ISSN 2691-7475 Health Policy Brief May 2020 Health at Risk: Policies Are Needed to End Cigarette, Marijuana, and E-Cigarette Secondhand Smoke in Multi-Unit Housing in Los Angeles Peggy Toy, Catherine Yount, Ying-Ying Meng, William Zou, Jessica Ventura, Huongly K. Do, and Nadereh Pourat ‘‘ Harmful toxins in tobacco are also found in marijuana secondhand SUMMARY: The proportion of Californians reporting exposure to secondhand smoke (SHS) from tobacco and marijuana and electronic cigarette (e-cigarette) vapor has grown over time, despite an increasing number of smoke-free local laws in the last 10 years. Residents of market-rate, privately had lived or were living with someone who had a chronic health condition were significantly more likely to report exposure to drifting SHS. The vast majority of tenants and owners supported policies that restricted smoking in MUH, with most supporting tobacco and marijuana policies. Yet support for smoke-free smoke and owned multi-unit housing (MUH)—e.g., apartments—are particularly at risk of drifting policies was mixed with strong concerns about enforcement of such policies. Our findings e-cigarette SHS. In a 2019 study of 4,800 tenants and 176 reveal the high level of SHS in MUH, gaps in secondhand MUH owners in the city of Los Angeles, we existing voluntary smoke-free policies, and ’’ found that 49% of tenants reported exposure the need for a consistent implementation and vapor. to drifting SHS, including SHS from tobacco enforcement plan to prevent exposure to SHS (39%), marijuana (36%), and e-cigarettes (9%). for all Los Angeles residents. Tenants who lived with children and those who S econdhand smoke (SHS) from tobacco causes approximately 33,950 deaths from heart disease and 7,330 deaths from lung worsen respiratory ailments, such as asthma, and they can also cause arteries to constrict, potentially triggering a heart attack.4, 5, 6 In cancer each year in the United States. Between addition, the legalization of marijuana and 1964 and 2014, 2.5 million adult nonsmokers the increasing prevalence of e-cigarettes have died from exposure to SHS.1 SHS is harmful increased exposure to SHS.3 E-cigarettes as a to children and other vulnerable populations,2 new medium for the delivery of tobacco and and there is no safe level of exposure.1 marijuana have reversed declining trends in tobacco use and reductions in SHS exposure. Harmful toxins in tobacco are also found in E-cigarettes have also become a new source of marijuana SHS and e-cigarette secondhand environmental air and waste pollution.7 vapor.2 Repeated exposure to marijuana SHS also affects heart health significantly.3 The SHS cannot be controlled in buildings, less perceptible e-cigarette vapor is actually because the toxic fumes and particulates it an aerosol that contains ultrafine particles, contains drift throughout a property. Exposure which are easily inhaled. The particles can to drifting SHS is a problem in multi-unit 2 UCLA CENTER FOR HEALTH POLICY RESEARCH A significant share of residents of major urban Exhibit 1 Secondhand Smoke Exposure Among areas live in privately owned MUH, which Multi-Unit Housing Tenants in Selected Los Angeles City Council Districts, 2020 has fewer tobacco control policies compared to more affluent suburban communities.9 Many neighborhoods in the city of Los Angeles are densely populated,10 but the city has no ordinance to restrict smoking in privately owned MUH. Impediments to such an ordinance have included concerns about lack of enforcement or evictions that could exacerbate homelessness;11 loss of affordable housing to 49% gentrification following smoke-free policies; and 39% inability to change existing leases to restrict 36% smoking in rent-controlled properties.12, 14 We surveyed tenants and owners of MUH in 12 of 15 city council districts in Los Angeles 9% between 2019 and 2020 to understand exposure to tobacco, marijuana, and e-cigarette Any SHS Tobacco SHS and to learn their opinions on policies Marijuana E-Cigarette to reduce SHS exposure. Tenants of council Source: Authors’ survey of tenants and owners in Los Angeles, 2019 districts 8, 9, and 10 were surveyed previously, Note: