=72  12.8%  N=58   The answers for ﬁNot Sureﬂ are excluded from this  Table.', 'TABLE 4D  Resident Support for Immediate Change to Smoke-free  Property  Education  Housing Type   College &   Graduate   School   N=485  College  N=195  Some    College   N=141  No College   N=103  House   Divided into   Apartments   N=94  Apartment   Building   N=478  Condominium   N=358  Strongly  Support  46.6%  N=226  47.7%  N=93  42.6%  N=60  35%  N=36  48.9%  N=46  43.7%  N=209  44.7%  N=160  Somewhat  Support  17.9%  N=87  16.4%  N=32  8.5%  N=12  14.6%  N=15  8.5%  N=8  16.5%  N=79  17%  N=61  Neutral   13.4%  N=65  8.7%  N=17  17.7%  N=25  17.5%  N=18  12.8%  N=12  13.8%  N=66  113.7%  N=49  Somewhat  Oppose  10.1%  N=49  13.3%  N=26  9.2%  N=13  14.6%  N=15  6.4%  N=6  10.3%  N=49  14%  N=50  Strongly  Oppose  11.3%  N=55  13.3%  N=26  21.3%  N=30  18.4%  N=19  23.4%  N=22  14.9%  N=71  10.3%  N=37   The answers for ﬁNot Sureﬂ are excluded from this  Table.', 'TABLE 5A  Percentage of Number of Rental Units Owned/Managed  by Respondents  N=363  1 Unit 2 Units 3 Units 4 Units 5 Units 6 Units 7 Un its 8 Units 9 Units 10+ Units  13.4%  N=51  44.9%  N=163  14.3%  N=52  5.2%  N=19  4.1%  N=15  3%  N=11  2.5%  N=9  .8%  N=3  1.1%  N=4  All others  under 1%  N=36  TABLE 5B  Percentage of Respondents Who Have Implemented Smok e-free Rules  N=365  All Properties  More than Half of   Properties   Less than Half of   Properties  None  50.4%  N=184  2.2%  N=8  2.2%  N=8  45.2%  N=165   28  TABLE 6A  Effect of Smoke-free Rule on Rental Business for La ndlords Who Had Implemented a Smoke-Free Rule   Vacancy   Rate   N=195  Turnover   Rate   N=193  Disputes   Over   Security   Deposits   N=192  Resources  Required to  Manage   N=192  Disputes   Between   Tenants   N=193  Potential   Legal   Liability    N=189  Maintenance/  Repair Costs  N=195  Risk of   Fire   N=197  Increase  6.7%  N=13  3.6%  N=7  7.2%  N=14  8.3%  N=16  6.7%  N=13  8.5%  N=16  9.2%  N=18  9.6%  N=19  No   Change  77.4%  N=151  77.7%  N=150  64.6%  N=124  28.1%  N=111  54.4%  N=105  42.3%  N=93  29.7%  N=58  73.1%  N=34  Decrease  15.9%  N=31  18.7%  N=36  30.2%  N=54  33.9%  N=65  38.9%  N=75  49.2%  N=80  61%  N=119  17.3%  N=144   TABLE 6B  Effect of Smoke-free Rule on Rental Business Who Ha d Not Implemented a Smoke-Free Rule   Vacancy   Rate   N=161  Turnover   Rate   N=163  Disputes   Over   Security   Deposits   N=161  Resource  Required to  Manage   N=159  Disputes   Between   Tenants   N=160  Potential   Legal   Liability    N=159  Maintenance  / Repair   Costs   N=162  Risk of   Fire   N=161  Increase  13.7%  N=22  10.4%  N=17  8.1%  N=13  14.5%  N=23  17.5%  N=28  15.1%  N=24  9.9%  N=16  10.6%  N=17  No   Change  80.1%  N=129  77.9%  N=127  77%  N=124  61%  N=97  59.4%  N=95  54.7%  N=87  39.5%  N=64  16.8%  N=27  Decrease  6.2%  N=10  11.7%  N=19  14.9%  N=24  24.5%  N=39  23.1%  N=37  30.2%  N=48  50.6%  N=82  72.7%  N=117   TABLE 6C  Implementation of Rule   N=196  Very Difficult Difficult  Easy  Very Easy  3.6%  N=7  6.1%  N=12  37.2%  N=73  53.1%  N=104   TABLE 6D  Difficulty of Enforcement   N=194  Difficult  Easy  Same as other   rules  Virtually Self   Enforcing   6.7%  N=13  20.1%  N=39  23.2%  N=45  50%  N=97   TABLE 6D  Perceived Legality of Rule of Landlords Who Had Imp lemented a Smoke-Free Rule  N=200  Legal  Not Legal   Some Units Must   Be Designated for   Smoking  Not Sure  76.5%  N=153  3%  N=6  2%  N=4  18.5%  N=37   TABLE 6E  Perceived Legality of Rule of Landlords Who Had Not  Implemented a Smoke Free  Rule  N=165  Legal  Not Legal   Some Units Must   Be Designated for   Smoking  Not Sure  44.8%  N=74  18.2%  N=30  1.2%  N=2  35.8%  N=59            Saving Lives, Saving Mone A state-by-state  report on the health and economic  impact of comprehensive  smoke-free laws  2011                                          Table of Contents  Executive Summary .', 'American Cancer Society Cancer Action Network Savings Lives, Saving Money: A State-By-State Report on the Health and Economic Benefits of Comprehensive Smoke-Free Laws 4                                                                                                                                                                      Smoke-free laws improve public health by reducing exposure to cancer- causing pollutants and by lowering the incidence of chronic disease.', 'Total Estimated State Health Care Cost Savings Over Five Years With Implementation of Comprehensive Smoke-free Law  Pregnancy  Savings Heart Attack & Stroke Savings Lung CancerSavings TOTAL  SAVINGS Alabama $5,831,511 $47,794,691 $15,556,637 $69,182,839 Alaska $978,238 $3,691,196 $1,351,653 $6,021,087 Arkansas $1,692,671 $9,027,239 $3,272,182 $13,992,092 California $17,804,716 $91,157,953 $33,570,386 $142,533,055 Colorado $893,338 $6,602,229 $2,608,058 $10,103,625 Connecticut $932,448 $12,495,497 $4,498,893 $17,926,838 Florida $1,784,670 $21,929,926 $7,229,789 $30,944,385 Georgia $8,246,896 $62,551,032 $21,820,648 $92,618,576 Idaho $1,456,663 $8,009,528 $2,953,624 $12,419,815 Indiana $10,433,435 $54,808,762 $19,537,182 $84,779,379 Kentucky $8,964,492 $42,104,502 $15,195,180 $66,264,174 Louisiana $738,586 $6,715,187 $2,084,180 $9,537,953 Mississippi $4,292,206 $31,818,943 $10,953,900 $47,065,049 Missouri $10,545,550 $53,056,193 $18,007,702 $81,609,445 Nevada $353,279 $3,988,216 $1,325,420 $5,666,915 New Hampshire $1,154,849 $7,432,016 $7,289,809 $15,876,674 New Mexico $289,408 $2,896,230 $1,042,091 $4,227,729 North Carolina $9,584,620 $70,600,278 $23,981,847 $104,166,745 North Dakota $247,701 $1,262,726 $434,890 $1,945,317 Oklahoma $5,071,703 $27,461,295 $9,850,258 $42,383,256 Pennsylvania $3,732,944 $28,137,486 $10,363,985 $42,234,415 South Carolina $6,153,943 $42,003,002 $13,943,234 $62,100,179 Tennessee  $3,896,806 $21,184,651 $7,519,700 $32,601,157 Texas  $13,877,778 $141,908,168 $51,967,212 $207,753,158 Virginia  $6,625,044 $63,976,144 $25,137,489 $95,738,677 West Virginia  $1,515,366 $7,504,979 $2,695,773 $11,716,118 Wyoming $1,156,170 $5,456,495 $1,923,007 $8,535,672 TOTAL  $1,319,944,324 7American Cancer Society Cancer Action Network Savings Lives, Saving Money: A State-By-State Report on the Health and Economic Benefits of Comprehensive Smoke-Free Laws                                                                   State Medicaid programs devote large sums to treating tobacco-related disease in both smokers and non-smokers who develop disease  through exposure to secondhand smoke.', 'Because ﬁETS  [environmental tobacco smoke] is known to be an   PHA [public housing authority] to achieve good  IAQ [indoor air quality] in its buildings if residents  are allowed to smoke, especially indoors.ﬂ The  notice further stated that a non-smoking policy  was an ﬁexcellent approachﬂ for those PHAs  seeking to improve their IAQ without the costs  of renovation.39Other possible savings from smoke-free policies  are:Ł    In several states (such as Maine, California  and New Hampshire), developers of low- income housing are able to earn tax credits  for providing smoke-free housing.40Ł   Smoke-free policies can help a building  earn ﬁGreen Buildingﬂ program credits  through programs such as the U.S. Green  Building Council™s Leadership in Energy  and Environmental Design (LEED)  program.41 Section II Œ Prohibiting Smoking  in Public Housing and HUD-Assisted Housing UnitsHUD Encourages the Adoption of Smoke-Free Policies HUD has indicated that subsidized and public  housing providers are free under federal law to  prohibit smoking in residential units as long as  the policies comply with applicable state and local  laws.42 There are no federal or state laws or cases  that prohibit HUD-assisted property owners and  PHAs from offering smoke-free rentals 43  and there  are no constitutional protections for smokers.44 The Chief Counsel in HUD™s Detroit office  concluded in a 2003 letter that private owners  of HUD-assisted housing may prohibit smoking  as long as they are in compliance with any state  law on smoking.'], '')\n",
      "\n",
      "\n",
      "Cluster 6\n",
      "\n",
      "    This pretty well destroys the Myth of second hand smoke:    Lungs from pack-a-day smokers safe for transplant, study finds.  By JoNel Aleccia, Staff Writer, NBC News.  Using lung transplants from heavy smokers may sound like a cruel joke, but a new study finds that organs taken from people who puffed a pack a day for more than 20 years are likely safe.  What's more, the analysis of lung transplant data from the U.S. between 2005 and 2011 confirms what transplant experts say they already know: For some patients on a crowded organ waiting list, lungs from smokers are better than none.  \"I think people are grateful just to have a shot at getting lungs,\" said Dr. Sharven Taghavi, a cardiovascular surgical resident at Temple University Hospital in Philadelphia, who led the new study...........................  Ive done the math here and this is how it works out with second ahnd smoke and people inhaling it!  The 16 cities study conducted by the U.S. DEPT OF ENERGY and later by Oakridge National laboratories discovered:  Cigarette smoke, bartenders annual exposure to smoke rises, at most, to the equivalent of 6 cigarettes/year.  146,000 CIGARETTES SMOKED IN 20 YEARS AT 1 PACK A DAY.  A bartender would have to work in second hand smoke for 2433 years to get an equivalent dose.  Then the average non-smoker in a ventilated restaurant for an hour would have to go back and forth each day for 119,000 years to get an equivalent 20 years of smoking a pack a day! Pretty well impossible ehh!  .\n",
      "\n",
      "\n",
      "Cluster 7\n",
      "\n",
      "Long Comment, Extracted Summary Below:\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "([('smoking', 9), ('e', 8), ('rule', 7), ('health', 6), ('tobacco', 5), ('s', 5), ('shs', 4), ('research', 3), ('housing', 3), ('hud', 3), ('jan', 3), ('ibid', 3), ('street', 2), ('march', 2), ('department', 2)], [' 15 , 201 6     The Honorable Julian Castro   Secretary   US Department of Housing and Urban Development   451 7th Street, SW   Washington, DC 20410     RE:    Instituting Smoke - Free Public Housing , Proposed Rule     RIN  2577 - AC97     Dear Secretary Castro,      The M arch of Dimes, a unique collaboration of scientists, clinicians, parents, members of  the business community, and other volunteers affiliated with ch a pters representing  every state, the District of Columbia and Puerto Rico, appreciates this opportunity to  o  Instituting Smoke - Free Public Housing  published in the  Federal Register   on  November   17 , 2015.', 'As advocates for the health and wellbeing of women of childbear ing age, pregnant  women ,   and infants across the Unite d States, we applaud HUD    us e of   the proposed  rule to  highlight the deleterious effect s of   smoking and  secondhand smoke (SHS)  on the  health of pregnant woman, unborn fetuses, and  children .', 'March of Dimes Foundation     Office of Government Affairs   1401 K Street, NW Suite 900A   Washington, DC 20005   Telephone (202) 659 - 1800   Fax (202) 296 - 2964     marchofdimes.org   nacersano.org        n public  housing indoor areas is   an impor tant step to limiting the adverse effects of smoking and  SHS.', 'Sincerely,           Dr. Jennifer L. Howse   President                                                           i   U S Department of Health   and Human Services.'], '')\n",
      "\n",
      "\n",
      "Cluster 8\n",
      "\n",
      "Long Comment, Extracted Summary Below:\n",
      "([('thank', 7), ('eritage', 1)], [], '')\n",
      "\n",
      "\n",
      "Cluster 9\n",
      "\n",
      "  I am an Executive Director of a small 20-unit housing authority of duplexes for elderly and those with a disability. We have residents who smoke inside and this rule will have a major impact on them. The most dramatic part of the Rule is the distance restriction of 25 feet. The Rule's restriction does not take into account that this is the individual's home. I understand restricting the smoking from inside but not the distance from buildings. Most of those who smoke will not change to smoke away from the building. I will probably lose most of those who do smoke. This is going to increase our expenses from move-outs and if we had a 25 feet restriction, we will need to build some type of structure so the resident doesn't have to smoke in the rain, snow, wind, etc. And this structure will be more than just 25 feet from some apartments so some residents will have a long distance to go smoke. I don't believe many of the smokers will remain in the program even though they need the housing assistance. Is that HUD's purpose? To get rid of all the smokers?   I'm not opposed to restricting the smoking inside buildings but the distance restriction is not going to work. Please remove that from your Rule.  \n",
      "\n",
      "\n",
      "Cluster 10\n",
      "\n",
      "Long Comment, Extracted Summary Below:\n",
      "([('rule', 14), ('smoke', 13), ('cessation', 11), ('policy', 10), ('smoking', 9), ('site', 8), ('secondhand', 8), ('housing', 6), ('department', 5), ('tobacco', 5), ('phas', 4), ('water', 4), ('enforcement', 4), ('e', 3), ('pipe', 3)], ['ment of Health    Tobacco Control Program   3 Capitol Hill, room 409   Providence, RI 02908         To: Regulations Division, Office of General Counsel, Department of Housing and Urban Development     From: Rhode Island Live Smoke Free project       R e: Proposed No Smoking Rule for PHAs [Docket No.', 'FR 5597 - P - 02] RIN 2577 - AC97             Instituting Smoke - Free Public Housing     Date: January 15, 2016   ______________________________________________________________________________     The Rhode Island Department o f Health  comments about the  Department of Housing and Urban Development (HUD)  proposed no smoking  rule in December 2015.', 'On behalf of the  forum participants , Live Smoke Free  is pleased to submit comm ents to the  Department of Housing and Urban Development (HUD) regarding the proposed no smoking rule .', 'Barriers for PHA s   in implementing a smoke - free housing policy include resident resistance   which   may  cause conflicts between smoking groups vs. n on - smoking groups, enforcement may be challenging in  the evening and on weekends when there is limited staff.', 'Cost associated with implementing and enforcing a no smoking policy include increased staff time to  survey residents, facilitate educational resident meetings, supplies for meetings such as  r efr eshments, printed educational materials and resident incentives to attend informational  meetings.', 'The data about the danger s of secondhand smoke in the proposed rule  supports the benefits of a no smoking rule and can be used to educate residents.', 'A no smoking policy with a 25ft buffer zone may not be a far eno ugh distance to protect secondhand  smoke from drifting back into the building through the entrance way, windows and or balconies.', 'Does this proposed rule create burdens, costs,   or confer benefits specific to  families, children, persons with disabilities, owners, or the elderly, particularly if any individual or  family is evicted as a result of this policy?', 'For those PHAs that have already implemented a smoke - free policy, what  experiences, lessons, or advice would you share based on your experiences with imp lementing and  enforcing the policy?'], '')\n",
      "\n",
      "\n",
      "Cluster 11\n",
      "\n",
      "Long Comment, Extracted Summary Below:\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "Warning: parsing empty text\n",
      "([('smoke', 53), ('housing', 52), ('health', 48), ('exposure', 44), ('smoking', 41), ('shs', 35), ('tobacco', 34), ('al', 25), ('control', 22), ('policy', 18), ('fire', 17), ('percent', 16), ('et', 15), ('e', 15), ('phas', 15)], ['                                                                                                      January  19,  2016   The Honorable Juli á n Castro   Secretary   Department of Housing and Urban Development   451 Seventh Street SW   Washington, DC   20410   Re:   Instituting Smoke - Free Public Housing; Docket No.', 'In 2007, the World Health Organization   (WHO) presented its clear conclusion that     percent   smokefree environments [is] the only effective strategy to reduce exposure  to tobacco smoke to safe levels in indoor environments and to provide an acceptable level of protection  from the   dangers of  SHS    32   The organization reaffirmed its recommendation in 2014 and  called for a  prohibition  on the use of  ENDS   indoors due to the risks presented by secondhand exposure  to the devices.', '15     Sincerely,   Action on Smoking & Health   Alpha - 1 Foundation   American Academy of Family Physicians   American Academy of Oral and Maxillofacial     Pathology   American Academy of Otolaryngology    Head and   Neck Surgery   American Academy of Pediatrics   American Association for Respiratory Care   American Cancer Society Cancer Action    Network   American College of Osteopathic Surgeons   American Congress of Obstetricians and Gynecologists   American Heart Association    American Lung Association   American Osteopathic Academy of Orthopedics   American Public Health Association   American School Health Association   American Society of Addiction Medicine   American Thoracic Society   Association o f State & Territorial Health Officials   Campaign for Tobacco - Free Kids   Cancer Prevention and Treatment Fund   ClearWay Minnesota   Community Anti - Drug Coalitions of America   COPD Foundation   Geographic Health Equity Alliance   Green and Healthy Homes Initiative   International Association for the Study  of Lung Cancer   March of Dimes   National African American Tobacco Prevention Network   National Association of County and City Health Officials   National Hispanic Medical Association   National La tino Alliance for Health Equity   National Network of Public Health I nstitutes      North American Quitline Consortium   Oncology Nursing Society   Prevention Institute   Society for Public Health Education     16     1   US Department  of Health and Human Services.', 'Roberts KH,                                                                17                                                                                                                                                                                                      Munafo MR, Rodriguez D, et al.', 'Preferences and practices among renters regarding smoking  18                                                                                                                                                                                                      restrictions i n apartment buildings.', '19                                                                                                                                                                                                      66   Housing and Redevelopment Authority of Duluth, MN.', '83       2015.   https://www.usfa.fema.gov/downloads/pdf/publications/electronic_cigarettes.pdf   84      http://www.faa.gov/other_visit/aviation_industry/airline_operators/airline_safety/safo/all_safos/media/201 5/SAFO15003.pdf   20                                                                                                                                                                                                      85    http://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_ industry/hookahs/ .', 'Smoking is allowed in some places   or at some times   c.   Smoking is permitted anywhere inside my home   Sample Resident Sur vey   Appendix A                   Source:   Portland - Vancouver Metro Area Smokefree Housing Project   Sample  Resident  Survey   |  2     Residents:  Please       circle      the answer     that     best     describes     you    and    your  situation.', \"Baseline Status of PHA  Philosophy (estimated by PHA staff) 55 27 16 7 5 9 0 10 20 30 40 50 60 70 80 90 100 PHA Responses Fully Support NS Somewhat Support NS Neutral Somewhat Oppose NS Strongly Oppose NS Don't Know 26 32 15 9 17 20 0 10 20 30 40 50 60 70 80 90 100 PHA Responses Baseline Status of Resident  Opinion (estimated by PHA staff)  0 5 10 15 20 25 30 35 Obstacles Losing Occupants Losing Potential Residents Compliance/ Enforcement Legal Concern Accomodating Current Smokers How to Provide for Low-Income Smokers  0 5 10 15 20 25 Resources Tenant Materials Approved Lease Adendum Signage Connect to Other HA Access to Lawyer Q & A Disabilities Heath Info Cessation Info Survey of Tenants We developed a package and sent them to the Public Housing Authorities that  provided the information and the support and guidance that they had requested.\", \"We considered:  Current status  PHA  Philosophy  Resident Feelings  Percentage of Smokers  Multi - family Building structure Number of Smoke Free Agencies 21, 17% 101,  83% Minnesota PHA's  Baseline 2009 Currently Has No Smoking Implemented Has Zero No Smoking Implemented 44,  36% 78, 63% Minnesota PHA's      June 2010 Currently Has No Smoking Implemented Has Zero No Smoking Implemented Added 8  No   from Pipeline   May 2010 Added  6   Pipeline June  2010  Attitudes 41 12 0 10 20 30 40 50 Baseline End of Project Resisted Changing Towards a Smoke Free PHA Model WE ARE NOT SURE IF  WE WANT TO BE  SMOKE FREE !\"], '')\n",
      "\n",
      "\n"
     ]
    }
   ],
   "source": [
    "print('Most Central Comments by Cluster\\n')\n",
    "for i in range(num_clusters):\n",
    "    print('Cluster {}\\n'.format(i))\n",
    "    if len(comment_frame[comment_frame.cluster==i].min().comment) < 2000:\n",
    "        print(comment_frame[comment_frame.cluster==i].min().comment)\n",
    "    else:\n",
    "        print('Long Comment, Extracted Summary Below:')\n",
    "        print(extract_summary(comment_frame[comment_frame.cluster==i].min().comment))\n",
    "    print()\n",
    "    print()"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 21,
   "metadata": {
    "collapsed": false
   },
   "outputs": [
    {
     "data": {
      "text/plain": [
       "'                                https://www.facebook.com/groups/WP4HE/                           January 15, 2016       Office of the Assistant Secretary for  Public and Indian Housing   U.S. Department of Housing and Urban Development     RE: Docket Number FR 5597 - P - 02   Instituting Smoke - Free Public Housing     To Whom  It   May Concern:     On behalf of the Westlawn Partnership for a Healthier Environment, I am pleased to pr ovide a  letter of support for the proposed rule to require all Public Housing Authorities to implement  smoke - free policies (HUD Docket No. FR 5597 - P - 02).     The Westlawn Partnership for a Healthier Environment  is a group of community stakeholders  that   has met on a regular basis since 2008 to identify, prioritize, and address environmental  health concerns in the Westlawn community.  Located in northwest Milwaukee, Westlawn is   - subsidized housing development.     Milwauke e County ranks as the worst county in the State of Wisconsin for asthma - related  hospitalizations and emergency department visits.  Moreover, specific to  the  Westlawn   community , the rate of hospitalizations for asthma among children is nearly twice that of  Mi l w aukee County, and the rate of asthma - related emergency department visits is 1.5 times  higher in this community compared to the rest of the county.  Thus, smoke - free housing could  help to   reduce asthma triggers, improve indoor air quality ,   and   improve health outcomes   for  children and families in Westlawn and beyond.       Thank  you for proposing this important rule     it  has the potential to reduce health care costs,  save lives, and improve the quality of life for so many Americans.     Sincerely,        Anne Dressel, PhD, CFPH   Project Director   Westlawn Partnership for a Healthier Environment   Email:  banda@uwm.edu   Phone: (414) 229 - 3995   '"
      ]
     },
     "execution_count": 21,
     "metadata": {},
     "output_type": "execute_result"
    }
   ],
   "source": [
    "comment_frame[comment_frame.cluster==4].min().comment"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 22,
   "metadata": {
    "collapsed": false
   },
   "outputs": [
    {
     "data": {
      "text/plain": [
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       "          4.84406128e-01,  -6.68097202e-02,  -9.97456023e-02,\n",
       "         -2.04252430e-01,  -1.48703717e-01,   1.77743442e-01,\n",
       "         -2.39305741e-01,   9.02820984e-02,   8.48372654e-02,\n",
       "          1.67237660e-01,  -1.14210034e-01,   5.76254619e-01,\n",
       "         -5.46695592e-02,  -1.55036850e-03,   4.56155871e-02,\n",
       "         -2.60529485e-01,   5.89002140e-02,  -9.36163552e-02],\n",
       "       [  4.96941278e-01,  -1.55745038e-01,   1.08927639e-02,\n",
       "          3.54045737e-01,  -1.50092754e-02,  -5.90192257e-02,\n",
       "          1.32379635e-01,  -8.40332567e-02,   1.27443000e-01,\n",
       "          2.29087401e-01,  -6.43369317e-03,  -2.74078919e-02,\n",
       "         -4.66412824e-02,  -6.05277520e-02,   6.34181136e-02,\n",
       "         -1.23834013e-01,  -2.62887234e-01,  -2.46809583e-01,\n",
       "         -2.73196336e-01,   2.80517945e-01,   4.53215076e-02,\n",
       "          6.09651093e-02,  -1.76705426e-01,   1.12337871e-02,\n",
       "          3.80481108e-01,   4.20349015e-02,   1.15388095e-01],\n",
       "       [ -4.67301101e-01,  -1.56467917e-01,   2.87350008e-02,\n",
       "          1.07404267e-01,   2.31206046e-01,  -1.95375192e-02,\n",
       "          4.60496103e-02,  -5.12434274e-02,   6.84460738e-01,\n",
       "          3.08266372e-01,   4.68133949e-02,   4.46734963e-02,\n",
       "         -5.91048042e-02,  -7.12723927e-02,   1.22539338e-01,\n",
       "          7.27449307e-02,   5.29427472e-03,   1.22586963e-02,\n",
       "         -1.57398029e-01,   9.27091980e-02,  -8.45427589e-02,\n",
       "         -4.26042355e-02,  -9.93920026e-02,   1.34560958e-02,\n",
       "         -1.87785898e-01,  -1.88760578e-02,  -3.78053673e-02],\n",
       "       [  2.69939009e-01,  -1.61721416e-01,   3.47344345e-02,\n",
       "          7.31087532e-02,   5.60339449e-01,  -1.27964831e-01,\n",
       "          9.08260677e-02,   4.17784133e-02,  -2.36731046e-01,\n",
       "         -5.44521222e-02,   5.60223702e-03,   1.41094325e-02,\n",
       "          7.27183962e-02,  -1.41529770e-02,   8.04408359e-03,\n",
       "          6.47973709e-02,  -1.19742596e-01,  -9.60410537e-02,\n",
       "         -1.18838096e-02,   1.07290741e-01,  -8.92972717e-02,\n",
       "          2.10074644e-01,  -4.99091589e-02,   1.08532674e-01,\n",
       "         -5.87008888e-01,  -4.91132241e-02,  -1.91068072e-01],\n",
       "       [ -3.62412010e-01,  -4.64681715e-02,  -1.02889669e-02,\n",
       "         -4.41481069e-02,   3.84910725e-03,  -9.54778079e-02,\n",
       "         -1.84194654e-01,   2.44085587e-01,  -1.20227156e-01,\n",
       "          9.36291392e-02,   3.08896591e-02,   2.38683338e-02,\n",
       "          3.37534661e-03,  -1.70894027e-03,  -6.59382676e-02,\n",
       "          6.34317251e-02,  -2.47237989e-01,  -2.26722058e-01,\n",
       "          7.20919554e-02,  -4.03809796e-02,   2.60173248e-01,\n",
       "          7.05156591e-01,  -8.57246971e-02,  -1.44519803e-02,\n",
       "          1.76089291e-01,   5.91725944e-02,   4.81321793e-02],\n",
       "       [  1.65599480e-01,  -1.26002770e-01,   6.56946524e-03,\n",
       "          2.78701836e-02,  -2.14910532e-01,   9.32652755e-02,\n",
       "         -1.36233779e-01,  -3.43615996e-01,  -3.68932088e-03,\n",
       "          1.19066109e-01,   9.52777182e-03,   1.38195195e-02,\n",
       "          5.74812757e-02,   5.50763216e-02,   1.09076935e-01,\n",
       "         -6.49353433e-03,   4.05351839e-01,   3.76466746e-01,\n",
       "         -1.48595866e-01,   2.68969293e-02,  -2.33059044e-01,\n",
       "          5.37805886e-01,  -9.85457320e-02,  -1.86167608e-01,\n",
       "         -9.71224094e-02,   7.32598979e-02,  -7.17720672e-03],\n",
       "       [  1.96130350e-02,   4.93424671e-01,   1.02649949e-02,\n",
       "         -1.70901312e-02,  -6.96067399e-02,   1.33329490e-01,\n",
       "          4.04403893e-01,   5.35219989e-01,  -6.27823081e-02,\n",
       "          2.45525177e-01,  -7.86455468e-02,  -6.77856331e-02,\n",
       "         -9.52597038e-02,  -5.56404227e-02,   2.56174850e-02,\n",
       "         -2.25144366e-02,   6.07952427e-02,   6.51647496e-02,\n",
       "         -2.33776672e-01,  -2.80151518e-02,  -3.02924070e-01,\n",
       "          1.31060613e-01,  -1.00603790e-01,  -5.92260156e-02,\n",
       "         -7.48767415e-02,  -4.73296320e-02,   3.15164716e-02],\n",
       "       [ -7.68053643e-02,   2.45905604e-01,   6.56602373e-02,\n",
       "          3.48609547e-01,  -3.36911464e-02,   4.02580285e-02,\n",
       "          9.12208149e-02,  -7.12772520e-02,   7.12103124e-02,\n",
       "         -3.06395508e-01,   5.83237070e-02,   4.77192318e-02,\n",
       "         -2.15434165e-01,  -1.66052875e-01,  -3.81955438e-01,\n",
       "         -3.90696777e-02,   1.82771460e-01,   1.68182353e-01,\n",
       "         -2.18686471e-01,   2.80244681e-01,   4.04638322e-01,\n",
       "          1.42265648e-01,   1.82647214e-01,   1.75740709e-01,\n",
       "         -1.00536057e-01,  -1.35608076e-01,  -2.89684390e-02],\n",
       "       [ -1.85104826e-01,  -2.90601088e-01,   1.21456956e-02,\n",
       "         -1.17808412e-01,  -1.04531421e-02,   1.88959248e-01,\n",
       "          6.85368257e-01,  -1.90860136e-01,  -1.21629210e-02,\n",
       "         -4.21557765e-01,  -6.58409109e-03,  -3.08479203e-02,\n",
       "         -1.01786645e-01,  -7.14828774e-02,   1.91449769e-01,\n",
       "         -1.52124036e-01,  -5.88247743e-02,  -5.93445729e-02,\n",
       "          6.06649026e-02,  -9.09125496e-02,  -6.99558192e-02,\n",
       "          1.76139797e-01,  -3.99467198e-02,   1.64869064e-02,\n",
       "          1.05530685e-01,   1.65499115e-03,   5.75877980e-02],\n",
       "       [  2.14989110e-02,   5.93049508e-01,  -2.45532339e-02,\n",
       "         -1.35207031e-01,   1.18371876e-01,   1.89144208e-01,\n",
       "         -2.30564318e-02,  -5.90507734e-01,   5.44794769e-02,\n",
       "          7.26819006e-02,  -3.61557765e-02,  -4.98557755e-02,\n",
       "         -1.31970853e-01,  -8.86086138e-02,   2.54546586e-03,\n",
       "          5.63626801e-02,  -2.69107815e-01,  -2.38683969e-01,\n",
       "          9.14058722e-02,  -6.44446747e-02,  -1.37263423e-02,\n",
       "          9.01715862e-02,  -4.64158341e-02,  -1.23159010e-01,\n",
       "         -8.60655528e-02,   1.15017723e-01,  -3.54664536e-02],\n",
       "       [ -5.04281419e-02,   2.55242447e-01,  -1.50428274e-01,\n",
       "          1.27243215e-01,  -9.29688555e-02,  -3.87100578e-01,\n",
       "          1.43464668e-02,  -1.53803970e-02,   4.77649274e-02,\n",
       "         -2.38987105e-01,  -2.48493592e-01,  -2.04626274e-01,\n",
       "          2.10099155e-01,   1.32348546e-01,   6.35734860e-01,\n",
       "          1.64268901e-01,   2.54599661e-02,   1.41241892e-02,\n",
       "         -1.02989037e-01,   1.10186999e-01,   1.99520053e-01,\n",
       "          3.58085903e-02,   4.14067495e-02,   7.66327942e-03,\n",
       "         -3.15211664e-02,  -1.02281936e-01,  -2.86988388e-02],\n",
       "       [  6.79549586e-02,  -9.06788147e-02,   6.87784517e-02,\n",
       "          1.95762863e-02,   1.87217397e-01,   4.25763240e-01,\n",
       "         -3.58088155e-01,   2.29704196e-01,  -3.43192024e-02,\n",
       "         -2.23134808e-01,  -8.75739349e-02,  -5.05552461e-02,\n",
       "         -4.15001119e-01,  -3.15309303e-01,   3.93694575e-01,\n",
       "          9.44577440e-02,   2.62993006e-02,   3.25408072e-02,\n",
       "         -1.26486450e-01,   4.80718787e-03,   7.30050054e-02,\n",
       "         -4.87373243e-02,   7.85063732e-03,  -1.31960737e-01,\n",
       "          3.98629188e-02,   2.08032928e-01,  -1.24427348e-02],\n",
       "       [  3.30947851e-02,   5.87468402e-02,   3.33263332e-02,\n",
       "         -7.71956653e-02,  -1.56240533e-01,   1.16386850e-01,\n",
       "         -1.73858178e-01,  -4.52399138e-02,   3.11799384e-02,\n",
       "          2.68327644e-02,   1.63110378e-02,   4.57468910e-02,\n",
       "         -5.59916446e-02,  -3.72245795e-02,   1.81120998e-01,\n",
       "         -9.97783190e-02,  -3.45003768e-02,  -2.64022299e-02,\n",
       "          7.63173240e-04,  -7.15231149e-02,  -1.92686370e-01,\n",
       "          9.55217499e-02,  -4.48326736e-02,   8.96093591e-01,\n",
       "          9.54843475e-03,  -8.30272968e-02,  -3.98346903e-02],\n",
       "       [  2.96132913e-03,  -1.86335028e-01,  -7.32978777e-02,\n",
       "         -3.55875215e-02,   1.52564278e-02,   1.25336998e-01,\n",
       "          8.73453865e-02,  -7.59625659e-02,  -2.58720775e-02,\n",
       "          1.12262462e-01,  -5.42263566e-01,  -4.39114017e-01,\n",
       "         -4.84169931e-02,  -1.08987960e-02,  -2.96480238e-01,\n",
       "          5.47138358e-01,   3.34162229e-02,   4.84573750e-02,\n",
       "         -3.81714190e-03,  -1.55897010e-02,   9.66221068e-03,\n",
       "         -3.29581201e-03,  -4.50834868e-02,   1.56245156e-01,\n",
       "          8.35661142e-02,  -4.18313476e-02,   2.04437581e-02]])"
      ]
     },
     "execution_count": 22,
     "metadata": {},
     "output_type": "execute_result"
    }
   ],
   "source": [
    "svd.components_"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": null,
   "metadata": {
    "collapsed": true
   },
   "outputs": [],
   "source": []
  },
  {
   "cell_type": "code",
   "execution_count": null,
   "metadata": {
    "collapsed": true
   },
   "outputs": [],
   "source": []
  },
  {
   "cell_type": "code",
   "execution_count": null,
   "metadata": {
    "collapsed": true
   },
   "outputs": [],
   "source": []
  },
  {
   "cell_type": "code",
   "execution_count": null,
   "metadata": {
    "collapsed": true
   },
   "outputs": [],
   "source": []
  },
  {
   "cell_type": "code",
   "execution_count": null,
   "metadata": {
    "collapsed": true
   },
   "outputs": [],
   "source": []
  },
  {
   "cell_type": "code",
   "execution_count": null,
   "metadata": {
    "collapsed": true
   },
   "outputs": [],
   "source": []
  },
  {
   "cell_type": "markdown",
   "metadata": {},
   "source": [
    "### K Means"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 23,
   "metadata": {
    "collapsed": true
   },
   "outputs": [],
   "source": [
    "from sklearn.cluster import KMeans\n",
    "\n",
    "num_clusters = 12\n",
    "km = KMeans(n_clusters=num_clusters)\n",
    "km.fit(tfidf_matrix)\n",
    "clusters = km.labels_.tolist()"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 24,
   "metadata": {
    "collapsed": true
   },
   "outputs": [],
   "source": [
    "from sklearn.metrics.pairwise import paired_distances\n",
    "\n",
    "cluster_center_list = []\n",
    "for c in clusters:\n",
    "    cluster_center_list.append(km.cluster_centers_[c])\n",
    "\n",
    "center_distances = paired_distances(tfidf_matrix, cluster_center_list)"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 25,
   "metadata": {
    "collapsed": false
   },
   "outputs": [],
   "source": [
    "import pandas as pd\n",
    "comment_clusters = {'comment': comments, 'cluster': clusters, 'dist': center_distances}\n",
    "comment_frame = pd.DataFrame(comment_clusters, index = [clusters] , columns = ['comment', 'cluster', 'dist'])"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 26,
   "metadata": {
    "collapsed": false
   },
   "outputs": [
    {
     "data": {
      "text/plain": [
       "1     297\n",
       "2     141\n",
       "6     132\n",
       "4     125\n",
       "3     102\n",
       "5      94\n",
       "8      91\n",
       "9      88\n",
       "10     85\n",
       "11     69\n",
       "7      41\n",
       "0      25\n",
       "Name: cluster, dtype: int64"
      ]
     },
     "execution_count": 26,
     "metadata": {},
     "output_type": "execute_result"
    }
   ],
   "source": [
    "comment_frame['cluster'].value_counts()"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 27,
   "metadata": {
    "collapsed": false
   },
   "outputs": [
    {
     "name": "stdout",
     "output_type": "stream",
     "text": [
      "comment    We would like to see this rule passed\n",
      "cluster                                        3\n",
      "dist                                    0.921081\n",
      "dtype: object\n",
      "\n",
      "comment            January  13, 201 6  The Honorable Juli...\n",
      "cluster                                                    3\n",
      "dist                                                0.434169\n",
      "dtype: object\n",
      "\n",
      "comment                                          January ...\n",
      "cluster                                                    5\n",
      "dist                                                0.385933\n",
      "dtype: object\n",
      "\n",
      "                                              comment  cluster      dist\n",
      "3   This comment addresses the possibility of limi...        3  0.628716\n",
      "3   The Cook County Department of Public Health of...        3  0.805541\n",
      "3   This is a Comment on the Department of Housing...        3  0.566029\n",
      "3   The U.S. Department of Housing and Urban Devel...        3  0.472694\n",
      "3   The Martin Housing Authority in Martin, SD is ...        3  0.543663\n",
      "3   ClearWay Minnesota strongly supports the propo...        3  0.585305\n",
      "3   Please see attached comments and addendum to c...        3  0.642685\n",
      "3   On behalf of the 15,000 members of the America...        3  0.675877\n",
      "3   The Peninsula Housing Authority adopted a smok...        3  0.747856\n",
      "3   As a pediatrician and a member of the American...        3  0.596759\n",
      "3   This is another unfunded mandate proposed (soo...        3  0.434169\n",
      "3   The Chelsea HA implemented a smoke-free policy...        3  0.629523\n",
      "3   Electronic cigarettes are needing to be addres...        3  0.801584\n",
      "3   HUD Should Apply the Final Smokefree Rule to A...        3  0.528737\n",
      "3   I fully support the Department of Housing and ...        3  0.558473\n",
      "3   January 19, 2016  Secretary Julin Castro  c/o ...        3  0.593684\n",
      "3   The Michigan Multicultural Network (MCN) is re...        3  0.473180\n",
      "3   We already have a non-smoking policy in place ...        3  0.827979\n",
      "3   ChangeLab Solutions strongly supports the prop...        3  0.619658\n",
      "3   Attached are Americans for Nonsmokers' Rights'...        3  0.585651\n",
      "3   Dear Secretary Castro-  I'm writing to express...        3  0.626486\n",
      "3   The proposed rule directly opposes Congression...        3  0.452571\n",
      "3   The Smoke-Free rule is ok but the 25' distance...        3  0.825897\n",
      "3   HUD Should Apply the Final Smokefree Rule to A...        3  0.659636\n",
      "3   Generally, non- smoking HAs are a good idea ba...        3  0.600225\n",
      "3   I agree with the rule that no one should smoke...        3  0.719073\n",
      "3   I support prohibition of smoking of tobacco pr...        3  0.689883\n",
      "3   Playgrounds Should be Included in the Final Sm...        3  0.545182\n",
      "3   I am the Executive Director of a small Public ...        3  0.460612\n",
      "3   This proposed rule would place an unfair burde...        3  0.548388\n",
      "..                                                ...      ...       ...\n",
      "3   As an individual who does not smoke I complete...        3  0.768948\n",
      "3     This proposed rule would be difficult and ex...        3  0.635390\n",
      "3   Comments of Norfolk Redevelopment and Housing ...        3  0.483553\n",
      "3   This rule is similar to prohibition which only...        3  0.753059\n",
      "3   I feel that this is an over reach of the gover...        3  0.921081\n",
      "3   Please see the attached document for PinneyAss...        3  0.619658\n",
      "3   I strongly support this proposed rule to offer...        3  0.665186\n",
      "3   I agree with PHADA that undoubtedly, smoke-fre...        3  0.565217\n",
      "3   Please add e-cigarettes, ENDS, and water pipes...        3  0.801584\n",
      "3   Unintended consequences of the 25ft rule.  The...        3  0.654374\n",
      "3   I support this proposed rule. It will increase...        3  0.772137\n",
      "3   I fully support the proposed rule and laud act...        3  0.664490\n",
      "3   This rule has the potential to improve public ...        3  0.704281\n",
      "3   The Allegheny County Health Department strongl...        3  0.655875\n",
      "3   Thank you for preparing the HUD proposed Rule....        3  0.707406\n",
      "3   Attached are Americans for Nonsmokers' Rights'...        3  0.524557\n",
      "3      January 19, 2016    Regulations Division  O...        3  0.542597\n",
      "3   Print Page 1 of 4 Subject: HUD SECRETARY CASTR...        3  0.565215\n",
      "3   ASHEBORO HOUSING AUTHORITY January 5, 2016 338...        3  0.482075\n",
      "3         221 Oak Street   Oakland, CA 94607   510...        3  0.560449\n",
      "3           January  13, 201 6  The Honorable Juli...        3  0.559994\n",
      "3     January 19, 2016          Secretary Julián C...        3  0.599736\n",
      "3   !\"! January 19 , 2016  Regulations Division, O...        3  0.640885\n",
      "3     January 13 , 2015     RE:  Comment on the   ...        3  0.563538\n",
      "3   1      January 19, 2016   Office of General Co...        3  0.567814\n",
      "3   Akron Metropolitan Housing Authority 100 W. Ce...        3  0.527822\n",
      "3   1101jolk retlevclupnrent J: HOUSING AUTHORITY ...        3  0.498529\n",
      "3   November 12, 2015 RE: HUD's Proposed  Rule to ...        3  0.437492\n",
      "3   Legal Aid Foundation of Los AngelesSouth Los A...        3  0.552827\n",
      "3    January 11, 2016 To whom it may concern: As E...        3  0.496475\n",
      "\n",
      "[102 rows x 3 columns]\n"
     ]
    }
   ],
   "source": [
    "print(comment_frame[comment_frame.cluster==3].max())\n",
    "print()\n",
    "print(comment_frame[comment_frame.cluster==3].min())\n",
    "print()\n",
    "print(comment_frame[comment_frame.cluster==5].min())\n",
    "print()\n",
    "print(comment_frame[comment_frame.cluster==3])"
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      "Most Central Comments by Cluster\n",
      "\n",
      "Cluster 0\n",
      "\n",
      "  January 19, 2016       The Honorable Julián Castro   Secretary   Department of Housing and Urban Development   451 Seventh Street SW   Washington, DC 20410   Re: Instituting Smoke - Free Public H ousing; Docket No. FR 5597 - P - 02     Dear Secretary Castro:     On behalf of the Advocacy Council of the American College of Allergy, Asthma and  Immunology, we are pleased to submit this letter of support for the  proposed rule published in  the  Federal Register   on November 17, 2015 (Docket No. FR - 5597 - P - 02) on instituti ng smoke - free public housing.       Immunology, represents the interests of over 6,000 allergists/immunologists and allied health  professionals.  Its members are at the   front line of caring for individuals with asthma which  disproportionately impacts those living in urban areas, especially children.       Our organization   support s   th e proposed new rule  as we believe it could significantly  improve the  health of public housin g residents , particularly those suffering from  a sthma and allergies . The  publication of the proposed rule represents a major step forward in protecting the millions of  Americans who currently live in federally - owned public housing from the harms of tobacco ,  particularly second - hand smoke .  We urge HUD to adopt a final rule implementing this measure.     Secondhand smoke contains many poisons and cancer - causing chemicals, including nicotine,  carbon monoxide, ammonia, formaldehyde, hydrogen cyanide, nitrogen  oxides, phenol, sulfur  dioxi de, lead, and others. As such, s econd - hand smoke  poses health concerns for all individuals,  particularly children and pregnant women.     The re   are numerous  repor ts on the direct health effects of second - hand smoke  exposure. The  mo  The Health  Consequences of Involuntary Exposure to Tobacco Smoke . The report details how even small  amounts of exposure can have serious health effects. S econd - hand smoke  can   exacerbate a wide  range of adverse health effects, including asthma.     Increased rates of lower respiratory illness, middle - ear infections, tonsillectomy and  adenoidectomy, cough, asthma and asthma exacerbations, hospitalizations have been  associated  with  second - hand smoke.   It has been estimated that  second - hand smoke   e xposure causes asthma             symptoms in  hundreds of thousands of children .    One study indicated that children with asthma  who were exposed to  second - hand smoke   had  additional co - morbid  condit ions including higher  levels of obesity and less healthcare usage compared with unexposed children. i     M aintaining a smoke - free  public housing environment   will undoubtedly   decrease  the exposure to  second - hand smoke for  a family   living in public housing.       Studies published in 2011 and 2012 confirmed that children who live in multi - unit housing have  significantly higher exposure to  second - hand smoke  than those who live in detached housing,  and that 15 million children aged 3 - 11 years were exposed to SHS, rep resenting the highest  prevalence of SHS exposure among all age groups.     U sing data from the National Health and Nutrition Examination Survey (NHANES),  t he studies,  showed that   levels of cotinine, a chemical marker of nicotine in the blood, were significant ly  higher among children living in multi - unit housing  compared to  chil dren living in detached  housing . ii , iii     Therefore,  it appears that  the  best   way to fully protect children and adults who live in multi - family housing from second - hand exposure is to impleme nt building - wide smoke - free policies.     All people, regardless of income, should be able to enjoy healthy housing, free of  second - hand  smoke  and other dangerous conditions.     Public housing residents with health conditions including asthma, chronic obstructi ve pulmonary  disease (COPD) and heart disease, could see significant health improvements once they are no  longer exposed to second - hand smoke, which can exacerbate their diseases.  Children and infants  could also significantly benefit from reduced exposure   to second - hand smoke in the form of  fewer ear infections, asthma attacks and lung infections including bronchitis and pneumonia.     The Advocacy Council supports this proposed rule.     If you have any questions, please contact  Don ald   Aaronson,   MD ,  Director of   Governmental   Affairs ,   Advocacy Council of the American College of Allergy, Asthma and Immu nology.       Sincerely,     J. Allen Meadows, MD   Chair   Advocacy Council of the American College of Allergy, Asthma and Immunology     i   Pyle RC et al. Asthma - associated comorbidities in children with and without secondhand smoke exposure.  Annals of Allergy, Asthma &  Immunology . 2015;115(3):205 - 210.   ii   Wilson et al. Tobacco - Smoke Exposure in Children Who Live in Multiunit Housing.  Pediatrics . 2011; 127(1): 85 - 92.   iii    - United States, 1999 - 2012.  Morbidity and Mortality Weekly Report .  2015 ;64(4):103 - 108.                                                         \n",
