Housing evidence / case study · working draft
San Francisco: voluntary smoke-free homes
Residents developed voluntary smoke-free-home plans, supported by staff training.
01 / THE APPROACH
What was tried
This trial involved 400 residents across forty permanent-supportive-housing sites in San Francisco. It tested voluntary help to create a smoke-free home, rather than a new tenancy-enforcement rule.
Research staff offered a one-hour individual coaching session using a structured pamphlet. Residents discussed smoking, exposure, costs, household rules and steps they could choose to take, with referrals to cessation resources.
Participating housing staff could receive a separate one-hour training session to help them raise smoking and connect residents with support during routine contact. Sites were compared with a waiting-list group receiving usual care.
02 / THE FINDINGS
What was learned
Maintaining a smoke-free home for at least ninety days (the main outcome) did not clearly improve: 6.8% versus 4.8%. A separate smoking measure was more favourable: verified seven-day abstinence at six months was 6.3% versus 1.0%.
The mixed results show why home rules and quitting need separate measures. The brief intervention showed some promise, but did not establish a sustained change in the main home-smoking outcome.
03 / TRANSFER TO WALES
What Wales could learn
Residents received individual coaching on changes they could choose at home, while housing staff received separate training on conversations and referral. The approach was voluntary.
A short session did not clearly improve the main sustained-home-rule outcome. The project illustrates both a supportive conversation format and the limits of a brief intervention.
Sources & review
Hawes et al. Smoke-Free Home Intervention in Permanent Supportive Housing: A Cluster Randomized Clinical Trial. JAMA Network Open 2026;9(9):e2632697. DOI 10.1001/jamanetworkopen.2026.32697.