Tenants in 12 of 15 Los Angeles City Council Districts were surveyed. in a similar study.13, 14 We also interviewed Tenants of districts 8, 9, and 10 were not surveyed in this some owners to gain additional insights on study. Owners were surveyed in all city districts. implementation and enforcement challenges. ‘‘ Many Tenants of Privately Owned Multi- Nearly half housing (MUH), such as apartments, condos, Unit Housing Are Exposed to Secondhand townhouses, duplexes, and any property in of all tenants which units share a common wall. These Smoke Nearly half (49%) of all tenants we surveyed reported that units often share plumbing, electrical, reported that SHS had drifted into their secondhand and ventilation systems. SHS drifts from neighboring units, balconies, and shared unit in the past year (Exhibit 1). The most smoke had common areas where smoking is permitted. common types of drifting smoke were from tobacco (39%) and marijuana (36%). A drifted into Public health experts recommend that MUH smaller percentage (9%) of tenants reported their unit. ’’ properties be 100% smoke-free to effectively protect residents from health risks caused by SHS.8 Similar policies are applied to experiencing drifting vapor from e-cigarettes. Of those who reported smoke drifting into their unit, 74% said the smoke had come publicly owned MUH that are regulated by from outdoors, 64% reported that smoke had the U.S. Department of Housing and Urban come from another unit, and 41% reported Development (HUD). However, privately that smoke had drifted in from both outdoors owned MUH is under the authority of local and another unit (data not shown). Only municipalities, which enact local housing 16% of tenants reported allowing smoking laws. Most municipalities do not consistently inside their home. include restrictions on smoking in MUH. UCLA CENTER FOR HEALTH POLICY RESEARCH 3 Secondhand Smoke Exposure Among Multi-Unit Housing Tenants and Among Exhibit 2 Households With Children and Chronic Health Conditions, Selected Los Angeles City Council Districts, 2020 55% 54% 46% 44% 42% 41% 9% 9% Household With Children Household Has Member With Chronic Condition Any SHS Tobacco Marijuana E-Cigarette Source: Authors’ survey of tenants and owners in Los Angeles, 2019 Note: Tenants in 12 of 15 Los Angeles City Council Districts were surveyed. Tenants in districts 8, 9, and 10 were not surveyed in this study. Owners were surveyed in all city districts. Households With Children and Those Living With Chronic Conditions Are Frequently Exposed to Secondhand Smoke Secondhand smoke exposure was reported in 54% of households with children (ages 0-17). Examining the type of SHS, we found (9%) reporting exposure to e-cigarette SHS (Exhibit 2). We also examined households in which someone was living with a chronic condition and found similar rates. Households without children or anyone with a chronic condition had lower rates of ‘‘ Secondhand smoke exposure was reported in 54% of households ’’ higher exposure to both tobacco (44%) and reporting SHS (41% and 45%, respectively; marijuana (41%), with a smaller percentage data not shown). with children. 4 UCLA CENTER FOR HEALTH POLICY RESEARCH Exhibit 3 Secondhand Smoke Exposure Among Tenants by Race/Ethnicity, Selected Los Angeles City Council Districts, 2020 54% 51% 44% 42% 45% 41% 41% 36% 37% 29% 30% 30% 9% 10% 9% 7% African American Latinx Asian American/ White Pacific Islander Overall Exposure Tobacco Marijuana E-Cigarette Source: Authors’ survey of tenants and owners in Los Angeles, 2019 Note: Tenants in 12 of 15 Los Angeles City Council Districts were surveyed. Tenants in districts 8, 9, and 10 were not surveyed in this study. Owners were surveyed in all city districts. African American and Latinx Tenants Exhibit 4 Secondhand Smoke Exposure Among Report Higher Rates of Secondhand Tenants of Multi-Unit Housing With and Without Smoke-Free Policies Smoke Drift in Their Homes ‘‘ In examining racial/ethnic differences in tenant exposure to SHS, we found that more African Americans (51%) and Latinx (54%) reported African drifting SHS in the past 12 months compared Americans and with whites (45%) and Asian