The cost-effectiveness of falls prevention interventions for older community-dwelling Australians

Objective: To evaluate the cost‐effectiveness of strategies designed to prevent falls among older people. Methods: A decision analytic Markov model of interventions designed to prevent falls was developed. Incremental cost‐effectiveness ratios (ICERs) using quality adjusted life year (QALYs) as the measure, were calculated for those interventions aimed at the general population (home exercise, group exercise, tai chi, multiple and multi‐factorial interventions); high‐risk populations (group exercise, home hazard assessment/modification and multi‐factorial interventions); and specific populations (cardiac pacing, expedited cataract surgery and psychotropic medication withdrawal). Uncertainty was explored using univariate and probabilistic sensitivity analysis. Conclusion: In the general population, compared with no intervention the ICERs were tai chi ($44,205), group‐based exercise ($70,834), multiple interventions ($72,306), home exercise ($93,432), multifactorial interventions with only referral ($125,868) and multifactorial interventions with an active component ($165,841). The interventions were ranked by cost in order to exclude dominated interventions (more costly, less effective) and extendedly dominated interventions (where an intervention is more costly and less effective than a combination of two other interventions). Tai chi remained the only cost‐effective intervention for the general population. Implications: Interventions designed to prevent falls in older adults living in the community can be cost‐effective. However, there is uncertainty around some of the model parameters which require further investigation.     

Integrating proven falls prevention interventions into government programs

Objective : To identify Department of Health programs with high potential to integrate evidence‐based interventions to prevent falls among older people. Methods : Broad consultation within the Department followed by structured decision making. This work was informed by an analysis of Victorian hospital separations data and a Cochrane Systematic Review to identify relevant target groups and interventions. Ranking of the integration potential of interventions for a broad range of Department program areas was achieved through a facilitated workshop. A short list of program areas was then developed and scored, using pre‐defined criteria, for their match with the interventions. Results : The ranked order of interventions, from most to least suitable for integration, were: multifactorial risk assessment and intervention; multi‐component group exercise; medication review; occupational therapy‐based home safety; home‐based exercise; and first eye cataract surgery. Four of six program areas had a strong match (a score of ≥75% of the maximum score) with one or more of three interventions. Two program areas (Primary Care Partnerships, and Home and Community Care) had strong matches with three interventions (group‐ and home‐based exercise; occupational therapy‐based home safety) and were selected as priority areas. The Hospital Admissions Risk Program had strong and good matches respectively with home‐based exercise and medication review, and was also selected. Conclusions : Our systematic methods identified Department programs with strong potential for integration of proven falls prevention interventions. Implications : Matching departmental programs and evidence‐based interventions for integration may lead to more efficient resource allocation for falls prevention in Victoria.     

Impact of Upgraded Lighting on Falls in Care Home Residents

ObjectivesFalls in care home residents have major health and economic implications. Given the impact of lighting on visual acuity, alertness, and sleep and their potential influence on falls, we aimed to assess the impact of upgraded lighting on the rate of falls in long-term care home residents.DesignAn observational study of 2 pairs of care homes (4 sites total). One site from each pair was selected for solid-state lighting upgrade, and the other site served as a control.Setting and ParticipantsTwo pairs of care homes with 758 residents (126,479 resident-days; mean age (±SD) 81.0 ± 11.7 years; 57% female; 31% with dementia).MethodsOne “experimental” site from each pair had solid-state lighting installed throughout the facility that changed in intensity and spectrum to increase short-wavelength (blue light) exposure during the day (6 am–6 pm) and decrease it overnight (6 pm–6 am). The control sites retained standard lighting with no change in intensity or spectrum throughout the day. The number of falls aggregated from medical records were assessed over an approximately 24-month interval. The primary comparison between the sites was the rate of falls per 1000 resident-days.ResultsBefore the lighting upgrade, the rate of falls was similar between experimental and control sites [6.94 vs 6.62 falls per 1000 resident-days, respectively; rate ratio (RR) 1.05; 95% CI 0.70–1.58; P = .82]. Following the upgrade, falls were reduced by 43% at experimental sites compared with control sites (4.82 vs 8.44 falls per 1000 resident-days, respectively; RR 0.57; 95% CI 0.39–0.84; P = .004).Conclusions and ImplicationsUpgrading ambient lighting to incorporate higher intensity blue-enriched white light during the daytime and lower intensity overnight represents an effective, passive, low-cost, low-burden addition to current preventive strategies to reduce fall risk in long-term care settings.     