      "\n",
      "Cluster 1\n",
      "\n",
      "\n",
      "\n",
      "Cluster 2\n",
      "\n",
      "          750 First Street, NE         Washington, DC 20002 - 4242       (202) 336 - 5500           Web: www.apa.org   (202) 336 - 6123 TDD     January 19, 2016     The Honorable Julián Castro   Secretary   Department of Housing and Urban Development   451 Seventh Street SW   Washington, DC 20410     Dear Secretary Castro:     The American Psychological Association (APA), the largest association of psychologists in the  U.S., works  to benefit society and improve people's lives through research, education, practice,  and advocacy.   We have a l ong - standing commitment   to supporting programs and policies to  improve the health and well - being of vulnerable and underserved populations across the lifespan,  which includes low - income, racial/ethnic minority, and other populations (taking into account  ge nder, gender identity, culture, national origin, religion, sexual orientation, disability, and  language)   at high risk for disease and other adverse health conditions 1 .   Reducing tobacco - related  disparities among health priority populations is one of our st rategic initiatives that  we address  primarily through awareness, professional education ,   and resource development 2 .     Research clearly demonstrates that tobacco is the leading caus e of preventable death in the  country across all populations 3   4 .  Vulnerable populations, however,  such as the poor, mentally  ill, racial/ethnic minority groups, persons living with HIV, LGBT persons,  and substance  abusing individuals are at increased ri sk for smoking - related illnesses because of higher exposure  to risks associated with smoking and lower availability of resources to combat smoking 5 .  For  example, second - hand smoke exposure is highest among African Americans (71%), people  living below the  poverty level (43.2%), children aged 3     11, and people living in rental housing  (36.8%) 6 .  African Americans are 20% more likely to have asthma and African American  children are 7 times more likely than non - Hispanic whites to die from asthma - related                                                                1   Public Interest Directorate, American Psychological Association.   http://www.apa.org/pi/   2   Health Disparities Initiative, Public Interest Directorate, American Psychological Association,  http://www.apa.org/to pics/health - disparities/initiative.aspx   3   Centers for Disease Control and Prevention (2015).  Cigarette smoking in the United States.  http://www .cdc.gov/tobacco/campaign/tips/resources/data/cigarette - smoking - in - united - states.html .     4    th   Anniversary, 1964     2014.  http://www.surgeongeneral.gov/priorities/tobacco/index.html   5    http://www.apa.org/topics/health - dispari ties/tobacco - meeting.aspx   6   Centers for Disease Control and Prevention.  Second Hand Smoke Facts.  http://www.cdc.gov/tobacco/data_statistics/fac t_sheets/secondhand_smoke/general_facts/index.htm   2     morbi dities.  Asthma rates are higher in children exposed to secondhand tobacco smoke exposure  and children living below or near the poverty level 7 .  Stress related to discrimination and  stigmatization is associated with smoking among the LGBT community, person s living with HIV  communities, and among the poor 8   9 . Groups at the intersections of these social identities such as  poor African American children with asthma are at even greater risk for smoking relat ed  morbidities and mortality.   Access to easily  available, appropriate, high quality health care  including smoking cessation support is more dif ficult for these populations.   For these reasons,  the field has come to realize  that targeted attention is required to reduce smoking and its  consequences  in vulnerable, health priority   communities .     We are concerned that vulnerable populations dependent on public housing will be threatened  with the prospect of housing insecu rity, the loss of housing, or prolonged homelessness if the  proposed smoke - free rule is adopted.   At the same time, we are aware that the most effective  interventions to reduce smoking over the last 50 years have been public policies that have  prohibited  smoking and restric ted access to tobacco products.    Most of the people in public  housing are children (41%) and seniors (31%) 10   and most, like the majority of Americans, are  nonsmokers 11 . Moreover, similar to most smokers, those who do smoke want to quit.  W e  believe that the tenants in public housing, like other citizens, are entitled to a smoke - free  environment.     APA asks that HUD takes steps to ensure that the rule does not adversely impact HUD  participants.  Results from the implementation of voluntary sm oke - free policies in public  housing are promising and suggest that such policies can be successfully implemented without  creating unanticipated negative consequences for the residents 12 .   We strongly encourage that  safeguards are instituted to minimize the  threat of eviction due to violations of the rule and that  culturally appropriate smoking prevention programs and smoking cessation support and  resources are offered.  We recommend that best practices gleaned from the experiences of  previously implemented v oluntary programs be required for the implementation of this rule.        With these safeguards and support programs in place, APA supports the Housing and Urban   November 17,   2015: Instituting Smoke - Free Public Housing; Docket No. FR5597 - P - 02 RIN  2577 - AC97).  Such a rule will result in higher air quality, fewer fires, and fewer smoke   related  illnesses among the residents and employees.                                                                   7   Office of Minority Health, HHS. Asthma and African Americans.  http://minorityhealth.hhs.gov/omh/browse.aspx?lvl=4&lvlid=15   8   Yu, M., Nebbitt, V. E., Lombe, M., Pitner, R. O., & Salas - Wright, C. P. (2012). Understanding tobacco use among  urban African American adolescents living in public housing communities: A test of problem behavior theory.  Addictive behaviors ,  37 (8), 978 - 981.   doi:  10.1037/e656882012 - 001   9   Remafedi, G. (2007). Lesbian, gay, bisexual, and transgender youths: Who smokes, and why?.  Nicotine & Tobacco  Research ,  9 (Suppl 1), S65 - S71.  doi: 1 0.1080/14622200601083491   10   Council of Large Public Housing Authorities. Public Housing Residents.  http://www.clpha.org/publichousingresidents   11    ee.  https://smokingcessationleadership.ucsf.edu/   12   Pizacani, B. A., Mahler, J.E., Rohde, K., Drach, L., & Stark, M.J. (2012).  Implementation of a smoke - free policy  in subsidized multiunit housin g: Effects on smoking cessation and secondhand smoke exposure.  Nicotine and  Tobacco Research, 14(9): 1027 - 1034  doi:10.1093/ntr/ntr334 .     3     If you have any questions about our pr ograms, please contact Gabriel Twose , PhD,   ( gtwose@apa.org , 202 - 336 - 5931) in our Government R elations office .    I wish you much success  in this important work.       Sincerely,         Gwendolyn Keita, PhD   Executive Director,  Public Interest Directorate       \n",
      "\n",
      "Cluster 3\n",
      "\n",
      "        January  13, 201 6  The Honorable Julián Castro   Office of the  Secretary   U.S. Department of Housing and Urban Development  Regulations Division, Office of General Counsel  Department  of Housing and Urban Development  451 7th Street SW, Room 10276  Washington, DC 20410 Œ0500  RE:  Instituting Smoke -Free Public Housing   Dear Secretary Castro:    On behalf of the American Academy of Family Physicians (AAFP), which represents 120,900  family phys icians and medical students across the country,  I write in response to the  proposed  rule  titled, ﬁInstituting Smoke -Free Public Housingﬂ as published by the Department of Housin g and Urban Development (HUD) in the November 17, 2015  Federal Register .   Since t obacco use is documented as the leading preventable cause of death and illness in our  nation , the AAFP enthusiastically supports this proposal.  Nicotine, a key ingredient in tobacco  products, is addictive. Tobacco use by and around children and adolescents is of particular  concern due  to the  increased risk for addiction and passive exposure.  We  therefore  applaud  HUD for taking this important step  that will create additional smoke -free environments.  We also  appreciate that HUD accepted th e recommendation  to create this policy  that t he AAFP  and  other  organizations  called for  in a March 27, 2015  letter  that  advocated  that  all government  subsidized housing be made smoke -free.  This  historic  step will help  protect  the  public health , esp ecially  that  of children , in our nation™s most vulnerable populations.    We appreciate that HUD and the Department of Health and Human Service held and invited the  AAFP to the White House Smoke -Free Housing Summit that occurred on January 5, 2016. This  sum mit provided an important opportunity to discuss the health and economic benefits of the  proposed regulation . including that:   One in four nonsmokers is exposed to second -hand smoke.   Individuals  living in rental housing  suffer from a higher second -hand smok e exposure  rate .   There are 760,000 children living in public housing.  Secretary Castro   Page 2 of 2  January  13, 201 6    The proposed rule would impact 2 million people.    Those living in public housing may be exposed to nicotine levels that equal five   cigarettes.    The rate of respiratory illness is signif icantly higher among those living in public housing.   The proposed rule is e stimated to save $153 million due to health, safety and facility  damage costs .  Despite  the clear  evidence  about the dangers of smoking, the Centers for Disease Control and  Preventi on (CDC)  reports that cigarette smoking causes about one in five deaths in the United  States every year . The AAFP considers  this  as  unacceptable  and  the  proposed rule will help to  address the health hazard  of secondhand smoke .  The AAFP also supports the  proposed 25 foot buffer zone from entrances, exits, windows and  ventilation intakes of buildings  that HUD included  in the proposed rule . We believe t his buffer  zone will  help  assist with enforcement  of smoke -free public housing  by ensuring that  second  hand smoke  does not  drift back into living units from  the  outside  or r equire  individuals  to walk  through  second hand smoke  around entrances  or exits from buildings.    We call on HUD to include in the final rule the exclusion of electronic nicotine  delivery systems  and waterpipe tobacco (hookahs) in restricted areas and that the regulation should apply to all  government -subsidized housing rather than just all government -owned housing.   The AAFP also believes the final rule should call for government -subsidized housing authorities  to refer residents to Quit -line services since the U.S. Public Health Service has found that  combining FDA -approved quit smoking therapies with counseling services are the most effective  for successful quit attempts. The AAFP  recently updated Tobacco and Nicotine  online toolkit  and we encourage family physicians to integrate tobacco prevention and control efforts into th eir  office system and support a tobacco -free community.      The AAFP is committed to working with HUD to ensure that all residents of HUD -assisted  housing live in healthy environments.  For any questions you might have please contact Robert  Bennett, Federal  Regulatory Manager, at 202 -232-9033 or  rbennett@aafp.org .   Sincerely,     Robert L. Wergin, MD, FAAFP  Board Chair   \n",
      "\n",
      "Cluster 4\n",
      "\n",
      "                                                                                    MARKET DEMAND FOR SMOKE-FREE RULES   IN MULTI-UNIT RESIDENTIAL PROPERTIES   &   LANDLORDS™ EXPERIENCES   WITH SMOKE-FREE RULES         April 2009     Prepared by:    The Massachusetts Smoke-Free Housing Project   Public Health Advocacy Institute  Northeastern University School of Law  Boston, Massachusetts                2 Massachusetts Smoke-Free Housing Project   Public Health Advocacy Institute, Inc.   Northeastern University School of Law   102 The Fenway, Suite 117   Boston, Massachusetts 02115       (617) 373-2026   www.phaionline.org                                                           3 INDEX                   Introduction . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . .        Executiv e Summary and Key Findings. . . . . . . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . .       Methodology . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . ..        Research Results and Find ings . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . . . .           Respondent Composition in Survey of Residents  . . . . . . . . . . . . . . . . . . .   Current Inventory of Smoke-Free Multi-unit    Residential Properties . . . .  . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . .    Demand for Smoke-Free Multi-unit Residential   Housing . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . .  . . . ..  Residents™ Support for Smoke- Free Rules . . . . . . . . . . . . . . . . . . . .  . . .  ..  Respondent Composition in Survey of Landlords . . .  . . . . . . . . . . . . . . . .   Landlords™ Experiences with Smoke- Free Rules . . . . . . . . . . . . . . . . . . . .  . .   Conclusion .  . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . .     Appendix . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . . . . . . . . . . . . . .  . . . . . . . . . . . . .       4        6        8        10        10        12        14      16      18      19      21      i     4 INTRODUCTION   In response to the high levels of morbidity and mor tality caused by exposure to  secondhand smoke, the Commonwealth of Massachusetts  prohibited smoking in nearly  all work and public places starting in 2004.  Passa ge of this law substantially reduced  exposure with some dramatic health benefits.  A rec ent report released by the  Massachusetts Department of Public Health demonstra ted that there were 577 fewer than  expected heart attack deaths each year after the pa ssage of the smoke-free law. 1   Exposure in the home, however, remains a significan t threat to public health.  In the 2006  Report entitled  Health Consequences of Involuntary Exposure to Toba cco Smoke , the  United States Surgeon General concluded that the ho me is ﬁa major location of  secondhand smoke exposure for adults.ﬂ The Report f ound that nonsmokers who are  exposed to secondhand smoke at home increase their  risk of developing lung cancer by  20% to 30% and their risk of heart disease by 25% t o 30%.      The Report also concluded that the ﬁhome is the pla ce where children are most exposed  to secondhand smoke.ﬂ Children exposed to secondhan d smoke are more likely to  develop bronchitis, pneumonia, asthma and ear infec tions. 2  In addition, secondhand  smoke has been linked to Sudden Infant Death Syndro me. 3  Given these proven health  consequences, it is not surprising that secondhand  smoke exposure causes a substantial  strain on private and public healthcare payers in M assachusetts.     In order to protect children and other vulnerable p opulations from exposure in the home,  the Massachusetts Tobacco Control Program launched  the Smoke-Free Families Initiative  in the winter of 2008.  Consisting of three major c omponents, the initiative strives to raise  awareness of secondhand smoke as an issue, integrat es that message in to existing  protocols within health and human service agencies  and encourages landlords and  property managers to adopt smoke-free policies with in their multi-unit buildings.  The  Public Health Advocacy Institute is leading the eff ort to increase the availability of  smoke-free housing in the Commonwealth.   While some people are able to avoid exposure by sim ply prohibiting smoking in their  homes, this solution may not be enough to protect r esidents of multi-unit buildings, as  secondhand smoke is often not contained inside an a partment or condominium unit.   Instead, the smoke seeps under doors, through venti lation ducts, wall chases, electrical  sockets, light fixtures, cracks in building walls o r other openings.  After seeping into  neighboring condominium units or apartments, second hand smoke can stay in the air for  hours, exposing nonsmokers and their families for l ong periods of time. 4        In order to provide accurate information on market  demand and other economic  rationales for smoke-free rules, the Public Health  Advocacy Institute conducted two  surveys in the summer of 2008.  The first of the tw o surveys measured the supply of and  demand for smoke-free multi-unit residential proper ties.  The second survey assessed the  experiences of landlords who have implemented smoke -free rules.  The findings of both  surveys are presented in this Report.     5 In general, the surveys reveal a strong demand for  smoke-free rules among residents of  multi-unit residential properties. (For purposes of  this Report, the phrase ﬁsmoke-free  ruleﬂ means a building-wide, no smoking rule that p rohibits smoking anywhere in or on  the property, except for designated smoking areas l ocated outside.)  Of the residents who  reside in smoke-free properties, 91% support the ru le, and just 2% oppose it.  Among  residents that live in buildings where smoking is c urrently allowed, 61% would support  the immediate implementation of a no smoking rule,  and approximately 75% would  support the change or remain neutral.  The demand i s largely consistent across age,  educational status, income level and housing type.       Despite the demand, however, just over 29% of multi -unit residential properties are  smoke-free.  The substantial gap between demand and  supply suggests that landlords and  condominium associations are in a position to benef it by going smoke-free.  Indeed, in  the survey of landlords, nearly all of the responde nts who had implemented a smoke-free  rule reported that it decreased their operating cos ts, increased demand for their properties  and was easy to implement and enforce.  Given the p otential benefits, it would not be  surprising if Massachusetts experienced a substanti al increase of smoke-free multi-unit  housing.                                               6 EXECUTIVE SUMMARY AND   KEY FINDINGS   SURVEY OF RESIDENTS OF MULTI-UNIT PROPERTIES IN   MASSACHUSETTS   A 2008 telephonic survey conducted by the Public He alth Advocacy Institute reveals a  strong demand for smoke-free rules among the reside nts of multi-unit properties in  Massachusetts.  Smoke-free rules prohibit smoking e verywhere in an apartment building  or condominium, except for designated smoking areas  located outside.  Smoke-free rules  are intended to prevent secondhand smoke from drift ing from one apartment or  condominium unit to another, and thus, prevent invo luntary exposure.  Smokers may live  in the building under a smoke-free rule and often d o reside in these properties.  They are  simply required to refrain from smoking, except in  designated smoking areas located  outside.      The Survey was funded by the Massachusetts Departme nt of Public Health and  administered by SurveyUSA Ž between June 20th and June 26th, 2008.  The survey   includes 1,304 interviews with residents of multi-u nit properties in Amherst, Cambridge,  Brookline, Easthampton, Hadley, Jamaica Plain, Newt on, Northampton, Somerville,  Southampton and Watertown.  The questionnaire scree ned respondents to ensure that  they resided in a multi-unit rental property or con dominium before asking questions  designed to measure demand for smoke-free rules.  T he Survey revealed the following  key findings:    Ł 75% of residents who do not currently live in a s moke-free building would  support the immediate implementation of a no smokin g rule or remain neutral.   The level of support would likely be even higher if  the rule were phased in  over the period of a year.    Ł Of the residents who currently live in a smoke-fr ee multi-unit building, 91%  support the rule.  Just 2% are opposed.  Ł 81% of prospective residents are immediately less  interested in an apartment  or condominium unit if they smell tobacco smoke whe n looking at it.     Ł 43% of residents are willing to pay more to live  in a smoke-free building.  Of  these residents who are willing to pay more, 26% ar e willing to pay 20%  more, and 63% are willing to pay 10% more.     Ł 69% of residents of multi-unit properties are mor e interested in knowing up  front, in the property listing that an apartment or  condominium unit is located  in smoke-free building.  Fewer than 20% feel this l isting information would  make no difference in their decision.    Ł The levels of support and demand are widely held,  remaining consistent  across gender, age, educational status, income leve l and housing type    7 SURVEY OF LANDLORDS OF MULTI-UNIT RESIDENTIAL RENTA L  PROPERTIES    A 2008 survey by the Public Health Advocacy Institu te reveals that 99% of landlords  who had implemented a smoke-free rule felt it was a  good decision.  The respondents  reported that implementing the rule increased deman d for their property and decreased  their operating costs.  Two-page questionnaires wer e mailed to 6,809 landlords in  Amherst, Cambridge, Brookline, Easthampton, Hadley,  Jamaica Plain, Newton,  Northampton, Somerville, Southampton and Watertown.   Mailing lists were provided by  the assessor™s office in each municipality.  Althou gh not necessarily representative of  landlords in general, the following are the key fin dings from the survey:           Ł 99% of the landlords who had implemented a smoke- free rule felt it was a  good decision.    Ł 66% of the landlords reported having to pay $100  or more extra in smoking- related maintenance costs per apartment compared to  an apartment where  smoking was not allowed.  33% expended more than $5 00 extra.   Ł   7% of the landlords reported that secondhand sm oke has triggered fire alarms.   Ł 5% of the landlords report that smoking caused a  fire in one or more of their  residential rental properties.   Ł 39% of the landlords who had implemented a smoke- free rule reported that it  decreased the number of disputes among tenants, and  54% reported no effect  on disputes.  Ł 90% of the landlords who had implemented a smoke- free rule reported that  implementation was easy or very easy.   Ł 93.3% of the landlords who had implemented a smok e-free rule reported that  the rule was virtually self-enforcing, the same as  enforcing any other rule or  easy to enforce.  Only 6.7% reported encountering d ifficulty in enforcement.     Ł 15% of the landlords who had implemented a smoke- free rule reported that it  decreased their vacancy rates, and 77% reported no  effect on vacancy rates.  Ł 19% of the landlords who had implemented a smoke- free rule reported that it  decreased their turnover rates, and 78% report no e ffect on turnover rates.    Ł 49% of the landlords reported that a smoke-free r ule decreased their potential  legal liability, and 42% reported no effect.   Despite the apparent benefits of implementing a smo ke-free rule, only 29% of multi-unit  properties the survey region are smoke-free.  The d ifference suggests that there may be  barriers for the implementation of smoke-free rules .  One potential barrier is the  misperception that smoke-free rules are or may be i llegal.  Among landlords who had not  implemented a smoke-free rule, 19.4% believed that  a smoke-free rule was illegal, and  35.8% were unsure of the legality.       8 METHODOLOGY   RESEARCH OBJECTIVES    Ł  Gauge the interest in, and market demand for, sm oke-free rules in multi-unit  properties (including residential rental properties  and condominiums).   Ł  Measure the percentage of the multi-unit housing  stock with smoke-free rules.   Ł  Assess the experiences of landlords in implement ing smoke-free rules.   Ł  Evaluate potential barriers for implementation o f smoke-free rules.     RESEARCH DESIGN       To accomplish the objectives outlined above, the Pu blic Health Advocacy Institute  conducted two surveys: an automated, random telepho nic survey administered by  SurveyUSA Ž of 1,304 residents in multi-unit dwellings, and a  written survey mailed to  6,809 landlords with a response rate of 5.5 percent  (or 372 completed surveys).      Three geographic regions in Massachusetts were sele cted for the two surveys. The first  region was comprised of Cambridge, Somerville and W atertown.  The second region was  comprised of Brookline, Newton and the Jamaica Plai n area of Boston.  The third region  was comprised of Amherst, Easthampton, Hadley, Nort hampton and Southampton.     The regions were selected due to their high demand  for housing and large inventory of  multi-unit residential properties. The demand for a nd supply of multi-unit housing in  each region was determined by analyzing the 2000 Fe deral Census, various housing  surveys and community assessments were conducted.   Interviews of area real estate  brokers were also completed.   The telephonic surveys were administered by SurveyU SA. Ž  Each survey was limited to  area codes that cover one or more of survey regions .  To confirm that the respondent  actually resided in the geographic region, initial  screening questions were included. The  telephonic surveys were administered separately by  region using Interactive Voice  Technology Ž between June 20, 2008 and June 26, 2008.    The results of the three regions were then combined .  To adjust for differences in the  sample size for each region, three adjustment weigh tings based on the total number of  adults in the region who lived in multi-unit housin g were generated.  The appropriate  adjustment weighting was then multiplied by the ind ividual respondent weightings  provided by SurveyUSA Ž.     The mail survey was administered by the Public Heal th Advocacy Institute.  Mailing  information for landlords was obtained from municip al assessors™ offices.  If an  individual landlord had more than one listing, the  extra listings were purged to avoid   9 duplicate copies being sent to a single individual.   Next, the listings were randomized.  Lastly, approximately the first 6,800 listings were  chosen, which was the maximum  number of mailings that could be accommodated under  our budget.     Each mailing consisted of a two-page questionnaire  printed on the front and back of a  single sheet of paper, along with instructions on c ompleting the survey.  To encourage  responses, a drawing for a $500 retail gift certifi cate was offered.  The surveys were  mailed June 30, 2008, and responses were required t o be postmarked by July 25, 2008.       QUESTIONNAIRE DESIGN:     The questionnaire was designed by the Public Health  Advocacy Institute with input from  the Massachusetts Tobacco Control Program and Surve yUSA. Ž  The design process was  informed by reviewing secondhand smoke attitudinal  surveys used in other states and  other surveys measuring demographic information com monly included in smoking and  health related surveys.      After screening for eligibility, the resident quest ionnaire identified respondents™ exact  housing type, smoking habits, the smoking habits of  household members and the  awareness of secondhand smoke as a danger.  The rem ainder of the questionnaire was  designed to accomplish the objectives outlined abov e.  The questionnaire also gathered  general demographic information, which was collecte d to document future attitudinal  shifts within demographic groups and to ensure surv ey accuracy, which was achieved by  comparing data collected here with the demographic  data from the 2000 Federal Census.     As the method used to develop the landlord mailing  list narrowed the field to only  eligible respondents, the questionnaire included on ly one screening question to verify  eligibility.  The questionnaire then identified the  total number of residential rental  properties owned by the respondent and the average  size of the properties.  The  remainder of the questionnaire was designed to achi eve the objectives outlined above.                                                  10  RESEARCH RESULTS AND DICUSSION     I. RESPONDENT COMPOSITION IN SURVEY RESIDENTS OF  MULTI-UNIT PROPERTIES     Residents of multi-unit rental properties and condo miniums located in any of the three  survey regions were eligible as respondents.  Combi ned, the three regions include the  municipalities of Amherst, Cambridge, Brookline, Ea sthampton, Hadley, Jamaica Plain,  Newton, Northampton, Somerville, Southampton and Wa tertown.     If the respondent was either a landlord in the prop erty where he resided, or if the  respondent owned more than one-half of the units in  the condominium where he lived, he  was excluded from completing the full questionnaire . These otherwise eligible  respondents were excluded because we felt that thei r opinions would likely deviate  significantly from that of most residents of multi- unit properties, and therefore, tend not  to accurately reflect market demand.      Also excluded were respondents residing in college  dormitories or other housing  provided by a college or university.  We believed m ost respondents living in this type of  housing are not familiar with the conditions, prici ng and policies of market rate multi-unit  housing in Massachusetts.  College students and col lege-age individuals who resided off  campus were, however, eligible to complete the enti re survey unless more than three such  individuals lived in the same apartment or condomin ium unit.    Tables 1A, 1B and 1C display general demographic in formation on residents who  completed the full questionnaire.  The demographic  information in these three tables  closely tracks data available from the 2000 Federal  Census, which suggests an accurate  sampling was achieved.                                        TABLE 1A  Gender and Age of Respondents  Gender  Age  Male Female 18-24 25-34 35-44 45-54 55-64 65+  45.3% 54.7% 12.1% 38.7% 16.9% 12.3% 8.5% 11.7%  TABLE 1B  Education and Income of Respondents  Education  Income  College + College Some College No College  < $60K >  $60K  53.1% 21.7% 15.2% 9.9% 49.6% 50.4%   11                         The prevalence of smoking-related health conditions  among residents and those who  share a household with residents were measured.  We  felt that residents who have (or live  with someone who has) one of these conditions would  tend to avoid exposure to  secondhand smoke by living in smoke-free properties .  Prevalence rates among the  survey respondents are displayed in Table 1D.  Thes e health conditions were chosen  because they are, according to the 2006 Surgeon Gen eral™s Report  The Health  Consequences of Involuntary Exposure to Tobacco Smo ke,  some of the most common  smoking-related health conditions.       The residents™ smoking behavior was also measured,  as we expected residents who  smoke would tend to avoid properties with smoke-fre e rules.  Phrasing for the questions  on smoking behavior were taken from the Massachuset ts Behavior Risk Statewide  Survey, which measures, among other health risk fac tors, smoking status. The prevalence  rates among survey respondents are displayed in Tab le 1E.  In comparison, the statewide  average for current smokers is 16.4%. 5                  The resident™s perception of the danger of secondha nd smoke was also assessed, as we  felt that residents who are aware of the health eff ects of secondhand smoke are more  likely to avoid exposure by living in smoke-free pr operties.  The perception of residents  about secondhand smoke is displayed in Table 1G.         TABLE 1C  Housing Type of Respondents  House Divided   into Apartments  Apartment   Building  Condominium   15% 52% 33%  TABLE 1D  Smoking-Related Health Conditions of Respondents  Child Health Conditions * Adult Health Conditions*  Asthma  Chronic Ear   Infection  Frequent   Respiratory   Infections  Asthma  Chronic   Respiratory   Condition  Heart   Disease  Stroke  19% 7.1% 5.6% 19.6% 10.6% 8.1% 4.3%  *Respondents who indicated ﬁNot Sureﬂ are not inclu ded.  TABLE 1E  Smoking Behavior of Respondents  100 Cigarettes in  Respondents™ Life*  Smoking Frequency  More   Than  Less Than Every Day Some Days  Never  35.3% 63.9% 27.2% 12.8% 59.9%  *Respondents who indicated ﬁNot Sureﬂ are not inclu ded.    12        Despite the high level of awareness shown in Table  1G, a relatively low number of  residents currently live in multi-unit residential  properties with smoke-free rules.  This  inconsistency is discussed in the following section .          II. CURRENT INVENTORY OF SMOKE-FREE MULTI-UNIT  RESIDENTIAL PROPERTIES IN MASSACHUSETTS     One factor in assessing market demand for smoke-fre e housing is the current supply of  residential properties with smoke-free rules. We ga thered information on smoking rules  by asking the following question:    ﬁIn the building where you live, is smoking allowed  in both common areas  and inside individual apartments? Is smoking allowe d only in individual  units? Or is smoking not allowed in the building at  all?ﬂ     Respondents were not afforded the opportunity to an swer ﬁNot Sure.ﬂ  By excluding this  option, we intended to encourage respondents, even  those who might be unfamiliar with  the smoking-related rules of their buildings, to ma ke a best guess.      Results indicated that only 28.7% of residents are  covered by a smoke-free rule.  This  percentage is interpreted as meaning that approxima tely 28.7% of multi-unit residential  properties in the survey area are smoke-free.  The  percentage is largely consistent across  the demographic range, including gender, age and in come, as indicated in Table 2A.    TABLE 2A  Smoking-Related Rules  Gender  Age Income   Male Female  18-24 25-34 35-44 45-54 55-64 65-74 <$60K >$60K  100% No smoking  27.2% 29.9% 47.2% 27.9% 25% 23.9%  25% 22.1% 29.5% 28.3%  No smoking in   Common Areas   40.2% 42.6% 25.2% 44.5% 46.4% 40.9% 44.6% 42.9% 39. 6% 43.4%  No Related Rules 32.6% 27.5% 27.7% 27.5% 28.6% 35.2 % 30.4% 35.1% 30.8% 28.3%    Given a higher smoking prevalence among 18-24 year  olds, as compared to other age  groups,  6  it is somewhat surprising that the group was also  more likely than other  respondents to live in a smoke-free building.  In r esponse to the question of whether they  smoke cigarettes every day, 18-24 year olds respond ed ﬁYesﬂ nearly twice as often as any  other age group.  The finding is suggestive that ev en smokers, at least those aged 18-24,  will not avoid living in properties with smoke-free  rules.   TABLE 1G  Respondents™ Perception of Secondhand Smoke Exposur e  Very   Harmful  Somewhat   Harmful  Minor   Nuisance  Not   Harmful   Not Sure   66.7% 25.4% 5% 1.9% 1%   13     Information on resident education level and the exi stence of a smoke-free rule is shown  in Table 2B.  As educational level negatively corre lates with smoking status in general,  7  it is not surprising that the survey found that res idents with higher education levels were  more likely to reside in a smoke-free building.       Also presented in Table 2B is data on the existence  of smoke-free rules across three types  of multi-unit housing type. Just over 52% of smoke- free properties consisted of houses  that had been divided into apartments.  The fact th at divided houses tend to be owner- occupied may suggests that owners tend to establish  smoke-free rules to avoid exposing  themselves.  Additionally, the passive ventilation  common to divided houses can  contribute to drifting secondhand smoke.  Unlike ac tive ventilations systems used in  larger buildings to service individual apartments o r condominium units, passive  ventilation relies on air moving through doorways,  hallways and stairways throughout the  entire building.  (It should be noted that drifting  secondhand smoke also occurs in many  types of active ventilation systems.)     Another factor that potentially influences the occu rrence of smoke-free rules is the  implementation process. For landlords or property m anagers, the implementation process  is easy.  They can decide unilaterally to institute  a smoke-free rule.  When they decided  to do so, they typically phase in the new smoke-fre e rule during lease renewal or when  new tenants sign their lease, which means that a pr operty will be smoke-free in one year.   Where tenants have month-to-month leases, otherwise  known as a tenancies-at-will, the  property will be smoke-free in about a month.  By c ontrast, making a condominium  smoke-free is slightly more complicated.  Making a  condominium smoke-free requires a  vote of unit owners.  Typically, 75% or more of uni t owners must vote in support of the  rule change.  (Trustees can make their condominium™ s common areas smoke-free without  a vote of unit owners.)    TABLE 2B  Smoking-Related Rules  Education  Housing Type   College &      Graduate   School   College  Some    College  No College  House   Divided into   Apartments  Apartment   Building  Condominium  100% No  smoking  29.7% 30.6% 28.9% 19.5% 52.3% 29.5% 16.7%  No smoking in   Common Areas   44.2% 39.5% 33.5% 43.8% 19% 40.6% 53.3%  No Related   Rules  26.1% 29.9% 37.6% 36.7% 28.7% 29.9% 30%    Table 2C compares smoking-related diseases among ch ildren and adult residents with the  smoking rules for their buildings.            14  TABLE 2C  Smoking-Related Rules  Child Health Conditions Adult Health Conditions   Asthma  Chronic Ear   Infections  Frequent    Respiratory   Infections  Asthma  Chronic   Respiratory   Condition  Heart   Disease  Stroke  100% No  smoking  21.1% 27.3% 17.6% 32% 25.9% 22.9% 38.6%  No smoking in   Common Areas   42.1% 31.8% 11.8% 42.2% 36.7% 47.6% 49.1%  No Related   Rules  36.8% 40.9% 70.6% 25.8% 37.4% 29.5% 12.3%     III. DEMAND FOR SMOKE-FREE MULTI-UNIT RESIDENTIAL  PROPERTIES   The survey assessed the effect of providing prospec tive residents with information up  front in a property listing on whether an apartment  or condominium unit is located in a  smoke-free building.  Over 69% of prospective resid ents are more interested in a property  listing in a smoke-free building.  In total, 80% of  prospective residents are more  interested in knowing in a listing whether or not t he apartment or condominium unit is in  a smoke-free building.      Additionally, this level of interest is consistent  across a broad range of prospective  residents.  Table 3A displays the levels of interes t by gender, age and income level.  In all  cases, the majority of prospective residents would  be more interested in knowing the  smoking policy in the listing.         TABLE 3A  Demand for Smoking-Related Listing Information  Gender Age Income   Male Female 18-24 25-34 35-44 45-54 55-64 65-74 <$6 0K >$60K  More  Interested  70.2% 68.5% 54.7% 71.5% 74.5% 65.2% 68.5% 70.5% 67%  71.8%  Less  Interested  10.3% 12.1% 15.7% 9.2% 11.4% 14.9% 11.7% 11.5% 14.8 % 7.4%  No   Difference  18.4% 17.8% 28.9% 18.1% 13.2% 16.1% 18.9% 17.9% 17. 4% 19.1%  Not Sure 1% 1.5% .6% 1.2% .9% 3.7% .9% 0% .8% 1.6%   Table 3B similarly shows a consistent level of inte rest across educational level and  housing type.  Indeed, in nearly ever demographic b reakdown shown in Tables 3A and  3B, three-quarters or more of the prospective resid ents would prefer property listings to  include information on whether the building is smok e-free or not.  The only two  exceptions are residents who are 18-24 years of age  and residents with no college  education.  Yet, even among these two groups, appro ximately 70% would prefer to have  smoking information in the property listing.            15   TABLE 3B  Demand for Smoking-Related Listing Information  Education  Housing Type   College &   Graduate   School    College  Some    College  No College  House   Divided into   Apartments  Apartment   Building  Condominium  More  Interested  77.1% 67.6% 59.4% 47.7% 67.7% 67.3% 73.3%  Less  Interested  7.8% 8.5% 16.8% 26.6% 11.3% 12.7% 9.1%  No   Difference  14.3% 22.1% 21.8% 25% 19.5% 19.2% 16%  Not Sure .7% 1.8% 2% .8% 1.5% .9% 1.6%   The prospective resident™s willingness to pay more  to rent an apartment or purchase a  condominium unit in a smoke-building was also asses sed in the survey. Over 43% of  prospective residents would be willing, in general,  to pay more.  Of those willing to pay  more, 25% would pay 20% more and 75% would be willi ng to pay 10% more.  As shown  in Tables 3C and 3D, the willingness to pay more is  relatively consistent across the  various demographic breakdowns.      The prospective resident may be willing to pay more  to avoid the possibility of prolonged  exposure to secondhand smoke or the potential of ha ving to relocate, if the exposure is  not remedied.  For prospective a condominium owner,  the transaction cost of relocating  can be substantial because it potentially involves  selling his or her unit.    TABLE 3C  Willingness to Pay More for Smoke-Free Property  Gender Age Income   Male Female 18-24 25-34 35-44 45-54 55-64 65-74 <$6 0K >$60K  Willing to Pay  More   44.3% 42% 34.6% 42.2% 46.1% 39% 46.8% 48.1% 36.1% 4 9.2%  20% More 22.7% 28.6% 19.3% 20.2% 29.8% 35.1% 25% 31 % 25.1% 27.1%  10% More 59.2% 65.9% 80.7% 61.1% 58.7% 61% 58.9% 67 % 61.8% 64.4%   TABLE 3D  Willingness to Pay More for Smoke-Free Property  Education  Housing Type   College and   Graduate   School  College  Some    College  No College  House   Divided into   Apartments  Apartment   Building  Condominium  Willing to Pay  More   50% 37.9% 30.1% 37.2% 42.9% 39.7% 48.6%  20% More 26.7% 20% 24.7% 35.3% 32.6% 21.9% 28.3%  10% More 65.9% 56% 60.3% 62.7% 67.4% 63.8% 59.5%      The presence of tobacco smoke also impacts the pros pective resident™s interest an  apartment or condominium unit.  As shown in tables  3E and 3F, the majority of  prospective residents are immediately less interest ed in a property if they smell tobacco   16  smoke.  This reaction is relatively consistent acro ss gender, income level, age and  housing type.    TABLE 3E  Effect of Prospective Resident Smelling Tobacco Smo ke   Gender Age Income   Male Female 18-24 25-34 35-44 45-54 55-64 65-74 <$6 0K >$60K  More  Interested  5.4% 7.2% 4.4% 5.2% 4.5% 6.9% 9% 6.5% 9.8% 3%  Less  Interested  82.2% 80.8% 76.7% 87.3% 89.1% 71.2% 74.8% 74% 74.6%  88.3%  No   Difference  11.3% 11.2% 18.2% 6.6% 5.9% 21.9% 15.3% 16.9% 14.8%  7.6%  Not Sure 1% .8% .6% 1% .5% 0% .9% 2.6% .8% 1.1%     TABLE 3F  Effect of Prospective Resident Smelling Tobacco Smo ke  Education  Housing Type   College and   Graduate   School  College  Some    College  No College  House   Divided into   Apartments  Apartment   Building  Condominium  More  Interested  3.8% 6.4% 9.1% 16.2% 3.1% 7.9% 5.4%  Less  Interested  91.8% 84.8% 64% 45.4% 84.1% 76.5% 88.1%  No   Difference  4.2% 8.5% 23.4% 36.2% 12.3% 14.3% 6.1%  Not Sure .3% .4% 3.6% 2.3% .5% 1.3% .5%       IV. RESIDENT SUPPORT FOR SMOKE-FREE RULES    When asked how they felt about living in a building  that is entirely smoke-free,  91% of residents indicated that they supported it.   Just 2% opposed it.  As shown in  Tables 4A and 4B, this level of support is relative ly consistent across gender, income  level, age, housing type and education level.     TABLE 4A  Resident Support for Smoke-free Rule*  Gender Age Income   Male Female 18-24 25-34 35-44 45-54 55-64 65-74 <$6 0K >$60K  Strongly  Support  81.8% 84% 82.7% 82.1% 81.5% 89.5% 81.5% 100% 81.6%  83.2  Somewhat  Support  8.8% 8% 17.3% 5% 13% 2.6% 11.1% 0% 11.4% 4.5%  Neutral   8.2% 3.8% 0% 10 % 1.9% 5.3% 3.7% 0% 2.2%  10.1%  Somewhat  Oppose  .6% 1.9% 0% 2.1% 1.9% 0% 0% 0% 1.6% 1.7%  Strongly  Oppose  .6% .9% 0% 0% 0% 2.6% 3.7 % 0% 1.6% .6%  * The answers for ﬁNot Sureﬂ are excluded from this  Table.    17  TABLE 4B  Resident Support for Smoke-free Rule*  Education  Housing Type   College &   Graduate   School    College  Some    College  No College  House   Divided into   Apartments  Apartment   Building  Condominium  Strongly  Support  90.8% 78.2% 70.2% 60% 83.5% 81.8% 84.7%  Somewhat  Support  3.9% 10.3% 14% 24% 5.83% 10.6% 6.9%  Neutral 2.9% 9.2% 12.3% 0% 8.7% 4.5% 4.2%  Somewhat  Oppose  1.5% 0% 0% 8% 0% 2% 1.4%  Strongly  Oppose  1% 1.1% 0% 4% 0% .5% 2.8%  * The answers for ﬁNot Sureﬂ are excluded from this  Table.   Of residents who are not currently living in a smok e-free property, over 74% would  support the immediate implementation of a smoke-fre e rule or remain neutral on the  issue.  As shown in tables 4C and 4D, the level of  support remains fairly consistent across  a range of demographics.      TABLE 4C  Resident Support for Immediate Change to Smoke-free *  Gender Age Income   Male Female 18-24 25-34 35-44 45-54 55-64 65-74 <$6 0K >$60K  Strongly  Support  41.2% 47.8% 23.8% 47.9% 49.1% 43.8% 36.9% 48.3% 42. 8% 46.7%  Somewhat  Support  14.7% 16.9% 19% 20.5% 12.1% 9.1% 15.5% 10% 13% 18.1 %  Neutral  16.5% 11.2% 26.2% 8.3% 15.2% 10.7% 21.4% 1 8.3% 14.6% 12.8%  Somewhat  Oppose  12.1% 10.6% 17.9% 10.8% 11.5% 13.2% 9.5% 6.7% 12.6%  9.3%  Strongly  Oppose  14.9% 13.3% 13.1% 12.5% 10.9% 22.3% 15.5% 16.7% 16. 5% 12.8%  * The answers for ﬁNot Sureﬂ are excluded from this  Table.     TABLE 4D  Resident Support for Immediate Change to Smoke-free    Education  Housing Type   College and   Graduate   School  College  Some    College  No College  House   Divided into   Apartments  Apartment   Building  Condominium  Strongly  Support  46.6% 47.7% 42.6% 35% 48.9% 43.7% 44.7%  Somewhat  Support  17.9% 16.4% 8.5% 14.6% 8.5% 16.5% 17%  Neutral  13.4% 8.7% 17.7% 17.5% 12.8% 13.8% 13.7%  Somewhat  Oppose  10.1% 13.3% 9.2% 14.6% 6.4% 10.3% 14%  Strongly  Oppose  11.3% 13.3% 21.3% 18.4% 23.4% 14.9% 10.3%  * The answers for ﬁNot Sureﬂ are excluded from this  Table.   18  Note that the level of support for smoke free rules  shown in Tables 4A and 4B is higher  in comparison to Tables 4C and 4D.  The difference  may be attributable to the fact that  the rule change shown in Tables 4C and 4D would be  implemented immediately.  In  practice, landlords and property managers can imple ment smoke-free rules over the  period of several months or a year, giving resident s a chance to adjust to the rule or, for  some residents, the chance to make alternative arra ngements, should they wish to  relocate.  However, once the rule is implemented, t he levels of support shown in Tables  4A and 4B are what landlords, property managers and  condominium trustees should  expect.             