Americans/Pacific Latinx reported Islanders (41%) (Exhibit 3). Across racial/ ethnic groups, Latinx had the highest levels the highest levels 55% of exposure to tobacco SHS (44%), and Asian of drifting 46% Americans/Pacific Islanders reported the secondhand lowest rates of tobacco SHS exposure (29%). ’’ Asian Americans/Pacific Islanders and whites smoke. reported the lowest rates of exposure to marijuana SHS (30%). Existing Smoke-Free Policies in Multi-Unit Lives in MUH Lives in MUH Housing Are Not Comprehensive But With Any Type of With No Smoke-Free Policy Smoke-Free Policy Reduce Exposure Thirty-seven percent of tenants said either Has Been Exposed to SHS Drifting Into Home in Past Year there was no policy restricting smoking in Source: Authors’ survey of tenants and owners in Los Angeles, 2019 their building or they were unaware of one. Note: Tenants in 12 of 15 Los Angeles City Council Districts were The remaining 63% lived in MUH with surveyed. some type of smoking-restriction policies. Tenants in districts 8, 9, and 10 were not surveyed in this study. Owners were surveyed in all city districts. These policies appeared to reduce SHS exposure. UCLA CENTER FOR HEALTH POLICY RESEARCH 5 Among tenants living in MUH with any smoke-free policies, 46% reported exposure Multi-Unit Housing Owner Support Exhibit 5 for Various Smoke-Free Policies, City to SHS in their homes, compared to 55% of of Los Angeles, 2020 those living in MUH without such policies (Exhibit 4). Tenants, Even Those Who Smoke, Support Smoke-Free Housing Policies Ninety percent of tenants surveyed believed SHS is harmful to a person’s health. The majority of tenants preferred to live in 54% smoke-free housing, including 86% who stated a preference for living in a section of 38% a building that is nonsmoking, and 80% who said they preferred to live in an entirely nonsmoking building. 9% When asked whether tobacco, marijuana, or e-cigarettes should be included in a smoke- Support Support Do Not free policy, 72% said they would support Smoke-Free Smoke-Free Support Any Policies for Policies for Smoke-Free a policy that covered both tobacco and Entire MUH Some Areas Policies marijuana, and 48% said all three should be of MUH included. Even among the 17% who smoked Source: Authors’ survey of tenants and owners in Los Angeles, 2019 either tobacco or e-cigarettes, 86% supported Note: Tenants in 12 of 15 Los Angeles City Council Districts were some type of smoke-free housing policy. surveyed. Tenants in districts 8, 9, and 10 were not surveyed in this study. Owners were surveyed in all city districts. ‘‘ The majority of tenants believed property owners had the right to prohibit smoking in common areas (86%) and in private areas (79%), such as units and balconies. Most Decreased maintenance costs and tenant health were among the top reasons given Ninety percent (67%) believed it is okay to levy a fine, and for adopting nonsmoking policies, followed of tenants more than half (55%) believed it is okay by reduced tenant conflicts and complaints. surveyed to evict tenants who repeatedly violate an agreement not to smoke in their unit (data Most owners (60%) reported that they had received tenant complaints about SHS. believed not shown). Among those who had received complaints, secondhand Multi-Unit Housing Owners Support 52% had received complaints about tobacco smoke is Smoke-Free Policies but Differ in Types smoke, 38% had received complaints about harmful to a ’’ marijuana, and 9% had received complaints of Policies about e-cigarettes. person’s health. Most owners (69%) already had some voluntary smoke-free policies. Among these When asked what areas of the property property owners, most had tobacco (90%), should be covered by a smoke-free policy, marijuana (75%), and e-cigarette (62%) more than half of owners said they would restrictions. Among 31% of owners without include the entire property. In contrast, less a policy, most had considered tobacco (83%) than 10% would not support any smoke-free and marijuana (69%) policies, and 43% had policy (Exhibit 5). considered e-cigarette restrictions. 