Smoking restrictions in the home and car among rural Native American and white families with young children

BACKGROUND: This paper examines the prevalence of household and car smoking restrictions, factors associated with these restrictions, and children's exposure to secondhand smoke in homes with varying levels of household smoking restrictions in rural Native American and White families. METHODS: In-person interviews were conducted with 380 rural, low-income Native American and White parents or guardians who were the primary caregivers of children aged 1-6 in northeastern Oklahoma. RESULTS: Prevalence of complete smoking bans was 49.1% in Native American homes and 42.7% in White homes. Car smoking bans were less common, with 34.9% of Native American and 39.6% of White caregivers reporting complete bans. Among nonsmoking households, the proportion of friends who smoked was associated with both car and home smoking bans. Race and education of the caregivers were also associated with car smoking bans in homes with no adult smokers. Among smokers, cigarettes smoked per day, quit attempts within the past year, and the strong belief that secondhand smoke harmed children and babies were related to household smoking bans, whereas cigarettes smoked per day and the proportion of friends who smoked were related to car smoking bans. CONCLUSIONS: Despite the relatively low prevalence of smoking bans in our population, factors associated with household and car smoking bans were similar to those found in the general population.     

Household smoking behaviours and exposure to environmental tobacco smoke among infants: are current strategies effectively protecting our young?

Objective: To determine the prevalence of infant exposure to environmental tobacco smoke (ETS) among infants attending child health clinics in regional NSW; the association between such exposure and household smoking behaviours; and the factors associated with smoking restrictions in households with infants. Methods: Parents completed a computer‐based questionnaire and infant urine samples were collected. Information was obtained regarding the smoking behaviours of household members and samples were analysed for cotinine. Results: Twenty seven per cent of infants had detectable levels of cotinine. Infant ETS exposure was significantly associated with the smoking status of household members, absence of complete smoking bans in smoking households and having more than one smoker in the home. Smoking households were significantly less likely to have a complete smoking ban in place. Conclusions: This study suggests that a significant proportion of the population group most vulnerable to ETS were exposed. Implications: Future efforts to reduce children's exposure to ETS need to target cessation by smoking parents, and smoking bans in households of infants where parents are smokers if desired reductions in childhood ETS‐related illness are to be realised.     

The Effect of Household Smoking Bans on Household Smoking

Objectives. Because household smoking levels and adoption of domestic smoking rules may be endogenously related, we estimated a nonrecursive regression model to determine the simultaneous relationship between home smoking restrictions and household smoking.Methods. We used data from a May–June 2012 survey of Philadelphia, Pennsylvania, households with smokers (n = 456) to determine the simultaneous association between smoking levels in the home and the presence of home restrictions on smoking.Results. We found that home smoking rules predicted smoking in the home but smoking in the home had no effect on home smoking restrictions.Conclusions. Absent in-home randomized experiments, a quasi-experimental causal inference suggesting that home smoking rules result in lower home smoking levels may be plausible.Secondhand smoke (also known as “passive smoking” or “environmental tobacco smoke”) is a health hazard for children and adults.1–5 Institutional, city, or national smoking restrictions reduce smoking prevalence and the average consumption of smokers while naturally limiting exposure to secondhand smoke.6–11 At the household level, the research focus has been on the efficacy of household bans on indoor smoking to reduce nonsmokers’ and children’s exposure.12–18 Many studies have found that smokers in households with smoking bans or restrictive smoking rules smoke fewer cigarettes than smokers in households with no bans or rules.19–23 This relationship appears to suggest that household smoking restrictions are effective in reducing household smoking. But do household bans really reduce household smoking? Unfortunately, this situation is not the same as when smoking bans are implemented in bars,24,25 hospitals,26 prisons,27 schools,28 or countries.29,30 In all of these examples, the bans are introduced independently of the prevalent smoking levels of the institution, city, or country because passive smoking exposure is seen as an important health hazard that requires an administrative or legislative response.In households, this analogy does not necessarily hold. Household smoking could be negatively related to household smoking bans because smokers who smoke fewer cigarettes or households with little smoking may implement a household smoking ban whereas heavier smokers or households with multiple smokers could not do so.23,31 In this situation, household smoking bans are endogenous32 relative to household smoking, which implies that household smoking levels cause the smoking ban, not the reverse. To determine which explanation is correct, an experiment that implemented a household ban randomly in regard to household smoking levels would be appropriate.14,33,34 Under experimental conditions, the ban would be independent of household smoking levels and the effect of implementing a household smoking ban on smoking could be unambiguously estimated.     