V. RESPONDENT CHARACTERISTICS IN SURVEY OF  LANDLORDS     An assessment of landlords and property managers™ a ttitudes towards smoke-free rules  was also conducted in this Survey.  Landlords and p roperty managers with properties  located the municipalities of Amherst, Cambridge, B rookline, Easthampton, Hadley,  Jamaica Plain, Newton, Northampton, Somerville, Sou thampton and Watertown were  eligible.  Listings of landlords and property manag ers were obtained from municipal  assessors™ offices.  Given that survey response rat e was 5.5%, the results are not  necessarily representative of landlord experiences  in general.       The number of units managed or owned by each respon dent is shown in Table 5A.  Just  over 84% of respondents managed 5 or fewer units, c lassifying them as small landlords.    Over 90% of respondents managed their own propertie s, as opposed to 9.4% who  retained employees or contractors to manage their p roperties.   * The respondents who had 10 or more units make up  approximately 10% of the total number of respondent s.    The percentage of respondents who have implemented  a smoke-free rule is displayed in  Table 5B.  Note that Table 5B does not accurately r eflect the percentage of the multi-unit  housing stock in the survey region with smoke-free  rules.  The survey of landlords was  not intended to provide this measurement.  As discu ssed in Section II of this Report, the  actual percentage is 28.7%.     TABLE 5A  Percentage of Number of Rental Units Owned/Managed  by Respondents  1 Unit 2 Units 3 Units 4 Units 5 Units 6 Units 7 Un its 8 Units 9 Units 10+ Units*  14% 44.9% 14.3% 5.2% 4.1% 3% 2.5% .8% 1.1%  All others  under 1%  TABLE 5B  Percentage of Respondents Who Have Implemented Smok e-free Rules  All Properties  More than Half of   Properties   Less than Half of   Properties  None  50.4% 2.2% 2.2% 45.2%   19  VI.  LANDLORDS™ EXPERIENCES WITH AND PERCEPTION  OF SMOKE-FREE RULES    Over 99% of all of the respondents who had actually  implemented a smoke-free rule  believed that it was a ﬁgood decision.ﬂ  For mainte nance costs, 65% of respondents  reported having to pay $100 or more extra in smokin g-related maintenance costs per  apartment when compared to an apartment where smoki ng was not allowed.  Over 19%  reported paying $100 to $300 extra, 14% reported pa ying $300 to $500 extra and 33%  reported paying more than $500 extra. Typical repai rs include patching or replacing  carpets, linoleum countertops and linoleum flooring  with cigarette burn.  Landlords also  report having to abate the odor of tobacco smoke an d repaint yellow stains in walls and  ceilings.    Table 6A shows how implementation of smoke-free rul es affected the respondents™ rental  property businesses.  The phrase ﬁvacancy rateﬂ in  Table 6A means the average number  of available units that are not rented throughout t he year.  The phrase ﬁturnover rateﬂ  means how often existing tenants are replaced by ne w tenants.  To maximize profits,  landlords want to achieve the lowest possible rates  of occurrence for all of the variables  shown in Table 6A.    TABLE 6A  Effect of Smoke-free Rule on Rental Business for La ndlords Who Had Implemented a Smoke-Free Rule   Vacancy   Rate  Turnover   Rate  Disputes   Over   Security   Deposits  Resources  Required to  Manage  Disputes   Between   Tenants  Potential   Legal   Liability   Maintenance/  Repair Costs  Risk of   Fire  Increase 6.7% 3.6% 7.3% 8.3% 6.7% 8.5% 9.2% 9.6%  No   Change  77.4% 77.7% 64.6% 57.8% 54.4% 42.3% 29.7% 73.1%  Decrease 15.9% 18.7% 28.1% 33.9% 38.9% 49.2% 61% 17 .3%         Table 6B displays the perceived benefit of implemen ting a smoke-free rule by landlords  who had not implemented such rules.       TABLE 6B  Effect of Smoke-free Rule on Rental Business Variab les for Landlord Who Had Not Implemented a Smoke-Fr ee Rule   Vacancy   Rate  Turnover   Rate  Disputes   Over   Security   Deposits  Resource  Required to  Manage  Disputes   Between   Tenants  Potential   Legal   Liability   Maintenance  / Repair   Costs  Risk of   Fire  Increase 13.7% 10.4% 8.1% 14.5% 17.5% 15.1% 9.9% 10 .6%  No   Change  80.1% 77.9% 77% 61% 59.4% 54.7% 39.5% 16.8%  Decrease 6.2% 11.7% 14.9% 24.5% 23.1% 30.2% 50.6% 7 2.7%     When asked specifically about the risk of fire, app roximately 7% of respondents reported  that secondhand smoke had triggered fire alarms.  O ver 4.5% reported that smoking had  caused a fire in one or more of their properties.     20  Although there is a high demand for smoke-free prop erties, only 28.7% of the multi-unit  housing stock is currently smoke-free.  The apparen t gap between the supply and demand  for smoke-free properties may suggest that there ar e barriers to change.  One of the  potential barriers is the perception that implement ation is difficult.  However, the survey  found that the opposite was true.  As shown in Tabl e 6C, over 90% of landlords who had  implemented a rule reported that implementation was  easy or very easy.  Landlords  generally phase in smoke-free rules when existing l eases renew and new tenants sign  their leases. In properties with month-to-month ten ants, otherwise known as tenancies-at- will, the implementation period can be as short as  one month.       TABLE 6C  Implementation of Rule   Very Difficult Difficult  Easy  Very Easy  3.6% 6.1% 37.2% 53.1%         Another potential barrier is the perception that en forcement would be difficult.   Landlords are very likely to weigh the difficulty o f enforcing a new rule against its  purported benefits.  If enforcement of a rule would  be too difficult, time consuming or  expensive, a landlord is less likely to use it.  As  shown in Table 6D, over 93% of  landlords who had implemented a rule did not find i t difficult.    TABLE 6D  Difficulty of Enforcement   Difficult  Easy  Same as other   rules  Virtually Self   Enforcing   6.7% 20.1% 23.2% 50%         Furthermore, landlords may incorrectly believe that  instituting a smoke-free rule is either  illegal or legally questionable. (It should be note d that it is entirely legal to make rental  properties smoke-free.)  As shown in Table 6E, 76.5 % of landlords who implemented a  rule believed it was legal.  As shown in table 6F,  only 44.8% of landlords who have not  implemented a rule held the same belief.    TABLE 6E  Perceived Legality of Rule of Landlords Who Had Imp lemented a Smoke-Free Rule  Legal  Not Legal   Some Units Must   Be Designated for   Smoking  Not Sure  76.5% 3% 2% 18.5%         TABLE 6F  Perceived Legality of Rule of Landlords Who Had Not  Implemented a Smoke-Free  Rule  Legal  Not Legal   Some Units Must   Be Designated for   Smoking  Not Sure  44.8% 18.2% 1.2% 35.8%    21  CONCLUSION   This Report provides several economic reasons for g oing smoke-free.  First, there is a  strong demand among residents for apartments and co ndominium units located in smoke- free buildings.   Second, relatively few properties  are currently smoke-free, which  suggests that the demand for smoke-free properties  is largely unmet.  Lastly, smoke-free  rules appear to reduce the operating costs of resid ential rental businesses.      Another important reason for going smoke-free is th e dramatic health effects caused by  exposure to secondhand smoke.  The owners and manag ers of multi-unit residential  properties provide housing for a large segment of o ur population.  Accordingly, they  make decisions that dramatically affect the public™  health.  By going smoke-free,  landlords and property managers will help reduce se condhand smoke-related diseases.                    ENDNOTES                                                    1 See  Lives Saved by Smoke Free Workplace Law, Massachuse tts Tobacco Control Program,  Massachusetts Dep™t of Public Health (Nov. 2008),  available at  http://www.mass.gov/Eeohhs2/docs/dph/  tobacco_control/secondhand_smoke_heart_attack_facts heet.pdf.  2 J. DiFranza et al.,  Prenatal and Postnatal Environmental Tobacco Smoke  Exposure and Children's  Health , Pediatrics 113  (4 Supp.) 1007-15 (April 2004).  3 H. S. Klonoff-Cohen et al.,  The Effects of Passive Smoking and Tobacco Exposure  Through Breast Milk  on Sudden Infant Death Syndrome , 273(10)  JAMA  818 (March 1995)    4 CA Envtl. Prot. Agency, Identification of Environm ental Tobacco Smoke as a Toxic Air Contaminant  (2005).  5 See  Stephen Smith, Adult Smoking Rate Plunges in Mass. , The Boston Globe (July 31, 2008).  6 Just over 22% individuals 18 to 24 currently smoke .  See  Centers for Disease Control and Prevention,  Cigarette Smoking Among Adults --- United States, 2 007 ,  57(45) M ORBIDITY  & M ORTALITY  WKLY . REP .  1221 (Nov. 14, 2008),  available at  http://www.cdc.gov/mmwr/PDF/wk/mm5745.pdf.  7 See id.  APPENDIX    The Appendix redisplays all of the tables of this  report with the number of  respondents (ﬁNﬂ) included.  The percentages of the  total population surveyed for this  study (1,304 interviews) are accurate by a margin o f plus or minus approximatley1.5 to  2.5 percentage points at the 95% confidence level.   Sampling tolerances vary depending  on the size of the subgroup analyzed as well as the  percentage of respondents giving a  particular response.  The table directly below indi cates the sampling tolerances for the  total sample and for subgroups of various sizes at  different percentages.  These tolerances  reflect error due to sampling error, and do not ref lect error due to other factors.    Sample Size  10%  20%  30%  40%  50%  60%  70%  80%  90%             1500 1.5 2.0 2.3 2.5 2.5 2.5 2.3 2.0 1.5  1000 1.9 2.5 2.8 3.0 3.1 3.0 2.8 2.5 1.9  900 2.0 2.6 3.0 3.2 3.3 3.2 3.0 2.6 2.0  750 2.1 2.8 3.3 3.5 3.6 3.5 3.3 2.8 2.1  700 2.2 3.0 3.4 3.6 3.7 3.6 3.4 3.0 2.2  650 2.3 3.1 3.5 3.7 3.8 3.7 3.5 3.1 2.3  600 2.4 3.2 3.7 3.9 4.0 3.9 3.7 3.2 2.4  550 2.5 3.3 3.8 4.1 4.2 4.1 3.8 3.3 2.5  500 2.6 3.5 4.0 4.3 4.4 4.3 4.0 3.5 2.6  450 2.7 3.7 4.2 4.5 4.6 4.5 4.2 3.7 2.7  400 2.9 3.9 4.5 4.8 4.9 4.8 4.5 3.9 2.9  350 3.1 4.2 4.8 5.1 5.2 5.1 4.8 4.2 3.1  300 3.4 4.5 5.2 5.5 5.7 5.5 5.2 4.5 3.4  250 3.8 5.0 5.7 6.1 6.3 6.1 5.7 5.0 3.8  200 4.2 5.5 6.4 6.8 6.9 6.8 6.4 5.5 4.2  150 4.8 6.4 7.3 7.8 8.0 7.8 7.3 6.4 4.8  100 5.9 7.8 9.0 9.6 9.8 9.6 9.0 7.8 5.9    75 6.8 9.0 10.4 11.1 11.3 11.1 10.4 9.0 6.8    50 8.3 11.1 12.7 13.6 13.9 13.6 12.7 11.1 8.3                 TABLE 1A  Gender and Age of Respondents  Gender   N=1304  Age  N=3255  Male Female 18-24 25-34 35-44 45-54 55-64 65+  45.3%  N=591  54.7%  N=713  12.1%  N=158  38.4%  N=502  16.9%  N=220  12.3%  N=160  8.6%  N=111  11.8%  N=152  TABLE 1B  Education and Income of Respondents  Education  N=3200  Income  N=2987  College + College Some College No College <$60K >$6 0K  53.1%  N=1503  21.7%  N=634  15.2%  N=654  9.9%  N=409  49.6%  N=623  50.4%  N=632   23                                                  TABLE 2A  Smoking-Related Rules  Gender   Age  Income   Male  N=592  Female  N=713  18-24   N=159  25-34   N=501  35-44   N=220  45-54   N=159  55-64   N=112  65-74   N=77  <$60K   N=623  >$60K   N=632  100% No Smoking   27.2%  N=161  29.9%  N=213  47.2%  N=75  27.9%  N=140  25%  N=55  23.9%  N=38  25%  N=28  22.1%  N=17  29.5%  N=184  28.3%  N=179  No Smoking in   Common Areas   40.2%  N=238  42.6%  N=304  25.2%  N=40  44.5%  N=223  46.4%  N=102  40.9%  N=65  44.6%  N=50  42.9%  N=33  39.6%  N=247  43.4%  N=274  No Related Rules  32.6%  N=193  27.5%  N=196  27.7%  N=44  27.5%  N=138  28.6%  N=63  35.2%  N=56  30.4%  N=34  35.1%  N=27  30.8%  N=192  28.3%  N=179                 TABLE 1C  Housing Type of Respondents  House   Divided into   Apartments  Apartment   Building  Condominium   15%  N=196  52%  N= 679  33%  N=430   TABLE 1D  Smoking-Related Health Conditions of Respondents  Child Health Conditions *  N=299  Adult Health Conditions*  N=1303  Asthma  Chronic Ear   Infection  Frequent   Respiratory   Infections  Asthma  Chronic   Respiratory   Condition  Heart   Disease  Stroke  19%  N=57  7.1%  N=21  5.6%  N=17  19.6%  N=256  10.6%  N=138  8.1%  N=105  4.3%  N=56  TABLE 1E  Smoking Behavior of Respondents  100 Cigarettes in  Respondents™ Life*  N=1303  Smoking Frequency  N=470  More   Than  Less Than Every Day Some Days  Never  35.3%  N=461  63.9%  N=833  27.2%  N=128  12.8%  N=60  59.9%  N=282  TABLE 1G  Respondents™ Perception of Secondhand Smoke Exposur e  N=1303  Very   Harmful  Somewhat   Harmful  Minor   Nuisance  Not   Harmful   Not Sure   66.7%  N=869  25.4%  N=330  5%  N=66  1.9%  N=25  1%  N=13   24  TABLE 2B  Smoking-Related Rules  Education  Housing Type   College &      Graduate   School   N=690   College  N=28 1  Some    College   N=197  No College   N=128  House   Divided into   Apartments   N=195  Apartment   Building   N=679  Condominium   N=430  100% No   Smoking   29.7%  N=205  30.6%  N=86  28.9%  N=57  19.5%  N=25  52.3%  N=102  29.5%  N=200  16.7%  N=72  No smoking in   Common Areas   44.2%  N=305  39.5%  N=111  33.5%  N=66  43.8%  N=56  19%  N=37  40.6%  N=276  53.3%  N=229  No Related   Rules  26.1%  N=180  29.9%  N=84  37.6%  N=74  36.7%  N=47  28.7%  N=56  29.9%  N=203  30%  N=129     TABLE 2C  Smoking-Related Rules  Child Health Conditions  N=299  Adult Health Conditions  N=1304   Asthma   N=57  Chronic Ear   Infections   N=22  Frequent    Respiratory   Infections   N=17  Asthma   N=256  Chronic   Respiratory   Condition   N=139  Heart   Disease   N=105  Stroke   N=57  100% No   Smoking   21.1%  N=12  27.3%  N=6  17.6%  N=3  32%  N=82  25.9%  N=36  22.9%  N=24  38.6%  N=22  No Smoking in   Common Areas   42.1%  N=24  31.8%  N=7  11.8%  N=2  42.2%  N=108  36.7%  N=51  47.6%  N=50  49.1%  N=28  No Related   Rules  36.8%  N=21  40.9%  N=9  70.6%  N=12  25.8%  N=66  37.4%  N=52  29.5%  N=31  12.3%  N=7     TABLE 3A  Demand for Smoking-Related Listing Information  Gender Age Income   Male  N=591  Female  N=712  18-24   N=159  25-34   N=502  35-44   N=220  45-54   N=161  55-64   N=111  65-74   N=78  <$60K   N=662  >$60K   N=632  More  Interested  70.2%  N=415  68.5%  N=488  54.7%  N=87  71.5%  N=359  74.5%  N=164  65.2%  N=105  68.5%  N=76  70.5%  N=55  67%  N=417  71.8%  N=454  Less  Interested  10.3%  N=61  12.1%  N=86  15.7%  N=25  9.2%  N=46  11.4%  N=25  14.9%  N=24  11.7%  N=13  11.5%  N=9  14.8%  N=92  7.4%  N=47  No   Difference  18.4%  N=109  17.8%  N=127  28.9%  N=46  18.1%  N=91  13.2%  N=29  16.1%  N=26  18.9%  N=21  17.9%  N=14  17.4%  N=108  19.1%  N=121  Not Sure  1%  N=6  1.5%  N=11  .6%  N=1  1.2%  N=6  .9%  N=2  3.7%  N=6  .9%  N=1  0%  N=0  1.6%  N=5  1.2%  N=10     TABLE 3B  Demand for Smoking-Related Listing Information  Education  Housing Type   College &   Graduate   School   N=691    College     N=281  Some    College   N=197  No College   N=128  House   Divided into   Apartments   N=195  Apartment   Building   N=678  Condominium   N=430  More  Interested  77.1%  N=533  67.6%  N=190  59.4%  N=117  47.7%  N=61  67.7%  N=132  67.3%  N=456  73.3%  N=315  Less  Interested  7.8%  N=54  8.5%  N=24  16.87%  N=33  26.6%  N=34  11.3%  N=22  12.7%  N=89  9.1%  N=39  No   Difference  14.3%  N=99  22.1%  N=62  21.8%  N=43  25%  N=32  19.5%  N=38  19.2%  N=130  16%  N=69  Not Sure  .7%  N=5  1.8%  N=5  2%  N=4  .8%  N=1  1.5%  N=3  .9%  N=6  1.6%  N=7   25   TABLE 3C  Willingness to Pay More for Smoke-free Property  Gender Age Income   Male  N=591  Female  N=712  18-24   N=159  25-34   N=502  35-44   N=219  45-54   N=159  55-64   N=111  65-74   N=77  <$60K   N=623  >$60K   N=632  Willing to Pay  More   44.3%  N=262  42%  N=299  34.6%  N=55  42.2%  N=212  46.1%  N=101  39%  N=62  46.8%  N=52  48.1%  N=37  36.1%  N=225  49.2%  N=311  20% More*  N=304  22.7%  N=69  N=343  28.6%  N=98  N=57  19.3%  N=11  N=247  20.2%  N=50  N=121  29.8%  N=36  N=77  35.1%  N=27  N=56  25%  N=14  N=42  31%  N=13  N=275  25.1%  N=69  N=343  27.1%  N=93  10% More**  59.2%  N=180  65.9%  N=226  80.7%  N=46  61.1%  N=151  58.6%  N=71  61%  N=47  58.9%  N=20  67%  N=28  61.8%  N=170  64.4%  N=221  *This question was asked of those who would be will ing to pay more in general or who were not sure if  they would pay  more.  The ﬁNﬂ value provided before the percentage s shown in this row includes those who are willing  to pay more in  general or are unsure whether or not they would pay  more.    **This question was asked of those who would be wil ling to pay more in general or who were not sure if  they would pay  more, but would not be willing to pay 20% or 15%.       TABLE 3D  Willingness to Pay More for Smoke-free Property  Education  Housing Type   College and   Graduate   School   N=690  College  N=280  Some    College   N=196  No College   N=129  House   Divided into   Apartments   N=196  Apartment   Building   N=678  Condominium   N=430  Willing to Pay  More   50%  N=345  37.9%  N=106  30.1%  N=59  37.2%  N=48  42.9%  N=84  39.7%  N=269  48.6%  N=209  20% More*  N=393  26.7%  N=105  N=125  20%  N=25  N=73  24.7%  N=18  N=51  35.3%  N=18  N=95  32.6%  N=31  N=315  21.9%  N=69  N=237  28.3%  N=67  10% More**  65.9%  N=259  56%  N=70  60.3%  N=44  62.7%  N=32  67.4%  N=64  63.8%  N=201  59.5%  N=141  *This question was asked of those who would be will ing to pay more in general or who were not sure if  they would pay  more.  The ﬁNﬂ value provided before the percentage s shown in this row includes those who are willing  to pay more in  general or are unsure whether or not they would pay  more.    **This question was asked of those who would be wil ling to pay more in general or who were not sure if  they would pay  more, but would not be willing to pay 20% or 15%.       TABLE 3E  Effect of Perspective Resident Smelling Tobacco Smo ke   Gender Age Income   Male  N=591  Female  N=712  18-24   N=159  25-34   N=502  35-44   N=220  45-54   N=160  55-64   N=111  65-74   N=77  <$60K   N=623  >$60K   N=632  More  Interested  5.4%  N=32  7.2%  N=51  4.4%  N=7  5.2%  N=26  4.5%  N=10  6.9%  N=11  9%  N=10  6.5%  N=5  9.8%  N=61  3%  N=19  Less  Interested  82.2%  N=486  80.8%  N=575  76.7%  N=122  87.3%  N=438  89.1%  N=196  71.2%  N=114  74.8%  N=83  74%  N=57  74.6%  N=465  88.3%  N=558  No   Difference  11.3%  N=67  11.2%  N=80  18.2%  N=29  6.6%  N=33  5.9%  N=13  21.9%  N=35  15.3%  N=17  16.9%  N=13  14.8%  N=92  7.6%  N=48  Not Sure  1%  N=6  .8%  N=6  .6%  N=1  1%  N=5  .5%  N=1  0%  N=0  .9%  N=1  2.6%  N=2  .8%  N=5  1.1%  N=7              26  TABLE 3F  Effect of Perspective Resident Smelling Tobacco Smo ke  Education  Housing Type   College and   Graduate   School   N=691   College   N=282  Some    College   N=197  No College   N=130  House   Divided into   Apartments   N=195  Apartment   Building   N=680  Condominium   N=429  More  Interested  3.8%  N=26  6.4%  N=18  9.1%  N=18  16.2%  N=21  3.1%  N=6  7.9%  N=54  5.4%  N=23  Less  Interested  91.8%  N=634  84.8%  N=239  64%  N=126  45.4%  N=59  84.1%  N=164  76.5%  N=520  88.1%  N=378  No   Difference  4.2%  N=29  8.5%  N=24  23.4%  N=46  36.2%  N=47  12.3%  N=24  14.3%  N=97  6.1%  N=26  Not Sure  .3%  N=2  .4%  N=1  3.6%  N=7  2.3%  N=3  .5%  N=1  1.3%  N=9  .5%  N=2     TABLE 4A*  Resident Support for Smoke-free Rule  Gender Age Income   Male  N=159  Female  N=213  18-24   N=75  25-34   N=140  35-44   N=54  45-54   N=38  55-64   N=27  65-74   N=16  <$60K   N=185  >$60K   N=179  Strongly  Support  81.8%  N=130  84%  N=179  82.7%  N=62  82.1%  N=115  81.5%  N=44  89.5%  N=34  81.5%  N=22  100%  N=16  81.6%  N=151  83.2  N=149  Somewhat  Support  8.8%  N=14  8%  N=17  17.3%  N=13  5%  N=7  13%  N=7  2.6%  N=1  11.1%  N=3  0%  N=0  11.4%  N=21  4.5%  N=8  Neutral  8.2%  N=13  3.8%  N=8  0%  N=0  10%  N=14  1.9%  N=1  5.3%  N=2  3.7%  N=1  0%  N=0  2.2%  N=4  10.1%  N=18  Somewhat  Oppose  .6%  N=1  1.9%  N=4  0%  N=0  2.1%  N=3  1.9%  N=1  0%  N=0  0%  N=0  0%  N=0  1.6%  N=3  1.7%  N=3  Strongly  Oppose  .6%  N=1  .9%  N=2  0%  N=0  0%  N=0  0%  N=0  2.6%  N=1  3.7 %  N=1  0%  N=0  1.6%  N=3  .6%  N=1  * The answers for ﬁNot Sureﬂ are excluded from this  Table.     TABLE 4B*  Resident Support for Smoke-free Rule  Education  Housing Type   College &   Graduate   School   N=206    College  N=87  Some    College   N=57  No College   N=25  House   Divided into   Apartments   N=103  Apartment   Building   N=198  Condominium   N=72  Strongly  Support  90.8%  N=187  78.2%  N=68  70.2%  N=40  60%  N=15  83.5%  N=86  81.8%  N=162  84.7%  N=61  Somewhat  Support  3.9%  N=8  10.3%  N=9  14%  N=8  24%  N=6  5.83%  N=6  10.6%  N=21  6.9%  N=5  Neutral   2.9%  N=6  9.2%  N=8  12.3%  N=7  0%  N=0  8.7%  N=9  4.5%  N=9  4.2%  N=3  Somewhat  Oppose  1.5%  N=3  0%  N=0  0%  N=0  8%  N=2  0%  N=0  2%  N=4  1.4%  N=1  Strongly  Oppose  1%  N=2  1.1%  N=1  0%  N=0  4%  N=1  0%  N=0  .5%  N=1  2.8%  N=2  * The answers for ﬁNot Sureﬂ are excluded from this  Table.              27  TABLE 4C*  Resident Support for Immediate Change to Smoke-free  Property  Gender Age Income   Male  N=430  Female  N=498  18-24   N=84  25-34   N=361  35-44   N=165  45-54   N=121  55-64   N=84  65-74   N=60  <$60K   N=437  >$60K   N=454  Strongly  Support  41.2%  N=177  47.8%  N=238  23.8%  N=20  47.9%  N=173  49.1%  N=81  43.8%  N=53  36.9%  N=31  48.3%  N=29  42.8%  N=187  46.7%  N=212  Somewhat  Support  14.7%  N=63  16.9%  N=84  19%  N=16  20.5%  N=74  12.1%  N=20  9.1%  N=11  15.5%  N=13  10%  N=6  13%  N=57  18.1%  N=82  Neutral   16.5%  N=71  11.2%  N=56  26.2%  N=22  8.3%  N=30  15.2%  N=25  10.7%  N=13  21.4%  N=18  18.3%  N=11  14.6%  N=64  12.8%  N=58  Somewhat  Oppose  12.1%  N=52  10.6%  N=53  17.9%  N=15  10.8%  N=39  11.5%  N=19  13.2%  N=16  9.5%  N=8  6.7%  N=4  12.6%  N=55  9.3%  N=42  Strongly  Oppose  14.9%  N=64  13.3%  N=66  13.1%  N=11  12.5%  N=45  10.9%  N=18  22.3%  N=27  15.5%  N=13  16.7%  N=10  16.5%  N=72  12.8%  N=58  * The answers for ﬁNot Sureﬂ are excluded from this  Table.     TABLE 4D*  Resident Support for Immediate Change to Smoke-free  Property  Education  Housing Type   College &   Graduate   School   N=485  College  N=195  Some    College   N=141  No College   N=103  House   Divided into   Apartments   N=94  Apartment   Building   N=478  Condominium   N=358  Strongly  Support  46.6%  N=226  47.7%  N=93  42.6%  N=60  35%  N=36  48.9%  N=46  43.7%  N=209  44.7%  N=160  Somewhat  Support  17.9%  N=87  16.4%  N=32  8.5%  N=12  14.6%  N=15  8.5%  N=8  16.5%  N=79  17%  N=61  Neutral   13.4%  N=65  8.7%  N=17  17.7%  N=25  17.5%  N=18  12.8%  N=12  13.8%  N=66  113.7%  N=49  Somewhat  Oppose  10.1%  N=49  13.3%  N=26  9.2%  N=13  14.6%  N=15  6.4%  N=6  10.3%  N=49  14%  N=50  Strongly  Oppose  11.3%  N=55  13.3%  N=26  21.3%  N=30  18.4%  N=19  23.4%  N=22  14.9%  N=71  10.3%  N=37  * The answers for ﬁNot Sureﬂ are excluded from this  Table.           TABLE 5A  Percentage of Number of Rental Units Owned/Managed  by Respondents  N=363  1 Unit 2 Units 3 Units 4 Units 5 Units 6 Units 7 Un its 8 Units 9 Units 10+ Units  13.4%  N=51  44.9%  N=163  14.3%  N=52  5.2%  N=19  4.1%  N=15  3%  N=11  2.5%  N=9  .8%  N=3  1.1%  N=4  All others  under 1%  N=36  TABLE 5B  Percentage of Respondents Who Have Implemented Smok e-free Rules  N=365  All Properties  More than Half of   Properties   Less than Half of   Properties  None  50.4%  N=184  2.2%  N=8  2.2%  N=8  45.2%  N=165   28  TABLE 6A  Effect of Smoke-free Rule on Rental Business for La ndlords Who Had Implemented a Smoke-Free Rule   Vacancy   Rate   N=195  Turnover   Rate   N=193  Disputes   Over   Security   Deposits   N=192  Resources  Required to  Manage   N=192  Disputes   Between   Tenants   N=193  Potential   Legal   Liability    N=189  Maintenance/  Repair Costs  N=195  Risk of   Fire   N=197  Increase  6.7%  N=13  3.6%  N=7  7.2%  N=14  8.3%  N=16  6.7%  N=13  8.5%  N=16  9.2%  N=18  9.6%  N=19  No   Change  77.4%  N=151  77.7%  N=150  64.6%  N=124  28.1%  N=111  54.4%  N=105  42.3%  N=93  29.7%  N=58  73.1%  N=34  Decrease  15.9%  N=31  18.7%  N=36  30.2%  N=54  33.9%  N=65  38.9%  N=75  49.2%  N=80  61%  N=119  17.3%  N=144   TABLE 6B  Effect of Smoke-free Rule on Rental Business Who Ha d Not Implemented a Smoke-Free Rule   Vacancy   Rate   N=161  Turnover   Rate   N=163  Disputes   Over   Security   Deposits   N=161  Resource  Required to  Manage   N=159  Disputes   Between   Tenants   N=160  Potential   Legal   Liability    N=159  Maintenance  / Repair   Costs   N=162  Risk of   Fire   N=161  Increase  13.7%  N=22  10.4%  N=17  8.1%  N=13  14.5%  N=23  17.5%  N=28  15.1%  N=24  9.9%  N=16  10.6%  N=17  No   Change  80.1%  N=129  77.9%  N=127  77%  N=124  61%  N=97  59.4%  N=95  54.7%  N=87  39.5%  N=64  16.8%  N=27  Decrease  6.2%  N=10  11.7%  N=19  14.9%  N=24  24.5%  N=39  23.1%  N=37  30.2%  N=48  50.6%  N=82  72.7%  N=117   TABLE 6C  Implementation of Rule   N=196  Very Difficult Difficult  Easy  Very Easy  3.6%  N=7  6.1%  N=12  37.2%  N=73  53.1%  N=104   TABLE 6D  Difficulty of Enforcement   N=194  Difficult  Easy  Same as other   rules  Virtually Self   Enforcing   6.7%  N=13  20.1%  N=39  23.2%  N=45  50%  N=97   TABLE 6D  Perceived Legality of Rule of Landlords Who Had Imp lemented a Smoke-Free Rule  N=200  Legal  Not Legal   Some Units Must   Be Designated for   Smoking  Not Sure  76.5%  N=153  3%  N=6  2%  N=4  18.5%  N=37   TABLE 6E  Perceived Legality of Rule of Landlords Who Had Not  Implemented a Smoke Free  Rule  N=165  Legal  Not Legal   Some Units Must   Be Designated for   Smoking  Not Sure  44.8%  N=74  18.2%  N=30  1.2%  N=2  35.8%  N=59            Saving Lives, Saving Mone A state-by-state  report on the health and economic  impact of comprehensive  smoke-free laws  2011                                          Table of Contents  Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Introduction .  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Saving Lives  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Saving Money . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Policy Recommendations  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .State Pages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Methodology .  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .The American Cancer Society Cancer Action Network (ACS CAN), the nonprofit, nonpartisan advocacy affiliate of the American Cancer Society,  supports evidence-based policy and legislative solutions designed to eliminate cancer as a major health problem. ACS CAN works to encourage   elected officials and candidates to make cancer a top national priority. ACS CAN gives ordinary people extraordinary power to fight cancer   with the training and tools they need to make their voices heard. For more information, visit www.acscan.org . 1American Cancer Society Cancer Action Network Savings Lives, Saving Money: A State-By-State Report on the Health and Economic Benefits of Comprehensive Smoke-Free Laws                                                      Each year, tobacco use causes hundreds of thousands of premature deaths and costs billions of dollars in medical care and productivity losses  in the United States. Strong tobacco control policies at the state level can help reduce the burden of tobacco use.  Saving Lives, Saving Money: A State-By-State Report on the Health and Economic Benefits of Comprehensive Smoke-Free Laws, provides new information about  the public health and economic benefits to states that implement smoke-free laws.  Comprehensive smoke-free laws reduce exposure to secondhand smoke, encourage people to quit or cut down on smoking, and prevent  youth from starting to smoke. As these laws reduce smoking and secondhand smoke exposure, data show that they reduce disease and  heath care spending, and they improve employee productivity.   The American Cancer Society Cancer Action Network (ACS CAN) commissioned leading experts to derive updated and expanded estimates for the public health benefits and economic savings in the 27 states that currently do not have a comprehensive smoke-free law in place.  The estimates show that in each of these states, a smoke-free law would result in fewer smokers, fewer smoking-related deaths, and fewer   youth who become smokers. In addition, a comprehensive smoke-free law in each state would substantially reduce health care costs associ ated with several smoking-related diseases.  SAVING LIVES  The data show that comprehensive smoke-free laws would decrease the number of adult smokers by tens of thousands in many states.   North Carolina, for example, would have 78,100 fewer adult smokers by adopting a comprehensive law that closed the current loophole   that allows smoking in non-hospitality workplaces. The results also show that nearly 400,000 fewer young people would become smokers if   states without a comprehensive smoke-free law adopted one, further reducing the health and economic burden of smoking. The reduction   in smoking-related deaths avoided by implementing smoke-free laws ranges from several hundred in states with smaller populations to more   than 110,000 in Texas. Non-smokersÕ deaths would be prevented in every state that applies a smoke-free law. If each of the 27 states without   a comprehensive smoke-free law had such a law in place, the following estimates of public health benefits would apply:  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-smokers 1.03M 398,700 624,000 69,500 SAVING MONEY  The total estimated savings in health care costs from adopting comprehensive smoke-free laws adds up to tens or hundreds of millions of   dollars in most states. Seven states would each save at least $80 million in spending on lung cancer, heart attacks and strokes, and pregnancy   complications over five years. All together, the 27 states without a comprehensive smoke-free law currently in place could save an estimated   $1.32 billion in treatment of those conditions over five years.  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  States' Medicaid Program Savings Smoking-RelatedPregnancy Treatment Savings  $316.11M $875.57M $42.79M $128.26M Figures represent savings for both smokers and non-smokers. 2 American Cancer Society Cancer Action Network Savings Lives, Saving Money: A State-By-State Report on the Health and Economic Benefits of Comprehensive Smoke-Free Laws                                                   WHAT STATES CAN DO  There is still much work to be done Ð 27 states have no statewide smoke-free  law in effect or have a law that does not cover all workplaces or populations.   Hospitality and casino workers, who studies show are exposed to dangerous second  hand smoke on the job, continue to be denied their right to breathe smoke-free   air in a large number of states. Opponents of smoke-free legislation continually   battle to weaken existing laws through loopholes and exemptions, further   complicating efforts to achieve the benefits of these laws. States in which some   residents are covered by city or county smoke-free laws would see greater health and   economic outcomes if a strong, comprehensive statewide law were implemented.  ACS CAN recommends that all states aim for statewide laws that are compre hensive and protect all workers from the dangers of secondhand smoke.  ¥ Smoke-free laws should cover  all workplaces. ¥ Venues should be  100 percent smoke-free with no exceptions , such as allowing smoking in certain places or at certain times. ¥ Statewide smoke-free laws should  not preempt local authorities from enacting stronger smoke-free laws in their jurisdictions.  American Cancer Society Cancer Action Network  Savings Lives, Saving Money: A State-By-State Report on the Health and Economic Benefits of Comprehensive Smoke-Free Laws 3                                                                                                                                                                   Intr TobaccoÕs burden on public health and the economy in the United States is well known. There are hundreds of thousands of premature  deaths, hundreds of billions of dollars in medical care and productivity losses each year, and more than 1,000 people start smoking every day.  Implementing strong tobacco control policies in the states has been proven to reduce smoking and discourage new smokers. Through a  three-pronged approach Ð higher tobacco taxes, comprehensive smoke-free laws, and fully funded tobacco prevention and cessation pro grams Ð experience and evidence show that state tobacco control policies can help curb the tobacco burden on this country.  In his 2006 report on the public health impact of tobacco use, U.S. Surgeon General Richard Carmona concluded that there is  no safe level of exposure to secondhand smoke. Evidence shows that smoke-free laws reduce exposure to secondhand smoke, encourage people to quit  or cut down on smoking, and prevent youth from starting to smoke. As these laws reduce smoking and secondhand smoke exposure, they  reduce disease, heath care spending, and improve employee productivity.   To better understand the power of comprehensive smoke-free policies, researchers have created models to measure the health and economic  benefits to states that implement smoke-free laws. Measuring the benefits of these policies can be complex, but the results are critical for  demonstrating just how many deaths can be prevented and how much money can be saved.  ABOUT THIS REPORT  This report provides new information about the public health and economic benefits to states from comprehensive smoke-free laws that   cover bars, restaurants, and workplaces. Twenty-seven states lacked comprehensive smoke-free laws as of June 1, 2011. This report focuses   on the public health and economic benefits if those states were to adopt comprehensive smoke-free laws. The report also looks at states   that do have a comprehensive smoke-free law in place and details critical actions that are still needed to protect and enforce the laws.  The first part of the report describes the dramatic impact that would result if comprehensive smoke-free laws were passed in every state nationwide.  This includes public health benefits, such as reductions in smoking and smoking-related deaths, as well as cost savings through reduced  spending on treating lung cancer and other diseases, caring for pregnant smokers, and reducing expenditures in state Medicaid programs.   The second half of the report includes a breakdown of the health and economic benefits that a comprehensive smoke-free law would bring to   those states without one in effect. For those states where a comprehensive law is currently in place, the information includes the population   covered by the law, examples of how the law has been successful, and potentially weak areas of the law, or loopholes that still should be   closed in order to fully protect people in the state.  The estimates in this report were calculated for ACS CAN using the most up-to-date economic and public health research and methodology.  In estimating the changes to the overall health of the population, the findings are based on standard assumptions about how tobacco users  react to changes in tobacco prices and laws around tobacco use, how these policies reduce the number of youth who become regular smokers,   and the most recent health data from the Centers for Disease Control and Prevention (CDC) on the percentage of smokers who would be   expected to die prematurely from smoking. Similarly, in estimating the cost savings to states from tobacco control policies, the report used the   latest studies and data on the costs of smoking-related disease and the savings to states without the burden of treating lung cancers, heart   attacks, and strokes related to smoking. The methodology and assumptions used to calculate the estimates are detailed in the Methodology  These estimates will change slightly each year, because the data are based on current tobacco control policies, as well as variables such as  population, local laws, and health care costs that can change over time. 1 Centers for Disease Control and Prevention. Smoking-Attributable Mortality, Years of Potential Life Lost, and Productivity LossesÑUnited States, 2000Ð2004.  Morbidity and Mortality Weekly Report  2008;57(45):1226Ð 8 [accessed 2011 Mar 11]. American Cancer Society Cancer Action Network Savings Lives, Saving Money: A State-By-State Report on the Health and Economic Benefits of Comprehensive Smoke-Free Laws 4                                                                                                                                                                      Smoke-free laws improve public health by reducing exposure to cancer- causing pollutants and by lowering the incidence of chronic disease.   These laws also encourage smokers to quit and reduce consumption of   cigarettes, preventing disease and premature death. The greatest public   health benefits are achieved with a strong and broad smoke-free law that   covers all types of workplaces, bars, and restaurants Ð including gaming   facilities, correctional facilities, and retail environments, such as cigar bars,   with no exemptions. Young people are less likely to start smoking when smoke-free laws are in  place. Preventing youth initiation of smoking is a critical factor in reducing  smoking and related death and disease.  Smoke-free laws do not just prevent premature deaths in smokers, but also in people who are exposed to secondhand smoke and are at risk   for developing smoking-related disease. Secondhand smoke causes nearly 49,000 deaths each year from cancer and heart disease nation wide.1 Comprehensive laws can dramatically reduce this death toll.  As of June 1, 2011, 27 states did not have a comprehensive smoke-free law. Fifteen of these states have no smoke-free law in place that applies   to all workplaces or restaurants or bars. Twelve additional states do not cover all three types of venues, or they have substantial loopholes that  weaken the impact of the law. In each of these states, a comprehensive smoke-free law would considerably improve public health. If each of   the 27 states without a comprehensive smoke-free law had such a law in place, the following estimates of public health benefits would apply:  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-smokers 1.03M 398,700 624,000 69,500 REDUCTIONS IN SMOKERS Several states would reduce the number of smokers by tens of thousands by implementing comprehensive smoke-free laws. Some smokers  would stop immediately, but overall smoking rates would decline over time. Each state without a comprehensive smoke-free law would have   fewer smokers and fewer future smokers. North Carolina, for example, would reduce the number of adult smokers by 78,100 by closing its   existing loophole for non-hospitality workplaces. Florida would reduce the number of adult smokers by 23,600 by closing its exemption for   stand-alone bars. With a stronger statewide law that includes all workplaces, California could prevent almost 40,000 people from initiating   smoking. With the implementation of a comprehensive smoke-free law in the 27 states without one, there would be a total of 1 million   fewer adult smokers and nearly 400,000 fewer young people would become smokers. PREVENTION OF PREMATURE DEATH  Smoke-free laws also prevent the deaths of smokers by providing strong incentives for them to quit or cut down, thus reducing smokersÕ risk   of fatal disease. If every state without a comprehensive smoke-free law implemented one, more than 355,000 premature deaths among current   smokers would be prevented. The number of deaths of current smokers avoided range from several hundred in states with smaller populations   to more than 59,700 in Texas. In Pennsylvania, an estimated 11,600 deaths of current smokers would be prevented with a comprehensive   smoke-free law in place. Thirteen of the 27 states without comprehensive smoke-free laws currently in place would each prevent an estimated   10,000 premature deaths among current adult smokers. The prevented deaths will occur gradually over a long period of time after the law is   implemented and smoking declines. 5American Cancer Society Cancer Action Network Savings Lives, Saving Money: A State-By-State Report on the Health and Economic Benefits of Comprehensive Smoke-Free Laws                                                 With the implementation of a comprehensive  smoke-free law in the 27 states without one,  there would be a total of 1 million fewer adult  smokers and nearly 400,000 fewer young people would become smokers in those states.  Smoke-free laws also discourage people, particularly youth, from becoming regular smokers. Estimates  of deaths prevented by reducing the number of people who become smokers in the first place are at   least 1,000 in 23 of the 27 states without comprehensive smoke-free laws currently in effect. North   Carolina would prevent 14,600 additional smoking-related deaths among young people due to a lower   smoking initiation rate. Non-smokersÕ deaths would be prevented in every state that implements a comprehensive smoke-free  law. High-population states such as California would avoid 7,200 deaths among non-smokers. North  Carolina would avoid 5,200 deaths among non-smokers.  Saving Money Smoke-free laws provide significant economic return for states by reducing smoking and preventing   potential new smokers from starting. States with comprehensive laws are expected to spend   significantly less on treating people for tobacco-related disease and recognize major savings in programs   such as Medicaid. Reducing smoking through implementation of smoke-free laws saves states millions   of dollars in expenditures for treating lung cancer, heart attacks and strokes, pregnancy complications,   and other diseases. Reduction in Prematur Deaths  Alabama 17,855 Alaska 1,552 Arkansas 3,755 California 37,599 Colorado 2,921 Connecticut 5,039 Florida 8,097 Georgia 25,055 Idaho 3,308 Indiana 22,430 Kentucky 17,455 Louisiana 2,334 Mississippi 12,579 Missouri 20,680 Nevada 1,484 New Hampshire 3,074 New Mexico 1,167 North Carolina 26,860 North Dakota 487 Oklahoma 11,312 Pennsylvania 11,608 South Carolina 16,003 Tennessee  8,635 Texas  59,710 Virginia  28,859 West Virginia  3,093 Wyoming 2,208 TOTAL  355,159 American Cancer Society Cancer Action Network Savings Lives, Saving Money: A State-By-State Report on the Health and Economic Benefits of Comprehensive Smoke-Free Laws 6                                                         Implementing comprehensive smoke-free laws in every state would yield tremendous cost savings across the country. The chart below summarizes  the total estimated savings for all states over five years. Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  States' Medicaid Program Savings Smoking-RelatedPregnancy Treatment Savings  $316.11M $875.57M $42.79M $128.26M Figures represent savings for both smokers and non-smokers DECREASED HEALTH CARE COSTS  In 12 states, a comprehensive smoke-free law would save at least $10 million each over five years on lung cancer costs alone. Texas and California   would reduce lung cancer treatment costs by more than $33 million each.   The health care savings from reducing costs for treating heart attacks and strokes related to smoking are even greater. Thirteen states would  save at least $25 million each, with seven states saving in excess of $50 million just from lower health care costs for these two conditions.  States would also benefit from lower costs for treating smoking-related pregnancy complications. Eleven states would save at least $5 million   in five years with a comprehensive smoke-free law. Twenty out of 27 states without these laws would save at least $1 million during that   same time period. Total Estimated State Health Care Cost Savings Over Five Years With Implementation of Comprehensive Smoke-free Law  Pregnancy  Savings Heart Attack & Stroke Savings Lung CancerSavings TOTAL  SAVINGS Alabama $5,831,511 $47,794,691 $15,556,637 $69,182,839 Alaska $978,238 $3,691,196 $1,351,653 $6,021,087 Arkansas $1,692,671 $9,027,239 $3,272,182 $13,992,092 California $17,804,716 $91,157,953 $33,570,386 $142,533,055 Colorado $893,338 $6,602,229 $2,608,058 $10,103,625 Connecticut $932,448 $12,495,497 $4,498,893 $17,926,838 Florida $1,784,670 $21,929,926 $7,229,789 $30,944,385 Georgia $8,246,896 $62,551,032 $21,820,648 $92,618,576 Idaho $1,456,663 $8,009,528 $2,953,624 $12,419,815 Indiana $10,433,435 $54,808,762 $19,537,182 $84,779,379 Kentucky $8,964,492 $42,104,502 $15,195,180 $66,264,174 Louisiana $738,586 $6,715,187 $2,084,180 $9,537,953 Mississippi $4,292,206 $31,818,943 $10,953,900 $47,065,049 Missouri $10,545,550 $53,056,193 $18,007,702 $81,609,445 Nevada $353,279 $3,988,216 $1,325,420 $5,666,915 New Hampshire $1,154,849 $7,432,016 $7,289,809 $15,876,674 New Mexico $289,408 $2,896,230 $1,042,091 $4,227,729 North Carolina $9,584,620 $70,600,278 $23,981,847 $104,166,745 North Dakota $247,701 $1,262,726 $434,890 $1,945,317 Oklahoma $5,071,703 $27,461,295 $9,850,258 $42,383,256 Pennsylvania $3,732,944 $28,137,486 $10,363,985 $42,234,415 South Carolina $6,153,943 $42,003,002 $13,943,234 $62,100,179 Tennessee  $3,896,806 $21,184,651 $7,519,700 $32,601,157 Texas  $13,877,778 $141,908,168 $51,967,212 $207,753,158 Virginia  $6,625,044 $63,976,144 $25,137,489 $95,738,677 West Virginia  $1,515,366 $7,504,979 $2,695,773 $11,716,118 Wyoming $1,156,170 $5,456,495 $1,923,007 $8,535,672 TOTAL  $1,319,944,324 7American Cancer Society Cancer Action Network Savings Lives, Saving Money: A State-By-State Report on the Health and Economic Benefits of Comprehensive Smoke-Free Laws                                                                   State Medicaid programs devote large sums to treating tobacco-related disease in both smokers and non-smokers who develop disease  through exposure to secondhand smoke. Twelve states would save an estimated $1 million over five years by passing a comprehensive  smoke-free law. Medicaid savings alone could be a combined $42.8 million over five years in the 27 states currently without comprehensive   smoke-free laws in place.  The total estimated health care cost savings add up to hundreds of millions of dollars in some states. In 10 states, more than $50 million in  total savings on lung cancer, heart attacks and strokes, and pregnancy complications are estimated over five years. All told, the 27 states  without comprehensive laws currently in place could save an estimated $1.32 billion in health care expenditures over five years.  Policy Recommendations The number of states with smoke-free laws continues to grow, and these laws now cover the majority of the U.S. population. Still, there is   much work to be done. Many states have no statewide smoke-free law or have a law that does not cover all places or populations. Hospitality   and casino workers in many states, who are exposed to dangerous levels of secondhand smoke on the job, continue to be denied their right   to breathe smoke-free air. Opponents of smoke-free legislation continually battle to weaken existing laws through loopholes and exemptions,   further complicating efforts to achieve the benefits of these laws. States that cover only some of the population with city or county smoke-free   laws would see greater health and economic benefits if a strong, comprehensive statewide law were implemented.   As the estimates in this report show, states derive significant, measurable benefits from putting smoke-free laws in place. ACS CAN recom mends that all states aim for statewide laws that are comprehensive and protect all workers from the dangers of secondhand smoke. Weak  laws with exemptions, loopholes, or limited enforcement capacity will not achieve these results.  ¥ Smoke-free laws should cover  all workplaces. Laws should cover all workplaces, restaurants, bars, gaming facilities, hookah bars, tobacco retail stores, and cigar bars, regardless of size,  primary use, age of patrons, or number of workers.  ¥ Venues should be  100 percent smoke-free with no exceptions  such as allowing smoking in certain places or at certain times. Laws should not allow venues to use smoking rooms, ventilation, or other unproven technology to attempt to avoid compliance with smoke-  free laws. Exemptions for certain hours of the day or special events should be avoided. ¥ State smoke-free laws should  not preempt local authorities from enacting stronger local smoke-free laws.  While state laws should be comprehensive, no state law should preempt a local government from enacting a stronger law to protect people   in their workplaces and public spaces. American Cancer Society Cancer Action Network Savings Lives, Saving Money: A State-By-State Report on the Health and Economic Benefits of Comprehensive Smoke-Free Laws 8                                                                                  The Health and Economic Benefits of Making Alabama Smoke-Free  Making all Alabama workplaces, restaurants, and bars 100% smoke-free would prevent about 18,300 youth from becoming smokers, and within five  years, save an estimated $63.35 million in lung cancer, heart attack, and   stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Alabama is one of only 15 states that currently has no law prohibiting smoking in all workplaces or restaurants or bars.  Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all Alabama residents  from the dangers of secondhand smoke.  SAVING LIVES  Making all Alabama workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 51,900 18,300 30,400 3,400 SAVING MONEY  In addition to saving lives, making Alabama smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all Alabama workplaces, restaurants, and bars would be expected   to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $15.56M $47.79M $570,000 $5.83M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  9                                                                                                     The Health and Economic Benefits of Making Alaska Smoke-Free  Making all Alaska workplaces, restaurants, and bars 100% smoke-free would prevent about 1,900 youth from becoming smokers, and within five years,  save an estimated $5.04 million in lung cancer, heart attack, and stroke costs.  According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Alaska is one of only 15 states that currently has no law prohibiting smoking in all workplaces or restaurants or bars. Making  all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all Alaska residents from the  dangers of secondhand smoke. SAVING LIVES  Making all Alaska workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following reductions   in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 4,500 1,900 2,800 300 SAVING MONEY  In addition to saving lives, making Alaska smoke-free would cut health care costs for both smokers and non-smokers. Over  five years, a comprehensive smoke-free law covering all Alaska workplaces, restaurants, and bars would be expected to   produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $1.35M $3.69M $520,000 $980,000 *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  10                                                            Keep Arizona Smoke-Free  Keeping all workplaces, restaurants, and bars in Arizona 100% smoke-free is the best way to continue protecting all 6,392,000 residents from the dangers  of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  ArizonaÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. ArizonaÕs  comprehensive smoke-free law went into effect on May 1, 2007.  SMOKE-FREE SUCCESS STORY  ArizonaÕs smoke-free law enjoys broad support among both consumers and business owners. + ¥° A 2010 survey by the Arizona Department of Public Health found that over 80 percent of residents were in favor   of the smoke-free law.  ¥° Seventy-six percent believed that food and drink service establishments became healthier environments to visit as   a result of the law.  ¥° Over 70 percent of business owners were in favor of the law.  ¥° Over half of business owners felt that the smoking ban made their organizations healthier working environments.  PROTECT ARIZONAÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Arizona residents   from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo parlors,   hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do not  adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + Arizona Department of Health Services. The Smoke-Free Arizona Act: ÒItÕs a Benefit, Not a Ban!Ó Smoke-Free Arizona Annual Report. June 2010.   Available at  http://www.azdhs.gov/phs/oeh/pdf/2010SmokeFreeAnnualReport.pdf . Accessed June 5, 2011. 11                                                                         The Health and Economic Benefits of Making Arkansas Smoke-Free  Making all Arkansas workplaces, restaurants, and bars 100% smoke-free would prevent about 4,900 youth from becoming smokers, and within five  years, save an estimated $12.30 million in lung cancer, heart attack, and   stroke costs.  According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to to  bacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the   number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Arkansas is one of only 15 states that currently has no law prohibiting smoking in all workplaces or restaurants or bars.  Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all Arkansas residents  from the dangers of secondhand smoke.  SAVING LIVES  Making all Arkansas workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 10,900 4,900 7,000 800 SAVING MONEY  In addition to saving lives, making Arkansas smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all Arkansas workplaces, restaurants, and bars would be expected   to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $3.27M $9.03M $150,000 $1.69M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  12                                                              The Health and Economic Benefits of Making California Smoke-Free  Making all California workplaces, restaurants, and bars 100% smoke-free would prevent about 39,900 youth from becoming smokers, and within five  years, save an estimated $124.73 million in lung cancer, heart attack, and   stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  California has a law that prohibits smoking in restaurants and bars, but it does not have a comprehensive law banning  smoking in all workplaces. Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all California residents from the dangers of secondhand smoke.  SAVING LIVES  Making all California workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 109,400 39,900 64,800 7,200 SAVING MONEY  In addition to saving lives, making California smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all California workplaces, restaurants, and bars would be   expected to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $33.57M $91.16M $11.05M $17.80M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  13                                                                                              The Health and Economic Benefits of Making Colorado Smoke-Free  Making all Colorado workplaces, restaurants, and bars 100% smoke-free would prevent about 3,700 youth from becoming smokers, and within five  years, save an estimated $9.21 million in lung cancer, heart attack, and   stroke costs.  According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Colorado has a law that prohibits smoking in restaurants and bars, but it does not have a comprehensive law banning  smoking in all workplaces. Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all Colorado residents from the dangers of secondhand smoke.  SAVING LIVES  Making all Colorado workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 8,500 3,700 5,300 600 SAVING MONEY  In addition to saving lives, making Colorado smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all Colorado workplaces, restaurants, and bars would be expected   to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $2.61M $6.60M $320,000 $890,000 *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  14                                                                                       The Health and Economic Benefits of Making Connecticut Smoke-Free  Making all Connecticut workplaces, restaurants, and bars 100% smoke-free would prevent about 5,700 youth from becoming smokers, and within five   years, save an estimated $16.99 million in lung cancer, heart attack, and   stroke costs.  According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Connecticut has a law that prohibits smoking in restaurants and bars, but it does not have a comprehensive law banning  smoking in all workplaces. Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all Connecticut residents from the dangers of secondhand smoke.  SAVING LIVES  Making all Connecticut workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 14,700 5,700 8,900 1,000 SAVING MONEY  In addition to saving lives, making Connecticut smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all Connecticut workplaces, restaurants, and bars would be   expected to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $4.51M $12.50M $770,000 $930,000 *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  15                                                            Keep Delaware Smoke-Free  Keeping all workplaces, restaurants, and bars in Delaware 100% smoke-free is the best way to continue protecting all 897,900 residents from the dangers  of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Delaware was the first state to require all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free.  DelawareÕs comprehensive smoke-free law went into effect on November 27, 2002.  SMOKE-FREE SUCCESS STORY  The implementation of DelawareÕs comprehensive smoke-free law in 2002 provided several public health and economic   benefits for the state. ¥ DelawareÕs adult smoking rate decreased by 11 percent in 2003. + ¥ Since the smoke-free law was enacted, revenue from food and drinking establishments has increased.*  ¥ The smoke-free law had no impact on total gaming revenue or revenue per machine. ^ PROTECT DELAWAREÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Delaware residents  from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo parlors,   hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do not  adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + State of Delaware, Office of the Governor Press Release. DelawareÕs Smoking Rate Decreased by 11 Percent in 2003. July 2, 2004.   Available at http://dhss.delaware.gov/dhss/pressreleases/2004/smkngstudy7-2-04.html . Accessed June 6, 2011. * Delaware Division of Public Health, Delaware Division of Revenue, and Delaware Department of Labor.  Economic Impact of Smokefree Laws. Americans for Non-smokersÕ Rights.    May 25, 2005. Available at  http://www.no-smoke.org/getthefacts.php?id=44 . Accessed June 6, 2011. ^Mandel LL, Alamar BC, Glantz SA. Smoke-free Law Did Not Affect Revenue from Gaming in Delaware.  Tobacco Control 2005; 14:10-12. 16                                                                 Keep the District of Columbia Smoke-Free  Keeping all workplaces, restaurants, and bars in the District of Columbia 100% smoke-free is the best way to continue protecting all 601,700 residents  from the dangers of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  The District of ColumbiaÕs smoke-free law requires all workplaces, restaurants, and bars to be 100% smoke-free. The District  of ColumbiaÕs comprehensive smoke-free law went into effect on January 1, 2007.  SMOKE-FREE SUCCESS STORY  The 2007 implementation of the District of ColumbiaÕs smoke-free law has contributed to several positive public health and   economic outcomes. ¥° The smoking rate decreased from 22 percent in 2005 to 16 percent in 2008. + ¥° Cigarette sales decreased from an average of approximately 2.1 million packs per month from 2000-2002  to approximately 1.5 million packs per month from 2008-2009, likely due to a comprehensive tobacco control  program and the enactment of the smoke-free law. + ¥° Research shows that the smoke-free law in restaurants and bars has effectively reduced environmental tobacco   smoke exposure for restaurant and bar employees.*  PROTECT DISTRICT OF COLUMBIAÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all District of   Columbia residents from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos,   bingo parlors, hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and  do not adequately protect the public. Removing any existing exemptions further strengthens the law and provides even   better protection for everyone against the dangers of secondhand smoke.  + Tobacco Free Families. Motivating Underserved Smokers to Take Action: An Evidence-Based Approach. 2009.  Available at http://www.dctff.org/wp-content/uploads/NCTOH-2009-Presentation-DCTFF1.pdf . Accessed June 6, 2011. *Pearson J, Windsor R, El-Mohandes A, and Perry D.  Evaluation of the Immediate Impact of the Washington, D.C., Smoke-Free Indoor Air Policy on Bar Employee Environmental   Tobacco Smoke Exposure.  Public Health Reports, 2009;1(124):135-142. 17                                                                                      The Health and Economic Benefits of Making Florida Smoke-Free  Making all Florida workplaces, restaurants, and bars 100% smoke-free would prevent about 7,300 youth from becoming smokers, and within five years, save   an estimated $29.16 million in lung cancer, heart attack, and stroke costs.  According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Florida has a law that prohibits smoking in restaurants and workplaces, but it does not have a comprehensive law banning  smoking in all bars. Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect  all Florida residents from the dangers of secondhand smoke.  SAVING LIVES  Making all Florida workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 23,600 7,300 13,200 1,500 SAVING MONEY  In addition to saving lives, making Florida smoke-free would cut health care costs for both smokers and non-smokers. Over  five years, a comprehensive smoke-free law covering all Florida workplaces, restaurants, and bars would be expected to   produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $7.23M $21.93M $1.08M $1.78M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  18                                                                                                   The Health and Economic Benefits of Making Georgia Smoke-Free  Making all Georgia workplaces, restaurants, and bars 100% smoke-free would prevent about 29,800 youth from becoming smokers, and within  five years, save an estimated $84.37 million in lung cancer, heart attack,   and stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Georgia is one of only 15 states that currently has no law prohibiting smoking in all workplaces or restaurants or bars.  Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all Georgia residents  from the dangers of secondhand smoke.  SAVING LIVES  Making all Georgia workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following reductions   in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 72,900 29,800 45,000 5,000 SAVING MONEY  In addition to saving lives, making Georgia smoke-free would cut health care costs for both smokers and non-smokers. Over  five years, a comprehensive smoke-free law covering all Georgia workplaces, restaurants, and bars would be expected to   produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $21.82M $62.55M $3.17M $8.25M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  19                                        Keep Hawaii Smoke-Free  Keeping all workplaces, restaurants, and bars in Hawaii 100% smoke-free is the best way to continue protecting all 1,360,300 residents from the dangers  of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  HawaiiÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. HawaiiÕs  comprehensive smoke-free law went into effect on November 16, 2006.  SMOKE-FREE SUCCESS STORY  Five years after its passage, HawaiiÕs comprehensive smoke-free law still enjoys strong public support. + ¥° In a recent poll, 87 percent of poll respondents were found to favor the law and 56 percent were strongly in favor.  ¥° Seventy-three percent of poll respondents believe it is very important for the state to use tobacco settlement funds   for tobacco prevention programs.  ¥° Of those in favor, 47 percent believe money spent on tobacco prevention should be increased.  PROTECT HAWAIIÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Hawaii residents   from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo parlors,   hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do not  adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + QMark Research. Public Attitude Towards Tobacco Settlement Funds. Coalition for a Tobacco-Free Hawaii. February 2011.  20                                                                                                                   The Health and Economic Benefits of Making Idaho Smoke-Free  Making all Idaho workplaces, restaurants, and bars 100% smoke-free would  prevent about 4,000 youth from becoming smokers, and within five years,   save an estimated $10.96 million in lung cancer, heart attack, and stroke costs.  According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Idaho has a law that prohibits smoking in restaurants, but it does not have a comprehensive law banning smoking in all bars  and workplaces. Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all  Idaho residents from the dangers of secondhand smoke.  SAVING LIVES  Making all Idaho workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following reductions   in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 9,600 4,000 6,000 700 SAVING MONEY  In addition to saving lives, making Idaho smoke-free would cut health care costs for both smokers and non-smokers. Over  five years, a comprehensive smoke-free law covering all Idaho workplaces, restaurants, and bars would be expected to   produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $2.95M $8.01M $280,000 $1.46M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  21                                        Keep Illinois Smoke-Free  Keeping all workplaces, restaurants, and bars in Illinois 100% smoke-free is the best way to continue protecting all 12,830,600 residents from the dangers  of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  IllinoisÕ smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. IllinoisÕ  comprehensive smoke-free law went into effect on January 1, 2008.  SMOKE-FREE SUCCESS STORY  Since IllinoisÕ comprehensive smoke-free law went into effect in 2008, the state has seen numerous health benefits. + ¥° Since the implementation of the smoke-free law, it has been estimated that 30,000 heart attacks and other   heart-related hospitalizations have been prevented.  ¥° Heart disease related hospitalizations have decreased by an estimated 9.3 percent.  ¥° An estimated $1.18 billion in health care costs have been saved.  PROTECT ILLINOISÕ STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Illinois residents   from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo parlors,   hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do not  adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + Smoke Free Illinois. Health Organizations Demonstrate Success of Smoke Free Illinois Act and Ask Lawmakers to Preserve It. Press Release. March 31, 2011.  Available at http://smokefreeillinois.org/pdfs/SmokeFreeIllinoispressrelease.pdf . Accessed June 5, 2011.  22                                                                               The Health and Economic Benefits of Making Indiana Smoke-Free  Making all Indiana workplaces, restaurants, and bars 100% smoke-free would prevent about 27,300 youth from becoming smokers, and within five  years, save an estimated $74.35 million in lung cancer, heart attack, and   stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Indiana is one of only 15 states that currently has no law prohibiting smoking in all workplaces or restaurants or bars.  Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all Indiana residents  from the dangers of secondhand smoke.  SAVING LIVES  Making all Indiana workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following reductions   in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 65,300 27,300 40,600 4,500 SAVING MONEY  In addition to saving lives, making Indiana smoke-free would cut health care costs for both smokers and non-smokers. Over  five years, a comprehensive smoke-free law covering all Indiana workplaces, restaurants, and bars would be expected to   produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $19.54M $54.81M $1.29M $10.43M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  23                                        Keep Iowa Smoke-Free  Keeping all workplaces, restaurants, and bars in Iowa 100% smoke-free is the best way to continue protecting all 3,046,400 residents from the dangers of  secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  IowaÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. IowaÕs  comprehensive smoke-free law went into effect on July 1, 2008.  SMOKE-FREE SUCCESS STORY  Three years after IowaÕs 2008 smoke-free law took effect, support for the law remains strong. + ¥° Seventy-nine percent of voters believe the law has made Iowa a better place to live.  ¥° Iowa residents say they are going out more often in response to cleaner air in restaurants, bars, and bowling alleys.    Of those that go out more often, 79 percent visit places they avoided before the smoke-free law took effect.  ¥° Sixty-three percent of voters believe that the smoke-free law should be expanded to casinos.     PROTECT IOWAÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Iowa residents   from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo parlors,   hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do not  adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + Selzer & Company on behalf of the Iowa Tobacco Prevention Alliance. February 20, 2011. Available at  http://www.iowatpa.org/Resources/Documents/ITPA%20Survey%20Key%20Findings%20Feb%202011.pdf . Accessed June 6, 2011. 24                                                             Keep Kansas Smoke-Free  Keeping all workplaces, restaurants, and bars in Kansas 100% smoke-free is the best way to continue protecting all 2,853,100 residents from the dangers  of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  KansasÕ smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. KansasÕ  comprehensive smoke-free law went into effect on July 1, 2010.  SMOKE-FREE SUCCESS STORY  The 2010 passage of a comprehensive smoke-free law in Kansas has contributed to public health and economic benefits.  ¥° A 2010 poll found that 77 percent of voters support the smoke-free law, and 59 percent were less likely to vote for  any candidate that wants to repeal the law. + ¥° As a result of the statewide smoke-free law, indoor particle pollution levels in KansasÕ restaurants and bars that previously   allowed smoking declined 94 percent to levels similar to those found in outdoor air. Prior to the law, employees working  full time in restaurants or bars that allowed indoor smoking were exposed to levels of air pollution 4.4 times higher than   safe annual levels established by the U.S. Environmental Protection Agency because of their occupational   exposure to tobacco smoke pollution.*  ¥° Research on the impact of local smoke-free laws in Kansas and neighboring Missouri found that these laws have had   no negative impact on restaurant or bar sales in those jurisdictions.^ PROTECT KANSASÕ STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Kansas residents   from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo parlors,   hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do not  adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + American Cancer Society and public health partners. Kansas Action Center: The Kansas Indoor Clean Air Act Works!  2010. Available at  http://www.acscan.org/action/ks/campaigns/httpacscanorgsmokefreekansas /. Accessed June 7, 2011. *Travers MJ and Vogl L.  Air Quality Effect of the Kansas Indoor Clean Air Law. Roswell Park Cancer Institute. January 2011. Available at http://www.tobaccofreekansas.org/site06/pdf/Kansas%20Air%20Quality%20Testing%20Report%202011.pdf . Accessed June 6, 2011.  ^ Tauras JA and Chaloupka FJ.  The Economic Impact of the 2008 Kansas City Missouri Smoke-Free Air Ordinance. Health Care Foundation of Greater Kansas City. December 2010.  Available at  http://www.healthcare4kc.org/uploadedFiles/Resources/exec%20summary1-15rev.pdf . Accessed June 6, 2011. 25                                                                                 The Health and Economic Benefits of Making Kentucky Smoke-Free  Making all Kentucky workplaces, restaurants, and bars 100% smoke-free would prevent about 20,000 youth from becoming smokers, and within five  years, save an estimated $57.30 million in lung cancer, heart attack, and   stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Kentucky is one of only 15 states that currently has no law prohibiting smoking in all workplaces or restaurants or bars.  Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all Kentucky residents  from the dangers of secondhand smoke.  SAVING LIVES  Making all Kentucky workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 50,800 20,000 30,900 3,400 SAVING MONEY  In addition to saving lives, making Kentucky smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all Kentucky workplaces, restaurants, and bars would be expected   to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $15.20M $42.10M $1.63M $8.96M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  26                                                                                    The Health and Economic Benefits of Making Louisiana Smoke-Free  Making all Louisiana workplaces, restaurants, and bars 100% smoke-free would prevent about 2,600 youth from becoming smokers, and within five  years, save an estimated $8.78 million in lung cancer, heart attack, and   stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Louisiana has a law that prohibits smoking in restaurants and workplaces, but it does not have a comprehensive law banning  smoking in all bars. Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect  all Louisiana residents from the dangers of secondhand smoke.  SAVING LIVES  Making all Louisiana workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 6,800 2,600 4,100 500 SAVING MONEY  In addition to saving lives, making Louisiana smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all Louisiana workplaces, restaurants, and bars would be expected   to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $2.08M $6.72M $340,000 $740,000 *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  27                                                                           Keep Maine Smoke-Free  Keeping all workplaces, restaurants, and bars in Maine 100% smoke-free is the best way to continue protecting all 1,328,400 residents from the dangers  of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  MaineÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. MaineÕs  comprehensive smoke-free restaurants and bars law went into effect on January 1, 2004, and its comprehensive smoke-free  workplaces law went into effect on September 12, 2009.  SMOKE-FREE SUCCESS STORY  Since MaineÕs smoke-free laws took effect, the state has seen numerous public health benefits.  ¥° Between 1997 and 2005, the rate of adult smoking decreased from 30 percent to 21 percent, and the high school  smoking rate dropped nearly 60 percent, due to strong tobacco prevention efforts. + ¥° According to a 2004 survey, just after MaineÕs law prohibiting smoking in restaurants and bars took effect, approximately   two in three (65%) adults in the state believed that people should be protected from secondhand smoke.*  ¥° According to the Maine Youth Drug & Alcohol Use Survey, one-third of youth believe that secondhand smoke exposure   poses a great risk.^ PROTECT MAINEÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Maine residents   from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo parlors,   hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do not  adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + Partnership for a Tobacco-Free Maine.  Maine Facts: Prevention Efforts are Working in Maine. 2006. Available at  http://www.tobaccofreemaine.org/explore_facts/Maine_facts_and_stats.php . Accessed June 6, 2011. * Partnership for a Tobacco-Free Maine. Quick Facts about Smoking in Maine. 2008. Available at http://www.tobaccofreemaine.org/explore_facts/Maine_facts_and_stats.php#smoke.  Accessed June 6, 2011. ^ Maine Department of Health and Human Services. Maine Youth Drug & Alcohol Use Survey (MYDAUS), 2006. Available at  http://www.maine.gov/dhhs/osa/data/mydaus/mydaus2006.htm . Accessed June 5, 2011. 28                                                            Keep Maryland Smoke-Free  Keeping all workplaces, restaurants, and bars in Maryland 100% smoke-free is the best way to continue protecting all 5,773,600 residents from the dan  gers of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  MarylandÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. MarylandÕs  comprehensive smoke-free law went into effect on February 1, 2008.  SMOKE-FREE SUCCESS STORY  Since the enactment of its smoke-free law, Maryland has seen reductions in tobacco use and secondhand smoke exposure.  ¥° The rate of tobacco use decreased from 22.4 percent in 1998 to 15.1 percent in 2009, which was more than double  the average decline nationally.+ ¥° In 2009, the year after the law was implemented, Maryland had the fourth lowest adult smoking rate in the nation.* ¥° The law has also been effective in reducing secondhand smoke exposure.  In 2010, 95 percent of adults reported no   smoking indoors at their place of work.* ¥° The percentage of youth reporting that they were not exposed to indoor secondhand smoke has increased 60 percent   since the lawÕs enactment.* PROTECT MARYLANDÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Maryland residents   from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo parlors,   hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do not  adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + Centers for Disease Control and Prevention.  Behavior Risk Factor Surveillance System: Prevalence and Trends Data. ÒMaryland- All Available Years Tobacco Use.Ó  2009.  Available at http://apps.nccd.cdc.gov/brfss/display.asp?yr=0&state=MD&qkey=4396&grp=0&SUBMIT3=Go . Accessed June 7, 2011.  * Department of Health and Mental Hygiene News Release. Maryland Quits Tobacco: 6th Lowest Rate in the Nation.  October 5, 2010. Available at   http://www.dhmh.state.md.us/pressreleases/2010/pr100510.html . Accessed June 6, 2011.  29                                        Keep Massachusetts Smoke-Free  Keeping all workplaces, restaurants, and bars in Massachusetts 100% smoke-free is the best way to continue protecting all 6,547,600 residents from the  dangers of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  MassachusettsÕ smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free.  MassachusettsÕ comprehensive smoke-free law went into effect on July 5, 2004.  SMOKE-FREE SUCCESS STORY  The 2004 Massachusetts smoke-free law has had no negative effects on the service industry, while providing positive public   health benefits. ¥° Since the implementation of the smoke-free law, there has been no statistically significant economic impact on businesses  in the service industry.+ ¥° Furthermore, after the law was enacted in 2004, employment in the service industry, including bars and restaurants, did   not decline.* ¥° Indoor air quality has also improved state-wide. + ¥° Following implementation of the smoke-free law, heart attack deaths declined in cities and towns that previously did not   have local smoke-free laws in place. There was no significant change in heart attack deaths in jurisdictions that previously  had a local law, suggesting that the decline in heart attack deaths was due to the smoke-free law. ^ ¥° MassachusettsÕ comprehensive statewide smoke-free law is associated with an estimated 270 fewer heart attack deaths   per year statewide.^ PROTECT MASSACHUSETTSÕ STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Massachusetts   residents from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo   parlors, hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do  not adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + Alpert HR, Carpenter CM, Travers MJ, Connolly GN. Environmental and economic evaluation of the Massachusetts Smoke-Free Workplace Law.  Journal of Community Health 2007;  32(4): 269-81. *Connolly GN, Carpenter C, Alpert HR, Skeer M, Travers, M. Evaluation of the Massachusetts Smoke-Free Workplace Law: A Preliminary Report. Division of Public Health Practice,  Harvard School of Public Health, Tobacco Research Program. April 2005.  ^ Dove, M.; D. Dockery; M. Mittleman; J. Schwartz; E. Sullivan; L. Keithly; T. Land. The Impact of MassachusettsÕ Smoke-Free Workplace Laws on Acute Myocardial Infarction Deaths.   American Journal of Public Health 2010; 100(11). 30                                                            Keep Michigan Smoke-Free  Keeping all workplaces, restaurants, and bars in Michigan 100% smoke-free is the best way to continue protecting all 9,883,600 residents from the dangers  of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  MichiganÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. MichiganÕs  comprehensive smoke-free law went into effect on May 1, 2010.  SMOKE-FREE SUCCESS STORY  The implementation of the 2010 Michigan smoke-free law has garnered much public support. + ¥° A poll commissioned by the American Cancer Society demonstrated that 74 percent of Michigan residents support   the smoke-free law.    ¥° In addition, 93 percent of respondents go to bars and restaurants just as often or more often than before the law   was enacted. PROTECT MICHIGANÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Michigan residents   from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo parlors,   hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do not  adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + American Cancer Society on behalf of the Michigan Campaign for Smokefree Air. Reports Show Public Opinion, Compliance High for MichiganÕs Smokefree Air Law. May 19, 2011.  Available at http://acsgld.org/communications/ACSGLD_Newsroom/?p=1434 . Accessed June 7, 2011. 31                                                     Keep Minnesota Smoke-Free  Keeping all workplaces, restaurants, and bars in Minnesota 100% smoke-free is the best way to continue protecting all 5,303,900 residents from the dangers   of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  MinnesotaÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free.  MinnesotaÕs comprehensive smoke-free law went into effect on October 1, 2007.  SMOKE-FREE SUCCESS STORY  MinnesotaÕs comprehensive smoke-free law has contributed to significant public health benefits for the state and has not   adversely impacted the stateÕs economy.  ¥° The stateÕs smoking rate decreased approximately 27 percent between 1999 and 2010, from 22.1 percent in 1999  to 16.1 percent in 2010.+ ¥° Per capita cigarette sales decreased 40 percent during this time period as well.*    ¥° Furthermore, a 2009 study concluded that local smoke-free bar policies in Minnesota cities that were in place before   the statewide law had no adverse impact on bar employment or service jobs.+ ¥° Minnesota spends $215.7 million annually to treat health conditions caused by secondhand smoke exposure, which   is over $40 per Minnesota resident. The smoke-free law and other efforts to fight tobacco use are helping to diminish  these high expenditures. ^ PROTECT MINNESOTAÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Minnesota   residents from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo   parlors, hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do  not adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + ClearWay Minnesota, Minneapolis and Minnesota Department of Health. Decrease in Smoking PrevalenceÑMinnesota, 1999-2010.  MMWR 2011; 60(05);138-141. *Klein EG, Forster JL, Erickson DJ, et al. Does the Type of CIA Policy Significantly Affect Bar and Restaurant Employment in Minnesota Cities? Prevention Science 2009; 10(2).   ^ Johns Hopkins Bloomberg School of Public Health and Blue Cross and Blue Shield of Minnesota.  Healthcare Costs and Secondhand Smoke. March 1, 2007.   Available at  http://www2.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/03-01-2007/0004538054&EDATE . 32                                                                                 The Health and Economic Benefits of Making Mississippi Smoke-Free  Making all Mississippi workplaces, restaurants, and bars 100% smoke-free would prevent about 14,600 youth from becoming smokers, and within five  years, save an estimated $42.77 million in lung cancer, heart attack, and   stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Mississippi is one of only 15 states that currently has no law prohibiting smoking in all workplaces or restaurants or bars.  Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all Mississippi residents  from the dangers of secondhand smoke.  SAVING LIVES  Making all Mississippi workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 36,600 14,600 22,400 2,500 SAVING MONEY  In addition to saving lives, making Mississippi smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all Mississippi workplaces, restaurants, and bars would be   expected to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $10.95M $31.82M $910,000 $4.29M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  33                                                                                  The Health and Economic Benefits of Making Missouri Smoke-Free  Making all Missouri workplaces, restaurants, and bars 100% smoke-free would prevent about 21,800 youth from becoming smokers, and within  five years, save an estimated $71.06 million in lung cancer, heart attack,   and stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Missouri is one of only 15 states that currently has no law prohibiting smoking in all workplaces or restaurants or bars.  Making all workplaces, restaurants, and bars in the state 100% smoke-free is the only way to protect all Missouri residents  from the dangers of secondhand smoke.  SAVING LIVES  Making all Missouri workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 60,200 21,800 35,600 4,000 SAVING MONEY  In addition to saving lives, making Missouri smoke-free would cut health care costs for both smokers and non-smokers. Over  five years, a comprehensive smoke-free law covering all Missouri workplaces, restaurants, and bars would be expected to   produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $18.01M $53.06M $2.09M $10.55M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  34                                                            Keep Montana Smoke-Free  Keeping all workplaces, restaurants, and bars in Montana 100% smoke-free is the best way to continue protecting all 989,400 residents from the dangers of  secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  MontanaÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. MontanaÕs  comprehensive smoke-free workplaces and restaurants law went into effect on October 1, 2005, and its comprehensive  smoke-free bars law went into effect on October 1, 2009.  SMOKE-FREE SUCCESS STORY  Research shows that both MontanaÕs statewide smoke-free law and Helena, MontanaÕs local smoke-free ordinance have   led to positive outcomes. ¥° The majority of residents (88%) support the statewide smoke-free law in restaurants, and 76 percent support the  smoke-free law in bars, taverns, and casinos. + ¥° Since implementation of the smoke-free law, Montana has enjoyed 98 percent compliance among bars, taverns,   and casinos.+ ¥° A 2009 survey conducted by the Montana Tobacco Use Prevention Program found that 92 percent of adults will   visit bars as often or more often than they did prior to the implementation of the law. + ¥° Six months after the implementation of the local smoke-free law in Helena, Montana, there was a 40 percent drop   in patient hospital admissions for heart attacks. When the law was overturned, the rate of heart attack admissions increased again.*  PROTECT MONTANAÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Montana residents   from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo parlors,   hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do not  adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + Montana Tobacco Use Prevention Program. Tobacco Surveillance Report: High Support for the Montana Clean Indoor Air Act.  October 2009.  Available at http://tobaccofree.mt.gov/publications/documents/CIAAsupport_Oct09_FINAL.pdf . Accessed June 6, 2011.  *Sargent RP, Shepard RM, Glantz SA. Reduced Incidence of Admissions for Myocardial Infarction Associated with Public Smoking Ban: Before and After Study.   British Medical Journal 2004; 328: 977-980. 35                                                                         Keep Nebraska Smoke-Free  Keeping all workplaces, restaurants, and bars in Nebraska 100% smoke-free is the best way to continue protecting all 1,826,300 residents from the dangers   of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  NebraskaÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. NebraskaÕs  comprehensive smoke-free law went into effect on June 1, 2009.  SMOKE-FREE SUCCESS STORY  NebraskaÕs 2009 smoke-free law has been met with high compliance and strong public support. + ¥° According to the Nebraska Adult Tobacco Survey/Social Climate Survey, a statewide survey to measure changes in   attitude and behavior, over 80 percent of Nebraska residents support the smoke-free law.   ¥° The 2010 survey concluded that the law did not significantly impact the frequency of visits to bars, restaurants, clubs,   and bowling alleys among adults in the state. ¥° Eighty-nine percent of survey respondents said they would go to restaurants as much or more often than they did prior   to the implementation of the law. ¥° Eighty-one percent of respondents claimed that they would frequent night clubs and bars just as often or more often   than before the law went into effect.  ¥° Between July and September 2009, 16 percent of callers to the stateÕs Quitline said that they were influenced to call   as a result of the smoke-free law.  PROTECT NEBRASKAÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Nebraska residents   from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo parlors,   hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do not  adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  +Nebraska DHHS. Six Months of Smoke-Free Air: The Nebraska Clean Indoor Air Act. January 2010. Available at  http://smokefree.ne.gov/SixMonthReport_SFAirLaw.pdf . Accessed June 6, 2011. 36                                                              The Health and Economic Benefits of Making Nevada Smoke-Free  Making all Nevada workplaces, restaurants, and bars 100% smoke-free would prevent about 1,500 youth from becoming smokers, and within five years,  save an estimated $5.31 million in lung cancer, heart attack, and stroke costs.  According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Nevada has a law that prohibits smoking in restaurants and workplaces, but it does not have a comprehensive law banning  smoking in all bars. Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect  all Nevada residents from the dangers of secondhand smoke.  SAVING LIVES  Making all Nevada workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 4,300 1,500 2,500 300 SAVING MONEY  In addition to saving lives, making Nevada smoke-free would cut health care costs for both smokers and non-smokers. Over  five years, a comprehensive smoke-free law covering all Nevada workplaces, restaurants, and bars would be expected to   produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $1.33M $3.99M $110,000 $350,000 *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  37                                                                                                       The Health and Economic Benefits of Making New Hampshire Smoke-Free  Making all New Hampshire workplaces, restaurants, and bars 100% smoke-free would prevent about 3,200 youth from becoming smokers, and within  five years, save an estimated $14.72 million in lung cancer, heart attack, and   stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  New Hampshire has a law that prohibits smoking in restaurants and bars, but it does not have a comprehensive law banning  smoking in all workplaces. Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all New Hampshire residents from the dangers of secondhand smoke.  SAVING LIVES  Making all New Hampshire workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 8,900 3,200 5,300 600 SAVING MONEY  In addition to saving lives, making New Hampshire smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all New Hampshire workplaces, restaurants, and bars would be   expected to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $7.29M $7.43M $220,000 $1.15M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  38                                                           Keep New Jersey Smoke-Free  Keeping all workplaces, restaurants, and bars in New Jersey 100% smoke-free is the best way to continue protecting all 8,791,900 residents from the dan  gers of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  New JerseyÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. New JerseyÕs  comprehensive smoke-free law went into effect on April 15, 2006.  SMOKE-FREE SUCCESS STORY  The enactment of New JerseyÕs 2006 comprehensive smoke-free law has provided public health benefits and public support   for other smoke-free venues.  ¥° Following implementation, there was 100 percent compliance with the law among restaurants, bars, and  bowling centers.+ ¥° Several months after the smoke-free law was passed, air pollution was reduced by an average of 91 percent   in these venues.+ ¥° The law has been so successful that almost 7 out of 10 New Jersey residents are supportive of extending the law   to make casinos smoke-free.