6 UCLA CENTER FOR HEALTH POLICY RESEARCH Exhibit 6 MUH Tenant and Owner Support for Citywide Policy, by Product Type 92% 88% 83% 77% 68% 54% Tenant Support by Product Type Owner Support by Product Type Tobacco Marijuana E-Cigarette Source: Authors’ survey of tenants and owners in Los Angeles, 2019 Note: Tenants in 12 of 15 Los Angeles City Council Districts were surveyed. ‘‘ Tenants in districts 8, 9, and 10 were not surveyed in this study. Owners were surveyed in all city districts. Owners without Owners’ Enforcement of Smoke-Free Policies In interviews, owners without policies policies reported We examined the implementation of smoke- free policies by owners and the challenges reported that enforcement was a top reason for not implementing a smoke-free policy. that enforcement they experienced. Almost 90% of owners Owners expressed concerns over eviction of was a top with smoke-free policies had included no- violators due to associated costs of eviction and potential loss of rent. Owners also did reason for not smoking policies in formal lease agreements, and the remaining 10% of owners with not believe that the city of Los Angeles would implementing smoke-free policies used other methods to support owners’ policies or consequences for a smoke-free communicate their policy to tenants, such as violations. Without that support, owners were policy. ’’ signs or verbal communication. Some owners with a smoke-free policy (43%) reluctant to enforce their policies. If there were no consequences for violating the policy, owners anticipated that tenants would be more reported having experienced problems in likely to disregard the policy entirely. enforcing their policy. Among owners who do not have a smoke-free policy, 82% anticipate Both Tenants and Owners Support a that enforcement would be a barrier to Citywide Smoke-Free MUH Policy implementing a smoke-free policy on their Both tenants and owners support a citywide property. One challenge to enforcement was policy, with the broadest support expressed the difficulty in identifying those who smoke for a smoke-free tobacco policy: 88% of and in proving the source of the smoke. Nearly tenants and 92% of owners favored such all owners with smoke-free policies (94%) a citywide policy (Exhibit 6). Marijuana said they did not evict tenants for violations. and e-cigarette policies were supported at a Among owners with smoke-free policies, 95% slightly lower rate, but by the majority of reported having no problems filling vacancies both groups. for nonsmoking units. UCLA CENTER FOR HEALTH POLICY RESEARCH 7 Support for a citywide policy was higher among MUH tenants and owners who had smoke-free policies than among those in MUH without such policies (97% vs. 92% and 94% vs. 84%, respectively; data not shown). However, owners expressed concerns over their ability to enforce their own or citywide policies. Owners indicated that city support for enforcement of owners’ policies was essential. They believed that accountability for enforcement of a citywide policy should ‘‘ Enforcement is crucial to ensuring the effectiveness of the smoke-free ’’ rest with the city, and that resources should Barriers to Owners’ Support for Citywide be devoted to effective enforcement of such policy. Smoke-Free Policy a policy. Additional findings from this In interviews, owners—especially those who study can be found at https://healthpolicy. owned or managed large buildings—said ucla.edu/publications/search/pages/detail. that they did not want the responsibility of aspx?PubID=1933. enforcing a citywide smoke-free policy. Some were concerned that they would face fines or Our findings are similar to results from a other consequences if their tenants did not previous study of the three Los Angeles City comply with a citywide policy. Council Districts that were not included in this study.14 Many owners said they would be more likely to support the policy if the city were to take Our findings highlight the importance of full responsibility for handling enforcement uniform and effective policies that can protect or to make a commitment to enforcing it. all residents from the health risks of SHS in Many owners were unwilling to give support their homes. Previous