Before approaching local landlords to introduce the idea of smoke-free housing, we assembled staff for the campaign and gathered information from national colleagues. In 2004, ALAO and MCHD partnered to address secondhand smoke exposure in multiunit housing. In early 2006, CCPH joined the effort, ALAO received start-up funding from the American Legacy Foundation, and the Portland-Vancouver Metro Area Smokefree Housing Project was created. From 2004 to 2006, each organization dedicated approximately one-half of 1 employee's time in in-kind staff time; in 2007, ALAO received a grant from the Northwest Health Foundation that funded another full-time employee for 3 years. In addition to ongoing tobacco use prevention funding at Multnomah and Clark counties, grant funding through April 2010 totaled $530,000 for the project (Figure 1). Project staff gathered information from the Smoke-Free Environments Law Project in Michigan, Association for Nonsmokers — Minnesota, and the Smokefree Housing Coalition of Maine, and honed strategies by talking with colleagues at national meetings and through a national listserve about smoke-free housing.

It became clear that these strategies needed to be matched to stakeholders' level of readiness for policy change, since few landlords or managers were considering no-smoking policies in 2004. The concept of stage-matching an intervention or strategy is familiar to many in public health and tobacco control because the stages of change model (7) encourages matching potential messages or interventions to a smoker's readiness to quit. We learned that continually making the business case for smoke-free housing was an effective motivational strategy for moving stakeholders through the early stages of change (precontemplation, contemplation, and preparation) into making and maintaining the change (action and maintenance).

In the stages of change model, precontemplation refers to those who are not yet considering behavior change, and contemplation refers to those who are considering change but not immediately. As noted, smoke-free policies were not an industry norm in 2004, and we knew from national data (1) that many housing providers were concerned about whether such policies would result in lost revenue or cause legal problems. We decided, therefore, to conduct informational interviews with stakeholders over coffee or lunch, using a low-key, collegial approach to address concerns and stimulate interest. Stakeholders included members of landlord trade associations, renter advocacy groups, the Fair Housing Council of Oregon, local housing authorities, and agencies that provide training and communication to property managers (eg, fire and police departments). We asked each if they would be interested in participating as advisory board members. All of the people who were identified as potential board members agreed, and many helped us recruit other key partners. The advisory board's initial focus was to guide the development and implementation of several assessment activities designed to measure the scope of renters' exposure to secondhand smoke, market demand for smoke-free living, and property managers' opinions about no-smoking policies. Advisory board responsibilities are listed in the Box, and the Appendix lists the organizations represented on the board.

In the summer of 2006, we contracted with an independent research firm to conduct a random-digit–dialed, population-based survey of 356 metro-area renters; 26% were current smokers. Survey results revealed 3 key findings: most renters who smoke already smoke outside, 75% of renters in the Portland-Vancouver metro area would rather live in nonsmoking buildings, and 52% of renters said they would even pay a little extra rent for smoke-free housing (8). This last finding does not mean that smoke-free units will or should cost more, but rather signals to landlords that renters view smoke-free as a desired amenity and that going smoke-free could help attract qualified applicants. A follow-up statewide survey in 2008 (n = 300, 33% were smokers) had similar findings, showing that approximately two-thirds of renters in the rest of the state preferred smoke-free housing and approximately 40% would pay more for it (9). These data showed our landlord partners that no-smoking policies were a business opportunity, a message they began to share within their organizations and trade associations.

The same research firm also conducted 6 landlord focus groups, with a total of 32 participants (9), and 10 key informant interviews with property managers and opinion leaders in the summer of 2006 (10). These qualitative data helped us understand why property managers would or would not adopt no-smoking rules and helped define practical issues related to policy adoption, including potential implementation strategies. They also allowed us to test several messages that were based on national examples and local renter survey data. We found that local property managers already knew that allowing smoking was costing them money and that it increased fire risk, but they worried about whether no-smoking policies were legal and whether there was sufficient tenant demand for units covered by such a policy. Property managers also said they lacked the tools needed for policy implementation (eg, appropriate lease language). Other findings were that tenant health was not a sufficient motivator for them to change their policies and that they trusted their own trade associations for information and guidance, not public health agencies. Finally, they showed a strong preference for educational materials with a business look and language.

The next step was to present the focus group and survey data to the advisory board. Using this information, the board helped produce informational pieces for landlords and renters such as the printed guide A Landlord's Guide to No-Smoking Policies (11) (www.smokefreehousingnw.com/landlords/Landlord's%20Guide%20to%20No-Smoking%20Policies%20third%20version%204-10.pdf) and a website (12). Board members provided practical tools for policy implementation, such as lease language, signage, and tenant notification letters. The website features tools for both landlords and renters and had more than 11,000 home page hits from July 2007 through December 2009.

Involving key leaders from the housing sector as advisors throughout the assessment process resulted in credible data that addressed the specific concerns of decision makers and opinion leaders. This involvement also ensured that advisory board members were invested in the findings and willing to communicate key messages through their websites, newsletters, and training programs.