* ¥° The majority of voters (74 percent) state that making casinos smoke-free would not impact how often they visit   gaming establishments, and 18 percent said they would actually go to casinos more often.*  PROTECT NEW JERSEYÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all New Jersey   residents from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo   parlors, hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do  not adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  +New Jersey Group Against Smoking Pollution (GASP).  Air Testing Shows Bars, Restaurants Now at Safe Level; but Casinos Fail. 2006.  <http://www.njgasp.org/i_conditions_airmon06_NJ_Gasp_Release.pdf > * New Jersey Breathes. New Poll Finds Nearly Seven in 10 New Jersey Voters Support Smoke-Free Casinos. November 9, 2006.  Available at http://www.njgasp.org/i_opinion_NJ_Smoke-free_Casinos_Poll_10-31-07%5B1%5D.pdf . Accessed June 6, 2011. 39                                                              The Health and Economic Benefits of Making New Mexico Smoke-Free  Making all New Mexico workplaces, restaurants, and bars 100% smoke-free would prevent about 1,200 youth from becoming smokers, and within five  years, save an estimated $3.94 million in lung cancer, heart attack, and   stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  New Mexico has a law that prohibits smoking in restaurants and bars, but it does not have a comprehensive law banning  smoking in all workplaces. Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all New Mexico residents from the dangers of secondhand smoke.  SAVING LIVES  Making all New Mexico workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 3,400 1,200 2,000 200 SAVING MONEY  In addition to saving lives, making New Mexico smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all New Mexico workplaces, restaurants, and bars would be   expected to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $1.04M $2.90M $230,000 $290,000 *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  40                                                             Keep New York Smoke-Free  Keeping all workplaces, restaurants, and bars in New York 100% smoke-free  is the best way to continue protecting all 19,378,100 residents from the  dangers of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  New YorkÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. New YorkÕs  comprehensive smoke-free law went into effect on July 24, 2003.  SMOKE-FREE SUCCESS STORY  New YorkÕs 2003 comprehensive smoke-free law has contributed to several public health and economic benefits.  ¥° Smoking rates in New York City declined by 11 percent between 2002 and 2003, which equated to 140,000 fewer  smokers in the city.+ New York CityÕs smoke-free law took effect approximately four months before the statewide law,  and other tobacco control measures were put in place around the same time period.  ¥° About 28,000 New York City residents quit using tobacco as a result of the cityÕs smoke-free law, and 157,000 fewer   residents were exposed to secondhand smoke at work or home. + ¥° Two months after New York City had become smoke-free, the cityÕs health department found a six-fold reduction in air   pollution levels in bars that used to permit smoking.* ¥° There was also little or no change in bar and restaurant patronage by smokers or non-smokers following implementation   of the statewide smoke-free law. Hospitality industry employment, alcohol tax revenue, and bar licenses have not been  adversely impacted by the law. ^ ¥° Following its passage, support for the smoke-free law increased. From June to September 2003, during which the law   took effect, 64 percent of New York residents said they were in favor of the smoke-free law. Just under one year after  the law had taken effect, in the second quarter of 2004, support for the law had increased to 74 percent. ^ PROTECT NEW YORKÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all New York residents   from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo parlors,   hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do not  adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  +Frieden TR., Mostashari F, Kerker BD, et al. Adult Tobacco Use Levels After Intensive Tobacco Control Measures: New York City, 2002-2003.  American Journal of Public Health 2005;95(6): 1016-1023. * New York City Department of Finance, New York City Department of Health and Mental Hygiene, New York City Department of Small Business Services, and New Y Economic Development Corporation. The State of Smoke-Free New York City: A One Year Review.  Mar Available at  http://www.nyc.gov/html/doh/downloads/pdf/smoke/sfaa-2004report.pdf .  ^ RTI International.  First Annual Independent Evaluation of New YorkÕs Tobacco Control Program.  New York State Department of Health. November 2004. Available at  http://www.health.state.ny.us/nysdoh/tobacco/reports/docs/nytcp_eval_report_final_11-19-04.pdf . Accessed June 6, 2011.  41                                                                                              The Health and Economic Benefits of Making North Carolina Smoke-Free  Making all North Carolina workplaces, restaurants, and bars 100% smoke-free would prevent about 29,100 youth from becoming smokers, and within  five years, save an estimated $94.58 million in lung cancer, heart attack, and   stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  North Carolina has a law that prohibits smoking in restaurants and bars, but it does not have a comprehensive law banning  smoking in all workplaces. Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all North Carolina residents from the dangers of secondhand smoke.  SAVING LIVES  Making all North Carolina workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 78,100 29,100 46,600 5,200 SAVING MONEY  In addition to saving lives, making North Carolina smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all North Carolina workplaces, restaurants, and bars would be   expected to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $23.98M $70.60M $3.11M $9.58M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  42                                                                         The Health and Economic Benefits of Making North Dakota Smoke-Free  Making all North Dakota workplaces, restaurants, and bars 100% smoke-free  would prevent about 500 youth from becoming smokers, and within five  years, save an estimated $1.70 million in lung cancer, heart attack, and   stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  North Dakota has a law that prohibits smoking in workplaces, but it does not have a comprehensive law banning smoking  in all restaurants and bars. Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all North Dakota residents from the dangers of secondhand smoke.  SAVING LIVES  Making all North Dakota workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 1,400 500 800 100 SAVING MONEY  In addition to saving lives, making North Dakota smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all North Dakota workplaces, restaurants, and bars would be   expected to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $430,000 $1.26M $34,000 $250,000 *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  43                                                     Keep Ohio Smoke-Free  Keeping all workplaces, restaurants, and bars in Ohio 100% smoke-free is the best way to continue protecting all 11,536,500 residents from the dangers   of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  OhioÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. OhioÕs  comprehensive smoke-free law went into effect on December 7, 2006.  SMOKE-FREE SUCCESS STORY  Since the 2006 implementation of OhioÕs smoke-free law, public support for the law has increased. + ¥° According to a 2010 poll, support for the law increased among voters across political parties, age groups, and gender   lines since the law's passage nearly four years earlier.. ¥° The 2010 poll found that 85 percent of voters believe workers should be protected from secondhand smoke.  ¥° Seventy percent of those surveyed agree that the smoke-free law has had no adverse effects on OhioÕs businesses.  ¥° Nearly three in four voters believe that bar employees should be protected from secondhand smoke in their workplace.   PROTECT OHIOÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Ohio residents   from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo parlors,   hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do not  adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + Fallon Research on behalf of SmokeFreeOhio. SmokeFreeOhio Survey Results. September 2010.  44                                                                                  The Health and Economic Benefits of Making Oklahoma Smoke-Free  Making all Oklahoma workplaces, restaurants, and bars 100% smoke-free would prevent about 13,300 youth from becoming smokers, and within five  years, save an estimated $37.31 million in lung cancer, heart attack, and   stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Oklahoma is one of only 15 states that currently has no law prohibiting smoking in all workplaces or restaurants or bars.  Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all Oklahoma residents  from the dangers of secondhand smoke.  SAVING LIVES  Making all Oklahoma workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 32,900 13,300 20,200 2,300 SAVING MONEY  In addition to saving lives, making Oklahoma smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all Oklahoma workplaces, restaurants, and bars would be   expected to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $9.85M $27.46M $840,000 $5.07M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  45                                        Keep Oregon Smoke-Free  Keeping all workplaces, restaurants, and bars in Oregon 100% smoke-free is the best way to continue protecting all 3,831,100 residents from the dangers  of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  OregonÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. OregonÕs  comprehensive smoke-free law went into effect on January 1, 2009.  SMOKE-FREE SUCCESS STORY  OregonÕs smoke-free law is effective in protecting workers and customers from secondhand smoke exposure and in   encouraging smokers to quit.+ ¥° Since the law went into effect in 2009, there has been high compliance. In a 2010 compliance study, no noted smoking   was seen within 10 feet of doorways, windows, or vents in 73 percent of bars and 100 percent of bowling centers.  ¥° The Oregon Tobacco Quit Line reported in November 2009 that since the law went into effect in January, almost one   in 10 callers said they were motivated to stop smoking due to the new law.  PROTECT OREGONÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Oregon residents   from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo parlors,   hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do not  adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + Oregon Department of Human Services. Oregon Bars, Bowling Centers are Following Smokefree Workplace Law, Study Shows. November 2009.  Available at http://smokefreeoregon.com/wp-content/uploads/2010/09/Compliance-Study-ReleaseFINAL.pdf . Accessed June 6, 2011. 46                                                              The Health and Economic Benefits of Making Pennsylvania Smoke-Free  Making all Pennsylvania workplaces, restaurants, and bars 100% smoke-free would prevent about 12,100 youth from becoming smokers, and within five  years, save an estimated $38.50 million in lung cancer, heart attack, and   stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Pennsylvania has a law that prohibits smoking workplaces, but it does not have a comprehensive law banning smoking in all  restaurants and bars. Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect  all Pennsylvania residents from the dangers of secondhand smoke.  SAVING LIVES  Making all Pennsylvania workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 33,800 12,100 19,900 2,200 SAVING MONEY  In addition to saving lives, making Pennsylvania smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all Pennsylvania workplaces, restaurants, and bars would be   expected to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $10.36M $28.14M $1.86M $3.72M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  47                                                         Keep Rhode Island Smoke-Free  Keeping all workplaces, restaurants, and bars in Rhode Island 100% smoke-free is the best way to continue protecting all 1,052,600 residents from the  dangers of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Rhode IslandÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. Rhode  IslandÕs comprehensive smoke-free workplaces and restaurants law went into effect on March 1, 2005, and its comprehen sive smoke-free bars law went into effect on May 4, 2005.  SMOKE-FREE SUCCESS STORY  The implementation of Rhode IslandÕs comprehensive smoke-free law has yielded positive public health and economic results.  ¥° In 2009, Rhode Island had an adult smoking rate of 15.1 percent, nearly 25 percent less than the national average of  about 20 percent.+ Studies show that there was a rapid decline in smoking beginning at approximately the same time  as the smoke-free laws and an increase in cigarette taxes took effect.*  ¥° Following the first quarter of implementation of the smoke-free law in 2005, bars and restaurants earned 20 percent   more in tax revenue than they had before the law was in effect. ^ PROTECT RHODE ISLANDÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Rhode Island   residents from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo   parlors, hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do  not adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  +Freyer, Felice.  ÒSmoking in RI Less than National Level.Ó  Providence JournalAvailable at  http://www.projo.com/health/content/SMOKING_RATE_DROPS_IN_RI_11-08-10_5BKQ0MK_v20.3a45db8.html .  * McClave A, Rock V, Thorne S, Malarcher A, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.  State-Specific Prevalence of Cigarette Smoking and Smokeless Tobacco Use Among Adults Ð United States, 2009.   MMWR 2010; 59(43): 1400-1406. ^ John J. Nugent, Assistant Tax Administrator. Revenues up From Smoke-free Bars, Restaurants,Ó  Associated Press. September 1, 2005. Available at  http://www.tobacco.org/news/205237.html . Accessed June 7, 2011.  48                                                                                 The Health and Economic Benefits of Making South Carolina Smoke-Free  Making all South Carolina workplaces, restaurants, and bars 100% smoke-free would prevent about 15,900 youth from becoming smokers, and within  five years, save an estimated $55.95 million in lung cancer, heart attack, and   stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  South Carolina is one of only 15 states that currently has no law prohibiting smoking in all workplaces or restaurants or  bars. Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all South  Carolina residents from the dangers of secondhand smoke.  SAVING LIVES  Making all South Carolina workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 46,600 15,900 26,900 3,000 SAVING MONEY  In addition to saving lives, making South Carolina smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all South Carolina workplaces, restaurants, and bars would be   expected to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $13.94M $42.00M $1.33M $6.15M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  49                                        Keep South Dakota Smoke-Free  Keeping all workplaces, restaurants, and bars in South Dakota 100% smoke-free is the best way to continue protecting all 814,200 residents from the  dangers of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  South DakotaÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. South  DakotaÕs comprehensive smoke-free workplaces law went into effect on July 1, 2002, and its comprehensive smoke-free  restaurants and bars law went into effect on November 10, 2010.  SMOKE-FREE SUCCESS STORY  South Dakota passed a comprehensive smoke-free law in 2010, having garnered much support from the public.  ¥° In 2009, opponents filed a petition to keep the comprehensive smoke-free law from taking effect and placed the  law on the ballot. In November 2010, South Dakota voters overwhelmingly supported by 64 to 36 percent.+ ¥° South Dakota spends $500 million yearly on smoking-related illnesses and more than 1,000 residents die each year   from smoking-related deaths.* South DakotaÕs smoke-free law and other tobacco control measures will help to  reduce these smoking-related costs and deaths.  PROTECT SOUTH DAKOTAÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all South Dakota   residents from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo   parlors, hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do  not adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  +Americans for Non-smokersÕ Rights. South Dakota. 2010. Available at  http://www.no-smoke.org/goingsmokefree.php?id=164 *American Lung Association. State at a Glance Ð South Dakota. State of Tobacco Control 2010. Available at  http://www.stateoftobaccocontrol.org/state-grades/south-dakota 50                                                                                 The Health and Economic Benefits of Making Tennessee Smoke-Free  Making all Tennessee workplaces, restaurants, and bars 100% smoke-free  would prevent about 8,500 youth from becoming smokers, and within five  years, save an estimated $28.70 million in lung cancer, heart attack, and   stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Tennessee is one of only 15 states that currently has no law prohibiting smoking in all workplaces or restaurants or bars.  Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all Tennessee residents  from the dangers of secondhand smoke.  SAVING LIVES  Making all Tennessee workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 25,100 8,500 14,500 1,600 SAVING MONEY  In addition to saving lives, making Tennessee smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all Tennessee workplaces, restaurants, and bars would be   expected to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $7.52M $21.18M $1.71M $3.90M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  51                                                                                The Health and Economic Benefits of Making Texas Smoke-Free  Making all Texas workplaces, restaurants, and bars 100% smoke-free  would prevent about 77,000 youth from becoming smokers, and within  five years, save an estimated $193.87 million in lung cancer, heart attack,   and stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Texas is one of only 15 states that currently has no law prohibiting smoking in all workplaces or restaurants or bars. Making  all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all Texas residents from the  dangers of secondhand smoke. SAVING LIVES  Making all Texas workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following reductions   in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 173,700 77,000 110,500 12,300 SAVING MONEY  In addition to saving lives, making Texas smoke-free would cut health care costs for both smokers and non-smokers. Over  five years, a comprehensive smoke-free law covering all Texas workplaces, restaurants, and bars would be expected to   produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $51.96M $141.91M $6.35M $13.88M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  52                                        Keep Utah Smoke-Free  Keeping all workplaces, restaurants, and bars in Utah 100% smoke-free is the best way to continue protecting all 2,763,900 residents from the dangers of  secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  UtahÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. UtahÕs  comprehensive smoke-free restaurants law went into effect on January 1, 1995; its comprehensive smoke-free workplaces  law went into effect on May 1, 2006; and its comprehensive smoke-free bars law went into effect on January 1, 2009.  SMOKE-FREE SUCCESS STORY  The implementation of UtahÕs statewide smoke-free law has contributed to positive public health and economic outcomes.  ¥° The rate of adult smoking decreased from 14 percent in 1999 to 9.8 percent in 2009. + ¥° Research comparing hotel revenues and tourism rates before and after the smoke-free restaurant law showed that  the law did not negatively affect business. In fact, it may be associated with an increase in tourism.*  PROTECT UTAHÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Utah residents   from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo parlors,   hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do not  adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + Centers for Disease Control and Prevention.  Behavior Risk Factor Surveillance System: Prevalence and Trends Data. ÒUtah- All Available Years Tobacco Use.Ó  2009.  Available at http://apps.nccd.cdc.gov/brfss/display.asp?yr=0&cat=TU&qkey=4396&state=UT.  Accessed June 6, 2011. * Glantz SA and Charlesworth A. Tourism and Hotel Revenues Before and After Passage of Smoke-free Restaurant Ordinances.  Journal of the American Medical Association 1999; 281(20): 1911-1918. 53                                                            Keep Vermont Smoke-Free  Keeping all workplaces, restaurants, and bars in Vermont 100% smoke-free is  the best way to continue protecting all 625,700 residents from the dangers of  secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  VermontÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. VermontÕs  comprehensive smoke-free restaurants and bars law went into effect on September 1, 2005, and its comprehensive smoke- free workplaces law went into effect on July 1, 2009.  SMOKE-FREE SUCCESS STORY  Since VermontÕs smoke-free laws have taken effect, the state has seen reductions in smoking and increases in quit attempts.   ¥° The adult smoking rate in Vermont declined 24 percent between 2001 and 2009, four years after the stateÕs  comprehensive restaurant and bar smoke-free law took effect, compared with only a 10 percent decline nationwide  during that time period.+ ¥° The percentage of smokers who tried to quit increased from 50.1 percent in 2004 to 62.2 percent in 2008.  + ¥° Each year, Vermont spends more than $430 million in smoking-related health care costs and lost productivity.*   VermontÕs smoke-free law and other tobacco control measures will help to reduce these smoking-related costs.  PROTECT VERMONTÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Vermont residents   from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo parlors,   hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do not  adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + RTI International for the Vermont Tobacco Evaluation and Review Board.  Independent Evaluation of Vermont Tobacco Control Program: Annual Report . March 2011.   Available at  http://humanservices.vermont.gov/boards-committees/tobacco-board/fy11-vtannualreport-final-3-11.pdf . Accessed June 6, 2011. *Centers for Disease Control and Prevention. Smoking-Attributable Mortality, Morbidity, and Economic Costs (SAMMEC): Adult SAMMEC and Maternal and Child Health (MCH)  SAMMEC Software. Available at  http://apps.nccd.cdc.gov/sammec/. 54                                                                                                   The Health and Economic Benefits of Making Virginia Smoke-Free  Making all Virginia workplaces, restaurants, and bars 100% smoke-free  would prevent about 29,200 youth from becoming smokers, and within five  years, save an estimated $89.11 million in lung cancer, heart attack, and   stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Virginia is one of only 15 states that currently has no law prohibiting smoking in all workplaces or restaurants or bars.  Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all Virginia residents  from the dangers of secondhand smoke.  SAVING LIVES  Making all Virginia workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following reductions   in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 84,000 29,200 48,900 5,400 SAVING MONEY  In addition to saving lives, making Virginia smoke-free would cut health care costs for both smokers and non-smokers. Over  five years, a comprehensive smoke-free law covering all Virginia workplaces, restaurants, and bars would be expected to   produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $25.14M $64.00M $2.41M $6.63M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  55                                                         Keep Washington Smoke-Free  Keeping all workplaces, restaurants, and bars in Washington 100% smoke- free is the best way to continue protecting all 6,724,500 residents from the  dangers of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  WashingtonÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. WashingtonÕs  comprehensive smoke-free law went into effect on December 8, 2005.  SMOKE-FREE SUCCESS STORY  WashingtonÕs comprehensive smoke-free law has contributed to public health and economic benefits.  ¥° One year after the implementation of the comprehensive statewide smoke-free law in Washington, the adult smoking  rate dropped to 17.8 percent, the 5 th lowest in the country at the time.+ ¥° Exposure to secondhand smoke among restaurant and bar employees dropped from 29 percent in 2005 to about   3 percent in 2006.* The smoke-free law also prompted many smokers to try to quit. According to the Washington  State Department of Health, the stateÕs Tobacco Quit Line reported receiving a record number of calls in the month   after implementation.* ¥° According to a 2011 Washington State Department of Health report, each dollar spent on tobacco prevention   in the last 10 years resulted in five dollars in reduced hospitalization costs. ^ PROTECT WASHINGTONÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Washington   residents from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo   parlors, hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do  not adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  + Washington State Office of the Governor. Governor Gregoire Announces Washington Smoking Rate Drops to 5th Lowest in Nation. August 30, 2006.  Available at http://www.governor.wa.gov/news/news-view.asp?pressRelease=345&newsType=1 . Accessed June 6, 2011. *Smoke-Free Washington. Smoking in Public Places Law. February 24, 2010.  Available at  http://www.smokefreewashington.com/laws/smokinginpublic.php . Accessed June 7, 2011. ^ Washington State Department of Health.  Progress Report: Tobacco Prevention and Control Program. March 2011. Available at  http://www.doh.wa.gov/tobacco/program/reports/2011ProgReport.pdf . Accessed June 7, 2011.  56                                                                                                                       The Health and Economic Benefits of Making West Virginia Smoke-Free  Making all West Virginia workplaces, restaurants, and bars 100% smoke-free  would prevent about 3,400 youth from becoming smokers, and within five   years, save an estimated $10.20 million in lung cancer, heart attack, and   stroke costs.  According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  West Virginia is one of only 15 states that currently has no law prohibiting smoking in all workplaces or restaurants or  bars. Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all West Virginia  residents from the dangers of secondhand smoke.  SAVING LIVES  Making all West Virginia workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 9,000 3,400 5,400 600 SAVING MONEY  In addition to saving lives, making West Virginia smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all West Virginia workplaces, restaurants, and bars would be   expected to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $2.70M $7.50M $150,000 $1.52M *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  57                                                                     Keep Wisconsin Smoke-Free  Keeping all workplaces, restaurants, and bars in Wisconsin 100% smoke-free is the best way to continue protecting all 5,687,000 residents from the dangers   of secondhand smoke. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke. Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to tobacco   smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase the number   of smokers who quit, and cut health care costs for smokers and non-smokers alike.  WisconsinÕs smoke-free law requires all of the stateÕs workplaces, restaurants, and bars to be 100% smoke-free. WisconsinÕs  comprehensive smoke-free law went into effect on July 5, 2010.  SMOKE-FREE SUCCESS STORY  Researchers analyzed the impact of previously enacted local smoke-free laws and the 2010 Wisconsin statewide comprehensive   smoke-free law on residentsÕ health and local economies.  ¥° Three to six months after the implementation of the statewide smoke-free law, non-smoking bar workers experienced  a significant decline in respiratory symptoms caused by secondhand smoke.+ ¥° Local smoke-free laws were found not to harm the local economies. In fact, the economic impacts were either neutral   or positive.* ¥° Studies found that there was no difference in the number of liquor licenses for establishments to serve alcoholic   beverages before and after the local laws took effect.*  ¥° The Wisconsin Restaurant Association supported the enactment of the statewide smoke-free law and to protect all   restaurant and bar workers from the dangers of secondhand smoke. ^ PROTECT WISCONSINÕS STRONG LAW  Keeping all workplaces, restaurants, and bars in the state 100% smoke-free is the best way to protect all Wisconsin   residents from the dangers of secondhand smoke. Loopholes that allow for smoking in ventilated areas, casinos, bingo   parlors, hookah bars, or cigar bars, at certain times of day in some venues, or for certain events, weaken the law and do  not adequately protect the public. Removing any existing exemptions further strengthens the law and provides even better   protection for everyone against the dangers of secondhand smoke.  +Palmersheim K A, Pfister KP, and Glysch RL.  The Impact of WisconsinÕs Statewide Smoke-free Law on Bartender Health and Attitudes.  University of Wisconsin: Milwaukee,  Center for Urban Initiatives and Research, 2010. Available at  http://www.governor.wa.gov/news/news-view.asp?pressRelease=345&newsType=1 . Accessed June 6, 2011. *Speight, Bruce. WISPIRG Public Interest Group.   ÒSmoke and Mirrors: Tobacco Industry Claims Unfounded.Ó  February 2008. Available at  http://www.wispirg.org/uploads/bo/CE/boCE7urGr6gnM3pCix1XKw/Smoke_and_Mirrors.pdf . Accessed June 6, 2011.  ^ Wisconsin Restaurant Association.  Wisconsin Restaurant Association Supports Smoke-Free Workplaces. February 19, 2009.   Available at http://www.no-smoke.org/pdf/WRA_smokefree_statement.pdf . Accessed June 7, 2011.  58                                                                                 The Health and Economic Benefits of Making Wyoming Smoke-Free  Making all Wyoming workplaces, restaurants, and bars 100% smoke-free  would prevent about 2,200 youth from becoming smokers, and within five  years, save an estimated $7.38 million in lung cancer, heart attack, and   stroke costs. According to the Surgeon General, the science is clear: There is no safe level of exposure to second hand smoke.  Just as tobacco smoke causes lung cancer, heart attacks, strokes, and other preventable diseases in smokers,  secondhand smoke causes disease and death in non-smokers, as well. Smoke-free laws not only decrease exposure to   tobacco smoke and the resulting disease and death, they also decrease the number of youth who start smoking, increase   the number of smokers who quit, and cut health care costs for smokers and non-smokers alike.  Wyoming is one of only 15 states that currently has no law prohibiting smoking in all workplaces or restaurants or bars.  Making all workplaces, restaurants, and bars in the state 100% smoke-free is the  only way to protect all Wyoming residents  from the dangers of secondhand smoke.  SAVING LIVES  Making all Wyoming workplaces, restaurants, and bars 100% smoke-free would be expected to provide the following   reductions in the number of smokers and the number of deaths caused by smoking or exposure to tobacco smoke:*  Adults Who Would Quit Smoking  Youth Who Would  Never Start Smoking Reduction in Smoking-Related Deaths Reduction in Deaths of Non-Smokers 6,400 2,200 3,700 400 SAVING MONEY  In addition to saving lives, making Wyoming smoke-free would cut health care costs for both smokers and non-smokers.  Over five years, a comprehensive smoke-free law covering all Wyoming workplaces, restaurants, and bars would be   expected to produce the following economic benefits:*  Lung CancerTreatment Savings  Heart Attack and Stroke  Treatment Savings  StateÕs Medicaid  Program Savings Smoking-RelatedPregnancy Treatment Savings  $1.92M $5.46M $260,000 $1.16M  *Estimates are based on analysis performed on behalf of the American Cancer Society Cancer Action Network.  Totals in charts have been rounded.  59                                                                                                                                                                                           KEY ASSUMPTIONS ¥° Comprehensive smoking bans will be effectively implemented and have high rates of compliance.   ¥° This report likely underestimates reductions in premature deaths among smokers and non-smokers resulting from exposure to tobacco smoke.  ¥° The estimates assume that the effects of smoke-free policies on smoking rates are the same across different populations.   ¥° The average probability of a premature death for a regular adult smoker falls from 0.50 to 0.10 after cessation.  ¥° Smoking attributable death is based on a 0.50 probability.  ¥° There is an underlying downward trend in cigarette smoking of 2 percent per year for adult smoking prevalence and future regular smoking  among youth under 18 over time. ¥° All numbers are rounded. Totals do not always equal the summation of the rounded parts.  DATA SOURCES  Smoke-free Policies and Tax Rates   Existing state smoke-free policies and effective dates for changes in these policies are taken from the ImpacTeen project's state tobacco pol  icy database (available on-line at www.impacteen.org/tobaccodata.htm ). Existing state and local smoke-free policies are taken from the Americans for Nonsmokers' Rights Foundation's local ordinance database  (available on-line at www.no-smoke.org/goingsmokefree.php?id=519 ). State cigarette excise tax rates and effective dates for changes over the past several years were obtained from multiple sources, including:  the Tax Burden on Tobacco,  2010 (Orzechowski and Walker, 2011); and factsheets on state tax rates and increases from the Campaign for To bacco-Free Kids (available on-line at: www.tobaccofreekids.org/research/factsheets/pdf/0275.pdf).  Average state-level retail cigarette prices, including generic brands, were reported in the  Tax Burden on Tobacco , 2010 (Orzechowski and Walker, 2011).   Smoking Prevalence  Adult Smoking Prevalence Ð data on state-level smoking prevalence among persons 18 years of age and older in 2008 and 2009 are taken   from the Centers for Disease Control and PreventionÕs Behavioral Risk Factor Surveillance System (available on-line at  www.cdc.gov/brfss ). Youth Smoking Prevalence Ð data on the estimated future smoking prevalence of the cohort of 0- to 17-year-olds in 2008 and 2009 are   based on the population weighted averages of smoking prevalence rates for 18- to 24-year-olds and 25- to 34-year-olds in 2007, taken from  the Centers for Disease Control and PreventionÕs Behavioral Risk Factor Surveillance System (available on-line at  www.cdc.gov/brfss ). Age-specific state-level population projections for each year were obtained from the U.S. Census Bureau ( www.census.gov ).  Pregnant Women Smoking Prevalence  In addition to the data on state cigarette taxes and cigarette prices described above:  State-specific smoking prevalence rates among pregnant women are taken from the Centers for Disease Control and Prevention Natality pub- lic-use data on CDC WONDER On-line Database. In reporting year 2006, maternal tobacco use for all the states that we are examining is pro vided, with the exception of Florida, Idaho, North Dakota, New Hampshire, and Pennsylvania. Between 2002 -2005, these states changed the   way they collect smoking information among pregnant women. The new data is not comparable to the old data. Therefore, smoking preva  lence rates among pregnant women using the latest year in which the old data collection is employed are used for these six states.  State-level birth projections for 2012-2021 were obtained from the U.S. Census Bureau  (http://www.census.gov/population/projections/DownldFile3.xls ).  American Cancer Society Cancer Action Network  Savings Lives, Saving Money: A State-By-State Report on the Health and Economic Benefits of Comprehensive Smoke-Free Laws 60                                            Monthly Consumer Price Index for Medical Care (all urban consumers, current series) produced by the Bureau of Labor Statistics  (http://www.bls.gov/cpi/home.htm ). Lung Cancer Incidence and Cost In addition to the data on state cigarette taxes, cigarette prices, and the consumer price index described above:  Weighted adjusted risk ratios for the four major histologic types of lung cancer were obtained from Khuder, S and A. Mutgi (2001). ÒEffects  of Smoking Cessation on Major Histologic Types of Cancer,Ó  CHEST 120(5): 1577-1583, 2001. Total lung cancer deaths and smoking attributable lung cancer percent were obtained from the American Lung Association, ÒTrends in Lung   Cancer Morbidity and Mortality,Ó Epidemiology and Statistical Unit, Research and Scientific Affairs, September 2008.  The total number of adult smokers for years 1998-2006 were obtained from various  MMWR reports (Cigarette Smoking Among Adults Ð  United States, 2006, 2004, 2003, 2002, 2001, 2000, 1999, and 1998 and Tobacco Use Among Adults - 2005).  The prevalence of histologic types of lung cancer were obtained from the Wellness Community National Cancer Support website  (http://www.thewellnesscommunity.com/programs/frankly/lung/lung_cancer_home.asp ). Data on state-level smoking prevalence among persons 18 years of age and older in 2009 are taken from the Centers for Disease Control  and PreventionÕs Behavioral Risk Factor Surveillance System (available on-line at  www.cdc.gov/brfss ). Lung cancer costs obtained from Chang et al. (2004), ÒEstimating the Cost of Cancer: Results on the Basis of Claims Data Analyses for Can  cer Patients Diagnosed With Seven Types of Cancer During 1999 to 2000,Ó  Journal of Clinical Oncology 22, (17): 3524-3530. Heart Attack and Stroke Savings   Monthly Consumer Price Index for Medical Care (all urban consumers, current series) produced by the Bureau of Labor Statistics   (http://www.bls.gov/cpi/home.htm ). Smoking prevalence among individuals aged 35-64 in 2009 is based on the state-specific population weighted averages of smoking preva lence rates for 35- to 44-year-olds, 45- to 54-year-olds, and 55- to 64-year-olds in 2009, taken from the Centers for Disease Control and Pre ventionÕs Behavioral Risk Factor Surveillance System (available on-line at  www.cdc.gov/brfss ). State Medicaid Savings In addition to the data on state cigarette taxes, cigarette prices, and the consumer price index described above:  The state-specific numbers of Adult Medicaid recipients in FY2007 were obtained from the Kaiser Family Foundation State Health Facts web- site: (http://www.statehealthfacts.org/medicaid.jsp ). The state-specific average expenditures per adult Medicaid recipients in FY2007 were obtained from the Kaiser Family Foundation State  Health Facts website: (http://www.statehealthfacts.org/medicaid.jsp ). Federal Medical Assistance Percentages (FMAP) for Medicaid in FY2011 were obtained from the Kaiser Family Foundation State Health Facts  website: http://www.statehealthfacts.org/comparetable.jsp?ind=184&cat=4 . Smoking-attributable fractions (SAFs) for publicly funded health care for the 50 states and DC for fiscal year 1993 were obtained from Miller, L.S,  et al. (1998) ÒState Estimates of Medicaid Expenditures Attributable to Cigarette Smoking Fiscal Year 1993Ó  Public Health Reports  113:140-151. State-specific prevalence of smoking among individuals with income levels less than $15,000 obtained from the Behavioral Risk Factor Sur  veillance System, 2009.2 2 The BRFSS smoking prevalence rates for the states of Alaska, Nevada, and Wisconsin for individuals with incomes <$15,000 were not provided in 2009. Instead, the most recent prevalence figures for individuals  with incomes<$15,000 were used for these states. In particular, for the states of Alaska, Nevada, and Wisconsin, the smoking prevalence rates (for individuals with incomes <$15,000) from 2005, 2007, and   2008 were used respectively. These earlier prevalence rates were used to predict the 2009 prevalence rate of smoking among individuals with incomes < $15,000 accounting for the impact of state-specific   changes in cigarette prices between 2005 and 2009 for Alaska, between 2007 and 2009 for Nevada, between 2008 and 2009 for Wisconsin and accounting for an annual natural decline of smoking prevalence   of 2 percent.   American Cancer Society Cancer Action Network Savings Lives, Saving Money: A State-By-State Report on the Health and Economic Benefits of Comprehensive Smoke-Free Laws 61 Law. Health. Justice. Secondhand Smoke Seepage into   Multi-Unit Affordable Housing Susan Schoenmarklin A Law Synopsis by the Tobacco Control Legal Consortium  April 2010   Suggested citation:Susan Schoenmarklin, Tobacco Control Legal Consortium,  Secondhand Smoke Seepage into Multi-Unit Affordable   Housing  (2010). Tobacco Control Legal Consortium 875 Summit AvenueSaint Paul, Minnesota 55105 USAtobaccolaw@wmitchell.eduwww.tobaccolawcenter.org 651.290.7506Copyright © 2010 Tobacco Control Legal Consortium  This publication was made possible by the ˜nancial support of the American Cancer Society and the Robert Wood  Johnson Foundation.This synopsis is provided for educational purposes only and is not to be construed as a legal opinion or as a substitute for obtaining legal  advice from an attorney. Laws cited are current as of January 2010. The Tobacco Control Legal Consortium provides legal information  and education about tobacco and health, but does not provide legal representation. Readers with questions about the application of the  law to speci˜c facts are encouraged to consult legal counsel familiar with the laws of their jurisdictions. 1Secondhand Smoke Seepage into Multi-Unit Affordable Housing Susan Schoenmarklin Key PointsPublic housing authorities and private owners of affordable multi-unit housing may prohibit  smoking in individual units. A smoke-free policy  adopted by a public housing authority or an owner of U.S. Department of Housing and Urban Development (HUD)-assisted housing may apply to smokers who already live in the building in addition to new residents as long as they are given ﬁlegally adequateﬂ notice.HUD has strongly encouraged public housing authorities to adopt smoke-free policies to protect the health of residents, who are often more vulnerable to secondhand smoke than those of higher income.Smoking is not a disability under federal or state law. In fact, prohibiting smoking can protect  against lawsuits by tenants with certain disabilities that are exacerbated by exposure to secondhand smoke.  Public housing authorities may change their house rules or leases to make individual units smoke-free. Those authorities that prefer to incorporate a  smoke-free policy into a lease may want to consult a change is considered ﬁreasonable.ﬂ Project-based section 8 housing may adopt a smoke-free policy by changing their house rules; owners must receive approval from HUD to change their leases. In the past, HUD has denied requests to change a lease to incorporate a smoke-free policy, but HUD™s views  may be changing. Providers of voucher-based  housing may choose to adopt a smoke-free policy through a rules change or by changing the lease, as long as all tenants are treated equally. ŁŁŁŁIntroduction In recent years, the smoke-free  trend has swept into multi-unit  housing as landlords, condominium  owners and housing authorities  have discovered the health and  financial benefits of smoke-free  multi-unit housing. Public housing  authorities and owners of multi-unit  subsidized housing have been on the  leading edge of this trend. In 2008,  the National Multi-Unit Housing  Council (NMHC), which represents   States, stated that the smoke-free  trend ﬁis actually more common  in public housing than privately  owned housing at this point.ﬂ 1 As an  example, at the beginning of January  2005, seventeen housing authorities  in six states had smoke-free policies  for some or all of their buildings.  By February 2010, this number  had soared to 141 local housing  authorities in twenty states.2The rising popularity of smoke- free policies for subsidized or  affordable housing units has led to  the need for research into the legal  and procedural aspects of adopting  and implementing such policies.  ﬁSubsidizedﬂ and ﬁaffordableﬂ are  terms that generally refer to housing  that receives government funding to  assist those with lower incomes who  are unable to pay the property™s full  rent. Different programs establish  different income levels to qualify  2for a government housing subsidy. In addition to  income-based requirements, some government  programs target certain segments of the population.  For example, Section 202 is a U.S. Department of  Housing and Urban Development (HUD)-assisted  housing program for low-income seniors and  Section 811 is HUD-assisted housing for those  who have a disability and are low income.While many government programs provide  affordable housing, this synopsis is limited to the  three most common forms of such housing, which  are: (1) public housing developments; (2) project- based section 8 housing; and (3) voucher-based  section 8 housing. Public housing developments  are owned and managed by local city or county  housing authorities. If the local housing authority  receives federal subsidies, then it must follow  certain regulations of HUD. Under the section 8  project-based housing program, a private multi- unit housing development receives federal HUD  funding to defray a portion of tenants™ rent and  the subsidy remains with the property. Under the  section 8 voucher program, HUD provides the  eligible tenant with a voucher to offset rent at  a private multi-unit development. Because the  subsidy stays with the tenant, not the property,  the tenant may use the voucher at a different  location. Much of the information in this synopsis  may apply to other kinds of affordable housing,  but procedures for enacting and implementing a  smoke-free policy may differ. Section I documents the urgent need for smoke- free housing for those who have lower incomes,   smoke-free housing. Section II makes it clear that  it is legal to prohibit smoking in public housing  and HUD-assisted residential units, debunks the  mistaken belief that smoking is a disability and  discusses why allowing smoking could lead to  lawsuits against the housing authority. Finally,  Section III outlines the procedure that public  housing authorities and HUD-assisted owners  must follow to enact smoke-free policies legally  and provides recommendations on how to enforce  such policies.Section I Œ The Case for Affordable Smoke-Free Housing The movement toward smoke-free affordable  housing is accelerating in the wake of a HUD  notice (ﬁHUD Noticeﬂ), issued on July 17, 2009,  strongly encouraging public housing authorities  to adopt smoke-free policies in their multi-unit  housing units. 