evidence shows that without an enforcement provision. uncertainty persists over how to implement such policies, especially a city law, which However, a guarantee of city support for has been a significant barrier to a citywide enforcement did not ease the concerns of all policy.15 The following recommendations owners. Some expressed skepticism that a address such uncertainty. city as large as Los Angeles would be able to devote resources to enforcing MUH smoke- Establish a single smoke-free MUH policy free policies effectively. that requires all MUH properties in the city of Los Angeles to be 100% smoke-free Policy Implications and Recommendations to protect all tenants. Such a policy would Our findings indicated that nearly half support owners’ implementation of no- of tenants of privately owned MUH in smoking policies covering the entire property Los Angeles were exposed to tobacco, and would protect all tenants. A citywide marijuana, and e-cigarette SHS in policy would not require changes to leases their homes. Communities of color and in rent-controlled areas or contribute to households with vulnerable populations were gentrification. disproportionately represented among tenants exposed to SHS in their homes. Identify a viable smoke-free MUH policy enforcement model to meet the needs of We found evidence of voluntary partial smoke- tenants and owners. Enforcement is crucial free policies in privately owned MUH for to ensuring the effectiveness of the policy. specific units and common areas and of reduced Enforcement is likely to be most effective SHS exposure where these policies existed. We if conducted by the city administration, found broad support for smoke-free policies using the administrative citation process and implemented by owners or citywide. community justice approaches. Alternative options to fines and evictions for violators can 8 UCLA CENTER FOR HEALTH POLICY RESEARCH ‘‘ For many tenants ... home is not a sanctuary from unwanted be considered, such as mandated cessation education classes, community service, and increasing penalties for repeat violations. These options would not contribute to homelessness and would address the concerns of housing rights and tenants’ rights advocates who fear the inappropriate use of For many tenants of privately owned MUH in Los Angeles and elsewhere, home is not a sanctuary from unwanted exposure to secondhand smoke. Methodology We conducted the Smoke-Free Multi-Unit Housing exposure to smoke-free policies to evict tenants.12 Evaluation in 12 Los Angeles City Council Districts: 1, 2, 3, 4, 5, 6, 7, 11, 12, 13, 14, and 15. Districts secondhand 8, 9, and 10 were surveyed in a similar project in ’’ Engage and mobilize stakeholders to ensure smoke. effective implementation. Broader public 2016. support is needed to develop, implement, and We adapted the MUH Tenant Survey from the 2012 enforce a citywide smoke-free policy. Engaging Smoke-Free Multi-Unit Housing Survey of the tenants, owners, housing advocates, apartment Los Angeles County Department of Public Health, Division of Chronic Disease and Injury, Tobacco associations, and community groups in the Control and Prevention Program. The MUH Tenant development of a citywide policy and its Survey asked tenants about their experiences with methods of enforcement is likely to promote SHS in their homes, their support for a smoke-free compliance and its effectiveness. The support policy, and some demographic questions. Tenant of 9 million California voters for Proposition survey participants were adults ages 18 and older 56 to enact the California Healthcare, living in multi-unit housing (e.g., apartments, condominiums, and townhouses) in 12 Los Angeles Research, and Prevention Tobacco Tax Act City Council Districts. No personal identifying may be an indication of the likely support for information was collected for the survey. such a policy. We engaged community partners, including Day Promote access to cessation resources to One, FAME Corporations, and Koreatown Youth support compliance and enforcement. Community Center (KYCC), to conduct the tenant HUD’s model for smoke-free public housing surveys in