A sustainable programme to prevent falls and near falls in community dwelling older people: results of a randomised trial

STUDY OBJECTIVE: In the causative mechanism of falls among older community dwellers, slips and trips have been found to be significant precursors. The purpose of the two year trial was to assess the effectiveness of multi-component interventions targeting major risk factors for falls in reducing the incidence of slips, trips and falls among the well, older community. DESIGN: Four groups with approximately equal numbers of participants were randomly allocated to interventions. The prevention strategies included education and awareness raising of falls risk factors, exercise sessions to improve strength and balance, home safety advice to modify environmental hazards, and medical assessment to optimise health. The interventions combined the strategies in an add on approach. The first intervention group receiving the information session only was regarded as the control. The outcome of interest was the occurrence of a slip, trip or fall, monitored prospectively using a daily calendar diary. PARTICIPANTS AND SETTING: Two hundred and fifty two members of the National Seniors Association in the Brisbane district agreed to participate. National Seniors clubs provide a forum for active, community dwelling Australians aged 50 and over to participate in policy, personal development and recreation. MAIN RESULTS: Using Cox's proportional hazards regression model, adjusted hazard ratios comparing intervention groups with the control ranged from 0.35 (95% CI 0.17, 0.73) to 0.48 (0.25, 0.91) for slips; 0.29 (0.16, 0.51) to 0.45 (0.27, 0.74) for trips; and 0.60 (0.36, 1.01) to 0.82 (0.51, 1.31) for falls. While calendar monitoring recorded outcome, it was also assessed as a prevention strategy by comparing the intervention groups with a hypothetical nonintervened group. At one year after intervention, reductions in the probability of slips, trips and falls (61 (95% CI 54, 66)%; 56 (49, 63)%; 29 (22, 36)% respectively) were demonstrated. CONCLUSIONS: This study makes an important contribution to the priority community health issue of falls prevention by showing that effective, sustainable, low cost programmes can be introduced through community-based organisations to reduce the incidence of slips, trips and falls in well older people.     

Psychosocial risk factors associated with falls among Chinese community‐dwelling older adults in Hong Kong

This study examined the relationship between psychosocial factors and falls among community‐dwelling older adults in the Hong Kong Special Administrative Region of China. The study included 1573 adults aged 60 or above who lived at home and who were applying for long‐term care services. These participants were part of a large cross‐sectional survey carried out between 2003 and 2004 in which they completed the Hong Kong Chinese version of the Resident Assessment Instrument‐Home Care (RAI‐HC) assessment. Of those persons who were surveyed, 516 (32.8%, 95% CI 30.5% to 35.2%) had fallen in the previous 90 days. Bivariate analyses showed that five psychosocial factors (depressive symptoms, fear of falling, a decline in social activities, the number of hours of informal care support during weekdays and living alone) were significantly associated with falls (P < 0.05). Logistic regression analysis showed living alone (odds ratio (OR) = 0.62; 95% CI 0.44 to 0.86) was the only psychosocial factor significantly associated with falls, after adjusting for the known significant factors related to falls. It was also found that more elders who lived with others had environmental hazards than those who lived alone (71.0% vs 29.0%, χ2 = 4.80, P = 0.028). These findings suggested that living with others may not be as safe as we assume. Interventions to increase awareness of home safety and to seek co‐operation with family members in falls prevention are recommended. Fall preventive strategies should be educated to family members who are living with frail older adults. On the other hand, Chinese older adults who live alone often receive support from relatives or friends. Social support seems to be crucial to prevent them from falls and this measure is recommended to be continued in the community.     

Impact of Atrial Fibrillation on Falls in Older Patients: Which is a Problem,Existence or Persistence?