A qualitative study of how families decide to adopt household smoking restrictions

Household smoking bans reduce exposure to secondhand smoke in adult nonsmokers and children. To explore the process families go through in adopting voluntary household smoking restrictions, qualitative interviews were conducted with rural African American and White adults in 102 households. The study investigated how families decide to restrict smoking in the home, who has significant influence in the decision-making process, the kinds of disagreements families have about household smoking restrictions, and reasons some families never consider household smoking policies. These findings have implications for designing intervention strategies and messages to promote household smoking bans and help family members negotiate smoke-free homes.     

The Relative Effect of Household and Workplace Smoking Restriction on Health Status Among Chinese Americans Living in New York City

Households and workplaces are the predominant location for exposure to secondhand smoke. The purpose of this study is to examine the association between health status and smoking restrictions at home and work and to compare the relative effect of household and workplace smoking restrictions on health status. This study uses data from a cross sectional representative probability sample of 2,537 Chinese American adults aged 18–74 living in New York City. The analysis was limited to 1,472 respondents who work indoors for wages. Forty-three percent of respondents reported a total smoking ban at home and the workplace, 20% at work only, 22% home only, and 15% reported no smoking restriction at home or work. Smokers who live under a total household smoking ban only or both a total household and total workplace ban were respectively 1.90 and 2.61 times more likely to report better health status compared with those who reported no smoking ban at work or home. Before the NYC Clean Indoor Air Act second-hand smoke (SHS) exposure among this immigrant Chinese population at home and work was high. This study finds that household smoking restrictions are more strongly associated with better health status than workplace smoking restrictions. However, better health status was most strongly associated with both a ban at work and home. Public health efforts should include a focus on promoting total household smoking bans to reduce the well-documented health risks of SHS exposure. Shelley and Hung are with the Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA; Yerneni and Fahs are with the Brookdale Center on Aging, Hunter College, City University of New York, New York, NY, USA. Fahs and Das are with the Economics Program Graduate Center, City University of New York, New York, USA. An erratum to this article can be found at     

Household smoking bans: which households have them and do they work?

BACKGROUND: This study characterized Oregon households according to type and degree of restrictions on smoking and explored whether smoking restrictions are associated with decreased environmental tobacco smoke (ETS) exposure. METHODS: A population-based, random-digit-dialed cross-sectional telephone survey of 6,199 adult Oregonians was performed in 1997 to provide baseline data on tobacco use in Oregon. RESULTS: Seventy percent of Oregon households were composed of nonsmokers only, and 85% of those had a full ban on smoking inside the home. Of the households containing one or more smokers, 38% had a full household ban on smoking. Among respondents with a full ban in place, 99% of nonsmoker-only households reported that no one smoked in the home in the previous month, compared with 91% of households with at least one smoker. In both nonsmoker-only households and those with at least one smoker, full bans were strongly associated with awareness of the harm of ETS (OR = 12.8, 95% CI 7.3-22.3, and OR = 6.6, 95% CI 3.6-12.3, respectively). The presence of children in the household was also closely associated with full bans in the two types of households (OR = 4.6, 95% CI 2.8-7.6, and OR = 3.0, 95% CI 2.1-4.4, respectively). Nevertheless, 50% of households with children and a smoker present did not have a full ban in place. CONCLUSIONS: While the prevalence of household smoking restrictions is high in Oregon, there remains room for improvement, since 50% of households with a smoker and a child present do not have a full ban on indoor smoking. Public health messages that focus on household smoking restrictions may help protect nonsmokers from exposure to ETS.     

A cost-effectiveness analysis of India's 2008 prohibition of smoking in public places in Gujarat

Tobacco smoking and exposure to secondhand tobacco smoke are associated with disability and premature mortality in low and middle-income countries. The aim of this study was to assess the cost-effectiveness of implementing India's Prohibition of Smoking in Public Places Rules in the state of Gujarat, compared to implementation of a complete smoking ban. Using standard cost-effectiveness analysis methods, the cost of implementing the alternatives was evaluated against the years of life saved and cases of acute myocardial infarction averted by reductions in smoking prevalence and secondhand smoke exposure. After one year, it is estimated that a complete smoking ban in Gujarat would avert 17,000 additional heart attacks and gain 438,000 life years (LY). A complete ban is highly cost-effective when key variables including legislation effectiveness were varied in the sensitivity analyses. Without including medical treatment costs averted, the cost-effectiveness ratio ranges from $2 to $112 per LY gained and $37 to $386 per acute myocardial infarction averted. Implementing a complete smoking ban would be a cost saving alternative to the current partial legislation in terms of reducing tobacco-attributable disease in Gujarat.     