3 of Healthy Homes and Lead Hazard Control  released a strategic plan targeting, among other  measures, the elimination of secondhand smoke in  homes ﬁto protect the health of children and other  sensitive populations in low-income households.ﬂ 4 Concurrently with the release of the Healthy  Homes Strategic Plan, the U.S. Surgeon General  had released ﬁThe Surgeon General™s Call to  Action to Promote Healthy Homes,ﬂ which called  for the elimination of secondhand smoke to protect  residents from health hazards in the home. 5 This   in 2006, that ﬁthere is no risk-free level of exposure  to secondhand smokeﬂ and that ﬁ[s]eparating  smokers from nonsmokers, cleaning the air, and  ventilating buildings cannot eliminate exposures  of nonsmokers to second-hand smoke.ﬂ 6 The  report also concluded that exposure to secondhand  smoke raises the risk of heart disease by at least  one quarter (25 to 30 percent).7Residents of Affordable Housing are  Especially Vulnerable to Secondhand SmokeAccording to the HUD Notice, more than half of  public housing residents (54 percent) are either  children or elderly residents over age sixty-two. 8 These populations ﬁare especially vulnerable to  the effects of [secondhand smoke].ﬂ 9 For children,  secondhand smoke increases the likelihood that  they will develop bronchitis, pneumonia, asthma,  poorer lung function and other breathing problems,  as well as ear infections. 10 For the elderly, every  major cause of death in their population Œ cancer,  heart disease, and stroke Œ is associated with  smoking and secondhand smoke, thus causing  3them ﬁin particular [to] bear a disproportionate  burden of the negative effects of smoking and  secondhand smoke.ﬂ11  The HUD Notice also mentioned that in addition to  the young and the elderly, there are ﬁa considerable  number of [public housing] residents with chronic  diseases such as asthma and cardiovascular  disease who are particularly vulnerable to the  effects of [secondhand smoke].ﬂ 12  A 2009  research study noted as well that low-income and  underserved racial and ethnic minorities, who live  disproportionately in public or subsidized housing,  suffer more from ﬁtobacco-related morbidity and  mortality, [and] have an increased incidence of  heart disease as well as asthma and cancer.ﬂ 13  Additionally, according to data from Boston™s 2005  Respiratory Health of Public Housing Residents  survey, a disproportionate number of smokers  live in public versus private housing, as well as  a higher percentage of adults with asthma. 14 The  special vulnerability of a substantial number of  residents of low income housing makes the case  for smoke-free housing even more compelling.The Market for Smoke-Free Affordable  HousingA majority of low income individuals do not  smoke, creating a demand for smoke-free units that  the market currently is not meeting. Nearly three  quarters (72 percent) of Americans with incomes  under $20,000 a year are non-smokers. 15  Smoking  rates are low in those groups disproportionately  represented in low-income housing: more than 90   smoke; more than 75 percent of African Americans  do not smoke; and 85 percent of Hispanics are  non-smokers.16  A 2009 survey of tenants in the four-county  Portland, Oregon metropolitan area revealed  that non-smoking tenants greatly outnumbered  smoking tenants, and nearly half (46 percent) of all  tenants were not comfortable renting an apartment  adjacent to smokers. According to the study, ﬁthe  number of applicants who will avoid smoking- permitted units is almost  4 times greater than the number of applicants who will avoid no-smoking  units.ﬂ17 The study concluded: As to the enduring perception that lower  income renters are substantially different  from higher income renters on this type of   have seen in past research as well: It simply  is not true. While it is true that lower income  renters are somewhat more likely to be  smokers themselves, this does not translate  into a greater tolerance to live next door to  indoor smokers.18 In keeping with this, a recent survey of residents of  public housing in Boston found that nearly half (49  percent) of tenants were experiencing secondhand  smoke incursion and nearly three quarters of all  tenants agreed that exposure to secondhand smoke  is harmful.19Secondhand Smoke Transfer in  Affordable Housing A recent Harvard School of Public Health study  suggested that greater exposure to secondhand  smoke in low-income housing is likely due to higher  smoking rates, smaller units, poor venti-lation, and   20  The Harvard study,  which examined forty-nine low-income multi-unit  residences, detected nicotine in 89 percent of non- smoking homes studied.  21 4The study concluded that secondhand smoke ﬁmay  infiltrate into homes through windows, doors,  shared air spaces, holes, and ventilation systems if  cigarettes are smoked outside or in neighbouring  residences.ﬂ  22  Research demonstrates that up to 65  percent of air can be exchanged between units.23 The recent HUD Notice cited the problem of  secondhand smoke seepage as a reason to adopt  a smoke-free policy in public housing. According  to the Notice, ﬁ[b]ecause [secondhand smoke] can  migrate between units in multifamily housing,  causing respiratory illness, heart disease, cancer,  and other adverse health effects in neighboring  families, the Department is encouraging PHAs  to adopt non-smoking policies.ﬂ 24  Further, the  Notice stated that its issuance ﬁwill enhance  the effectiveness of [HUD™s] efforts to provide  increased public health protection for residents  of public housing.25The 2006 Surgeon General™s report discussed the   housing and supported the adoption of smoke-free  policies. 26  The report warned against reliance on air   involuntary smoke exposure. 27  may reduce smoke odor, they are not designed to  remove the toxic particles from tobacco smoke. 28 The American Society of Heating, Refrigeration  and Air-Conditioning Engineers (ASHRAE),  which sets the standard for indoor air quality, has   is capable of eliminating secondhand smoke.  Consequently, ASHRAE does not recommend  a ventilation standard for buildings that permit  smoking. According to ASHRAE, ﬁ[a]t present, the  only means of effectively eliminating [the] health  risk associated with indoor exposure is to ban  smoking activity.ﬂ 29  Adjusting ventilation, sealing  gaps, and other remedial treatments may reduce  but not eliminate secondhand smoke exposure.30 As public awareness of the health risks of  secondhand smoke increases, owners and managers  who continue to allow smoking can expect to  spend more time refereeing disputes and engaging  in remediation efforts. ﬁProperty managers say  complaints about secondhand smoke in apartment  communities are on the rise,ﬂ according to the  National Multi-Unit Housing Council (NMHC).  The Council notes, ﬁA majority of renters would  actually prefer to rent an apartment in a smoke-free  community. In addition, about half say that they  have moved or would move because of secondhand  smoke.ﬂ 31  The National Center for Healthy Housing  has reported that secondhand smoke complaints  and requests for unit transfers drop following the  implementation of a smoke-free policy. 32Smoke-Free Policies Save Money  While adopting smoke-free policies is good public   is particularly critical in an economic downturn.  Preventing fires from cigarettes is yet another  good example of a public health measure that  saves money. Cigarette smoking is a leading cause   smoking kill more people than any other kind   Administration (USFA), smoking was responsible    which statistics are available. 33  The USFA reports  that older residents are at especially high risk for  34The National Multi-Unit Housing Council notes  that restricting smoking in apartment units can  help owners reduce the ﬁextremely costly risk of     reduce property insurance premiums, although  no statistics are readily available to indicate what   bans enjoy.ﬂ 35 Landlords and public housing authorities who go  smoke-free can also save money on cleaning costs  and building maintenance, stretching building  budgets. For example, data collected in 2009  from housing authorities and subsidized housing  facilities in New England indicated that the cost  5of rehabilitating a unit was more than double for  a light smoker ($1,810) vs. a non-smoker ($560).  Even more dramatic, the cost of rehabilitating the   nearly $3,000 more, than the cost of rehabilitating a  non-smoker™s unit. 36   According to NMHC, ﬁSome  estimates suggest that cleaning walls, carpets,   $400 to $3,000 to unit turnover costs, depending on  the length of residency and how much the resident  smoked in the unit.ﬂ37 In addition, banning smoking reduces the load on  heating and air-conditioning equipment, lowering  operating costs. According to an article in the  Occupational Health and Safety Journal, ﬁ[t]he  option of banning smoking from facilities brings the   less maintenance on air handling equipment, and  lower operating costs for the HVAC system.ﬂ 38  HUD, in its 2009 notice, recommended a non- smoking policy as a lower-cost means of achieving  good indoor air quality (IAQ). According to  the HUD Notice, achieving good IAQ requires  minimizing indoor air pollutants. Because ﬁETS  [environmental tobacco smoke] is known to be an   PHA [public housing authority] to achieve good  IAQ [indoor air quality] in its buildings if residents  are allowed to smoke, especially indoors.ﬂ The  notice further stated that a non-smoking policy  was an ﬁexcellent approachﬂ for those PHAs  seeking to improve their IAQ without the costs  of renovation.39Other possible savings from smoke-free policies  are:Ł    In several states (such as Maine, California  and New Hampshire), developers of low- income housing are able to earn tax credits  for providing smoke-free housing.40Ł   Smoke-free policies can help a building  earn ﬁGreen Buildingﬂ program credits  through programs such as the U.S. Green  Building Council™s Leadership in Energy  and Environmental Design (LEED)  program.41 Section II Œ Prohibiting Smoking  in Public Housing and HUD-Assisted Housing UnitsHUD Encourages the Adoption of Smoke-Free Policies HUD has indicated that subsidized and public  housing providers are free under federal law to  prohibit smoking in residential units as long as  the policies comply with applicable state and local  laws.42 There are no federal or state laws or cases  that prohibit HUD-assisted property owners and  PHAs from offering smoke-free rentals 43  and there  are no constitutional protections for smokers.44 The Chief Counsel in HUD™s Detroit office  concluded in a 2003 letter that private owners  of HUD-assisted housing may prohibit smoking  as long as they are in compliance with any state  law on smoking. The letter stated that ﬁthe right  to smoke or not to smoke is not a right that is  protected under the Civil Rights Act of 1964 or  any other HUD-enforced civil rights authori-ties. .  . .ﬂ 45  In August 2007, the Chief Counsel of HUD™s   that with respect to multi-residential properties  assisted by HUD ﬁthere is no HUD policy, by  statute, regulation, handbook or otherwise that  restricts landlords from adopting a prohibition  of smoking in common areas or in individual  units.ﬂ46 A similar letter, written in January 2007 by the   noted that in Michigan ﬁseveral housing authorities  and private landlords and management companies  have voluntarily adopted smoke-free policies for  their HUD-assisted developments.ﬂ The letter   restricting smoking in HUD-assisted housing.47 A 1996 HUD opinion permitted Nebraska™s  Kearney Housing Authority to ban smoking  in its public housing development. That same  year, a HUD opinion permitted the Fort Pierce  6Housing Authority in Florida to ban smoking in  its public housing. 48  HUD has also agreed to a  non-smoking policy in two cases brought under  the Fair Housing Act. In 1998, HUD approved  a conciliation agreement providing smoke-free  housing in a private HUD-assisted building for  a tenant with respiratory difficulties who was  exposed to smoke from a neighboring apartment. 49  In 2002, the Seattle Housing Authority entered into  a consent decree providing a smoke-free unit for  a tenant who had a respiratory condition after the  Department of Justice brought suit. In response  to the lawsuit, the housing authority made one  building at a high-rise complex smoke-free and  phased in a non-smoking policy in the other two  buildings at the complex. 50  Most recently, in its  2009 Notice, HUD has made it clear that it not  only permits smoke-free policies but now actively  encourages public housing authorities to adopt  them.51 Smoking is Not a Disability under  Federal or State LawsConstitutional LawThe National Multi-Unit Housing Council has  noted that ﬁone of the biggest reasons many  apartment firms have been hesitant to adopt  smoke-free policies is a mistaken belief that  restricting a resident™s ability to smoke on the  property or within [his or her] apartment could  violate the law.ﬂ However, the council noted in  its attorney-written memorandum, ﬁThere is no  ‚right to smoke™ and smokers are not a protected   actually reduce their legal liability by restricting  or banning smoking.ﬂ52State and federal courts have consistently ruled  that smoking is not a protected activity under  the U.S. Constitution or state constitutions, and  smokers are not a protected class. 53 The court in  Axelrod v. Fagan  stated bluntly, ﬁ[t]here is no more  a fundamental right to smoke cigarettes than there  is to shoot up or snort heroin or cocaine or run a  red light.ﬂ54Statutory LawSeveral pieces of federal legislation protect the  rights of the disabled. The federal Fair Housing  Act (FHA) prohibits housing discrimination based  on disability (in addition to race, color, religion,  sex, family status and national origin). 55   Other  anti-discrimination laws, including Section 504  of the Rehabilitation Act 56  and Title II of the  Americans with Disabilities Act (ADA), 57  as well  as various state laws, prohibit discrimination based  on disability. However, none of these laws protect smokers. For  example, in  Brashear v. Simms , a federal court  dismissed as ﬁfrivolousﬂ a state prisoner™s claim  that a smoking ban in Maryland™s prisons violated  his rights as a smoker under the ADA. The court  stated:[C]ommon sense compels the conclusion  that smoking . . . is not a ﬁdisabilityﬂ  within the meaning of the ADA. Congress  could not possibly have intended the  absurd result of including smoking within   render somewhere between 25 percent  and 30 percent of the American public  disabled under federal law because they  smoke.58A state court expressed this same concern in a  ruling against a smoker who alleged a violation of  state disability laws as well as the ADA. The Court  of Appeals of Michigan ruled that an employee who   not protected under the state™s civil rights act or  the ADA. 59  The court said that classifying smoking  as a disability would thwart the purposes of the  state™s Handicappers™ Civil Rights Act (HCRA).  ﬁPlaintiff™s claimed ‚handicap™ is shared by  countless other individuals in the workplace and in  society as a whole,ﬂ the court stated. 60  It concluded  that to ﬁautomatically label this condition as one  that substantially impairs a major life activity is  inconsistent with the HCRA and would do a gross  disservice to the truly handicapped.ﬂ617While that case™s holding applies only to Michigan  disability laws, no court has found that state  disability laws protect smokers. A law review  article examining the issue of secondhand smoke  in multi-unit residential housing noted that while  smoking behavior can change frequently, state  anti-discrimination laws were intended to protect  only immutable characteristics. According to the  author, ﬁthe reality is that more than 30 million  Americans have quit and thousands more start  smoking every day.ﬂ 62Liability for Failure to Provide Smoke- Free Housing While smokers cannot avail themselves of any legal  protection under federal and state disability laws  because smoking is not considered a disability,  non-smokers exposed to smoke in multi-unit  housing can access those same laws under certain  limited circumstances. The National Multi-Unit  Housing Council has warned its members that  ﬁcourts have held that an apartment resident with   secondhand smoke may actually be entitled to a  reasonable accommodation under the Fair Housing  Act.ﬂ It went on to note:In contrast to conventional wisdom,  apartment owners may be held more  legally liable by allowing smoking than by  restricting it. Residents have become more  knowledgeable about the risks of secondhand  smoke and savvier about pursuing legal  options to protect their health. State courts  have ruled against apartment owners and   other penalties under the nuisance, warranty  of habitability, and quiet enjoyment theories  of law. 63 However, simply showing an adverse health   proof of a ﬁdisabilityﬂ under the Fair Housing Act  (FHA). To use the FHA, the affected person must  prove the adverse health reaction substantially  limits one or more major life activities 64 Œ which  could include things such as breathing, walking  or performing manual tasks.  A person who merely   obtain FHA protection. 65  Some state disability laws   standards under various state laws for showing a  disability affected by secondhand smoke exposure  appear equally high.66 If a non-smoker has a medical condition severe  enough to be considered a disability under state  or federal law, then he or she is entitled to a  ﬁreasonable accommodationﬂ to protect against  secondhand smoke as long as the accommodation  does not impose an ﬁundue hardshipﬂ on the  housing provider. 67  Such an accommodation  could include developing or enforcing a smoke- free policy, either in the building or in the units  surrounding the affected non-smoker, repairs to   to a unit away from the secondhand smoke. The  non-smoker may seek to have smoking banned  from building common areas if secondhand smoke  is seeping into his or her unit from those areas. 68 Which actions are considered a ﬁreasonable  accommodationﬂ and which might be considered  an ﬁundue hardshipﬂ (and thus not required) are  determined on a case-by-case basis. Section III Œ Adopting a Smoke-Free Policy for Affordable  Housing The decision to adopt a smoke-free policy for  affordable housing does not end the process.  Public housing authorities and each type of HUD- assisted housing have different requirements for  giving notice to tenants of the change and there  are different rules on whether the change needs  to be made through the lease or through a change  in tenant rules. As the chief counsel of the HUD  HUD . . . funds a substantial variety of  housing programs . . . each with its own  set of rules as to residency and occupancy.  None, however, prohibit establishment of a  8smoke-free environment. The differences  might be as to whether the establishment can  be through the lease, a lease addendum, or  a house rule. Section 202/811 projects, for   model lease, but a smoke-free policy could  be established through the house rules.69Public Housing Authority (PHA)A public housing authority can adopt a smoke- free policy through house rules 70  or through a  change in the lease. House rules must be posted  in a conspicuous manner and incorporated by  reference in the lease. 71  Before making a rule  change, public housing authorities must provide  residents with a 30-day notice and the opportunity  to present written comments.72A public housing authority can implement a policy  change through a lease addendum if the provision  is considered ﬁreasonable.ﬂ 73  While in the past   HUD™s PHA regulations have said that HUD would  be unlikely to support a smoke-free amendment  to a lease, 74 the 2009 HUD notice states: ﬁPHAs  are encouraged to revise their lease agreements to  include the non-smoking provisions.ﬂ 75  The HUD  notice is a ﬁrecommendationﬂ to local housing  authorities, and not a directive, so if the PHA  would prefer to make the change in its house rules,  it is permissible.  The advantage of having a smoke-free provision  in the lease rather than a house rule is that,  if challenged by a non-compliant tenant, the  provision is more likely to withstand judicial  scrutiny. A lease provision provides a tenant with  clear and conspicuous notice of any smoking ban.  Before adopting a lease change, which is effective  only at the end of a lease term, the public housing  authority needs to give tenants at least sixty days  of notice prior to the end of the term. 76  Due to the  advantages of a smoke-free lease provision versus  a rule change, advocates may decide to move  forward with a lease addendum or may want to  ask for an opinion on a lease addendum from their  A smoke-free lease provision is clearly permissible  for the twenty-nine housing authorities participating  in a HUD pilot project for low-income housing. 77 Congress in 1996 created the ﬁMoving to Workﬂ  program to allow a limited number of public  housing authorities to design and test innovative  local housing strategies for low-income families.  Housing authorities under the Moving to Work  program are exempt from existing HUD public  housing regulations, and consequently have  the discretion to add a smoke-free provision to  their leases. 78  Since 2001, the Seattle housing  authority has offered a smoke-free lease at its  Tri-Court public housing development under this  program.79Project-Based Section 8 Housing In general, private multi-unit housing projects  that accept federal subsidies tied to the property  (i.e., project-based Section 8 housing) must use  a HUD-approved lease 80 and must receive HUD  approval to make any changes in the lease. 81  HUD may approve changes to keep the lease in  compliance with state or local law or to conform  to ﬁproperty management practices generally used  in the project™s market area.ﬂ 82 Although not a HUD requirement, 83 a 2003 letter   office makes it clear that project owners may  adopt non-smoking policies through a change  in the house rules. The letter states: ﬁ[P]roject  owners may devise reasonable no smoking rules  at their properties that express legitimate concerns  for the safety of the residents and condition of  individual units and buildings as a whole. As long  as no-smoking policies meet the normal house  rules criteria, HUD approval is not required.ﬂ  The letter goes on to note that if owners want to  make the non-smoking policy a condition of the  lease, ﬁHUD approval is required to the extent  that the owner is bound to utilize HUD™s model  lease.ﬂ84  The language in the 2009 HUD Notice  recommending that public housing authorities  make the change in their lease provisions, bodes  well for project owners seeking HUD approval for  such lease changes.9Voucher-Based Section 8 Housing Private developments that accept vouchers can  adopt a smoke-free policy either through a lease  addendum or through house rules. However, if the  change is made through a change to the owner™s  standard lease form, it must apply to all residents  and not just to federally assisted tenants. 85 There  are no particular notice procedures required under  the voucher program other than the state and local  notice requirements that apply to all landlords.Grandfathering of Existing Tenants  The 2009 HUD notice stated that public housing  authorities have exercised considerable discretion in  implementing their smoke-free policies. According  to the notice, ﬁ[s]ome PHAs have established  smoke-free buildings. Some PHAs have continued  to allow current residents who smoke to continue  to do so, but only in designated areas and only  until lease renewal or a date established by the  PHA. Some PHAs are prohibiting smoking for  new residents.ﬂ86 It is apparent from this notice, and other HUD  letters, that it is permissible to enact a smoke-free  policy that applies both to current as well as new  residents of a PHA or HUD assisted-housing,  including current smokers. PHAs and HUD- assisted housing providers are not required to  permanently ﬁgrandfatherﬂ or exempt existing  tenants, although they must provide ﬁlegally  adequateﬂ notice of any impending change. For  example, the recent letter from the Chief Counsel   was no HUD policy requiring HUD-assisted  properties to grandfather existing tenants, but that  state and local law must be followed, which would  include any notice provisions.87 A 2004 letter from the regional director of the   by HUD legal staff, noted that HUD did not require  the permanent grandfathering of any tenant in  HUD-assisted housing. The letter stated that it  is permissible to require existing tenants to stop  smoking in their units as long as they are given  88 in her 2003 letter stated that owners of HUD- assisted housing must ﬁtake caution to grandfather  in those smoking residents currently residing at  the complex.ﬂ 89  ﬁgrandfatherﬂ as used in her letter does not mean  a permanent exemption for existing smokers. She  said that the landlord could either wait until the  annual review or expiration of the smoker™s lease,  or, in the case of a long-term lease, until after the  provision of legally adequate notice. She said that  it was reasonable to require tenants with long-term  leases to move or cease smoking, as long as the  smoker received reasonably adequate advance  notice.90 It should be noted that leases in a public housing  project technically do not ﬁexpireﬂ under HUD  regulations. All public housing leases are for  one-year terms, and are renewable annually ﬁin  perpetuityﬂ as long as the tenant is in compliance  with certain key lease provisions. Although  10the leases are renewable annually, they may be  91Implementing a smoke-free policy after the lease™s  expiration or after providing legally adequate  notice makes sense due to the length of time it  would take for a building to become completely  smoke-free if the owner had to wait for each tenant  to move or die. Waiting for such a prolonged period  defeats the purpose of a smoke-free policy, as  individual units are not truly smoke-free until the  entire building is smoke-free. Residents who suffer  from exposure to secondhand smoke should not  have to wait for every smoking tenant to leave or  die in order to get relief from their symptoms. From a practical standpoint, it is easier to make the  change to smoke-free at the time of lease review  or renewal or after providing legally adequate  notice because it reduces the amount of time that  differing rules will apply to tenants. For example,  in the case discussed in Section II involving a  HUD-approved conciliation agreement providing  smoke-free housing for a tenant with respiratory   smoke in their apartments for as long as they  stayed in the apartment building. 92  According to the  building™s manager, this approach has caused some   some new tenants were confused as to why they  were required to comply with the smoke-free policy  when existing tenants were permitted to smoke. In  a few instances management or tenants believed  that a new tenant was smoking in violation of the  ban but were unable to prove it. Overall, however,  the manager reported that tenant response to the  new smoke-free policy is positive.93ConclusionWe owe our elderly, our children, and those with  chronic illness a safe shelter that does not include  secondhand tobacco smoke. When we adopt a  smoke-free policy, we have a rare opportunity to do  what is right while saving money and preventing  lawsuits. It is not only legal to prohibit smoking  in public and HUD-assisted housing, but it also  protects against lawsuits from tenants exposed to  secondhand smoke. The change to smoke-free status in multi-unit  affordable housing can take place at the time of  lease renewal or after legally adequate notice.  Public housing directors from the twenty-nine  Moving to Work program sites are urged to make  the change as part of the public housing lease  rather than through house rules. Housing directors  and project-based Section 8 housing providers  can adopt the change through house rules and  possibly through a change in the lease. Providers  of voucherŒbased Section 8 housing can either  make a rules change or change the lease, as long as  subsidized and non-subsidized tenants are treated  equally.   Affordable housing providers are urged to join the  growing smoke-free movement within the multi- unit housing market. Smoke-free housing should not be a right reserved only for the rich. About the AuthorSusan Schoenmarklin is a Consulting Attorney for  the Smoke-free Environments Law Project.AcknowledgementsThe author would like to thank Sara Guardino of  the Public Health Advocacy Institute, Jim Bergman  of the Smoke-Free Environments Law Project,  Warren Ortland at the Public Health Law Center,  and Kerry Cork at the Tobacco Control Legal  Consortium and Public Health Law Center for  reviewing this synopsis.11Endnotes1  Nat™l Multi-Unit Housing Council (NMHC), Property Mgmt., Update: No Smoking Policies in Apartments (Feb. 2008) at 1,  available at http://www.tcsg.org/sfelp/S-F_NMHC.pdf. 2  Smoke-Free Environments Law Project, Housing Authorities/Commissions which have adopted smoke-free policies,  available at http://www.tcsg.org/sfelp/SFHousingAuthorities.pdf.  3  U.S. Dep™t of Housing & Urban Dev., Non-Smoking Policies in Public Housing, Notice: PIH-2009-21 (HA) (July 17, 2009),  available at http://www.hud.gov/of˜ces/pih/publications/notices/09/pih2009-21.pd f.4  U.S. Dep™t of Housing & Urban Dev., Leading Our Nation to Healthier Homes: The Healthy Homes Strategic Plan (2009) at 7,  available at http://www.hud.gov/utilities/intercept.cfm?/of˜ces/lead/library/hhi/DraftHHStratPlan_9.10.08.pdf. 5  U.S. Dep™t of Health & Human Services, The Surgeon General™s Call to Action to Promote Healthy Homes (2009),  available at  http://www.surgeongeneral.gov/topics/healthyhomes/calltoactiontopromotehealthyhomes.pd f.6  U.S. D EP ™T OF  H EALT H & H UMAN  S ERVICE S,  The Health Consequences of Involuntary Exposure to Tobacco Smoke: Report of the  Surgeon General  11 (2006), available at http://www.surgeongeneral.gov/library/secondhandsmoke/index.html. 7  Id. at 531.8  HUD Notice, supra note 3, at 2.9  Id. at 1.10  Joseph DiFranza et al.,  Prenatal and Postnatal Environmental Tobacco Smoke Exposure and Children™s Health,  113 PEDIATRIC S (4 Supp.) 1007-15 (2004).11  HUD Plan, supra note 4, at 4948.12  HUD Notice, supra note 3, at 2.13  Tiffany Kraev, Gary Adamkiewicz, S. Katherine Hammond et al.,  Indoor Concentrations of Nicotine in Low-income, Multi-Unit  Housing: Associations with Smoking Behaviours and Housing Characteristics,  18 TOBACCO  CONTROL  438 (2009)  available at  http://tobaccocontrol.bmj.com/content/18/6/ 438.full.pdf.14  Amy Helburn, Asthma Regional Council of New England, Health Resources in Action, A Case for Smoke-free Housing, at 6  (2007), available at http://www.hria.org/uploads/reports/HRIA-Smoke_Free_Housing_2007.pd f.15  U.S. Dep™t of Health & Human Servs., Centers for Disease Control and Prevention, National Center for Health Statistics,  Vital  and Health Statistics, Summary Health Statistics for U.S. Adults: National Health Interview Survey, 2006,  Series 10, Number  235 Table XV p. 1 35 (Dec. 2007).16  See U.S. Dep™t of Health and Human Servs., Centers for Disease Control and Prevention,  Cigarette Smoking Among Adults  and Trends in Smoking Cessation Œ United States, 2008,  58 MORBI DITY  AN D MORTALITY  W EEKLY  REPORT  44,1227-32 (Table)  (2009).17  Smoke-Free Rental Housing in the Portland Metropolitan Area, 2009 Benchmark Research Summary Report, at 1 4 (2009), available at  http://smokefreeoregon.com/housing/whats_new/2009percent20Benchmarkpercent20Portland- Vancouverpercent20Renterpercent20Survey.pdf. 18  Id. 19  Helburn, supra note 14, at 25.20  Kraev,  supra note 13, at 438.21  Id. at 442.22  Id. at 443.23  National Center for Healthy Housing, Reasons to Explore Smoke-Free Housing, at 2 (2009),  available at  http://www.nchh. org/Portals/0/Contents/Greenpercent20Factsheet_Smokefree.pd f.24  HUD Notice, supra note 3, at 1.25  Id.26  2006 Surgeon General™s Report,  supra note 6, at 632-33.27  Id. at i.28  National Center for Healthy Housing, supra note 23, at 2.29  Am. Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc., Environmental Tobacco Smoke Position Document,  at 1 (2008), available at http://www.ashrae.org/docLib/20090120_POS_ETS.pdf. 30  Susan Schoenmarklin, Tobacco Control Legal Consortium,  In˜ltration of Secondhand Smoke into Condominiums, Apart- ments and Other Multi-Unit Dwellings: 2009  (2009), at 4. available at  http://tclconline.org/documents/in˜ltration.pdf. This  publication also contains a more detailed discussion of remedial treatments.  1231  NMHC Update, supra note 1, at 2.32  National Center for Healthy Housing, supra note 23, at 1.33  Dep™t of Homeland Security, U.S. Fire Administration, Residential Structure and Building Fires (2008),  available at  www. usfa.dhs.gov/downloads/pdf/publications/Residential_Structure_and_Building_Fires.pd f.34  Dep™t of Homeland Security, U.S. Fire Administration, National Fire Data CanterCenter, Fire and the Older Adult 1 (2006),  available at www.usfa.dhs.gov/downloads/pdf/publications/fa- 300.pdf. 35  NHMC Update, supra note 1, at 2.36  National Center for Healthy Housing, supra note 23, at 2.37  NMHC Update, supra note 1, at 2.38  Jeff Burton,  Controlling Environmental Tobacco Smoke,  67 OCC UPATIONAL  H EALT H & S AFETY  12, 22 (1998).  39  HUD Notice, supra note 3, at 2.40  National Center for Healthy Housing, supra note 23, at 2.41  Id.42  See NMHC Update, supra note 1, at 1.43  See David Ezra,  Get Your Ashes Out of My Living Room!: Controlling Tobacco Smoke in Multi-Unit Residential Housing,  54 RUTGER S L.  REV .  135, 179-8 3 (2001). This article drew the same conclusion with respect to all providers of rental  housing.44  See Samantha K. Graff, Tobacco Control Legal Consortium,  There is No Constitutional Right to Smoke: 2008,  5 (2d ed.  2008), available at http://tclconline.org/documents/constitutional-right.pdf. 45  Letter from Sheila Walker, Chief Counsel, U.S. Dep™t of Housing & Urban Dev., Detroit Field Of˜ce to James Bergman, J.D.,  Co-Director, Center for Social Gerontology, Inc., at 2 (July 18, 200 3), available at  http://www.mismokefreeapartment. org/hudletter.pd f.46  Letter from Stephen Gronewold, Chief Counsel, U.S. Dep™t of Housing & Urban Dev., Minneapolis Field Of˜ce to Warren  Ortland, Staff Attorney, Public Health Law Center, William Mitchell College of Law, at 1 (Aug. 1, 2007),  available at  http://www.alamn.org/smokefreehousing/Minneapolis_HUD_Letter1.pd f.47  Letter from Lana J. Vacha, Director, U.S. Dep™t of Housing & Urban Dev., Detroit Field Of˜ce to Roy Struble (Jan.  31, 2007), available at http://www.smokefreeforme.org/documents/hudletter.pd f.48  See Smoke-Free Environments Law Project, Analysis of the Authority of Housing Authorities and Section 8 Multi-Unit  Housing Owners to Adopt Smoke-free Policies in Their Residential Units, at p. 2,  available at  http://www.tcsg.org/sfelp/ public_housing24E577.pdf, citing In re Kearney, Nebraska Public Housing Authority Tenant/Unit Assignment According  to Smoking Preference Compatibility with Tenant Selection/Assignment Regulations, HUD Opinion (June 27, 1996); In re  City of Fort Pierce, Florida Housing Authority, HUD Opinion (July 9, 1996). 49  See id.  at 8,  citing In re HUD and Kirk and Guilford Management Corp. and Park Towers Apartments, HUD Case No. 05- 97-0010-8, 504, Case No. 05-97-11-0005-370, 8 (1998).50  U.S. v. Seattle Housing Authority, C01-11 33L (W.D. Wa., 2002) (consent decree). 51  HUD Notice, supra note 3, at 2.52  NMHC Update, supra note 1, at 1.53  Graff,  supra note 44, at 5.54  Fagan v. Axelrod, 550 N.Y.S.2d 552, 559 (N.Y. Sup. Ct.1990). 55  Fair Housing Act, 42 U.S.C. §§ 3601Œ3631 (2007).56  29 U.S.C. § 794.57  4 2 U.S.C. §§ 12101-12213 (2008).58  Brashear v. Simms, 1 38 F. Supp. 2d 69 3 (D. Md. 2001).59  Stevens v. Inland Waters, Inc., 559 N.W. 2d 61 (Mich. App. 1996). The Michigan Supreme Court upheld the lower court  decision in Stevens v. Inland Waters, Inc., 568 N.W. 2d 682 (Table) (Mich. 1997). Holdings in employment cases may  be used as guidance in housing cases. Pfaff v. U.S. HUD, 88 F.  3d 739, 745 n. 1 (9th Cir. 1996). 60  Stevens, 559 N.W.2d at at 65. 61  Id.62  Ezra, supra note 43, at 181.63  NMHC Update,  supra note 1, at 1. For a more detailed discussion of the use of state and federal disability laws to  protect a non-smoker living in multi-unit housing, including possible options for accommodation, readers should consult  the fact sheet  How Disability Laws Can Help Tenants Suffering from Drifting Tobacco Smoke,  available on the Technical  13Assistance Legal Center website at  http://www.phlpnet.org/tobacco-control/products/disabilitylawsdriftingsmok e. Additionally, The Federal Fair Housing Act and the Protection of Persons Who are Disabled by Secondhand Smoke in  Most Private and Public Housing, available on the website of the Smoke-Free Environments Law Project at  http://www. tcsg.org/sfelp/fha_01.pd f, gives a step-by-step guide on the procedure for making an FHA claim. For recommendations  on reducing secondhand smoke transfer, see Canada Mortgage and Housing Corp., Solving Odour Transfer Problems  in Your Apartment (Dec. 2006),  available at  http://www.cmhc-schl.gc.ca/en/co/reho/reho_002.cfm .  The Tobacco  Control Legal Consortium law synopsis  In˜ltration of Secondhand Smoke into Condominiums, Apartments and Other  Multi-Unit Dwellings: 2009  provides information on remedies for secondhand smoke exposure available through the  courts under various common law theories and a listing of successful cases ( see Schoenmarklin, supra note 30.).64  4 2 U.S.C § 3602(h).65  See Schoenmarklin, supra note 30, at 9.66  A 200 3 Massachusetts case is instructive. Analyzing a Massachusetts civil rights law modeled after the ADA, the state™s  Superior (trial) Court ruled that a plaintiff who claimed fatigue and itchy eyes when exposed to secondhand smoke did  not qualify for protection from secondhand smoke as a disabled person.  See Donnelley v. Cohasset Housing Authority,  No. 01009 33, 200 3WL 212 46199 at *10-11 (Mass. Super. 200 3). While not controlling outside of Massachusetts,  this ruling exempli˜es the high standard plaintiffs may need to meet to show that their sensitivity to secondhand smoke  substantially limits a major life activity. 67  Joint Statement of the Dep™t of Housing & Urban Dev. and the Dep™t of Justice: Reasonable Accommodations Under The  Fair Housing Act, at 7 (2004), available at www.hud.gov/of˜ces/fheo/library/huddojstatement.pdf. 68  Residents who qualify as ﬁdisabledﬂ under the FHA would be entitled to ﬁreasonable accommodationsﬂ in the public areas  of the complex, under Title III of the ADA, which protects the disabled in ﬁpublic accommodations.ﬂ  See Garza v. Raft,  1999 WL  33882969, at * 3 (N.D. Cal. 1999) (holding that the FHA applies to common areas of residential complexes).  But see Birke v. Oakwood Worldwide, 169 Cal.App. 4th 15 40, 155 3 (Cal.App. 2 Dist. 2009) (holding that apartment  and condominium residents, regardless of whether they qualify as ﬁdisabled,ﬂ do not have a cause of action for ADA  violations because private residential facilities do not constitute ﬁpublic accommodationsﬂ covered by the Act). 69  Gronewold Letter,  supra note 46, at 1.70  Walker Letter,  supra note 45, at 2.71  Of˜ce of Public and Indian Housing, U.S. Dep™t of Housing & Urban Dev., Public Housing Occupancy Guidebook, Part 5- Chapter 17 General Public Housing Lease Requirements, at 190, 205 (200 3), available at  http://www.hud.gov/of˜ces/ pih/programs/ph/rhiip/phguidebook.cf m.72  Id. at 190.73  Id. at 189-90.74  Smoke-Free Environments Law Project, Analysis,  supra note 48, citing May 25, 2005 conversation with Harlan Stewart,  HUD Of˜ce of Public Housing, Seattle. 75  HUD Notice, supra note 3, at 2.76  U.S. Dep™t of Housing & Urban Dev., HUD Occupancy Handbook, p. 6-26 (2007),  available at  http://www.hud.gov/ of˜ces/adm/hudclips/handbooks/hsgh/ 4350.3/43503c6HSGH.pdf.77  The twenty-nine housing authorities participating in the program are: Alaska; Atlanta, GA; Baltimore, MD; Boston, MA;  Cambridge, MA; Chicago, IL; Charlotte, NC; Delaware; D.C.; Keene, NH; King County, WA; Lawrence-Douglas County,  KS; Lincoln, NE; Louisville, KY; Massachusetts; Minneapolis; New Haven, CT; Oakland, CA; Philadelphia, PA; Pittsburg,  PA; Portage, OH; Portland, OR; San Antonio; San Bernardino, CA; San Diego; San Mateo, CA; county counties of Santa  Clara and San Jose, CA; Seattle, WA; Tulare, CA; and Vancouver, WA. The list of current Moving to Work states can be  found at: http://www.hud.gov/of˜ces/pih/programs/ph/mtw/contact-list.pdf. 78  Moving to Work is a federal program that was authorized under the Omnibus Consolidated Recissions and Appropriations  Act of 1996 (Public Law 10 4-134, 110 Stat 1 321), April 26, 1996. See U.S. Department of Housing and Urban  Development, Moving to Work (MTW) Background and Purpose,  available at  http://www.hud.gov/of˜ces/pih/programs/ ph/mtw/background.cfm. 79  Seattle Housing Authority Memorandum to Board of Commissioners in Re Resolution No.  4600, at p. 2 (May 21,  2001).80  HUD Occupancy Handbook, supra note 76, at 6-4.81  Id. at 6-27.82  Id.83  Vacha Letter,  supra note 47 (although ﬁseveral housing authorities and private landlords [in Michigan] have voluntarily  adopted smoke-free policies for their HUD-assisted developments,ﬂ such policies were ﬁ[p]resumably . . . a result of  concerted efforts by residentsﬂ and not a HUD requirement.) 1484  Walker Letter,  supra note 45, at 2.85  Of˜ce of Public & Indian Housing, U.S. Dep™t of Housing & Urban Dev., Voucher Program Guidebook, Housing Choice,  Chapter 8: Housing Search and Leasing, 8-21 (2001),  available at  http://www.hud.gov/of˜ces/adm/hudclips/ guidebooks/7420.10G/7420g08GUID.pdf (ﬁif the owner uses a standard lease form for rental to unassisted tenants,  that lease form is used for the assisted unit as wellﬂ).86  HUD Notice, supra note 3, at 2.87  Gronewold Letter,  supra note 46, at 1.88  Smoke-Free Environments Law Project, Analysis,  supra note 48, at 7,  citing October 1 3, 200 4 letter from John Meyers,  HUD Regional Director, Seattle of˜ce. 89  Walker Letter,  supra note 45, at 2.90  Smoke-Free Environments Law Project, Analysis,  supra note 48, at 7,  citing personal conversation with Sheila Walker,  May 20, 2005.91  24 CFR Part 966. 4 (a)(3).92  Smoke-Free Environments Law Project, Analysis,  supra note 48, at 8, citing In re HUD and Kirk and Guilford Management  Corp. and Park Towers Apartments, HUD Case No. 05-97-0010-8, 50 4, Case No. 05-97-11-0005-370 (1998).93  Id. at 8-9,  citing Smoke-Free Air for Everyone (S.A.F.E.), Smoke-Free Affordable Housing Compliance Survey, March  2004.About the Tobacco Control Legal Consortium The Tobacco Control Legal Consortium is a  network of legal programs  supporting tobacco control policy change throughout the United  States. Drawing on the expertise of its collaborating legal centers, the  Consortium works to assist communities with urgent legal needs and to  increase the legal resources available to the tobacco control movement.  The Consortium™s coordinating of˜ce, located at William Mitchell  College of Law in St. Paul, Minnesota, ˜elds requests for legal technical  assistance and coordinates the delivery of services by the collaborating  legal resource centers. Our legal technical assistance includes help with  legislative drafting; legal research, analysis and strategy; training and  presentations; preparation of friend-of-the-court legal briefs; and litigation  support.   875 Summit Avenue Ł St. Paul, Minnesota 55105www.tclconline.org  Ł tobaccolaw@wmitchell.edu Ł 651.290.7506  Preemption: The Biggest Challenge to Tobacco  Control  / 1                              Fact Sheet   Why  Preemption  is Bad for  Tobacco Control   Public health practitioners and tobacco control advocates generally agree   that preemption is detrimental to tobacco control efforts.  Preemption   occurs when  a ﬁhigher ﬂ level of government  eliminates or limits the  authority of  a ﬁlower ﬂ level of government to regulate a certain issue .  When laws are preempted, they have no force or effect.  Because local   control is so integral to tobacco control, the tobacco industry and  its   allies have historically used, and continue to use, preemptive strategies   to thwart smoke -free laws, youth access  and retailer licensing  restrictions, advertising  and  promotion  regulations, and similar policies.       For decades,  the strongest and most  innovative tobacco control policies have  emerged  at the  local level  Œ often  after  long and hard -fought  grassroots community efforts  Œ before ultimately  being adopted at the state  or federal  level. These grassroots campaigns increase local awareness  of tobacco control issues,  build community readiness and support, and  foster  public  debate  about  the need for policy change and healthy social norms. A preemptive  state or federal  law can   invalida te many local tobacco control policies that represent years of efforts at the local level.   Moreover, o nce enacted, preemptive laws are traditionally difficult to repeal , and can affect not  just the legal but also the advocacy landscape for years to come . Unfortunately, but not  surprisingly, research has shown that preemption has  result ed in health and social norm  disparities between states where local authorities have the ability to adopt tobacco control   policies  and states where local authorities are pree mpted from enacting  such policies.      The tobacco industry  has been  relentless  in its  pursuit of  preemption to  weaken , impede  or  defeat  tobacco control efforts.  Preemptive policies and legal challenges  can  often  block  state and  local  advances in  tobacco  control , and  seemingly innocuous  preemptive language in serted  into  proposed  legislation can  derail important  tobacco control initiatives .  For more information , see  the Consortium™s  Preemption: The Biggest Challenge to Tobacco Control . This publication  describes  common ways preemption can affect tobacco control strategies , and  provides examples  of preemptive and non -preemptive legislative language , guidelines on preventing or addressing  preemption in tobacco control legislation , select  tobacco -related legal challenges to preemption,  and  a list of resources on preemption and tobacco control.   Last updated: October 2014   \n",
