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.     

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.     

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.     

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.     

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 the United Kingdom smoking ban on alcohol spending: Evidence from the Living Costs and Food Survey

The effect of smoking bans on alcohol consumption is unclear, and this is especially true of the differing effect on smokers and non-smokers. This paper uses spending survey data to examine the effect of the United Kingdom smoking bans on alcohol spending. It finds the introduction of a smoking ban decreased alcohol expenditure, specifically in the on-trade (pubs and restaurants) and amongst smoking households. Smoking households are estimated to have reduced their weekly on-premise alcohol expenditure by £1.70 (approximately 15–20%), whilst non-smoking households do not significantly change their expenditure. The smoking ban may therefore have affected on-premise outlets through a reduction in revenue. This study provides further evidence that tobacco policies affect drinking behaviour.     

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.     

Prevalence and Indicators of Household Smoking Bans Among American Indians

More than 58 million nonsmokers in the U.S. encounter secondhand smoke that leads to tobacco-related diseases and deaths every year, making voluntary household smoking bans an important public health goal. American Indians/Alaska Natives are rarely included in research related to household smoking bans. Further, most studies dichotomize household smoking bans into complete bans versus partial/no bans, rendering it impossible to determine if partial and no bans are associated with different or similar risk factors. Using the 2014 Cherokee Nation American Indian Adult Tobacco Survey, our study sought to identify prevalence of household smoking bans, their extent, and their correlates in an American Indian population. This cross-sectional analysis used multinomial logistic regression to determine correlates of complete, partial, and no household smoking bans. Results indicated that approximately 84% of Cherokee households have a complete ban. Younger age, female gender, higher education, higher household income, respondent’s nonsmoking status, good health, better awareness of harms related to secondhand smoke, visits with a healthcare provider within the past year, and children in the home were positively and significantly associated with complete household smoking bans. Additionally, there were notable differences between correlates related to partial bans and no bans. These results provide insight for the development of more appropriate interventions for American Indian households that do not have a complete household smoking ban.     

The relationship between home smoking bans and exposure to state tobacco control efforts and smoking behaviors

PURPOSE: To examine the relationship between home smoking bans and adult smokers' exposure to the statewide California Tobacco Control Program (TCP) and their cigarette smoking behavior. DESIGN: Cross-sectional survey that was part of the statewide Independent Evaluation of the California Tobacco Control, Prevention and Education Program. SETTING: Random telephone interviews within 18 California counties. SUBJECTS: A representative sample of 1315 adult smokers, aged 25 years and older. MEASURES: The telephone survey included questions about smoking behavior, quitting smoking, exposure to tobacco control program components, home smoking rules, and attitudes related to tobacco use and environmental tobacco smoke (ETS). RESULTS: Smokers with a home smoking ban were twice as likely (OR = 2.29; 95% CI 1.22, 4.29) to have heard of TCP community programs and three times more likely (OR = 3.18; 95% CI 1.34, 7.57) to have seen and talked about the ETS media spot than smokers with no home smoking policy. Multivariate regression models indicated that having a home smoking ban was related to smoking fewer cigarettes per day and greater interest in quitting smoking compared with smokers with no smoking rules in the home (p < .05). CONCLUSIONS: These findings suggest that smokers reporting exposure to the California TCP were more likely to have restrictive home smoking policies and that more restrictive home smoking policies were associated with reduced smoking behavior.     

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.     

Tobacco use behaviors and household smoking bans among Chinese Americans

PURPOSE: To assess the relationship between household smoking restrictions and smoking patterns among Chinese American adults. DESIGN: This is a cross-sectional analysis based on a National Institutes of Health-funded population-based household and telephone survey of 2537 Chinese American adults. SETTING: Two communities in New York City. SUBJECTS: The analyses focused on male current smokers (N = 600). MEASURES: Demographic characteristics, smoking status, household smoking restrictions, cigarettes smoked per day, and past quit attempts were based on self-reported data. RESULTS: Among current smokers, 37% reported living in a home with a complete smoking ban. Smokers with a full household smoking ban smoked fewer cigarettes on weekdays and weekends than smokers with no household smoking ban (p < or = .05) and were 3.4 times (p < .01) more likely to report having at least one quit attempt in the past 12 months. Smokers with knowledge of the dangers of environmental tobacco smoke (ETS) exposure were 2.8 times (p < or = .01) more likely to have at least one quit attempt in the last 12 months compared with those who were unaware of the danger of ETS and more likely to live in a smoke-free household. CONCLUSIONS: Smoke-free home policies and interventions to raise awareness among smokers of the dangers of ETS have the potential to significantly reduce tobacco use and exposure to household ETS among this immigrant population.     