Our next step was to develop a communication strategy that could answer questions and provide tools. Our strategy was built on existing relationships and resources such as housing sector trade shows, trainings, industry publications and listserves, and business publications, and print and broadcast media for general audiences. Successes in the fall of 2006 included staffing a display at the major property manager trade show in our area and soliciting a commitment from the trade newspaper The Apartment Manager to run a monthly series of front-page articles on smoke-free housing that continued for 26 months. In 2007 and 2008, we facilitated a conference workshop on adopting no-smoking policies and worked with mainstream media to develop stories about the smoke-free project. After each trade show, we contacted the largest or most influential property management companies that were present, scheduled meetings with managers, and provided them with tools to implement no-smoking policies.

The City of Portland and the Fair Housing Council of Oregon were key partners in developing resources for tenants. We augmented the city's free housing-finder website (HousingConnections.org) instead of creating a stand-alone registry that would require staff time to maintain. A grant from the National Association of Counties funded a new feature to sort properties by smoking status and a landlord survey to ensure that smoking policies were described accurately for the listings.

The Fair Housing Council of Oregon continued to provide outreach and education to landlords through existing landlord training programs and developed several resources for renters, including educational materials on when and how to pursue protection from secondhand smoke under fair housing laws. In addition, the council staffed a renter hotline to help tenants seek reasonable accommodation if they had a pre-existing chronic health condition or other disability aggravated by secondhand smoke. Finally, we urged apartment guides and online listing services to include "no-smoking" as a featured amenity, and 4 have done so (Housing Connections, Apartment Guide [web and print versions], OregonLive.com, and RentLinx). Additionally, the websites ShowMeTheRent.com (which uses RentLinx information) and Rentals.com also offer smoke-free in their housing search criteria.

Two local housing providers — Guardian Management LLC and the Housing Authority of Portland (HAP) — adopted no-smoking policies. In January 2008, Guardian Management LLC, Oregon's largest property management company with 6,500 units in Oregon and 1,500 in 6 other states, prohibited smoking on the properties they own or manage, which include high-end, market-rate units and subsidized, low-income housing. When some tenants complained to the media about the policy, we helped Guardian create positive media messages, resulting in favorable coverage. Guardian sent out a notification letter approximately 3 months before the policy went into effect on January 1, 2008, for most tenants on month-to-month leases; the few tenants with annual leases were required to comply as their leases were renewed over the following months. In an evaluation of a group of 17 rent-subsidized Guardian buildings, most tenants reported that the smoke-free policy was acceptable in a survey conducted 5 months after implementation (6). Over a 1-year follow-up in this group of buildings, only 6 Guardian residents reportedly left because of the policy, and 1 of those later tried to return (B. Pizacani, March 2009). Guardian made its notification letter, no-smoking lease addendum, warning letter, and changes in House Rules for Rural Development Properties available to other property managers (12).

In August 2009, HAP prohibited smoking in all of its 1,993 public housing units, and in August 2010 it instituted the same policy in its 3,760 affordable housing units. Although stakeholders from both HAP and Guardian found the business case for smoke-free policies compelling, those from HAP additionally cited health and safety of residents and site staff as a reason for the policy change. HAP requested additional support and information regarding health education for dangers of secondhand smoke and links to cessation services. Both Guardian and HAP participated in workshops for their onsite managers, some of whom smoke, to help them deal with enforcement challenges, feel more comfortable talking to residents about their smoking, and refer tenants who want to quit smoking to appropriate resources. Details about the steps taken by HAP, the implementation tools it developed (13), and its enforcement plan (14), which includes referral to smoking cessation resources, are available on the Internet.

In July 2009, ALAO and project partners surveyed 300 metro-area renters (23% of whom were current smokers) to assess changes in no-smoking policies since the 2006 survey. Findings showed a 29% increase in the availability of smoke-free rental units in the Portland-Vancouver metro area, amounting to approximately 13,000 new smoke-free units in the 3-year period (15).

The 2009 Oregon legislature passed a law that requires Oregon landlords, as they sign residential rental agreements, to disclose their smoking policy to their tenants. According to the law, "The disclosure must state whether smoking is prohibited on the premises, allowed on the entire premises or allowed in limited areas on the premises. If the smoking policy allows smoking in limited areas on the premises, the disclosure must identify the areas on the premises where smoking is allowed" (16). The law went into effect January 1, 2010. Key to the bipartisan success of the bill was the fact that the landlord trade associations and fair housing advocates, both crucial partners in the project from the beginning, supported the bill.

After adopting a no-smoking policy in January 2008, a high-level manager at Guardian and past president of an influential landlord trade association became a champion of smoke-free housing locally, regionally, and even nationally. Guardian's policy changes and the champion's support have been invaluable, as property managers tend to emulate large and successful property management companies.

Our project resulted in sustainable systems-level changes that are setting a new industry standard and facilitating the change to smoke-free policies for other landlords. Examples of these changes include the following:

In addition, our model was adopted by the Oregon Tobacco Prevention and Education Program (TPEP), which initiated a new contract with Health In Sight LLC for coordinating smoke-free housing efforts at the state level. TPEP also requires grantees in all 36 counties in Oregon to work with property managers to adopt no-smoking policies. A schematic outlining activities to accomplish this, depicted in terms of a landlord's stage of change, was developed as a tool for these county programs (Figure 2).