      "\n",
      "Cluster 5\n",
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      "                                      January 15, 2016     Secretary Julián Castro   c/o  t he Regulations   Division , Office of General Counsel   Department of   Housing and Urban Development   451 7th Street  SW., Room 10276   Washington, DC 20410 - 0500.     RE:  FR 5597 - P - 02 Institu ting Smoke - Free Public Housing     Dear  Se cretary Castro ,      The Conference of Boston Teaching Hospitals (COBTH) on behalf of its fourteen member institutions is  pleased to offer the following comments in strong support of the U.S. Department of Housing and Urban  Development (HUD) proposed rule   to make all indoor pu blic housing in the U.S. smoke - free,  as well as  designating the surrounding    around public housing  as a smoke - free  barrier.   Additionally COBTH  would suggest two additions to the proposed rule to strengthen its effectiveness namely: (1) that the  smoke - fr ee provisions include electronic nicotine delivery systems (ENDS) and hookah pipes and  devices; and  ( 2) that the rule applies to all multi - unit housing properties that accepts funding from HUD .         Annually more than 8,000 Massachusetts residents die from  tobacco related causes which include  cancer, heart disease, stroke, emphysema, and other respiratory diseases. 1   This estimate includes  nonsmokers exposed to secondhand smoke whose risk for heart disease is increased by 25 - 30% and risk  for lung cancer is in crease d   by 20 - 30% as a result of their exposure.      In a report  2   published by t he Massachusetts   Department of Public   Health   (DPH) with data from 2014,  population  groups  that more frequently  occupy public housing      namely  individuals of low socio - economic s tatus and people with disabilities      were found to be   more likely to smoke and be exposed to  secondhand   smoke.  DPH estimated that   14.7% of Massachusetts adu lts (or 763,960 residents) were, in  2014,  smokers   and  that individuals of low socio - economic status  and people with disabilities,  were  among those   groups whose smoking rate was highest.   Specifically   it found that   32.8% of people on  MassHealth (    program ),   26.3% of individuals  with   a disability, and 26.3% of  households  whose income  was   less than $25k, were more likely to smoke.      workplaces, restaurants, and bars which effectively reduced the overall exposure of nonsmoking adults  to secondhand  smoke from 32% in 2002 to 10% in 2014. However, the risk of secondhand smoke in the  home, particularly for those who live in multi - unit dwellings like public housing, continues to be a risk  for nonsmokers.                                                         1   http://www.mass.gov/eohhs/docs/dph/tobacco - control/adults - health - consequences.pdf   2   http://www.mass.gov/eohhs/docs/dph/tobacco - control/adults - who - smoke.pdf   11 Beacon Street, Suite 710   Boston, MA  02108   Phone:  617 - 723 - 6100   Fax:  617 - 723 - 6111   www.cobth.org      Faulkner Hospital     -          In  a second   report , 3   DPH estimated  that  16.4% of  Massachusetts households allow ed   smoking in their  homes   thereby exposing a potential   456,000 adult  nonsmokers   to  secondhand   smoke for   more than one  hour per week.  Specifically   the report found,   19.5% of people on MassHealth, 13.6% of people with  disabiliti es, and 17.2% of households whose income was less than $25k, were more likely to be exposed  to  secondhand   smoke.       According to 2013 data, 4   13% of Massachusetts households with children allow smoking in the home.  This means that an estimated 187,000 childr en in the Commonwealth  are exposed to   the dangerous  conditions     sudden infant death syndrome (SIDS), acute respiratory infections, ear problems, and more  frequent and severe asthma attacks     a ssociated with secondhand smoke .     Following passage of the 2004   smoke - free workplace legislation, the Commonwealth had 577 fewer  heart attack deaths annually than expected. 5    Additionally it was found that overall indoor air quality  improved throughout the state.   Including both suggested additions with the proposed ru le would  further improve the outcome of the measure as well as the quality of air in the home.      Inclusion of      to the proposed rule , that smoke - free provisions include electronic  nicotine delivery systems (ENDS) and hookah pipes and   devices,   would ensure that nonsmokers and  children experience the same level of indoor air quality in their home as they may find in public spaces.  The emissions from ENDS aerosol are    .  R ather , the emissions from ENDS devices  conta in nicotine  and   additional toxins   whose level is not   regulated nor subject to manufacturer  standards . While  ENDS emissions contain  fewer  toxins  than the 250 chemicals contained in secondhand  smoke, the vapor released by ENDS devices contain  acetaldehydes ,  a known cancer causing substance.  The smoke from Hookah devices contain  high levels of nicotine, carbon monoxide, carcinogens,  hydrocarbons, heavy metals ,   and fine particles, which are  higher levels than cigarettes.  The risks of  hookah are documented to be   similar  to the  risks  of   cigarette   smoking, including lung cancer, respiratory  illness, low birth weight, and   respiratory problems among infants . It is in the best interest of those who     proposed smoke - free rule.      housing properties that accept funding from HUD so that more individuals are protected from the  potential risks and dangers asso ciated with exposure to tobacco smoke and ENDS emissions.     COBTH and its members believe  the proposed rule to  be a valid and necessary public health endeavor.  We therefore respectfully request the proposed rule be a dopted as amended.     Sincerely,          John Erw in   Executive Director, Conference of Boston Teaching Hospitals                                                         3   http://www.mass.gov/eohhs/docs/dph/tobacco - control/adults - exposed - to - secondhand - smoke.pdf   4   http://www.mass.gov/eohhs/docs/dph/tobacco - control/secondhand - smoke - factsheet.pdf   5   http:/ /www.mass.gov/eohhs/docs/dph/tobacco - control/smoke - free - law - factsheet - 5year.pdf   \n",
      "\n",
      "Cluster 6\n",
      "\n",
      "                                https://www.facebook.com/groups/WP4HE/                           January 15, 2016       Office of the Assistant Secretary for  Public and Indian Housing   U.S. Department of Housing and Urban Development     RE: Docket Number FR 5597 - P - 02   Instituting Smoke - Free Public Housing     To Whom  It   May Concern:     On behalf of the Westlawn Partnership for a Healthier Environment, I am pleased to pr ovide a  letter of support for the proposed rule to require all Public Housing Authorities to implement  smoke - free policies (HUD Docket No. FR 5597 - P - 02).     The Westlawn Partnership for a Healthier Environment  is a group of community stakeholders  that   has met on a regular basis since 2008 to identify, prioritize, and address environmental  health concerns in the Westlawn community.  Located in northwest Milwaukee, Westlawn is   - subsidized housing development.     Milwauke e County ranks as the worst county in the State of Wisconsin for asthma - related  hospitalizations and emergency department visits.  Moreover, specific to  the  Westlawn   community , the rate of hospitalizations for asthma among children is nearly twice that of  Mi l w aukee County, and the rate of asthma - related emergency department visits is 1.5 times  higher in this community compared to the rest of the county.  Thus, smoke - free housing could  help to   reduce asthma triggers, improve indoor air quality ,   and   improve health outcomes   for  children and families in Westlawn and beyond.       Thank  you for proposing this important rule     it  has the potential to reduce health care costs,  save lives, and improve the quality of life for so many Americans.     Sincerely,        Anne Dressel, PhD, CFPH   Project Director   Westlawn Partnership for a Healthier Environment   Email:  banda@uwm.edu   Phone: (414) 229 - 3995   \n",
      "\n",
      "Cluster 7\n",
      "\n",
      "As I so understand the healthy thinking, the second hand smoke thing and I can see the reasoning for the cost of maintenance.  I think it's fair to ban smoking inside public housing.  But, I feel it is a violation of taking away one's freedom to choose.  Even God gave us the right to make our own decisions.  Your right, it's probably healthier for all, I know it is for me, I've been smoking for 40 years and I should quit smoking, I want to quit smoking as I wouldn't be able to walk 25 feet to smoke especially in the winter.  But it's my right to make my own decisions, couldn't a compromise be to allow us to smoke on our porches, our apts are far enough away that the neighbors don't have to worry about 2nd hand smoke.  Thank you for listening and I certainly hope you take this into consideration when making your decision.  \n",
      "\n",
      "Cluster 8\n",
      "\n",
      "                 ˇ   ˇ  ˇ       ˇ   ˇ ˇ      ˇ   ˇ                       ˇ  ˇ   ˇ   ˇ   ˇ ˇ  ˇ ˇ ˝ ˛ A MERICAN H ERITAGE          Thank You For Not Smoking | American History Lives at American Heritage http://www.americanheritage.com/content/thank-you-not-smoking?page=show 1 of 7 1/14/2016 10:55 AM  ˇ   ˝   ˛       ˇ   ˇ  ˝ ˛  ˇ  ˇ   ˇ ˇ    ˝  ˛       ˝ ˛  ˝ ˛ ˝  ˇ ˛  ˝ ˛ ˝  ˛  ˝ ˛ ˝  ˛   ˝ ˛   ˝ ˛ ˝  ˛ ˝ ˛  ˇ    ˝        ˛         ˝ ˛ ˝ ˇ ˛ ˝ ˛ ˝ ˛ ˝ ˛ ˝  ˛     ˝ ˛  ˝ ˛  ˝ ˛   ˇ ˇ  ˝ ˛ ˝ ˛ ˝ ˇ ˛   ˝ ˛     ˝  ˛      ˇ  ˇ ˝ ˛   ˝ ˛    Thank You For Not Smoking | American History Lives at American Heritage http://www.americanheritage.com/content/thank-you-not-smoking?page=show 2 of 7 1/14/2016 10:55 AM  ˇ  ˝ ˛      ˝ ˇ  ˝ ˛ ˝ ˛ ˝ ˛  ˝ ˛ ˝ ˛ ˇ ˝ ˛     ˝  ˛  ˝  ˛  ˝ ˛  ˇ ˇ ˇ      ˝ ˇ    ˛    ˝ ˛    ˝   ˘ ˇ   ˛  ˇ      ˝  ˛  ˇ   ˇ    ˇ    ˇ   ˇ  ˇ  ˇ ˝ ˛ ˝  ˛     ˇ           ˝ ˛  ˇ     Thank You For Not Smoking | American History Lives at American Heritage http://www.americanheritage.com/content/thank-you-not-smoking?page=show 3 of 7 1/14/2016 10:55 AM    ˇ                ˝ ˛       ˇ    ˝  ˛                     ˝ ˛  ˝  ˛   ˝  ˛  ˝  ˛ ˝  ˛  ˇ    ˝ ˛ ˝  ˛    ˝ ˛  ˝ ˛   ˝ ˛  ˝ ˛       ˇ  ˝ ˛      Thank You For Not Smoking | American History Lives at American Heritage http://www.americanheritage.com/content/thank-you-not-smoking?page=show 4 of 7 1/14/2016 10:55 AM        ˝ ˛ ˝ ˛  ˝ ˛ ˝ ˛ ˝ ˛ ˝ ˛  ˝ ˛ ˝ ˛ ˝ ˛   ˇ  ˝ ˛ ˝ ˛  ˝ ˛  ˝ ˛ ˝ ˇ  ˛  ˝ ˛   ˝ ˛ ˝ ˛  ˇ ˝ ˛     ˇ ˇ    ˝ ˛  ˇ             ˇ ˇ      ˝ ˛  ˝ ˛       ˝ ˛ ˇ  ˝ ˛ ˝ ˘ ˇ  ˛ ˇ     ˝ ˛ ˝ ˛   ˇ    ˇ ˝ ˛   ˝  ˝ ˛  ˝ ˛    ˝ ˛      ˝  ˛  ˝ ˛   ˝ ˛     ˝ ˛     ˇ   Thank You For Not Smoking | American History Lives at American Heritage http://www.americanheritage.com/content/thank-you-not-smoking?page=show 5 of 7 1/14/2016 10:55 AM  ˝ ˛    ˇ     ˝ ˛           ˝ ˛     ˇ             ˝ ˛ ˝  ˛ ˝ ˛        ˝ ˛  ˝ ˛    ˝  ˛  ˝ ˛            ˇ      ˇ ˇ  ˇ  ˇ     ˝ ˛  ˝       Thank You For Not Smoking | American History Lives at American Heritage http://www.americanheritage.com/content/thank-you-not-smoking?page=show 6 of 7 1/14/2016 10:55 AM           Thank You For Not Smoking | American History Lives at American Heritage http://www.americanheritage.com/content/thank-you-not-smoking?page=show 7 of 7 1/14/2016 10:55 AM \n",
      "\n",
      "Cluster 9\n",
      "\n",
      "  I am an Executive Director of a small 20-unit housing authority of duplexes for elderly and those with a disability. We have residents who smoke inside and this rule will have a major impact on them. The most dramatic part of the Rule is the distance restriction of 25 feet. The Rule's restriction does not take into account that this is the individual's home. I understand restricting the smoking from inside but not the distance from buildings. Most of those who smoke will not change to smoke away from the building. I will probably lose most of those who do smoke. This is going to increase our expenses from move-outs and if we had a 25 feet restriction, we will need to build some type of structure so the resident doesn't have to smoke in the rain, snow, wind, etc. And this structure will be more than just 25 feet from some apartments so some residents will have a long distance to go smoke. I don't believe many of the smokers will remain in the program even though they need the housing assistance. Is that HUD's purpose? To get rid of all the smokers?   I'm not opposed to restricting the smoking inside buildings but the distance restriction is not going to work. Please remove that from your Rule.  \n",
      "\n",
      "Cluster 10\n",
      "\n",
      "                                                                                                                               January  19,  2016   The Honorable Juli á n Castro   Secretary   Department of Housing and Urban Development   451 Seventh Street SW   Washington, DC   20410   Re:   Instituting Smoke - Free Public Housing; Docket No. FR 5597 - P - 02 RIN 2577 - AC97     Dear Secretary Castro:   As  health  organizations dedicated to reducing the death and  disease caused by tobacco use and  exposure to secondhand smoke, we appreciate this opportunity   to comment on the proposed rule  published in the  Federal Register   on November 17, 2015 (Docket No. FR - 5597 - P - 02) on instituting   that   will  greatly improve the he alth of public housing residents. The publication of the proposed rule represents  a major step forward in protecting the  millions of Americans who currently live in federally - owned  public housing from the harms of tobacco.    We urge   the   Department of Housin g and Urban  Development   ( HUD )   to adopt a final rule implementing this measure as soon as possible.   At the same time, our organizations believe the proposed rule could and should  also include  electronic  nicotine delivery systems (ENDS)   and  waterpipe   tobacco   (hookah)   in restricted areas .  Our organizations  also believe that the rule should apply to all government - subsidized housing rather than just all  government - owned housing.  Our comments will expand on   these recommendations   below.     2     Our organizations  want   to make clear:  the only way to protect everyone from the dangers of  secondhand smoke is to make the smokefree policies mandatory and make them apply to everyone.   W hile voluntary smokefree policies have been effective   in   allowing   HUD to determine best pr actices for  smokefree policy implementation, voluntary smokefree policies are not sufficient to protect everyone  from secondhand smoke.   policies that delay implementation beyond the  18   month period or allow case - by - case decisions that  would allow some smokers to still smoke indoors.  A  mandatory policy  that applies to everyone from the  beginning of the policy  is  the  only   way   to ensure everyone can breathe clean, safe air in their homes   and  achieve health benefits .     Secondhand Smoke Exposure Poses   Serious Health Threats to Children and Adults   Secondhand smoke (SHS) contains many poisons and cancer - causing chemicals, including nicotine,  carbon monoxide, ammonia, formaldehyde, hydrogen cyanide, nitrogen oxides, phenol, sulfur dioxide,  lead,  and others. 1   Twenty years ago, in 1992, the U . S .   Environ mental Protection Agency classified SHS as  a Class A known human carcinogen. 2   As such, SHS poses health concerns for all individuals, particularly  children and pregnant women.   The reports of direct health effects of SHS exposure are numerous and growing in   number. The most  comprehensive report of these effects is the 2006 U . S .    The Health  Consequences of Involuntary Exposure to Tobacco Smoke . 3   The report details how even small amounts of  exposure can have serious health effects   and  concludes  that there is no safe level of exposure to  SHS .  SHS can   cause or exacerbate a wide range of adverse health effects, including lung cancer, heart disease,  stroke,  respiratory infections,  sudden infant death syndrome (SIDS)   and asthma. 4   The evidenc e supporting the association of SHS exposure of children with respiratory illnesses is strong.  Increased rates of lower respiratory illness, middle - ear infections, tonsillectomy and adenoidectomy,  cough, asthma and asthma exacerbations, hospitalizations, a nd  SIDS   have been reported. 5   It has been  estimated that SHS exposure causes asthma symptoms in 200,000 to one million children. 6   One study  indicated that children with asthma who were exposed to SHS had additional co - morbid conditions  including higher leve ls of obesity  compared with unexposed children. 7   The scope of these illnesses is  huge: SHS exposure exacerbates many chronic diseases. Children with sickle cell disease who are  exposed to SHS have a higher risk of crises that require hospita lization than do unexposed children. 8   Finally, in addition to the  exacerbating  chronic conditions, SHS is immediately life - threatening, especially  among vulnerable populations such as infants. In one year alone, SHS exposure  is estimated to have  resulted i n the   death of 900 infants. 9   Another effect of SHS exposure is increased school absenteeism. Analysis of data from the National  Health Interview Survey (NHIS) indicated that 24 to 36   percent   of school absenteeism was related to SHS  exposure in children age s 6 to 11. The study also showed that the number of days that a child was  absent from school predictably increased with the number of active smokers in the household. 10   Even  very low levels of SHS exposure, such as  those  seen in a child with a parent who sm okes only outside, 11   have been associated with decreases in reading and math scores. 12   In addition to SHS exposure for developing children and adolescents, prenatal exposure to SHS has been  associated with   low birthweight, prematurity 13 , and   future susceptibility to nicotine addiction  as well as  significant adverse events in childhood development. One of the significant consequences of prenatal  3     tobacco exposure is sensitization of the fetal brain to nicotine, which results in increased likeli hood of  addiction when the brain is exposed to nicotine at a later age. Studies of rodents 14   and primates 15 , 16   that  were exposed prenatally to tobacco have demonstrated subtle brain changes that persist into  adolescence and are associated with tobacco use, ni cotine addiction, and reduced cognitive function. 17   Population - based human studies have demonstrated associations between prenatal tobacco exposure  and early tobacco experimentation 18   as well as increased likelihood of tobacco use  in adolescence  and  adult hoo d . 19   In addition, further research has indicated adverse developmental effects on infants,  children, and adolescents including lessened perceptual skills, deficits in information processing, and a  significantly higher likelihood of being diagnosed with atte ntion deficit hyperactivity disorder (ADHD). 20   Children and the elderly represent a disproportionate ly large   share of fire victims, and smoking  materials are the most common ignition source of fatal residential fires. 21   It has been estimated that  smoking cau ses approximately 30 percent of US fire deaths overall, and that smoking - material fires  accounted for nearly 20   percent   of the 90,000 home structure fire deaths in 2011 according to National  Fire Protection Association data. 22   However, the rate of fire deat hs has decreased as smoking has  decreased, although part of the reduction has been attributed to modifications to cigarette - ignition  resistance in mattresses and upholstered furniture. 23   Residents of  Public   Housing are  Involuntarily  Exposed to Secondhand Sm oke   SHS   is clearly a significant public health hazard, and maintaining a smokefree home is a wise decision to   step  alone is not sufficient to prevent all  exposure to SHS   for residents of multi - unit b uildings . Tobacco smoke does not stay confined within a  single room nor does it stay confined within a single unit in multi - family apartment buildings. Ventilation  systems can distribute SHS throughout a building. 24   SHS can seep through walls and cracks. 25     D ata clearly demonstrate that the residents of smokefree units in multi - family buildings without  smokefree air policies are not safe from tobacco smoke exposure. A Boston - based study published in  2009 measured levels of nicotine, an indicator of SHS exposu re, in 49 low - income units in multi - unit  buildings. Overall, 94 percent of units had detectable nicotine levels, including 89 percent of units where  no one smoked in the home. 26     A 2011 nationally representative study, conducted through the Social Climate S urvey, found that among  individuals who lived in multi - family housing where no one smokes inside the home, 31 percent smelled  smoke in their building. Of these respondents that reported smelling smoke in their building,  approximately half (49 percent) repo rted smelling smoke in their own units, 38 percent reported  smelling smoke in their unit at least once per week, and 12 percent reported smelling smoke in their  unit at least once per day. 27   This nationally representative study confirms the results of sever al state -   and community - level studies measuring prevalence of smoke incursions into smokefree units. 28   This  trend is echoed in a 2012 study that indicated that  although  63 million of the 79 million Americans  who  live in multi - unit housing do not allow smoki ng in their homes approximately 28 million of those  reported secondhand smoke infiltration in their home. 29     Studies published in 2011 and 2012 confirmed that children who live in multi - unit   housing have  significantly higher exposure to  SHS   than those who l ive in detached housing, and that 15 million  children aged 3 - 11 years were exposed to  SHS , representing the highest prevalence of SHS exposure  among all age groups. The studies, using data from the National Health and Nutrition Examination  4     Survey (NHANES),   showed that levels of cotinine, a chemical marker of nicotine in the blood, among  children living in multi - unit   housing were significantly higher   than those of chil dren living in detached  housing ;   and that SHS prevalence  compared with adults  was  second - highest among adolescents aged 12  to 19, only superseded by young children. 30 , 31   Prevention of Secondhand Smoke Exposure  Requires   Smokefree Policies   The above evidence clearly demonstrates that residents of multi - family housing are exposed to  SHS   even   if they live in a unit where no one smokes. Therefore, the only way to fully protect children and  adults who live in multi - family housing from secondhand exposure is to implement building - wide  smokefree air policies. In 2007, the World Health Organization   (WHO) presented its clear conclusion that     percent   smokefree environments [is] the only effective strategy to reduce exposure  to tobacco smoke to safe levels in indoor environments and to provide an acceptable level of protection  from the   dangers of  SHS    32   The organization reaffirmed its recommendation in 2014 and  called for a  prohibition  on the use of  ENDS   indoors due to the risks presented by secondhand exposure  to the devices. 33     Partial smokefree policies,  such as  those that pr ohibit smoking in common areas  such as  hallways, will  not protect all residents from SHS. The 2011 Social Climate Survey showed that multi - unit residents in  buildings with the strongest smokefree air policies were the least likely to report smelling smoke.   The  data also showed that policies that only prohibited smoking in common spaces  and not individual  units  did little to prevent residents from smelling smoke. 34   Research  published in  the  American Journal  of Public  Health   has further  shown   that  SHS   exposure   for nonsmokers persist s   despite separating  smokers from nonsmokers within housing, indicating that partial smokefree policies are not effective in  protecting nonsmokers from harm. 35     Experts in building ventilation agree that keeping  individual   unit s   smoke free is  not  sufficient  to   remov e   health risks.  The American Soc iety of Heating, Refrigerating and   Air - Conditioning Engineers (ASHRAE)   explained in a policy statement   that the only means of effectively eliminating  the  health risk s   associated  with indoor exposure  to  SHS   is to make the   entire indoor area   smokefree. 36   Recent research by public  health professionals has reinforced the fact that scrubbing and ventilating the air in buildings, cannot  completely eliminate exposure SHS and  t he  other harmful substances associated with it. 37     HUD Must Adopt a Nation wide   Smokefree Policy    Our organizations commend the Department of Housing and Urban Development (HUD) for its efforts  over the last several  years  to protect the health of residents of federally assisted housing by encouraging  broader adoption of smokefree policies in public housing. In 2009, HUD first encouraged public housing  agencies (PHAs) to adopt smokefree policies, and in 2010, HUD extended th is recommendation to  owners and management agents of  other  federally assisted housing   programs such as the Housing  Choice Voucher program   (also known as   S ection 8 housing ) . A short time  after   for voluntary adoption of smokefree policie s, HUD partnered with the American Academy of Pediatrics,  the American Lung Association, and the Department of Health and Human Services to publish smokefree  housing toolkits   for   both residents and managers of federally assisted housing , which were intende d to  help   in the implementation   of  smokefree policies. Most recently, in 2014, HUD released further  guidance for PHAs and owners of subsidized housing on   implementing successful   voluntary smokefree  policies in their units.    5     To date, over 600 PHAs have succ essfully implemented smokefree policies in some or all units.  None of  these PHAs  have chosen to reverse smokefree policies after  implementation .  Th ese are   important  indication s   that smokefree policies are achievable   and have widespread acceptability after  they are put  in place . However, the current voluntary approach leaves many residents, including 775,000 children,  unprotected from the dangers of tobacco smoke in their own homes. Our organizations strongly support   using smokefree because the only way to protect all residents  of public housing is to adopt a nationwide smokefree policy.   All people, regardless of income, should be able to enjoy healthy housing, free of  SHS   and  other  dangerous conditions.  As private, hi gher - rent, market - rate buildings increasing ly   go smokefree, it is  important that our poorest and most vulnerable citizens not be left out. T he existing lack of smokefree  air policies   in public housing   disproportionately impacts lower - income families  who cannot move due  to   economic, health or other reasons.   Higher - income individuals are better able to relocate their families  to remove them from an unhealthy environment.  Public housing residents are   more   likely to be  member s of vulnerable populations: 3 8   percent   are children, 31   percent   are seniors, 30   percent   are  disabled, a nd 89   percent    38   Further, many residents in multi - family public housing are renters from low - income populations and are more likely to be ra cial or ethnic  minorities, disproportionately exposing these populations to the dangers of SHS exposure. 39   The 2011  Social Climate Survey showed that multi - family housing residents were more likely to smell smoke in  their building if they received governmen t subsidies for their housing. 40   Clearly, the status quo  discriminates against vulnerable populations.   M ulti - unit housing residents consistently report that they desire smokefree air policies.  A   majority of  residents want smokefree air policies implemented  where they live. 41   One study examined the 2012  voluntary implementation of a smokefree policy by the Boston Housing Authority in its housing,  indicating that a year after implementation 91   percent   knew of  the policy prohibiting smoking indoors   and 82   percen t   were strongly supportive of such a policy in their building. 42     While our organizations believe the health and other benefits of making public housing smokefree are  overwhelming, it is likely HUD will receive some comments  opposing  smokefree housing.   One  argument     While  it may be legal to some in some places, it is subject to restrictions on the time and place of  smoking in order to protect the rights o f non - smokers.    Many jurisdictions in the United States have  placed restrictions on where smoking is permitted to protect the health of nonsmokers, and these  restrictions have been almost universally upheld in court cases.    U.S. law supports many restrict ions on the conduct of individuals that affects their neighbors, including  prohibitions on nuisances such as excessive noise levels. Smokefree air policies in buildings do not  prohibit residents from smoking altogether; they only prohibit residents from sm oking in locations that  can cause harm to their neighbors. People who smoke could still be allowed to smoke in outdoor  locations away from the building that would not pose harm to others. Building - wide smokefree air  policies, therefore, do not infringe on  any protected liberties or freedoms afforded to a person who  smokes. Rather, such policies protect the right of all the children and nonsmokers who reside in shared  indoor environments. 43   Smokefree air policies also have collateral benefits for building man agers as nonsmoking units are  significantly less expensive to turn over than smoking units when a tenant moves out. Because turnover  6     costs are two to seven times higher in homes when smoking is allowed, smokefree policies in public  housing can result in mi llions of dollars in savings to PHAs and property managers annually. 44 , 45   Because  the risk of fire is   also   reduced when smokefree air policies are implemented, some insurance companies  offer discounts on property casualty insurance. 46   Reductions in SHS will a lso lead to lower costs to  society, both from decreased health care costs and improved productivity. Smokefree policies may also  encourage existing smokers to quit.   As with any worthwhile public health innovation, there will undoubtedly be implementation c hallenges.  However, as HUD points out, hundreds of PHAs have already implemented smokefree air policies and  found that these challenges are anything but insurmountable. We urge HUD to closely analyze the  comments received in this docket in order to fully u nderstand how these obstacles have been  successfully addressed and overcome in many communities around the nation. We believe that many  commonly cited objections to smokefree air policies  such as a concern that  such measures  will  increase undesirable loite ring outside buildings  have not  posed  significant  problems  when a policy is  actually implemented.   Enforcement has been raised as a particular challenge, with some arguing that smokefree air policies  will result in  increased evictions.  Displacement and/or e viction of residents is an important issue that  can have health and other unintended consequences for residents.   Our organizations have seen that  proper implementation using resources developed by HUD, as well as consistent and uniform  enforcement can pre vent almost all of these challenges.  In addition,  smokefree policy violations should  be treated like any other housing policy violation , e.g.   restrictions on noise levels   and should be  addressed, enforced and respected in the same manner and consistency as   any other housing provision.   Eviction is often a means of last resort for any lease violation and  public housing officials whose  properties have gone smokefree share th at evictions are very rare.     Some have also argued that smokefree policies discriminat e against disabled individuals who may be  less able to smoke outside. In fact,  however,  smoking inside buildings discriminates against the greater  majority of nonsmoking disabled individuals because they cannot escape tobacco smoke infiltrating their  own a partments.  Smoking is not a basic human need and therefore does not require reasonable  accommodation under the Americans with Disabilities Act.    Nicotine addiction can be addressed using  available, safe,  Food and Drug Administration (FDA)   - approved options   to help smokers quit . These  five  forms of nicotine  replacement therapy  are  available as gum, patch, lozenge, nasal spray, and inhaler   as  well as two non - nicotine medications,  b uproprion and  v arenicline .  Research has shown that with  assistance, smokers can   quit.  Studies have also shown that at least 70 percent of smokers say they want  to quit and over half have made a quit attempt in the past year. 47 , 48    We recognize that some smokers,  especially those with behavioral health or substance abuse issues, may ne ed specially tailored cessation  treatments  that specifically address these issues. In many circumstances those tailored treatments can  be accommodated by working with local health departments and partner organizations .   Overall, the  rights of the disabled  population, including disabled children , veterans,   and those with respiratory  disabilities, are best protected by smokefree building policies that ensure a safe environment for all  residents. 49      Responses to Specific Questions   1.   What barriers that PHAs could   encounter in implementing smokefree housing? What costs could  PHAs incur? Are there any specific costs to enforcing such a policy?   7     Our organizations recognize the greatest challenges to and barriers with implementation are  significantly reduced when there is sufficient lead time before a smokefree policy takes effect.   This time  allows staff to be trained and residents to be empowered  to participate in the rollout and  implementation of the policy.   Resident involvement from the beginning leads to greater buy - in and with  that buy - in comes greater compliance.   Examples of such involvement can include:       Educat ing   staff about why smokefree po  how smokefree policies will lead to reduced fire hazards and how maintenance   costs for units  are   reduced and  turn - over  costs are lower for non - smoking units.       C onduct ing, if resources permit,   a pre -   a nd post - implementation air quality study to detect  SHS   levels in common and non - smoking units.        Conduct ing   resident surveys (please see Appendix A) and focus groups to inform the  development of the smokefree policy.        Schedul ing   multiple meetings with resid ents 2 - 3 months before the policy will go into effect to  share results from the survey, educate residents about the dangers of  SHS , and announce  and/or provide resources for residents who want to quit smoking.      Provid ing   sufficient notification, including l ease addendums and signage, making the policy  known and clear.      Allow ing   residents to help decide where the outside gathering spot for smokers will be.   A kick - off event for residents to celebrate the start of the new smokefree policy has also been a  success ful tactic used by PHAs that have already gone smokefree.      Barriers and less successful implementation are more common when there has been a lack of ad vance   communication with and education of residents.   In a 2010 survey of all public housing authorities  in  Minnesota, conducted by  the Public and Indian Housing   Minneapolis Field Office, the Office of Healthy  Homes and Lead Hazard Control and the American Lung Association of the Upper Midwest,  respondents  were   asked about ob stacles to implementing a smoke fre e policy .   C ompliance and enforcement  were  the  top   obstacle s named   (30%) followed by accommodating current smokers (19%) and losing occupants  (17%). 50     While our organizations urge that everything be done  to help smokers quit, our organizations recognize  the   importance of accommodating those smokers who may not be initially successful.  Previous PHAs  have found that creating  a covered gathering space for smokers or  providing  ashtrays   to be a very  worthwhile expenditure.   Other costs associated with implementin g a smokefree policy mainly relate to  informing residents of the policy, including securing signatures on lease addendums, printing fliers and  purchasing smokefree signs.   However,  as previously mentioned,  smokefree policies will ultimately save  PHAs money   through lower operating and turnover costs for smokefree  units   as opposed to housing  that has been partially or never smokefree .   A 2012 study found that operating costs were lower for  smokefree housing than partially or never smokefree housing properties. 51     As stated above, our organizations strongly recommend HUD include the prohibition of  ENDS  and  waterpipe   tobacco (hookah)   in the final smokefree policy.   Exempting ENDS and hookah  may  make  effective  enforcement   of smokefree policies more difficult.  For ex ample, the  Duluth, Minnesota housing  authority, which allowed e - cigarette use after otherwise going smokefree, reported that when their staff  smelled cigarette smoke, they would knock on the door and residents told them they were using  ENDS . 52     8     Several  early   smokefree policies  were not   comprehensive and did not address smoking on balconies,  patios or by entrances, which also caused implementation challenges.   Our organizations support the  HUD proposal, which addresses both of these issues and protects ten ant health and safety.       As with any policy, staff time will be required for training and communication.   PHAs that have already  gone smokefree have found that staff time associated with enforcement is minimal and similar to the  enforcement of noise and oth er nuisance complaints.     2.   Does this proposed rule adequately address the adverse effects of smoking and secondhand smoke  on PHAs and PHA residents?   In general, for the reasons described above, this proposal  effectively addresses  the adverse effects of  smoki ng and  SHS . However, the proposal could better address these adverse effects by: (1) ensuring  that the policy applies to all federally supported housing, including privately owned housing, (2)  extending  the policy to playgrounds, (3) extending the policy t o   e lectronic nicotine delivery systems  (ENDS), and (4) extending the policy to  waterpipe tobacco ( hookah ) . Each of these issues is discussed in  more detail below.   3.   Does this proposed rule create burdens, costs, or confer benefits specific to families, child ren, persons  with disabilities, owners, or the elderly, particularly if any individual or family is evicted as a result of  this policy?   The U.S. Surgeon General has found there is no safe level of exposure to  SHS . 53   Making all PHAs  smokefree   will lead to an increased quality of life and increased health for every PHA resident, staff  member and visitor.   Residents with health conditions including asthma, chronic obstructive pulmonary  disease (COPD) and heart disease, will see significant health   improvements once they are no longer  exposed to  SHS , which can exacerbate their diseases.     Youth, children and infants will also significantly  benefit.  SHS   exposure among infants and children causes ear infections, asthma attacks, lung infections  includin g bronchitis and pneumonia and causes an increased risk of sudden infant death syndrome  (SIDS). 54 , 55 , 56     The benefits of PHAs becoming smokefree will be realized by individuals and families who face  significant disadvantages. According to the Department of Ho using and Urban Development, 45 percent  of PHA residents are African American (compared to 13.2% of the general population), 37 percent are  children (compared to 23.1% of the general population) and 95 percent are low to extremely low  income.   57   Protecting  these vulnerable populations from the dangers of  SHS   is likely to have a dramatic  impact   and proper implementation will go a long way in addressing the unintended consequences     including eviction and displacement     associated with this policy .       The regul atory impact analysis discusses but does not inc l ude the benefits to smokers who will quit as a  result of the new smokefree policy.  Approximately 70 percent of smokers want to quit smoking, and  adoption of this smokefree policy increases the likelihood th at smokers will quit smoking.  58 Smokers  who successful ly   quit can dramatically improve the quality and length of their lives.     Another financial benefit not properly accounted for in the re gulatory impact assessment   is reduction in  lost productivity costs  attributed to asthma.    absenteeism and when children miss school, their parents miss work. 59    As a result, asthma has a  tremendous economic toll  --   $3.8 billion annually     caused by lost productivity re sulting f rom missed  9     school and work days. 60    In addition to the reduction in healthcare costs that come from a decreased  number of asthma exacerbations, improving the health of individuals with asthma living in public  housing will also reduce the number of  school and work days missed.     The Centers for Disease Control and Prevention  (CDC)  estimates that cost - savings for renovation costs  will total almost $43 million each year. 61   The smokefree policy will have significant benefits for owners,  who may also expe rience reduced fire insurance costs, as well as residents.    The policy would  also significantly reduce risk for both human and property losses caused by fires.   According to the U.S. Fire Administration, smoking is the leading cause of fatal fires in reside ntial  structures. 62   In the proposed rule, it is estimated there will be a $32 million annual cost savings as the  result of the reduction of fires in PHAs     10 times greater than the regulatory impact analysis estimate of  compliance by PHAs for this regulati on.       Residents who smoke and have mobility issues may have greater challenges with repeat trips outside to  smoke and meet a new smokefree policy that requires smokefree balconies and patios, as well as a 25  foot smokefree zone.   While it is imperative that   smokefree laws be adopted to protect the public    health , some PHAs have worked in advance  with residents who smoke  to relocate them to units closer  to exits or to elevators.   This underscores the need to help all residents, especially those who may have  these physical challenges, with cessation treatments.   A Rhode Island PHA found when it went smokefree  that onsite smoking cessation counseling sessions     either group or one - on - one     were especially  important for and utilized by the elderly and disabled. 63   Evictions must be the very last resort to smokefree policy violations.   As with any other lease violations,  there should be multi - step consequence procedures for infractions.   Smokefree PHAs found that regular  dialogue and direct engagement with smokers, inc luding providing tips on how to comply with the  policy, can lead to success.   Lake County, Illinois Housing Authority begin its smokefree policy in 2008  and while there  were   some documented violations of the policy, there have been no evictions. 64    Duluth,  M innesota      which fully implemented its smokefree policy in 2010     only had one eviction related to its  smokefree policy and PHA officials said that violating the smokefree policy was not the only violation   65   4.   For t hose PHAs that have already implemented a smoke - free policy, what exceptions to the  requirements have been granted based on tenants' requests?   The policy proposed by HUD is to make PHAs smokefree in order to protect all residents, especially  children and o ther vulnerable residents, from the proven dangers of  SHS . Our organizations oppose   a  provision will lead to  enforcement challenges but more importantly, will continue to expos e residents to the dangers of  SHS .   For example, the Duluth,  Minnesota   PHA   not   fundamentally change the nature    of the program or policy. 66   Any exceptions or allowances for  certain tenants to continue to smoke in their units would fundamentally change the nature of the  smokefree policy, which is meant to protect everyone from the dangers of  SHS .   It would also reduce the  savings from maintenanc e costs and increase fire risk relative to a completely smokefree policy.     Instead, as outlined previously, our organizations suggest that building staff work with residents with  physical challenges or mental illnesses who smoke to ens ure they understand t he policy.   Staff might  10     instead relocate smokers so they are closer to elevators or exits to make  outdoor access   easier on  residents.   Further, staff may work with residents who refuse to comply with new smokefree policies to  allow them to move without incur ring expenses related to breaking their lease.    units.   In Duluth, MN, the PHA phased in smokefree policies across a series of buildings, and the last two  were phased in after a year. In addition to the  SHS   exposure continuing for residents in the final two  buildings, a fatal fire occurred in one of the two remaining buildings that allowed smoking indoors.     5.   For those PHAs that have already implemented a smok e - free policy, what experiences, lessons, or  advice would you share based on your experiences with implementing and enforcing the policy?   Our organizations fundamentally recognize the importance of clearly articulating that smokefree polic ies   are   about protecting everyone from  SHS   and not about smokers . Residents must understand that  while  they do not have to quit smoking to live in the building,  they must help maintain a smokefree  environment within the smokefree perimeter established around the b uilding, including inside the  structure .   While our organizations strongly encourage PHAs to partner with local departments of health,  hospitals, community health centers and nonprofit organizations to assist residents who want to quit  smoking, the emphasis   must be on protecting everyone from the dangers of  SHS .     PHAs that have already implemented such policies found that communication and education  were  key  to success.   