ObjectivesSeveral studies have suggested a possible relationship between atrial fibrillation (AF) and falls. However, whether the relationship depends on AF types is unclear. We investigated the relationship between sustaining AF and falls.DesignSingle hospital-based cohort study with a follow-up of falls within 3 years after baseline.Setting and ParticipantsA total of 14,056 patients from our cohort between February 2010 and March 2016.MeasuresIncidence of falls within 3 years by baseline cardiac rhythm was measured, and we investigated the effects of AF types on incidence of falls.ResultsThe study population was divided into younger (<75 years old; n = 11,808) and older (≥75 years old; n = 2248) groups, and then divided into 3 groups according to the baseline cardiac rhythm: sinus rhythm (SR), paroxysmal AF (PAF), and persistent AF (PeAF). There were more male patients in the PeAF group; these patients had more comorbidities both in the younger and older groups. The cumulative incidence rates of falls at 1 year in patients with SR, PAF, and PeAF were similar in the younger group (0.4%, 0.4%, and 0.6%, respectively; P = .496), whereas those were significantly different in the older group (2.3%, 2.7%, and 5.0%, respectively; P = .024). In multivariate analysis, both PAF [hazard ratio (HR) 1.179; 95% confidence interval (CI) 0.553–2.511, reference SR] and PeAF (HR 1.502; 95% CI 0.635–3.556) were not associated with falls in the younger group. In the older group, PeAF was independently associated with incidence of falls (HR 2.257; 95% CI 1.262–4.037), but PAF was not (HR 1.317; 95% CI 0.673–2.574).Conclusions/ImplicationsPeAF, not PAF, was associated independently with falls in older patients, suggesting the possible effect of irregular beats on physical frailty in the older population.     

Fatal occupational injuries among electric power company workers

Surveillance data suggest high rates of electrocutions and fatal falls among workers in electric utility companies, who may be exposed to electric current, heights, flammable agents, and frequent motor vehicle travel. To characterize the occurrence of fatal injuries among electric utility workers, we studied workers in five electric power companies in the United States. A cohort of 127,129 men hired between 1950 and 1986 was followed through 1988. Injuries at work were identified through manual review of death certificates. The occurrence of occupational injuries was analyzed with directly adjusted rates and Poisson regression. The overall rate of fatal occupational injuries was 13.20 per 100,000 person‐years (n = 192), with 76% due to electric current, homicide, and falls from heights. Deaths were concentrated in a few groups with elevated injury rates, notably linemen (rate ratio (RR) 3.33), electricians (RR 2.79), and painters (RR 3.27). Occupations requiring daily work on elevations or frequent, direct contact with energized electrical equipment experienced markedly higher rates of fatal injury from falls and electrocutions with rate ratios of 21.8 (95% confidence interval (CI) 11.4–41.5) and 16.7 (95% CI 6.6–42.6), respectively, independent of worker age and seniority. Although fatal injury rates in this industry have declined in recent decades, significant numbers of deaths still occur. Based on the premise that all injuries are preventable, a need for continued vigilance and efforts at prevention is indicated. Am. J. Ind. Med. 35:302–309, 1999. © 1999 Wiley‐Liss, Inc.     

Fall-Associated Drugs in Community-Dwelling Older Adults: Results from the ActiFE Ulm Study

ObjectivesMany studies describing an association of drugs with falls focus mostly on drugs acting in the central nervous system. We aim to analyze the association of all drugs taken with falls in older adults.DesignProspective population-based study (ActiFE study).Setting and ParticipantsA total of 1377 community-dwelling older adults with complete recording of falls and baseline information on drug intake.MethodsNegative binomial regression was used to analyze the association of 34 drug classes with a 12-month incidence rate ratio (IRR) of falls adjusting for age, sex, comorbidities, gait speed, balance, chair rise, kidney function, liver disease, and smoking.ResultsParticipants took a median 3 drugs (interquartile range 1, 5), with 34.5% (n = 469) having ≥5 drugs. The median IRR for a fall per person-year was overall 0.72 [95% confidence interval (CI) 0.60–0.83] and 2.22 (95% CI 1.90–2.53) among those who experienced ≥1 fall. The following drug classes showed significant associations: antiparkinsonian medication [IRR 2.68 (95% CI 1.59–4.51)], thyroid therapy [IRR 1.40 (95% CI 1.08–1.81)], and systemic corticosteroids [IRR 0.33 (95% CI 0.13–0.81)]. Among fall-risk-increasing drugs only antiepileptics [IRR 2.16 (95% CI 1.10–4.24)] and urologicals [IRR 2.47 (95% CI 1.33–4.59)] were associated with falls in those participants without a prior fall history at baseline.Conclusion and ImplicationsAdditional drug classes, such as antiparkinsonian medication, thyroid therapy, and systemic corticosteroids, might be associated with falls in older adults, possibly representing pharmacological effects on the musculoskeletal and central nervous systems. Further evaluations in larger study populations are recommended.     