The Role of Ethnicity and Nativity in the Correspondence between Subjective and Objective Measures of In-Home Smoking

Studies are needed to understand the association between self-reported home smoking bans and objective measures of in-home smoking according to smokers’ ethnicity/nativity. Data came from a trial that used air particle monitors to reduce children’s secondhand smoke exposure in smokers’ households (N?=?251). Linear regressions modeled (a) full home smoking bans by ethnicity/nativity, and (b) objectively measured in-home smoking events, predicted by main and interaction effects of self-reported home smoking bans and ethnicity/nativity. Among smokers reporting?<?a full ban, US-born and Foreign-born Latinos had fewer in-home smoking events than US-born Whites (p?<?0.001). Participants who reported a full smoking ban had a similar frequency of smoking events regardless of ethnicity/nativity. Results indicate that self-reported home smoking bans can be used as a proxy for in-home smoking. Establishing smoking bans in the households of US-born White smokers has the largest impact on potential exposure compared to other ethnicity/nativity groups.

     

Is there an impact of public smoking bans on self-reported smoking status and exposure to secondhand smoke?

Background  

Implementation of smoke free policies has potentially substantial effects on health by reducing secondhand smoke exposure. However little is known about whether the introduction of anti-smoking legislation translates into decreased secondhand smoke exposure. We examined whether smoking bans impact rates of secondhand smoke exposure in public places and rates of complete workplace smoking restriction.     

Smoking Bans in the Home and Car: Do Those Who Really Need Them Have Them?

Background. This paper addresses the question of whether individuals who are most in need of household and car smoking bans, such as individuals with children living at home or who have many friends who smoke, are the ones who have them.Method. A representative sample of 6985 California adults ages 18 and older participated in telephone interviews.Results. Overall, 76% of adults report having home smoking bans and 66% have car smoking bans. Being a smoker or African American, not having children in the home, having more friends who smoke, and lower household income were associated with lower prevalence of both home and car smoking bans (P < 0.01). In multivariate analyses, nonsmokers were 7.9 (95% CI = 3.56, 17.31) times more likely to have a home smoking ban when none of their friends were smokers compared to when most of their friends were smokers. Among smokers, there was an interaction between having children at home and the proportion of friends who smoke. Only 27 to 55% of smokers had home smoking bans unless most of their friends were smokers, then the odds of having a ban were 6.1 (95% CI = 2.76, 13.68) times higher for smokers with children (67% with home bans) than for smokers without children at home (25% with home bans).Conclusions. Efforts to increase home and car smoking bans for nonsmokers who have friends who smoke and smokers with children living at home are needed.     

Formative research on creating smoke-free homes in rural communities

The home is a significant place for exposure to secondhand smokefor children and non-smoking adults. This study explored factorsthat would convince families to adopt household smoking bansand actions to create and maintain smoke-free homes. Interviewswere conducted with adults in 102 households in rural Georgia.Participating families had a young adolescent and included householdswith a mix of smokers and non-smokers and smoking ban status.Families reported they would consider a total ban to protectchildren from secondhand smoke and protect family members ifthey got sick. Few described difficulties in enforcement withover half of smokers accepting the rules. Situations that madeit hard to enforce restrictions were if there was a visitorwho smoked, a smoker who had cravings, and bad weather outsidewhen the smoker desired to smoke. Smokers explained that familymembers could assist them in quitting by talking to them, notpurchasing cigarettes for them, not smoking around them, andsupporting them. Ideas for promoting smoke-free homes were havinga no smoking sign, saying no to visitors who want to smoke,removing ashtrays, and creating a place outside for smokers.These findings can inform interventions designed to create andmaintain smoke-free households. Received on June 21, 2007; accepted on November 20, 2007     

Smoking bans and the secondhand smoking problem: an economic analysis

Smoking bans are gaining widespread support in the European Union and other countries. The vast majority of these bans are partial bans given that smoking is still permitted in certain places. This article investigates the role of partial smoking bans in coping with externalities caused by the secondhand smoking problem. Although it is widely known that Pigouvian taxation is superior to a perfect ban, this result does not necessarily carry over to a partial ban because taxes cannot (easily) be differentiated according to location. We show that under an easy and intuitive condition, (1) enacting a partial smoking ban alone always improves social welfare (a) in an unregulated society and (b) even in a regulated society if externalities can be eliminated, and (2) it is ensured that a combination of Pigouvian tax and a partial smoking ban leads to a higher social optimum than implementing corrective Pigouvian taxation alone.     

