In 2018, the U.S. Department of Housing and Urban Development required public housing authorities to implement a smoke-free housing (SFH) policy that included individual apartments. We analyzed the policy implementation process in the New York City Public Housing Authority (NYCHA). From June–November 2019, we conducted 9 focus groups with 64 NYCHA residents (smokers and nonsmokers), 8 key informant interviews with NYCHA staff and resident association leaders, and repeated surveys with a cohort of 130 nonsmoking households pre- and 12-month post policy. One year post policy implementation, participants reported widespread smoking violations and multi-level factors impeding policy implementation. These included the shared belief among residents and staff that the policy overreached by “telling people what to do in their own apartments”. This hindered compliance and enforcement efforts. Inconsistent enforcement of illegal marijuana use, staff smoking violations, and a lack of accountability for other pressing housing issues created the perception that smokers were being unfairly targeted, as did the lack of smoking cessation resources. Resident support for the policy remained unchanged but satisfaction with enforcement declined (60.1% vs. 48.8%, p = 0.047). We identified multilevel contextual factors that are influencing SFH policy implementation. Findings can inform the design of strategies to optimize policy implementation.

Background: African American and Hispanic populations have been affected disproportionately by COVID-19. Reasons are multifactorial and include social and structural determinants of health. During the onset and height of the pandemic, evidence suggested decreased access to SARS CoV-2 testing. In 2020, the National Institutes of Health launched the Rapid Acceleration of Diagnostics (RADx)- Underserved Populations initiative to improve SARS CoV-2 testing in underserved communities. In this study, we explored attitudes, experiences, and barriers to SARS CoV-2 testing and vaccination among New York City public housing residents. Methods: Between December 2020 and March 2021, we conducted 9 virtual focus groups among 36 low-income minority residents living in New York City public housing. Results: Among residents reporting a prior SARS CoV-2 test, main reasons for testing were to prepare for a medical procedure or because of a high-risk exposure. Barriers to testing included fear of discomfort from the nasal swab, fear of exposure to COVID-19 while traveling to get tested, concerns about the consequences of testing positive and the belief that testing was not necessary. Residents reported a mistrust of information sources and the health care system in general; they depended more on “word of mouth” for information. The major barrier to vaccination was lack of trust in vaccine safety. Residents endorsed more convenient testing, onsite testing at residential buildings, and home self-test kits. Residents also emphasized the need for language-concordant information sharing and for information to come from “people who look like [them] and come from the same background as [them]”. Conclusions: Barriers to SARS CoV-2 testing and vaccination centered on themes of a lack of accurate information, fear, mistrust, safety, and convenience. Resident-endorsed strategies to increase testing include making testing easier to access either through home or onsite testing locations. Education and information sharing by trusted members of the community are important tools to combat misinformation and build trust.

Background: As part of an initiative to increase COVID-19 testing uptake among underserved populations, we conducted focus groups to explore experiences and attitudes related to testing in two understudied groups—young adults and socially-isolated older adults—recruited from residents living in New York City Housing Authority (NYCHA) public housing developments.Materials and methods: In June through November 2022, we conducted eight virtual focus groups with 21 young adults and 11 older adults living in NYCHA (n = 32 total). To identify themes, we conducted a rapid qualitative analysis approach.Results: Residents discussed four overarching themes: (1) trusted COVID-19 information sources; (2) reasons for testing; (3) barriers to testing, and (4) strategies to increase testing uptake. Findings were similar across the two age groups; both cited multiple sources of information, including major media outlets, government or public health officials, and doctors. Young adults were more likely to access information from social media despite concerns about misinformation. Participants identified several barriers to testing, such as long lines, insurance coverage, and cost. Young adults reported that at-home COVID testing was more convenient, while older adults expressed concern about accuracy and administering the tests themselves. Recommendations for improving testing emphasized easier access via a central well-known location, in-home visits, free or low-cost tests, and increased outreach.Conclusion: Mainstream media, doctors and public agencies remain the most trusted sources of information among younger and older residents alike. Many resident recommendations involved leveraging NYCHA infrastructure, highlighting the continuing role public housing authorities can play in COVID-19 and other health initiatives.

Secondhand smoke (SHS) exposure remains a major public health concern in the United States. Homes have become the primary source of SHS exposure, with elevated risks for residents of multiunit housing. Though this differential risk is well-documented, little is known about whether SHS exposure varies by floor height. The aim of this study was to examine whether SHS accumulates in higher floors of multiunit housing. Using validated passive nicotine sampling monitors, we sampled air nicotine concentrations on multiple floors of 21 high-rise (>15 floors) buildings in New York City. Within the buildings, measurements were collected in three locations: non-smoking individual apartments, hallways and stairwells. Measurements were collected in two winter and two summer waves to account for potential seasonality effects. We analyzed the percent of filters with detectable nicotine and quantified nicotine concentration (µg/m³). Higher floor levels were positively associated with both airborne nicotine measures, with some variation by location and season observed. In winter, the trends were statistically significant in apartments (floors ≤7: 0.022 µg/m³; floors 8–14: 0.026 µg/m³; floors ≥15: 0.029 µg/m³; p = 0.011) and stairwells (floors ≤7: 0.18 µg/m³; floors 8–14: 0.19 µg/m³; floors ≥15: 0.59 µg/m³; p = 0.006). These findings can inform interventions to mitigate the SHS exposure of residents in multiunit housing.

Introduction: For the public to adopt health promoting behaviors widely, there has to be sufficient trust in the institutions that disseminate information on protective behaviors. However, when members of the public lose trust in formal information sources, many seek information from informal information sources. Identifying trusted informal messengers is key to restore trust and effectively promote public health. Methods: We conducted repeat surveys with young adults and older adults living in New York City public housing to assess who they consider a trusted source of COVID-19 information, as well as their protective behavior practices across a period of five weeks. We then examined the association between trusted sources and participant behavior. Results: Participants in both age groups showed the highest trust in doctors or healthcare providers. Associations with protective behavior existed across multiple information sources, but strongest associations for both age groups were seen in relation to trusting one’s faith leader for information. Discussion: Although other sources of information were more frequently cited as trustworthy by participants, trust in one’s faith leader was the strongest predictor of protective behavior practices.