Associations between obesity and overweight and fall risk,health status and quality of life in older people

Objectives: To determine whether overweight and obese individuals have higher reported fall and fall injury risk than individuals of healthy weight, and to examine the influence of BMI on health, quality of life and lifestyle characteristics of fallers. Methods: A representative sample of community‐based individuals aged 65 years and older in New South Wales was surveyed regarding their history of falls, height, weight, lifestyle and general health within a 12‐month period. Results: Obese individuals had a 31% higher risk of having fallen, but no higher risk of a fall‐related injury compared to healthy‐weight individuals. Obese fallers also had a 57% higher risk of believing nothing could be done to prevent falls; a 41% higher risk of using four or more medications; a 30% higher risk of experiencing moderate or extreme pain or discomfort; were 26% less likely have walked for two or more hours in the last week; and were less likely to think they were doing enough physical activity. Conclusions: Older obese individuals have an increased risk of falls and obese fallers have a higher prevalence of pain and inactivity than fallers of a healthy weight. Implications: A decrease in sedentary lifestyle and regular weight‐bearing exercise may reduce fall risk in older obese individuals.     

Baseline indicators for measuring progress in preventing falls injury in older people

Objective: Over recent years, there has been increasing attention given to preventing falls and falls injury in older people through policy and other initiatives. This paper presents a baseline set of fall injury outcome indicators against which these preventive efforts can be assessed in terms of monitoring the rate of fall-related deaths and hospitalisations.
Methods: ICD-10-AM coded hospital separations, Australian Bureau of Statistics (ABS) mortality and ABS population data were used to determine the rate of fall-related injury mortality and hospitalisations occurring in people aged 65+ years in New South Wales (NSW), Australia, over the six-year period from 1998/99 to 2003/04, inclusive.
Results: Baseline trends for one fatality and five separations-based metrics are presented. Overall, fall mortality rates increased over the six years, with higher rates in males. Falls hospitalisation rates also increased slightly, with higher rates in females. The rates of hip fracture and pelvic fracture hospital separations generally declined over the six years and were highest in females. The level of unspecified and missing information about the place where falls occur increased by 1.5%.
Conclusion: Baseline trends in fall injury outcome metrics highlight the severity and frequency of fall injuries before wide scale implementation of the Management Policy to Reduce Fall Injury Among Older People in NSW.
Implications: Future use of these metrics will help to evaluate and monitor the progress of falls prevention in older people in NSW. They could also be adopted in other jurisdictions.     

Economic evaluation of a community based exercise programme to prevent falls

OBJECTIVE: To assess the incremental costs and cost effectiveness of implementing a home based muscle strengthening and balance retraining programme that reduced falls and injuries in older women. DESIGN: An economic evaluation carried out within a randomised controlled trial with two years of follow up. Participants were individually prescribed an exercise programme (exercise group, n=116) or received usual care and social visits (control group, n=117). SETTING: 17 general practices in Dunedin, New Zealand. PARTICIPANTS: Women aged 80 years and older living in the community and invited by their general practitioner to take part. MAIN OUTCOME MEASURES: Number of falls and injuries related to falls, costs of implementing the intervention, healthcare service costs resulting from falls and total healthcare service costs during the trial. Cost effectiveness was measured as the incremental cost of implementing the exercise programme per fall event prevented. MAIN RESULTS: 27% of total hospital costs during the trial were related to falls. However, there were no significant differences in health service costs between the two groups. Implementing the exercise programme for one and two years respectively cost $314 and $265 (1995 New Zealand dollars) per fall prevented, and $457 and $426 per fall resulting in a moderate or serious injury prevented. CONCLUSIONS: The costs resulting from falls make up a substantial proportion of the hospital costs for older people. Despite a reduction in falls as a result of this home exercise programme there was no significant reduction in healthcare costs. However, the results reported will provide information on the cost effectiveness of the programme for those making decisions on falls prevention strategies.     

Increased cancer risk among relatives of nonsmoking lung cancer cases

Lung cancer has been shown to aggregate in families of nonsmoking lung cancer cases with an earlier age at onset. The current study evaluates whether relatives of nonsmoking lung cancer cases are at increased risk of cancers at sites other than lung. Families were identified through 257 population‐based, nonsmoking lung cancer cases and 277 population‐based, nonsmoking controls residing in metropolitan Detroit. Data were collected for 2,252 relatives of cases and 2,408 relatives of controls. First‐degree relatives of nonsmoking lung cancer cases were at 1.52‐fold (95% CI, 1.02–2.27) increased risk of cancer of the digestive system after adjustment for each relative's age, race, sex, and smoking status. Relative risk estimates also were elevated, but not significantly, for tobacco‐related cancers (RR = 1.39) and breast cancer (RR = 1.72). Among first‐degree relatives of younger probands (age 40–59), risk was non‐significantly increased 72% (95% CI 0.95–3.10) for all cancers combined and 3.14‐fold for cancers of the digestive system (95% CI 0.76–12.9). Nonsmoking relatives of cases were at increased risk of all cancer sites combined (RR = 1.32; 95% CI 1.003–1.73), cancers other than lung (RR = 1.37; 95% CI 1.03–1.82), and digestive system cancers (RR = 2.01; 95% CI 1.20–3.37). These findings of moderate familial aggregation for cancers of the lung, digestive system, breast, and tobacco‐related sites suggest that common susceptibility genes may act to increase risk for a variety of cancers in families. Genet. Epidemiol. 17:1–15, 1999. © 1999 Wiley‐Liss, Inc.     