Home smoking bans in Finland and the association with child smoking

BACKGROUND: Few studies in Europe have investigated home smoking bans and their association with child smoking. METHODS: A nationwide survey of 12 to 18-year olds in 2005 (n = 6503, response rate 66%) was used to study home smoking bans in Finland. Multinomial logistic regression analyses were used to study association of home smoking bans and child smoking. RESULTS: Of the respondents, 58% reported a total ban, 27% a partial ban, 4% reported no ban and 10% chose the option 'I cannot say'. The lack of total ban was strongly associated with living in non-intact families, parents' lower educational level, parental smoking and parents' permissive attitude towards child smoking. Moreover, partial or no ban increased the likelihood of being a daily smoker. In the multinomial logistic regression model, the odds ratios (ORs) for children's daily smoking, adjusted for sociodemographic factors, parental smoking and their permissive attitude, were OR 2.9 [95% confidence interval (CI) 2.3-3.6] for partial ban and OR 14.3 (8.6-23.7) for no ban. In families where both parents smoked, the adjusted ORs were correspondingly 1.5 (95% CI 0.7-3.0) and 2.9 (95% CI 1.1-7.8). CONCLUSIONS: Home smoking bans will contribute towards a reduced risk of child smoking even when parents smoke. Tobacco control legislation needs to be enhanced with measures promoting awareness of the benefits achievable through strict home smoking bans. Families characterized by lower socioeconomic status and smoking parents are particular target groups.     

Household smoking bans and adolescent antismoking attitudes and smoking initiation: findings from a longitudinal study of a Massachusetts youth cohort

Objectives. We sought to determine whether adolescents living in households in which smoking was banned were more likely to develop antismoking attitudes and less likely to progress to smoking compared with those living in households in which smoking was not banned.Methods. We completed a longitudinal 4-year, 3-wave study of a representative sample of 3834 Massachusetts youths aged 12 to 17 years at baseline; 2791 (72.8%) were reinterviewed after 2 years, and 2217 (57.8%) were reinterviewed after 4 years. We used a 3-level hierarchical linear model to analyze the effect of a household ban on antismoking attitudes and smoking behaviors.Results. The absence of a household smoking ban increased the odds that youths perceived a high prevalence of adult smoking, among both youths living with a smoker (odds ratio [OR] = 1.56; 95% confidence interval [CI] = 1.15, 2.13) and those living with nonsmokers (OR = 1.75; 95% CI = 1.29, 2.37). Among youths who lived with nonsmokers, those with no home ban were more likely to transition from nonsmoking to early experimentation (OR = 1.89; 95% CI = 1.30, 2.74) than were those with a ban.Conclusions. Home smoking bans may promote antismoking attitudes among youths and reduce progression to smoking experimentation among youths who live with nonsmokers.The proliferation of US smoke-free workplace policies and laws over the past decade has been accompanied by increased attention to private household smoking restrictions. The number of US households with comprehensive rules that make homes smoke free in all areas at all times has increased substantially.¹ The proportion of US households with smoke-free home rules increased from 43% in 1992 to 1993 to 72% in 2003.² Even smokers appear to be increasingly adopting such rules, particularly in homes in which they live with a nonsmoking adult.Although smoke-free home bans are typically implemented to reduce or eliminate environmental tobacco smoke exposure in the household, these bans may have the additional benefit of reducing the initiation of smoking among youths by changing norms about the prevalence and social acceptability of smoking. Very little is known about the specific effect of a household smoking ban on youth smoking behavior or on smoking-related attitudes and norms that may mediate an effect on smoking behavior. In particular, few studies have addressed the independent effect of bans on youths who live with smokers—those who are at the greatest risk for becoming smokers themselves.Recent studies showed that strong smoking regulations in local restaurants and bars were associated with more negative attitudes among youths toward the social acceptability of smoking in restaurants and bars.^3–6 Establishing household smoking bans conveys to youths living within these smoke-free home environments the message that smoking is unacceptable. Some supportive evidence, derived from cross-sectional data, indicates that a household smoking ban is associated with antismoking attitudes and norms. A recent cross-sectional study found that a household ban was associated with a lower perceived prevalence of adult smoking and more-negative attitudes about the social acceptability of smoking, 2 factors that affect the likelihood of smoking initiation.⁷Several cross-sectional studies have reported that a smoking ban in the household was associated with a lower likelihood of being in an earlier stage of smoking and a lower current smoking prevalence among adolescents.^8–11 Conversely, other studies found no statistically significant association between a household smoking ban and reduced adolescent smoking.^12–14 Several factors may account for these conflicting results, including varying sample sizes, age groups, and smoking measures used in these cross-sectional studies.A critical question is whether antismoking socialization occurs when parents themselves smoke. One study found that a household smoking ban was related to lower levels of smoking onset for children with nonsmoking parents but not for children with 1 or more parent who smoked.¹⁵ Another study reported that a household smoking ban was not associated with trying smoking among high school students who had 1 or more parents who were current or former smokers.¹⁶ Only 1 study reported an association between a household smoking ban and a reduced likelihood of smoking among 12th graders whose parents were smokers but not among those whose parents were nonsmokers.¹⁷ In summary, more evidence supports an association between home smoking bans and lower levels of smoking behaviors among youths who live with nonsmokers.Current research on household smoking bans has significant limitations. First, these studies rely on cross-sectional data that limit the ability to indicate causality in the relation between home smoking bans and trajectories of attitudes and smoking. Second, most studies have focused on individual-level predictors of attitudes and smoking behaviors, despite evidence that part of the explanation lies within the community context.¹⁸ Third, few studies have investigated the unique effects of a household smoking ban among adolescents living in home environments with parental smokers compared with those living with nonsmokers.In this study, our goal was to improve existing research by (1) using longitudinal data that followed up a cohort of youths and young adults who lived in parental homes over a 4-year period, with a total of 3 repeated observations for each participant; (2) using a multilevel model that simultaneously examined the effects of individual-level and town-level factors; and (3) investigating separately the effects of a household ban on youths who live with at least 1 smoker and youths who live with nonsmokers.     