English, Spanish, and Korean. Each organization was assigned four council districts. A includes referral to cessation resources to total of 4,800 surveys were completed between May foster compliance. Educating tenants on the and October of 2019, equally divided between each effects of SHS, dispelling the perception that council district. marijuana and e-cigarettes are benign and less harmful than tobacco or not harmful to We engaged the Apartment Association of Greater others, and assisting those who want to quit Los Angeles (AAGLA), which has more than 6,000 members in the Greater Los Angeles area, to recruit all promote compliance with smoke-free owners to take part in surveys and interviews. policies, reducing the need for enforcement. MUH Owner Survey participants owned properties Increasing awareness of available resources throughout the city of Los Angeles, totaling 21,911 —such as the California Smokers’ Helpline, units. Surveys were conducted online using Survey to help smokers quit, or the Truth Initiative, Monkey. Members of the evaluation team conducted which uses social media and youth network the interviews. texting to help individuals overcome To participate in the MUH Owner Survey, owners e-cigarette addiction—can help promote had to have a property in any Los Angeles City smoke-free policy compliance.15 Council District. Property managers could take the survey if the owner was unavailable. We conducted The recent COVID-19 pandemic and the 156 surveys and 20 phone interviews from June to “shelter-in-place” orders have heightened December 2019. The survey asked owners about their the importance of the home as a safe experiences with SHS on their property and their support for different types of smoke-free policies. Key sanctuary from exposure to unwanted and informant interviews provided insights into owners’ harmful environmental threats to health. views on voluntary and legislated smoke-free housing policy and their recommendations for addressing barriers to policy adoption. UCLA CENTER FOR HEALTH POLICY RESEARCH 9 Author Information Endnotes Peggy Toy is director of the Health DATA Program 1 U.S. Department of Health and Human Services. 2014. The Health Consequences of Smoking—50 Years of Progress: at the UCLA Center for Health Policy Research. A Report of the Surgeon General. https://www.ncbi.nlm.nih. Catherine Yount is the evaluation coordinator and gov/books/NBK179276/pdf/Bookshelf_NBK179276.pdf; Ying-Ying Meng the co-director of the Chronic Centers for Disease Control and Prevention. 2015. Let’s Make the Next Generation Tobacco-Free: Your Guide to the Disease Program at the UCLA Center for Health 50th Anniversary Surgeon General’s Report on Smoking and Policy Research. William Zou and Jessica Ventura Health. Office on Smoking and Health. https://www.hhs. are project assistants and Huongly K. Do a project gov/sites/default/files/consequences-smoking-consumer-guide.pdf intern at the UCLA Center for Health Policy 2 California Tobacco Control Program, TobaccoFreeCA. 2020. Secondhand Dangers. https://tobaccofreeca.com/ Research. Nadereh Pourat is associate director of the secondhand-dangers/ UCLA Center for Health Policy Research. 3 California Tobacco Control Program. 2017. Marijuana and Tobacco Use. Fact Sheet. Sacramento, CA: California Department of Public Health. https:// Funder Information www.cdph.ca.gov/Programs/CCDPHP/DCDIC/CTCB/ This research and publication have been funded CDPH%20Document%20Library/ResearchandEvaluation/ FactsandFigures/MJAndTobaccoUseFac%20Sheet-CDPH- by the Los Angeles County Department of Public CTCP-5-2017.pdf Health, Division of Chronic Disease and Injury, 4 Liqiao L, Yan L, Tian X, Yifang Z. 2020. Effects of Tobacco Control and Prevention Program. This Electronic Cigarettes on Indoor Air Quality and Health. content is solely the responsibility of the authors Annual Review of Public Health 41(1): 1-18. and does not necessarily represent the official views 5 Grana R, Benowitz N, Glantz S. 2013. Background Paper on E-Cigarettes. Center for Tobacco Control Research and of the funder. Education; University of California, San Francisco; and WHO Collaborating Center on Tobacco