老年跌倒干预措施效果的Meta分析

[目的]评价各种锻炼、家居环境危险因素调整和多因素评估与干预在预防老年跌倒上的效应大小。[方法]通过检索Medline、Cochrane Database of Systematic Reviews、Cochrane Central Register of Controlled Trials、《中国生物医学文献数据库》(CBMdisc)与其他数据库及追溯参考文献收集与老年跌倒预防有关的随机对照试验,按入选标准筛选后提取其中的数据进行Meta分析。[结果]共有25篇文献收录。Meta分析显示,锻炼在预防老年跌倒发生上,总RR为0.885,95%CI为(0.808,0.970);在预防创伤性跌倒的发生上,总RR(95%CI)为0.675(0.511,0.892)。家居环境危险因素调整在预防全老年人群上总RR(95%CI)为0.854(0.751,0.972);在预防有跌倒史的老年人群上总RR(95%CI)为0.659(0.537,0.808)。多因素评估及干预在预防老年跌倒和创伤性跌倒上,总效应RR(95%CI)分别为0.817(0.688,0.969)和0.764(0.595,0.981)。[结论]锻炼、家居环境危险因素调整和多因素评估及干预都可以减少老年跌倒或创伤性跌倒的发生。     

Prevalence and correlates of falls in a middle-aged population with osteoarthritis: Data from the Osteoarthritis Initiative

People with osteoarthritis (OA) are at a higher risk of falls and fall-related injuries. However, there is limited knowledge of the burden and correlates of falls in middle-aged people with OA. Using data from the Osteoarthritis Initiative, this study aimed to determine the prevalence and correlates of falls among middle-aged people with OA. A total of 1,019 adults aged 45–64 years with OA were included in this cross-sectional analysis. The prevalence of self-reported falls in the past 12 months was calculated and relationships between demographic and clinical characteristics and falls history were explored via univariable and multivariable logistic regression. Of the study population (61.7% female), 43.7% (445/1,019) reported having had a fall in the last 12 months. In multivariable models, female sex (odds ratio [OR] 2.09, 95% confidence interval [CI] 1.50–2.90), Charlson score ≥1 (OR 1.90, 95% CI 1.42–2.55) and opioid use (OR 2.68, 95% CI 1.77–4.06) were associated with a higher likelihood of falls. Higher depression score, being White/Caucasian and higher educational attainment were also associated with a greater likelihood of falls. Having knee and hip OA was associated with a higher likelihood of falls (OR 1.79, 95% CI 1.24–2.59), compared to knee OA alone. In summary, previous falls history is concerningly common among middle-aged adults with OA, with modifiable risk factors including depression and opioid use. Greater attention to falls prevention is therefore needed for this patient group, including screening for falls and tailoring existing falls prevention interventions.     

The physical environment as a fall risk factor in older adults: Systematic review and meta-analysis of cross-sectional and cohort studies

Background/aim:  Evidence that the physical environment is a fall risk factor in older adults is inconsistent. The study evaluated and summarised evidence of the physical environment as a fall risk factor.
Methods:  Eight databases (1985–2006) were searched. Investigators evaluated quality of two categories (cross-sectional and cohort) of studies, extracted and analysed data.
Results:  Cross-sectional: falls occur in a variety of environments; gait aids were present in approximately 30% of falls.
Cohort:  Home hazards increased fall risk (odds ratio (OR) = 1.15; 95% confidence interval (CI): 0.97–1.36) although not significantly. When only the high quality studies were included, the OR = 1.38 (95% CI: 1.03–1.87), which was statistically significant. Use of mobility aids significantly increased fall risk in community (OR = 2.07; 95% CI: 1.59–2.71) and institutional (OR = 1.77; 95% CI: 1.66–1.89) settings.
Conclusions:  Home hazards appear to be a significant risk factor in older community-dwelling adults, although they may present the greatest risk for persons who fall repeatedly. Future research should examine relationships between mobility impairments, use of mobility aids and falls.     