Smoking ban policies and their influence on smoking behaviors among current California smokers: A population-based study

ObjectiveTo assess whether smoking ban policies are associated with smoking reduction and quit attempts among California smokers.MethodsData were examined for 1718 current smokers from follow-up telephone interviews conducted in 2011 of persons previously identified as smokers in a representative sample of the adult population of California. Population weighted logistic regressions controlling for demographic and other variables were used to evaluate the association between smoking ban policies (home, work, and town) and changes in tobacco use (past year quit attempt or reduction in smoking rate).ResultsLiving in a home with a total ban was significantly associated with smoking reduction (adjusted odds ratio, AOR: 2.4, 95% CI: 1.4–4.2) and making a quit attempt (AOR: 2.3, 95% CI: 1.3–3.9) compared to living in a home with no home ban. Self-reported perception of an outdoor ban in one's city/town was associated with smoking reduction (AOR: 1.7, 95% CI: 1.02–2.7) and making a quit attempt (AOR: 1.8, 95% CI: 1.05–2.9).ConclusionThese results indicate that smoking bans not only protect nonsmokers from the harms of secondhand smoke, but are also associated with smoking reduction and cessation.     

Impact of a smoking ban on restaurant and bar revenues--El Paso, Texas, 2002

Smoke-free indoor air ordinances protect employees and customers from secondhand smoke exposure, which is associated with increased risks for heart disease and lung cancer in adults and respiratory disease in children. As of January 2004, five states (California, Connecticut, Delaware, Maine, and New York) and 72 municipalities in the United States had passed laws that prohibit smoking in almost all workplaces, restaurants, and bars. On January 2, 2002, El Paso, Texas (2000 population: 563,662), implemented an ordinance banning smoking in all public places and workplaces, including restaurants and bars. The El Paso smoking ban is the strongest smoke-free indoor air ordinance in Texas and includes stipulations for enforcement of the ban by firefighting and law enforcement agencies, with fines of up to $500 for ordinance violations. To assess whether the El Paso smoking ban affected restaurant and bar revenues, the Texas Department of Health (TDH) and CDC analyzed sales tax and mixed-beverage tax data during the 12 years preceding and 1 year after the smoking ban was implemented. This report summarizes the results of that analysis, which determined that no statistically significant changes in restaurant and bar revenues occurred after the smoking ban took effect. These findings are consistent with those from studies of smoking bans in other U.S. cities. Local public health officials can use these data to support implementation of smokefree environments as recommended by the Task Force on Community Preventive Services.     