Control. https:// Acknowledgments no-smoke.org/electronic-smoking-devices-secondhand-aerosol/ 6 Glantz SA, Bareham DW. 2018. E-Cigarettes: Use, The authors wish to thank Claud Moradian, MPH, Effects on Smoking, Risks, and Policy Implications. Christine Cerven, PhD, and Tonya Gorham Gallow, Annual Review of Public Health 39(1): 215-235. MSW, director, Los Angeles County Department 7 Gardinar P. 2016. “The Triangulum: Tobacco, Marijuana and E-Cigarettes—The Future Is Now!” Tobacco-Related of Public Health–Tobacco Control and Prevention Disease Research Program (TRDRP) Live Webcast, Program; project partners Esther Schiller, Smokefree UCSF. Oakland, Calif.: TDRP Research Grants Program Air For Everyone (S.A.F.E.); Daniel M. Yukelson, Office, University of California, Office of the President. Apartment Association of Greater Los Angeles; 8 Americans for Nonsmokers’ Rights Foundation. 2020. U.S. Laws for 100% Smoke-Free Multi-Unit Housing. Alisha Lopez and Michael Browning, Day One; https://center4tobaccopolicy.org/wp-content/uploads/2019/06/ Diego Cruz, Ricardo Torres, and Antonio Le Mons, Multi-housing-Case-Study.pdf FAME Corporations; and Jeff Yoo and Gennesis 9 American Lung Association, Center for Tobacco Policy Jerez, Koreatown Youth and Community Center. and Organizing. 2019. Evaluating Smoke-Free Multi-Unit Housing Policies of Berkeley and Huntington Park, California. The authors thank the following individuals for https://center4tobaccopolicy.org/wp-content/uploads/2019/06/ their thoughtful reviews and helpful comments: Multi-housing-Case-Study.pdf Michael K. Ong, MD, PhD, UCLA School of 10 Los Angeles Times. 2016. Population Density: Mapping Medicine and California Tobacco Education L.A. U.S. Census Bureau. Retrieved from Wikipedia, 2020. and Research Oversight Committee chair; Liz 11 UCLA-SAFE Smoke-Free Apartments Los Angeles. Williams, Americans for Nonsmokers’ Rights; 2015. Formative Assessment for Communications Key Nora D. Manzanilla, Office of the Los Angeles Informant Interviews. Los Angeles, Calif.: UCLA Center for Health Policy Research. City Attorney, Tobacco Enforcement Program; 12 Los Angeles County Department of Public Health and E. Felicia Brannon, MPA, government and Tobacco Control and Prevention Program. 2019. community relations consultant. The authors also Collaborative Approaches to Smoke-Free Multi-Unit thank the following individuals for their guidance Housing in a Large Metropolitan Area 2019. National Conference on Tobacco or Health (NCTOH) 2019. This and assistance: Tiffany Lopes, Venetia Lai, Elaiza citation is from a presentation at the National Conference Torralba, and Celeste Maglan Peralta. (cited, not published or posted). 13 Meng YY, Rahman T, Hanaya D, Lam V, Gomez M, Toy Suggested Citation P, Wallace SP. 2016. Unequal Protection: Secondhand Smoke Threatens Health of Tenants in Multi-Unit Housing in Los Toy P, Yount C, Meng YY, Zou W, Ventura J, Do Angeles. Los Angeles, Calif.: UCLA Center for Health HK, Pourat N. 2020. Health at Risk: Policies Are Policy Research. Needed to End Cigarette, Marijuana, and E-Cigarette 14 Meng YY, Lam V, Hanaya D, Rahman T, Gomez M, Toy P, Wallace S. 2016. Apartment Owners Support Nonsmoking Secondhand Smoke in Multi-Unit Housing in Los Policy in Los Angeles. Los Angeles, Calif.: UCLA Center for Angeles. Los Angeles, Calif.: UCLA Center for Health Policy Research. Health Policy Research. 15 Graham AL, Jacobs MA, Amato MS. 2020. Engagement and 3-Month Outcomes From a Digital E-Cigarette Cessation Program in a Cohort of 27,000 Teens and Young Adults. Nicotine & Tobacco Research (22) 5: 859-60. https://doi.org/10.1093/ntr/ntz097 UCLA CENTER FOR HEALTH POLICY RESEARCH 10960 Wilshire Blvd., Suite 1550 Los Angeles, California 90024 The UCLA Center for Health Policy Research is part of the UCLA Fielding School of Public Health. The analyses, interpretations, conclusions, and views expressed in this policy brief are those of the authors and do not necessarily represent the UCLA Center for Health Policy Research, the Regents of the University of California, or collaborating organizations or funders. 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