Older fallers attended to by an ambulance but not transported to hospital: a vulnerable population at high risk of future falls

Objective : This prospective cohort study describes older non‐transported fallers seen by the Ambulance Service of New South Wales (ASNSW), quantifies the level of risk and identifies predictors of future falls and ambulance use. Methods : Participants were 262 people aged 70 years or older with a fall‐related ASNSW attendance who were not transported to an emergency department. They completed a questionnaire about health, medical and physical factors previously associated with falling. Falls were monitored for six months after ambulance attendance with monthly fall calendars. Results : Participants had a high prevalence of chronic medical conditions, functional limitations and past falls. During follow‐up, 145 participants (58%) experienced 488 falls. Significant predictors of falls during follow‐up were three or more falls in the past year, being unable to walk more than 10 minutes without resting, and requiring assistance for personal‐care activities of daily living (ADLs). Sixty‐two participants (25%) required repeat, fall‐related ambulance attendance during the study. Predictors of repeat ambulance use were: 3+ falls in past year, requiring assistance for personal‐care ADLs and having disabling pain in past month. Conclusions : Older, non‐transported fallers seen by the ASNSW are a vulnerable population with high rates of chronic health conditions. Implications : Onward referral for preventive interventions may reduce future falls and ambulance service calls.     

Bathroom modifications among community-dwelling older adults who experience falls in the United States: A cross-sectional study

Falls impose substantial health and economic burdens on older adults. Over half of falls in older adults occur at home, with many involving bathroom areas. Limited information is available on the presence of bathroom modifications for those who experience them. Therefore, we examined factors associated with bathroom modifications among older adults with at least one fall in the United States. We analysed the nationally representative 2016 Medicare Current Beneficiary Survey Public Use File of Medicare beneficiaries aged ≥65 years with ≥1 fall (n = 2,404). A survey-weighted logistic model was used to examine associations between bathroom modifications and factors including socio-demographic characteristics, health-related conditions, and fear of falling. Among Medicare beneficiaries with ≥1 fall, 55.5% had bathroom modifications and 50.1% had repeated falls (≥2 falls). Approximately 40.2% of those with repeated falls had no bathroom modifications. In the adjusted model, non-Hispanic Blacks (odds ratio [OR] = 0.38; p < 0.001) and Hispanics (OR = 0.64; p = 0.039) had lower odds of having bathroom modifications than non-Hispanic Whites. Fear of falling and activities of daily living limitations had incremental impacts on having bathroom modifications. This study highlights the need to improve disparities in bathroom modifications for non-Hispanic Black and Hispanic Medicare beneficiaries, including those with repeated falls. With the aging population and growing number of older minorities in the United States, reducing these disparities is vital for fall prevention efforts and aging-in-place.     

Factors associated with smoke-free homes in NSW: results from the 1998 NSW Health Survey

Objective : To examine the socio‐demographic characteristics associated with smoke‐free homes (SFHs) in NSW and specify high‐risk groups with a low prevalence of household smoking restrictions. Methods : Data were drawn from the 1998 NSW Health Survey, a computer‐assisted telephone interview survey of 17,494 randomly selected respondents aged 16 years across NSW (response rate =70%). Logistic regression analyses, stratified by smoking status, were used. Results : Overall, 72% of adults reported having a SFH; 87% of never‐smokers, 81% of ex‐and 35% of current smokers. The highest percentages of SFHs were reported in households with young children (78%) and with older children (72%) or with adults only (72%). For smokers, SFHs were independently associated with the presence of young children (OR=3.8, 95% Cl 3.1–4.7) compared with those who lived alone, but the odds of living in a SFH were only slightly increased for smokers living with older children (aged 6–15) and for those living with adults only (OR=1.9, OR=1.8 respectively). Speaking a language other than English at home, having more than 10 years' education, and being <35 years old were independently and positively associated with SFH. Being employed in smoke‐free workplaces increased the likelihood of SFHs for both current and past smokers (OR=1.6, OR=1.2 respectively). Conclusion : Most NSW homes have restrictions on smoking inside, but more than half the households with children and at least one smoker adult are not smoke free. Implications : Interventions to shape parents' smoking behaviour around older children are warranted. Strategies need to address never‐smokers in communities with high prevalence of smoking and adults with lower levels of education. A continued commitment to workplace smoking bans is important as they may affect household smoking restrictions.