They also found that a long lead time  was  important to allow for sufficient communication   and education. In some cases, education of staff and residents began more than a year in advance of the  smokefree implementation date so that residents had time to get the help they needed to make a  successful quit attempt. An implementation plan with a l ong lead time also allows for resident surveys  to be conducted,  for sufficient  notice  for residents  about the impending change,  for  staff and resident  education sessions, for signage to be created and for cessation services to be arranged for residents.    B asic education about the dangers of  SHS   and how smoke can migrate between units is necessary. While  many staff and residents may understand that exposure to  SHS   is not healthy, they may not fully  understand how dangerous it is and how it infiltrates betwee n units in multi - unit housing. Officials in  Rhode Island found that most residents wanted to be good neighbors but did not realize that smoke  travelled into nearby units. Another housing authority official found it helpful to ask residents if they  could sm  SHS   travels  similarly.     Other suggestions from smokefree PHAs and our organizations that worked with them include:      Work ing   with tenants to determine whether a designated outside smoking area is appropriate  and if so, where it should be.       Ensur ing   addendums for smokefree policies are included in the lease that outline violations and  consequences.       Document ing   each infraction o f the smokefree policy so that a  record   of all communications  with residents  is  created     including efforts to assist tenants in addition to enforcement.        Listen ing    ing   them ample lead - in time to adjust to the new policy  but a lso enforce it.    11        Help ing   staff and residents understand how smokefree policies will benefit both them and their  neighbors     from the health benefits to the cost savings associated with maintenance and  reduction in fire dangers.          Provid ing   resources to smo kers who want to quit smoking to ensure they have help doing so.  PHAs that are already smokefree have noted that offering cessation assistance  before   the policy  takes effect is critical.       Our organizations also understand and have seen that the vast major ity of tenants are happy with  smokefree policies after they are implemented.   This mirrors satisfaction with smokefree regulations put  in place in other environments including bars , restaurants, and workplaces.   6.   For those PHAs that have already implemented a   smoke - free policy, what tobacco cessation services  were offered to residents to assist with the change? Did you establish partnerships with external  groups to provide or refer residents to these services?   Anecdotal reports from many PHAs that have already   implemented a smokefree policy found that  providing  smoking cessation  services well in advance of the implementation date helps smokers prepare  for implementation and reduce policy violations. In addition, providing quit smoking resources for a  period  after implementation helps smokers who are having trouble quitting and can even show goodwill  on the part of the PHA.       Many of the PHAs that are already smokefree have referred residents to state Quitlines for services.  Some quitlines provide free nicotin e replacement therapy to callers in addition to providing counseling  services. 67   The U.S. Public Health Service has found that combining FDA - approved quit smoking  therapies with counseling services are the most effective for successful quit attempts. 68   Many  PHAs have found it helpful to partner with local public health groups and/or hospitals. The  American Lung Association has worked with PHAs to provide cessation resources via door hangers   and   resident education sessions, tied quitting with promotions such a  American Smokeout, and provided fliers and quit kits for distribution.   In a number of instances, a local  hospital provided group counseling to residents. Rhode Island PHA officials found that onsite cessation  counselin g sessions were most important for elderly and disabled residents, whereas other residents  may find Quitline or text messaging to be more accessible. 69     Recognizing the significant overlap between PHA residents and Medicaid recipients, state Medicaid  progra ms also have the opportunity to increase access to quit smoking benefits including medications  and counseling. According to the American Lung Association, only three state Medicaid programs cover  a comprehensive quit smoking benefit and another 27 states c over all seven FDA - approved medications .  Virtually a l l states still have significant barriers that make it harder for smokers to access that benefit. 70   Partnerships between PHAs, health departments and Medicaid staff can increase access to coverage and  serv ices that will ultimately help residents quit smoking.    Other partnerships might include federally qualified health centers and local health departments that  can also assist smokers in getting the help they need to quit.  We strongly recommend that HUD  cont inue to provide resources and best practices for PHAs to link their residents who smoke to the  cessation services available.    12     7.   Are there specific areas of support that HUD could provide PHAs that would be particularly helpful in  the implementation of the pr oposed rule?   Representatives from many of our organizations who have worked with PHAs recommend:      Template signage, including multiple choices to allow for a variety of building layouts;       Toolkits containing sample timelines on how best to implement smokefr ee policies, education  materials for staff and residents, including sample resident surveys, lease addendums, a sample       8.   Should the policy extend to electronic nicotine delivery systems, such as   e - cigarettes?   Smokefree policies should extend to the use of electronic nicotine delivery systems (ENDS).   The  nicotine - containing liquid aerosolized by ENDS  has been found to  contain several harmful compounds,  including heavy metals and tobacco - specific n itrosamines, which  can be  carried over from the tobacco  into the liquid during the nicotine extraction process. 71 , 72   Even propylene glycol, a main ingredient of   respiratory irritation for those exposed to exhaled vapor, even in non - asthmatic patients. 73     There is insufficient research on the long - term effects of using e - cigarettes, which involves regular  inhalation of nicotine, glycerin or some other solvent, and  other additives. 74   According to the CDC, e -  75   E - cigarette aerosol  contains nicotine, which is absorbed by users and bystanders. 76   Studies have found other chemicals and  toxins  present in some e - cigarettes,  including formaldehyde, acrolein, volatile organic compounds like  toluene, tobacco - specific nitrosamines, and metals like nickel and lead. 77   These compounds are  generally present at levels much lower than in cigarette smoke, al though the compounds themselves   78   Because e - cigarettes are not yet  regulated by the FDA and are available in hundreds of different brands 79 , there is no way for consumers  to know for sure  what is in the products or the aerosol. 80   P reliminary animal model data  has shown   damage to growing lungs resulting from second - han d exposure to  ENDS  aerosols . Two studies show  developmental changes and organ effec ts in mice exposed to ENDS aero sols. 81   T he n egative health  impact of   ENDS  on   non - users, including   children ,   deserves more research.    In addition,  the manufacture of ENDS   is currently unregulated by the federal government and there is  not a  standardized method for safety testing. Recent studies have  shown that due to the extensive  variability in design and function, as well as the relative ease with which users may make modifications  to the battery, case, and heating element of these products, explosion and fire hazards have been seen  with these produ cts. 82   An October 2014 report from the U.S. Fire Administration found that improper  use of charging devices can lead to explosion and fire and that because of the shape and size of  ENDS ,   83     In  2015, the Federal Aviation   ENDS   in checked bags.  In the alert, the  FAA highlighted examples of  ENDS   that have caught fire when the heating element was activated by  accident. 84   The report and alert highlight the risk posed to housing units from  ENDS   and underscores  that from a safety perspective,  ENDS   use indoors should also be prohibited.    Lastly, use of ENDS in smoking - restricted areas would make it more difficult to enforce s mokefree  policies since use of ENDS often looks indistinguishable from cigarette smoking.      13     9.   Should the policy extend to waterpipe tobacco smoking? Does such smoking increase the risk of fire  or property damage?   Smokefree policies should extend to the use o f   waterpipe tobacco   ( hookah ) . According to the CDC ,  SHS   from hookah     which comes from both the tobacco and the charcoal typically used to heat it     poses  health risks to nonusers. 85   A study conducted in Virginia showed that air quality in waterpipe cafes  w as  worse than in restaurants that permitted cigarette smoking. It also showed that air quality in non - smoking rooms in waterpipe cafes was poor, demonstrating how  SHS   from hookah can easily travel to  adjacent spaces. 86   One study showed that the exposure   of  nicotine, tobacco - specific nitrosamines, and  cilia/cardio - toxins such as acrolein in children in the homes of daily, and even weekly or monthly,  hookah smokers was significantly higher than in children living in nonsmoking environments,  representing a seri ous threat to child health. 87   The heat source  used with hookah  also poses risks of  fire  and other property damage.   Additional  Recommendations   25 - Foot  Buffer Zone   Our organizations are supportive of the proposed  25 - foot buffer zone from entrances, exits, win dows  and ventilation  intakes of   buildings in the proposed rule , and including patios and balconies in the  policy .  This buffer zone will assist with enforcement by ensuring that  SHS   does not drift back into living  units from outside or require residents ,  staff or visitors   to walk through clouds of  SHS   around entrances  or exits from buildings.    One study that looked at  SHS   exposure outside restaurants and bars found that  exposure to  SHS   was higher than normal outdoor air levels. 88    Some early adopters of smo kefree policies  that did not include a sufficient buffer zone, or allowed smoking to continue on balconies and patios   that  SHS   still came into units when   smoking occurred on balconies, patios or outside windows.       Implementation Timeframe    of the  final regulation being released.  Experiences from the PHAs th at are already smokefree show that  an effective implementation can occur within an 18 month period.  That will allow PHAs to  educate their  staffs, empower and involve their residents in implementation, secure addendums for leases and work  with public healt h partners to ensure residents who want to  quit can get the help they need.    Our organizations also encourage  HUD to finalize this rule within six months   to ensure adequate  implementation before the end of the Administration .     Inclusion of  All   Federally S upported   Housing   The proposed rule would  only apply to public housing, but would not apply to housing units in mixed - finance developments . It would also not apply to p rivately owned, federally sub sidized multifamily  housing such  as  project - based Section 8  housing. The type of housing program a family participates in  should not dictate whether that family is protected from the harms of  SHS . We strongly urge HUD to  apply the smokefree housing rule to all types of housing that are supported by the federal gove rnment.   HUD has been a leader in protecting  children living in housing supported by programs such as Section 8  from the hazards of lead - based paint. SHS exposure has been linked to higher blood lead levels in  14     children. 89   Extending smokefree policies to Sect  efforts to protect the negative health consequences associated with lead exposure.   If HUD chooses not to require all supported housing to implement smokefree   policies, we suggest that  HUD, at a minimum, include smokefree policies in all model lease language published by the agency.   Inclusion of Playgrounds   The proposed rule specifies that PHA s   may prohibit smoking near playgrounds, but unfortunately stops  shor t of requiring that smokefree policies extend to outdoor spaces designed for use by children. We  strongly recommend that the final rule extend the smokefree policy to playgrounds outside the 25 - foot  buffer zone around buildings. It would be  a  serious missed  opportunity if this rule protects children from  SHS   in their homes but fails to protect them where they play outdoors. Therefore, we recommend that  playgrounds and other outdoor facilities intended for use by children be added to the definition of      a 25 - foot buffer zone around such  playgrounds.   Clarification on Indoor Spaces    units and interior common  areas .    We recommend that    from this paragraph in order to clarify that  smoking would be prohibited throughout the entire building. For instance, this would clarify that indoor  spaces where residents are not typically allowed, such as utility rooms and m aintenance facilities, would  also be included in the smokefree policy.   Clarification on  Ability to Prohibit All Tobacco Products    recommended expanding the proposal t o include ENDS and hookah. If HUD chooses not to extend the  policy to either ENDS or hookah, we urge HUD to specify in §965.653 that PHA s   may choose to do so  voluntarily.   Conclusion   Thank you for moving forward on this critical public health issue. We look   forward to continuing to work  with HUD to promote healthy living environments, free of exposure to  SHS , for all children and adults.  Many of our organizations also advocate for smokefree workplace laws as well as policies to ensure that  all smokers have a ccess to proven cessation services to help them quit, particularly smokers who are  newly insured, Medicaid - eligible, and uninsured.   If you have any questions, please contact James  Baumberger at the American Academy of Pediatrics (202.347.8600) or Erika Sw ard at the American Lung  Association (202.785.3355).       15     Sincerely,   Action on Smoking & Health   Alpha - 1 Foundation   American Academy of Family Physicians   American Academy of Oral and Maxillofacial     Pathology   American Academy of Otolaryngology    Head and   Neck Surgery   American Academy of Pediatrics   American Association for Respiratory Care   American Cancer Society Cancer Action    Network   American College of Osteopathic Surgeons   American Congress of Obstetricians and Gynecologists   American Heart Association    American Lung Association   American Osteopathic Academy of Orthopedics   American Public Health Association   American School Health Association   American Society of Addiction Medicine   American Thoracic Society   Association o f State & Territorial Health Officials   Campaign for Tobacco - Free Kids   Cancer Prevention and Treatment Fund   ClearWay Minnesota   Community Anti - Drug Coalitions of America   COPD Foundation   Geographic Health Equity Alliance   Green and Healthy Homes Initiative   International Association for the Study  of Lung Cancer   March of Dimes   National African American Tobacco Prevention Network   National Association of County and City Health Officials   National Hispanic Medical Association   National La tino Alliance for Health Equity   National Network of Public Health I nstitutes      North American Quitline Consortium   Oncology Nursing Society   Prevention Institute   Society for Public Health Education     16     1   US Department  of Health and Human Services.  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Roberts KH,                                                                17                                                                                                                                                                                                      Munafo MR, Rodriguez D, et al. Longitudinal analysis of the effect of prenatal nicotine exposure on  subsequent smoking behavior of offspring.  Nicotine Tob Res . 2005; 7(5):801  808.   20   Cornelius MD and NL Day. Developmental consequenc es of prenatal tobacco exposure.  Curr Opin Neurol.  April  2009; 22(2):121 - 5. See also  Weitzman M, S Gortmaker, A Sobol. Maternal smoking and behavior problems of  children.  Pediatrics . Sep 1992, 90 (3) 342 - 349.   21   Barillo DJ, Goode R. Fire fatality study: dem ographics of fire victims.  Burns . 1996;22(2): 85  88. Copeland AR.  Accidental fire deaths: the 5 - year Metropolitan Dade Country experience from 1979 until 1983.  Z Rechtsmed .  1985;94(1):71  79. Squires T, Busuttil A. Can child fatalities in house fires be pre vented?  Inj Prev.   1996;2(2):  109  113. Whidden P. Deaths of children in house fires.  BMJ . 1996;312(7029):511.   22   Hall JR. The smoking - material fire problem. National Fire Protection Association. July 2013.  http://www.nfpa.org/~/media/files/research/nfpa - reports/major - causes/ossmoking.pdf?la=en .    23   Leistikow BN, Martin DC, Milano CE. Fire injuries, disasters , and costs from cigarettes and cigarette lights: a  global overview.  Prev Med . 2000;31(2 pt 1):91  99.   24   Spengler JD. Buildings operations and ETS exposure.  Environ Health Perspect . 1999; 107(suppl 2):313  317.   25     http://www.cancer.org/cancer/cancercauses/tobaccocancer/secondhand - smoke .    26   Kraev   TA et al. Indoor concentrations of nicotine in low - income, multi - unit housing: Associations with smoking  behaviours and housing characteristics.  Tob Control . 2009 Dec;18(6):438 - 44.   27   Wilson, et al. Tobacco Smoke Incursions in Multi - Unit Housing. Pediatric   Academic Societies Meeting. 29 April  2012. Boston, MA. E - PAS2012:2410.4.   28    - free policies.  Nicotine Tob  Res . 2010 Jun;12(6):598 - 605. Hennrikus, D. et al. Preferences and pra ctices among renters regarding smoking  restrictions in apartment buildings. Tob Control. 2003 June; 12(2): 189  194. Hewett MJ et al. Secondhand  Smoke in Apartment Buildings: Renter and Owner or Manager Perspectives.  Nicotine  &  Tob acco   Res earch .  2007 Jan;9  Suppl 1:S39 - 47.   29   Fallin et al. A short online community readiness survey for smoke - free policy.  Nicotine & Tobacco Research .  2012; 14(12): 1494.   30   Wilson et al. Tobacco - Smoke Exposure in Children Who Live in Multiunit Housing.  Pediatrics . 2011; 127(1): 85 - 92.   31   Homa DM et al. D isparities   o secondhand smoke - United States, 1999 - 2012.  Morbidity  and Mortality Weekly Report .   2015;64(4):103 - 108.   32   World Health Organization (WHO).  P rotection from exposur e to secondhand tobacco smoke: P oli cy  recommendations.  WHO Press .   2007 .   33   Lacobucci G. WHO calls for ban on e - cigarette use indoors.  British Medical Journal . Aug. 2014; 349:g5335.   34   Wilson, et al. Tobacco Smoke Incursions in Multi - Unit Housing. Pediatric Academic Societies Meeting.   29 April  2012. Boston, MA. E - PAS2012:2410.4.   35   Wilson KM et al .  T obacco  smoke incursions i n multiunit housing.  American Journal of Public Health . 2014  Aug;104(8):1445 - 1453.   36   American Society of Heating, Refrigerating and Air - Conditioning Engineers  Envi ronmental Toba  2010. Available at  http://www.ashrae.org/File%20Library/docLib/About%20Us/PositionDocuments/ASHRAE_PD_Environmental _Tobacco_Smoke_2010.pdf .   37   Homa DM et al. D isparities   o secondhand smoke - United States, 19 99 - 2012.  Morbidity  and Mortality Weekly Report .   2015;64(4):103 - 108.   38    http://www.healthandpublichousing.org/pdfs/Demographics%20Fact%20Sheet.pdf.   39   Second hand smoke and multi - unit housing in Gilroy: A desktop health impact assessment. Santa Clara Public  Health Department. January 2014 :  https://www.sccgov.org/sites/sccphd/en - us/Partners/Data/Documents/Tobacco/report_Secondhand_Smoke_Gilroy_jan2014.pdf .    40   Wilson, et al. Tobacco Smoke Incursions in Multi - Unit Housing. Pediatric Academic Societies Meeting. 29 April  2012. Boston, M A. E - PAS2012:2410.4.   41    - free policies.  Nicotine Tob  Res . 2010 Jun;12(6):598 - 605. Hennrikus, D. et al. Preferences and practices among renters regarding smoking  18                                                                                                                                                                                                      restrictions i n apartment buildings.  Tobacco Control . 2003 June; 12(2): 189  194. Hewett MJ et al.  Secondhand Smoke in Apartment Buildings: Renter and Owner or Manager Perspectives.  Nicotine Tob Res .  2007 Jan;9 Suppl 1:S39 - 47.   42   Rokicki    - free policy in Boston multiunit housing.  Nicotine &Tobacco Research . 2015 Oct.;1 - 8.     43   Winickoff JP, Gottlieb M, Mello MM. Regulation of smoking in pub lic housing.  NEJM.      44    -  http://www.nchh.org/Portals/0/Contents/Green%20Factsheet_Smokefree.pdf .   45   Ong MK et al. Estimates of smoking - related property  costs in california multiunit housing.  American Journal of  Public Health . March 2012; 102(3):490 - 493.   46    -  http://www.nchh.org/Portals/0/Contents/Green%20Factsheet_Smok efree.pdf .   47    2008. Available at  http://www.ahrq.gov/clinic/tobacco/treating_tobacco_use08.pdf .   48   Centers for Disease Control and Prevention. Quitting smokin g among adults     united states, 2001 - 2010.  Morbidity and Mortality Weekly Report . 11 Nov. 2011; 60(44):1513 - 45.   49   Winickoff JP, Gottlieb M, Mello MM. Regulation of smoking in public housing.  NEJM.      50   Appendix   B    51   Ong MK et al. Estimates of smoking - related property costs in california multiunit housing.  American Journal of  Public Health . March 2012; 102(3):490 - 493.   52    - Free Housing Autho  Panel Discussion,   Harvard Catalyst Population Health Research Program,   Boston, December 3, 2015.   53   U.S. Department of Health and Human Services.   The Health Consequences  of Involuntary Exposure to Tobacco  Smoke: A Report of the Surgeon General .   Atlanta: U.S. Department of Health and Human Services, Centers  for Disease Control and Prevention, Office on Smoking and Health, 2006.   54   U.S. Department of Health and Human Services .   The Health Consequences of Smoking  50 Years of Progress: A  Report of the Surgeon General .  Atlanta: U.S. Department of Health and Human Services, Centers for Disease  Control  and Prevention, Office on Smoking and Health, 2014.   55   U.S. Department of Health and Human Services.   A Report of the Surgeon General: How Tobacco Smoke Causes  Disease: What It Means to You .  Atlanta: U.S. Department of Health and Human Services, Centers for Disease  Control and Prevention, National Office on Smoking and Health, 2010.   56   U.S. Department of Health and Human Services.   The Health Consequences of Involuntary Exposure to Tobacco  Smoke: A Report of the Surgeon General .   Atlanta: U.S. Department of Health and Human Services,  Centers  for Disease Control and Prevention, Office on Smoking and Health, 2006.   57    Development of the HUD Smoke - Free Housing Initiative  Panel Discussion,   Harvard Catalyst Population Health Research Program ,   Boston, December 3, 2015.   58   Centers   for Disease Control and Prevention (CDC. \"Quitting smoking among adults -- United States, 2001 - 2010.\"  MMWR. Morbidity and mortality weekly report   60.44 (2011): 1513   59    http://www.cdc.gov/healthyschools/asthma/index.htm .  Accessed January 7, 2016.   60   Barnett SBL, Nurmagambetov TA. Costs of  asthma in the United States: 2002  2007. J Allergy Clin Immunol  2011;127:145  52.   61     tober 2014). Available at  http://www.cdc.gov/pcd/issues/2014/pdf/14_0222.pdf .     62   U.S. Fire Administration, Residential Structure and Building Fires, page 20. Available at  http://www.usfa.fe ma.gov/downloads/pdf/publications/residential_structure_and_building_fires.pdfd.   63      Smoke - Free Housing     Harvard Catalyst Population Health  Research Program,   Boston,  3  Dec .   2015.   64   Lake County   Housing Authority. Discussion,   White House Convening, Washington, January 6, 2016 .   65      Smoke -  Panel Disc ussion,   Harvard Catalyst Population Health Research Program ,   Boston, December 3, 2015.   19                                                                                                                                                                                                      66   Housing and Redevelopment Authority of Duluth, MN. Available at  http://www.duluthhousing.com/faq/ .   67   North American  Quitline Consortium. 2013. Results from the 2013 NAQC Annual Survey of Quitlines. Available at     68   US Public Health Service. Treating tobacco use and dependence: 2008 update. Clinical practice guideline.  Rockville , MD: US Department of Health and Human Services, US Public Health Service; 2008. Available at  http://www.ahrq.gov/professionals/clinicians - providers/guidelines - recommendations/tobacco/index.html .    69      Smoke - Free Housing     Harvard Catalyst Population Health Research Program,   Boston, December 3,  2015.   70   Singleterry J, Jump Z, DiGiulio A, et al. State Medicaid coverage for tobacco cessation treatments and barriers to  coverage  United States, 2014  2015. MMWR Morb Mortal Wkly Rep 2015;64:1194  9.   71   Goniewicz M., et al. Levels of se lected carcinogens and toxicants in vapor from electronic cigarettes.  Tobacco  Control . March 2013; 0:1 - 7.    72   Offermann FJ. Chemical emissions from e - cigarettes: Direct and indirect (passive) exposures.  Building and  Environment . November 2015 ;93(P1):101 - 105 .   73   Wieslander C., et al. Experimental exposure to propylene glycol mist in aviation emergency training: Acute ocular  and respiratory effects.  Occupational and Environmental Medicine . 2011; 58(10):649 - 655.   74    http://www.cdc.gov/tobacco/campaign/tips/diseases/dual - tobacco - use.html#ten .   Accessed November 19, 2015.     75    November 19, 2015.   http://www.cdc.gov/tobacco/stateandcommunity/pdfs/ends - key - facts2015.pdf     76    http://www.cdc.gov/tobacco/campaign/tips/diseases/dual - tobacco - use.html#ten .   Accessed November 19, 2015.     77    Tobacco  Control  23:ii11 - ii17, May 2014.   http://tobaccocontrol.bmj.com/content/23/suppl_2/ii11.full  carcinogens and toxicants in vapour from ele  Tobacco Control  23(2):133 - 9, March 6, 2013.    PlosOne,  8(3), March 2013. See also Williams, M,    http://www.trdrp.org /docs/Williams%20ecig%20vapor%20this%20time%20slides%202013.pdf .   78    Tobacco Control   23(2):133 -   PlosOne,  8(3), March 2013.   s in Tobacco Products and Tobacco Smoke:   http://www.fda.gov/TobaccoProducts/GuidanceComplianceRegulatoryInformation/ucm2 97786.htm .   79   Zhu, S -  - cigarettes and Counting: Implications for Product   Tobacco Control , 23(Suppl 3):iii3 - iii9, 2014,  http: //tobaccocontrol.bmj.com/content/23/suppl_3/iii3.full .    80    http://www.cdc.gov/tobacco/campaign/tips/diseases/dual - tobacco - u se.html#ten .   Accessed November 19, 2015.   81   Smith D, Aherrera A, Lopez A, Neptune E, Winickoff JP, Klein JD, et al. Adult behavior in male mice exposed to e - cigarette nicotine vapors during late prenatal and early postnatal life. PLoS ONE. 2015;10 (9):e0137953.  McGrath - Morrow SA, Hayashi M, Aherrera A, Lopez A, Malinina A, Collaco JM, Neptune E, Klein JD, Winickoff  JP, Breysse P, Lazarus P, Chen G. The effects of electronic cigarette emissions on systemic cotinine levels,  weight and postnatal lung g rowth in neonatal mice. PLoS One. 2015 Feb 23;10(2):e0118344.   82   Brown CJ and JM Cheng. Electronic cigarettes: Product characterization and design considerations.  Tobacco  Control . 2014;23(2):ii4 - ii10.   83       2015.   https://www.usfa.fema.gov/downloads/pdf/publications/electronic_cigarettes.pdf   84      http://www.faa.gov/other_visit/aviation_industry/airline_operators/airline_safety/safo/all_safos/media/201 5/SAFO15003.pdf   20                                                                                                                                                                                                      85    http://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_ industry/hookahs/ .   86   Cobb CO, Vansickel AR, Blank MD, Jentink K, Travers MJ, Eissenberg T. Indo or air quality in virginia waterpipe  c afés.  Tobacco Control .   24 March 2012;   doi:10.1 136/tobaccocontrol - 2011 - 050350 .   87    ondhand and thirdhand smoke carcinogens and toxicants in homes  of hookah smokers.  Nicotine & Tobacco Research . July 2014; 16(7):961 - 75.   88   St Helen G1, Bernert JT, Hall DB, Sosnoff CS, Xia Y, Balmes JR, Vena JE, Wang JS, Holland NT, Naeher LP.   Exposure  to s econdhand smoke outside of a bar and a restaurant and tobacco exposure biomarkers in  nonsmokers. Environ Health Perspect . 2012 Jul;120(7):1010 - 6   89   Apostolou A,  Garcia - Esquinas,   E,   Fadrowski,   JJ,   McLain,  P , Weaver,  VW,  Navas - Acien,   Secondhand Tobacco  Smoke: A Source of Lead Exposure in US Children and Adolescents  Am J Public Health . 2012 April; 102(4):  714  722.   Appendix A                   Source:   Portland - Vancouver Metro Area Smokefree Housing Project   Sample  Resident  Survey   |  1           Property managers/owners :  Y ou can use these questions to create your own  re sident   survey about smoking and secondhand smoke.     Healthy Air Survey   Re sidents :  Please        circle        the answer     that     best     describes     you     and    your  situation .     1.   Do   you or   anyone   else   in your household smoke cigarettes, cigars   or a pipe?   a.   Yes, regularly (daily or weekly)   b.   Yes, occasionally (less than weekly)   c.   No     If   answered    yes    to   Q u estion 1 , do   you or any   household members smoke  indoors?   a.   Yes   b.   No     2.   Which of the following stat ements best describes the rules about smoking  inside   your home?   a.   No one is allowed to smoke anywhere inside my home   b.   Smoking is allowed in some places   or at some times   c.   Smoking is permitted anywhere inside my home   Sample Resident Sur vey   Appendix A                   Source:   Portland - Vancouver Metro Area Smokefree Housing Project   Sample  Resident  Survey   |  2     Residents:  Please       circle      the answer     that     best     describes     you    and    your  situation.     If   a  Question  2 ,   why  d o    you allow smoking in your           home?  Circle all that apply .   a.   The smoke makes someone in my home sick   b.      c.   I am worried about fires   d.    my  children   to be around people smoking   e.   Other ( Please explain )  ______________________________________   ________________________________________________________     If   answered    b  c  to   Question 2, why  do   you allow smoking in your          home?  Circle all t hat apply .   a.      b.      c.      d.   Other ( Please explain )  ______________________________________   ________________________________________________________     3.   Do you  have children   or teenage minors  (0 - 17 years) living with you?   a.   Yes   b.   No     4.   Do you have elderly residents (over 65 years) living with you?   a.   Yes   b.   No   Appendix A                   Source:   Portland - Vancouver Metro Area Smokefree Housing Project   Sample  Resident  Survey   |  3     Residents:  Please       circle      the    answer     that     best     describes     you    and    your  situation.     5.   Do you ,   or someone  who lives with you, suffer from chronic illnesses such as  asthma, chronic bronchitis ,   emphysema, heart disease, diabetes,  arthritis,  cancer or are a cancer survivor?   a.   Yes   b.   No   c.   Maybe   d.        6.      a.   Yes   b.   No   c.   Maybe   d.        7.   Have you smelled tobacco smoke in your home that comes from another  unit  or from outside?   a.   Yes   b.   No   c.   Maybe      yes             home  bother you?   a.   Yes   b.   No     Appendix A                   Source:   Portland - Vancouver Metro Area Smokefree Housing Project   Sample  Resident  Survey   |  4     Residents:  Please       circ le      the    answer     that     best     describes     you    and    your  situation.        yes           management about the tobacco smoke drifting into your home?   a.   Yes   b.   No   c.   Maybe   d.   Does not apply     8.   Would you prefer to  live on a property:   a.   Where smoking  is allowed   everywhere on the property   b.   Where smoking  is allowed   in apartments, but not in indoor common  areas   c.   Where smoking  is allowed   outdoors, but not in apartments or indoor  common areas (Smokefree Building)   d.   Where smokin g  is NOT allowed   anywhere, indoors and outdoors  (Smokefree Property)     9.   If your property became non - smoking (including the units), what would you  do?   a.   I would thank my landlord !   b.   I would not be affected      c.   I would take my smoking outside   d.   I would w ant to move   e.          This is the end of the survey. Thank you for your feedback.   The No Smoking in Minnesota Public  Housing Project June 2010 Update A HUD Leadership Development Program Project Presented by:  Laura Wright To increase communication of the processes and benefits and promote  MN  Public Housing Authorities to  adopt non - smoking in multi - families  buildings as per Notice PIH 2009 - 21. The project will be a partnership  between the PIH Minneapolis Field Office, the Office of Healthy Homes  and Lead Hazard Control and the American Lung Association of the  Upper Midwest.   The team will focus on creating and distributing promotional   to non - smoking buildings.  implement policies and choosing to  provide healthy living  environments to  low - income residents.  Project Mission June 2010 Updated Data 36% 64% Minnesota PHA's Currently Has Some No Smoking Implemented Has NOT Implemented No Smoking Minnesota Laws  The Minnesota Clean Indoor Air Act took in effect 1975. The purpose of this act was  to enforce the \"protection of the public health.\" It prohibited smoking in areas  where children, ill or injured are present. This first Minnesota act also limited  smoking indoor at public places and private meetings.  On May 16, 2007, Minnesota passed the  Freedom to Breathe Act . This act protects  the public from hazardous secondhand smoke by banning smoking in public places.  The ban took effect October 1, 2007.  Minnesota is the 17th state to enforce a  statewide smoking ban. Baseline Status of PHA  Philosophy (estimated by PHA staff) 55 27 16 7 5 9 0 10 20 30 40 50 60 70 80 90 100 PHA Responses Fully Support NS Somewhat Support NS Neutral Somewhat Oppose NS Strongly Oppose NS Don't Know 26 32 15 9 17 20 0 10 20 30 40 50 60 70 80 90 100 PHA Responses Baseline Status of Resident  Opinion (estimated by PHA staff)  0 5 10 15 20 25 30 35 Obstacles Losing Occupants Losing Potential Residents Compliance/ Enforcement Legal Concern Accomodating Current Smokers How to Provide for Low-Income Smokers  0 5 10 15 20 25 Resources Tenant Materials Approved Lease Adendum Signage Connect to Other HA Access to Lawyer Q & A Disabilities Heath Info Cessation Info Survey of Tenants We developed a package and sent them to the Public Housing Authorities that  provided the information and the support and guidance that they had requested.  After providing this information, we   policies that moved towards providing healthier living environments.  Each PHA was charted on their baseline responses and other vital data to  see  what individual circumstance and influences were in place. We considered:  Current status  PHA  Philosophy  Resident Feelings  Percentage of Smokers  Multi - family Building structure Number of Smoke Free Agencies 21, 17% 101,  83% Minnesota PHA's  Baseline 2009 Currently Has No Smoking Implemented Has Zero No Smoking Implemented 44,  36% 78, 63% Minnesota PHA's      June 2010 Currently Has No Smoking Implemented Has Zero No Smoking Implemented Added 8  No   from Pipeline   May 2010 Added  6   Pipeline June  2010  Attitudes 41 12 0 10 20 30 40 50 Baseline End of Project Resisted Changing Towards a Smoke Free PHA Model WE ARE NOT SURE IF  WE WANT TO BE  SMOKE FREE ! 37 3 0 10 20 30 40 Baseline End of Project Undecide d About Moving Towards a Smoke Free Model Increase Community  Health Education  Resources 0 20 40 60 80 100 Baseline End of Project 18 38 11 33 Willing to Display Smoking Cessation Information Willing to Display 2nd Hand Smoke Information +200% +111% 36% 5% 38% 2% 10% 9% The New Climate June 2010 No Smoking In the Pipeline Committed to Progress Undecided Resistors No Response \n",
      "\n",
      "Cluster 11\n",
      "\n",
      "    This pretty well destroys the Myth of second hand smoke:    Lungs from pack-a-day smokers safe for transplant, study finds.  By JoNel Aleccia, Staff Writer, NBC News.  Using lung transplants from heavy smokers may sound like a cruel joke, but a new study finds that organs taken from people who puffed a pack a day for more than 20 years are likely safe.  What's more, the analysis of lung transplant data from the U.S. between 2005 and 2011 confirms what transplant experts say they already know: For some patients on a crowded organ waiting list, lungs from smokers are better than none.  \"I think people are grateful just to have a shot at getting lungs,\" said Dr. Sharven Taghavi, a cardiovascular surgical resident at Temple University Hospital in Philadelphia, who led the new study...........................  Ive done the math here and this is how it works out with second ahnd smoke and people inhaling it!  The 16 cities study conducted by the U.S. DEPT OF ENERGY and later by Oakridge National laboratories discovered:  Cigarette smoke, bartenders annual exposure to smoke rises, at most, to the equivalent of 6 cigarettes/year.  146,000 CIGARETTES SMOKED IN 20 YEARS AT 1 PACK A DAY.  A bartender would have to work in second hand smoke for 2433 years to get an equivalent dose.  Then the average non-smoker in a ventilated restaurant for an hour would have to go back and forth each day for 119,000 years to get an equivalent 20 years of smoking a pack a day! Pretty well impossible ehh!  .\n",
      "\n"
     ]
    }
   ],
   "source": [
    "print('Most Central Comments by Cluster\\n')\n",
    "for i in range(num_clusters):\n",
    "    print('Cluster {}\\n'.format(i))\n",
    "    print(comment_frame[comment_frame.cluster==i].min().comment)\n",
    "    print()"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 29,
   "metadata": {
    "collapsed": true
   },
   "outputs": [],
   "source": [
    "# Modified from Brandon Rose and\n",
    "# http://scikit-learn.org/stable/auto_examples/applications/topics_extraction_with_nmf_lda.html\n",
    "def vocabulary_frame(text):\n",
    "    tokens = tokenize_text(text)\n",
    "    stems = stem_text(text)\n",
    "    return pd.DataFrame({'words': tokens}, index = stems).drop_duplicates()\n",
    "\n",
    "def extended_vocabulary_frame(texts):\n",
    "    frames = []\n",
    "    for t in texts:\n",
    "        vf = vocabulary_frame(t)\n",
    "        frames.append(vf)\n",
    "    extended = pd.concat(frames).drop_duplicates()\n",
    "    return extended\n",
    "\n",
    "def km_print_top_words(model, num_clusters, vocab_frame, feature_names, n_top_words):    \n",
    "    print(\"Top terms per cluster:\\n\")\n",
    "    order_centroids = model.cluster_centers_.argsort()[:, ::-1] \n",
    "    for i in range(num_clusters):\n",
    "        print(\"Cluster %d Words:\" % i, end=' ')\n",
    "        print(', '.join(vocab_frame.ix[feature_names[ind].split(' ')].values.tolist()[0][0]\n",
    "                        for ind in order_centroids[i, :n_top_words]))\n",
    "        print()"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 30,
   "metadata": {
    "collapsed": false
   },
   "outputs": [
    {
     "name": "stdout",
     "output_type": "stream",
     "text": [
      "Top terms per cluster:\n",
      "\n",
      "Cluster 0 Words: "
     ]
    },
    {
     "ename": "TypeError",
     "evalue": "sequence item 2: expected str instance, float found",
     "output_type": "error",
     "traceback": [
      "\u001b[0;31m---------------------------------------------------------------------------\u001b[0m",
      "\u001b[0;31mTypeError\u001b[0m                                 Traceback (most recent call last)",
      "\u001b[0;32m<ipython-input-30-752b6c6d523b>\u001b[0m in \u001b[0;36m<module>\u001b[0;34m()\u001b[0m\n\u001b[1;32m      1\u001b[0m \u001b[0mfeature_names\u001b[0m \u001b[0;34m=\u001b[0m \u001b[0mtfidf_vec\u001b[0m\u001b[0;34m.\u001b[0m\u001b[0mget_feature_names\u001b[0m\u001b[0;34m(\u001b[0m\u001b[0;34m)\u001b[0m\u001b[0;34m\u001b[0m\u001b[0m\n\u001b[1;32m      2\u001b[0m \u001b[0mcomment_vf\u001b[0m \u001b[0;34m=\u001b[0m \u001b[0mextended_vocabulary_frame\u001b[0m\u001b[0;34m(\u001b[0m\u001b[0mcomments\u001b[0m\u001b[0;34m)\u001b[0m\u001b[0;34m\u001b[0m\u001b[0m\n\u001b[0;32m----> 3\u001b[0;31m \u001b[0mkm_print_top_words\u001b[0m\u001b[0;34m(\u001b[0m\u001b[0mkm\u001b[0m\u001b[0;34m,\u001b[0m \u001b[0mnum_clusters\u001b[0m\u001b[0;34m,\u001b[0m \u001b[0mcomment_vf\u001b[0m\u001b[0;34m,\u001b[0m \u001b[0mfeature_names\u001b[0m\u001b[0;34m,\u001b[0m \u001b[0;36m6\u001b[0m\u001b[0;34m)\u001b[0m\u001b[0;34m\u001b[0m\u001b[0m\n\u001b[0m",
      "\u001b[0;32m<ipython-input-29-ecbbcf731548>\u001b[0m in \u001b[0;36mkm_print_top_words\u001b[0;34m(model, num_clusters, vocab_frame, feature_names, n_top_words)\u001b[0m\n\u001b[1;32m     20\u001b[0m         \u001b[0mprint\u001b[0m\u001b[0;34m(\u001b[0m\u001b[0;34m\"Cluster %d Words:\"\u001b[0m \u001b[0;34m%\u001b[0m \u001b[0mi\u001b[0m\u001b[0;34m,\u001b[0m \u001b[0mend\u001b[0m\u001b[0;34m=\u001b[0m\u001b[0;34m' '\u001b[0m\u001b[0;34m)\u001b[0m\u001b[0;34m\u001b[0m\u001b[0m\n\u001b[1;32m     21\u001b[0m         print(', '.join(vocab_frame.ix[feature_names[ind].split(' ')].values.tolist()[0][0]\n\u001b[0;32m---> 22\u001b[0;31m                         for ind in order_centroids[i, :n_top_words]))\n\u001b[0m\u001b[1;32m     23\u001b[0m         \u001b[0mprint\u001b[0m\u001b[0;34m(\u001b[0m\u001b[0;34m)\u001b[0m\u001b[0;34m\u001b[0m\u001b[0m\n",
      "\u001b[0;31mTypeError\u001b[0m: sequence item 2: expected str instance, float found"
     ]
    }
   ],
   "source": [
    "feature_names = tfidf_vec.get_feature_names()\n",
    "comment_vf = extended_vocabulary_frame(comments)\n",
    "km_print_top_words(km, num_clusters, comment_vf, feature_names, 6)"
   ]
  },
  {
   "cell_type": "markdown",
   "metadata": {},
   "source": [
    "### LDA"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 21,
   "metadata": {
    "collapsed": false
   },
   "outputs": [
    {
     "name": "stderr",
     "output_type": "stream",
     "text": [
      "/Users/ohmu/anaconda/lib/python3.5/site-packages/sklearn/decomposition/online_lda.py:508: DeprecationWarning: The default value for 'learning_method' will be changed from 'online' to 'batch' in the release 0.20. This warning was introduced in 0.18.\n",
      "  DeprecationWarning)\n"
     ]
    },
    {
     "data": {
      "text/plain": [
       "LatentDirichletAllocation(batch_size=128, doc_topic_prior=None,\n",
       "             evaluate_every=-1, learning_decay=0.7, learning_method=None,\n",
       "             learning_offset=10.0, max_doc_update_iter=100, max_iter=10,\n",
       "             mean_change_tol=0.001, n_jobs=1, n_topics=10, perp_tol=0.1,\n",
       "             random_state=None, topic_word_prior=None,\n",
       "             total_samples=1000000.0, verbose=0)"
      ]
     },
     "execution_count": 21,
     "metadata": {},
     "output_type": "execute_result"
    }
   ],
   "source": [
    "from sklearn.decomposition import LatentDirichletAllocation\n",
    "lda = LatentDirichletAllocation()\n",
    "lda.fit(tfidf_matrix)"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 22,
   "metadata": {
    "collapsed": true
   },
   "outputs": [],
   "source": [
    "# Modified from:\n",
    "# http://scikit-learn.org/stable/auto_examples/applications/topics_extraction_with_nmf_lda.html\n",
    "def lda_print_top_words(model, feature_names, n_top_words):\n",
    "    for topic_idx, topic in enumerate(model.components_):\n",
    "        print(\"Topic {}:\".format(topic_idx))\n",
    "        print(\", \".join([feature_names[i]\n",
    "                        for i in topic.argsort()[:-n_top_words - 1:-1]]))\n",
    "        print()"
   ]
  },
  {
   "cell_type": "code",
   "execution_count": 23,
   "metadata": {
    "collapsed": false
   },
   "outputs": [
    {
     "name": "stdout",
     "output_type": "stream",
     "text": [
      "Topic 0:\n",
      "right, 's, smoke-fre, children, smoke, attach, make, health, build, peopl, tobacco, hous, propos rule, secondhand, unit, rule, cigarett, becaus, public, public hous\n",
      "\n",
      "Topic 1:\n",
      "smoke, hous, comment, ban, propos, hud, depart, public, rule, allow, use, public hous, propos rule, pleas, free, provid, develop, unit, health, institut\n",
      "\n",
      "Topic 2:\n",
      "smoke, health, hous, public, tobacco, secondhand, secondhand smoke, public hous, rule, polici, protect, includ, resid, children, cigarett, use, smoke-fre, hud, propos, live\n",
      "\n",
      "Topic 3:\n",
      "pleas, ban, smoke, hous, ani, public hous, smoker, public, make, health, secondhand, rule, unit, smoke-fre, mani, live, resid, polici, apart, provid\n",
      "\n",
      "Topic 4:\n",
      "smoke, live, peopl, smoker, apart, right, hous, like, 's, ban, home, build, public, year, becaus, cigarett, rule, health, make, allow\n",
      "\n",
      "Topic 5:\n",
      "implement, public, hous, smoke-fre, smoke, public hous, health, peopl, tobacco, support, polici, ban, includ, 's, mani, protect, year, live, make, becaus\n",
      "\n",
      "Topic 6:\n",
      "smoke, hous, polici, resid, free, smoke free, public, rule, public hous, implement, hud, author, unit, health, propos, smoke-fre, build, provid, support, propos rule\n",
      "\n",
      "Topic 7:\n",
      "'s, mani, live, smoke, apart, resid, smoker, pleas, public, hud, hous, public hous, year, build, make, smoke-fre, protect, health, support, cigarett\n",
      "\n",
      "Topic 8:\n",
      "smoke-fre, hous, propos, rule, propos rule, public, public hous, comment, institut, depart, support, develop, attach, pleas, hud, health, make, unit, includ, 's\n",
      "\n",
      "Topic 9:\n",
      "attach, pleas, comment, health, ani, 's, hous, smoke-fre, tobacco, depart, live, right, implement, support, polici, smoke, rule, includ, area, propos\n",
      "\n"
     ]
    }
   ],
   "source": [
    "lda_print_top_words(lda, feature_names, 20)"
   ]
  }
 ],
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