News on tobacco and public attitudes toward smokefree air policies in the United States

OBJECTIVES: Smoking bans are a central component of comprehensive tobacco control programs, and an increasing number of states and localities have adopted them. Public support is critical as efforts continue to extend protection from secondhand smoke to all. We examine the relationship between state print news coverage of tobacco and public sentiment towards smoking bans. METHODS: We utilize two data sources: the February 2002 Current Population Survey Tobacco Use Supplement, and articles from 2 months in a database comprised of content-analyzed newspaper articles on tobacco from all daily U.S. newspapers. We control for demographic and state-level tobacco covariates, and use logistic regression to identify associations between news coverage and attitudes towards policy initiatives by smoking status. RESULTS: We find no association between tone of news coverage and any outcome measure and little evidence of a relationship between the volume of overall tobacco news and attitudes towards smoking bans. Our data suggest that people exposed to more news on secondhand smoke issues are less likely to support restaurant smoking bans. Higher volume of secondhand smoke news is also predictive of lower support for bar bans among recent quitters. Support for hospital bans is, however, largely independent of news coverage. CONCLUSIONS: We suggest two alternate explanations for our findings. First, for certain people, greater news volume on secondhand smoke may lead to lower support for bans. Alternatively, secondhand smoke may be more newsworthy in states where bans are more controversial.     

Home smoking restrictions. Problems in classification

BACKGROUND: Evidence of the effectiveness of smoking restrictions in workplaces and other public places is creating awareness of the role of bans in private spaces. The purpose of this study was to examine who is affected by strict home smoking bans at the household level. METHODS: Using the 1998/1999 Tobacco Use Supplement to the U.S. Current Population Survey, we examined the characteristics of 43,613 households with two or more adults who responded to the home ban question. Analyses were conducted in 2003-2004. RESULTS: An estimated 12% of sample households provided inconsistent reports about home smoking bans. Multimember households with smokers were substantially less likely to consistently report strict home bans. Discrepancies vary systematically by smoking behavior, socioeconomic status, and race/ethnicity. Children living with smokers are especially at risk of inconsistent adult reports. CONCLUSIONS: Analyses should not rely on individual reports of home bans, especially in households with smokers and children. Policies should be directed toward educating members of households with smokers and children about the importance of household bans.     

Correlates of home smoking bans among Mexican-Americans

PURPOSE: This study examines the individual and environmental correlates of home smoking bans among a population-based sample of Mexican-Americans. Design. A telephone survey on tobacco use and home policies was conducted using stratified, random sampling of listed phone numbers. SETTING: Surveys were completed by telephone in San Diego, California. SUBJECTS: The sample consisted of San Diego adult residents of Mexican descent (N=1103). MEASURES: The interview included questions on home rules regarding smoking in the household and a number of potential correlates, based on the Behavioral Ecological Model (BEM). This model emphasizes the influence of family, social, and cultural factors on health behaviors. RESULTS: Overall, 90.6% of all respondents reported a ban on smoking in the home. Multivariate analyses indicated that home bans on smoking are more likely among individuals that do not smoke, live with children, are more acculturated to U.S. society, report greater aversion to ETS, and/or report more social pressure against indoor smoking. In contrast, smoking bans are less likely among Mexican Americans who live with smokers. CONCLUSIONS: Individual and environmental factors play a protective role by increasing the likelihood of smoking bans in the home of Mexican-descent individuals. These factors should be considered for the design of interventions to sustain and promote the adoption of smoking bans in the home among this and other populations.     

The effects on smokers of Boston's smoke-free bar ordinance: a longitudinal analysis of changes in compliance, patronage, policy support, and smoking at home.

OBJECTIVE: We prospectively examined effects of the implementation of a smoking ban in bars on Boston, Massachusetts, smokers. METHODS: A representative sample of Massachusetts smokers was interviewed before and after the smoking ban was implemented in Boston. Participants were adult smokers living in Boston (n = 83) and in 203 other Massachusetts cities and towns that did not adopt smoking bans in bars prior to July 2004 (n = 903). The outcome measures were changes in reports of smoking in bars, frequency of bar patronage, support for smoke-free bars, smoking at home, and exposure to secondhand smoke at home based on town of residence. RESULTS: Compared to changes over the same time period among smokers in towns where smoking in bars was permitted, smokers in Boston were significantly less likely to observe smoking and less likely to decrease their bar patronage after the smoking ban was implemented. Changes in support for smoke-free bars, smoking patterns at home, and exposure to secondhand smoke at home did not differ between the groups. Conclusion: Expectations about noncompliance, declines in patronage, and displacement of smoking to the home as a consequence of extending smoking restrictions to bars are not supported by the data.