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.     

Support for No-Smoking Policies Among Residents of Public Multiunit Housing Differs by Smoking Status

We compared perceptions of smoking and non-smoking Tacoma, WA multiunit public housing residents regarding smoke-free policies and in-home smoking rules. Two-hundred-twenty-nine completed surveys (~16 % of units) of a modified version of the CDC’s multiunit housing resident survey were analyzed. Smokers differed significantly (p < 0.05) from non-smokers with respect to agreement with policies that would ban smoking in homes (41 % of smokers and 82 % of non-smokers strongly agreed or agreed), in common indoor areas (74 % of smokers and 82 % of non-smokers strongly agreed or agreed), and for outdoor areas (38 % of smokers and 68 % of non-smokers strongly agreed or agreed). For in-home smoking rules, smokers and non-smokers again differed significantly (p < 0.05) with 53 % of smokers and 90 % of non-smokers not allowing smoking in their homes. Twenty-five percent of residents reported smelling secondhand smoke that infiltrated their residence from the outside on a daily basis. The most notable findings are that more than 50 % of smokers do not allow smoking in their homes and that more than 50 % of smokers are supportive of or neutral with respect to smoke-free policies for one’s home. This suggests that implementation of smoke-free policies may not greatly impact vacancy rates even in populations with high rates of smoking (37 % in this study).     

Factors Influencing Adoption of and Adherence to Indoor Smoking Bans Among Health Disparity Communities

Objectives. We assessed current home smoking behaviors and secondhand smoke (SHS) levels among parents of children in low-income, racial/ethnic minority communities in Massachusetts.Methods. We used a cross-sectional design to assess home smoking rules, smoking status, cigarettes smoked in the home, and barriers and benefits to attaining a smoke-free home among 138 caregivers (mean age = 30.0 years; 92% women) of children aged 0 to 6 years, between April 2010 and September 2012. Indoor SHS was assessed using a nicotine dosimeter.Results. Households with no ban reported a higher weekly mean number of cigarettes smoked in the home (114 cigarettes/week) than homes with partial (71 cigarettes/week) or complete (30 cigarettes/week) bans (P < .01). Smoking occurred outside more than inside homes with partial or complete bans. Air nicotine levels were positively associated with no household smoking ban, current smoking by the caregiver, and smoking indoors.Conclusions. Strategies to reduce home SHS should focus on a “complete” home smoking ban and smoking cessation. SHS mitigation strategies such as smoking outside were associated with lower SHS among participants unable to maintain a complete ban, and might enhance the likelihood of longer term success while immediately reducing home SHS.Secondhand smoke (SHS) exposure is associated with serious pediatric illnesses, yet is entirely preventable.1 Children’s exposure to SHS occurs chiefly in domestic environments, including the home and car.2,3 SHS exposure varies by income, race, and parental education,4 and the likelihood of exposure to SHS tends to be higher among African American and low socioeconomic status (SES) groups.5 Children from low-income backgrounds are at greater risk for SHS exposure and share a disproportionate burden of disease.6–8 Young children (aged 6 years and younger) from lower SES communities are 3 times more likely to be exposed to the highest levels of SHS in the home (≥ 4 days/week) as children from middle- and high-income groups.9 Recent data indicate that the percentage of households with a voluntary smoke-free rule has risen nationwide.3,10 In 1995, approximately 58% of homes in the United States were reportedly smoke-free, whereas more recent data suggest that this percentage now approaches 84%.11 This figure may be higher in homes in which children are present.10 Despite the increase in smoke-free homes, children’s cotinine levels (an index of SHS exposure) have remained steady since 2000.12 This may be explained, in part, by incomplete or diminishing adherence to self-imposed home smoking bans. However, little research has been conducted to understand the factors associated with implementation and adherence to home smoking bans, including facilitators and barriers to the maintenance of a smoke-free home.Although efficacious interventions to help families establish smoke-free home rules have been widely reported,13 strategies to tailor those interventions to the needs of low-income and minority race/ethnicity communities have so far been limited.14,15 Complete home smoking bans are associated with lower SHS16,17; however, a better understanding is needed of current home smoking behaviors and attitudes among parents of young children in low-income minority communities. Such questions might appropriately be posed in Massachusetts—a state in which the prevalence of children’s exposure to SHS in the home ranks well below the median of US states,4 yet where public health efforts have so far failed to provide protection from SHS exposure for 4.3% (an estimated 61 000) of Massachusetts children.4,18 Nevertheless, it is possible that microlevel changes directed at mitigating SHS exposure have occurred within homes that have not become completely smoke-free. Limiting the number of cigarettes smoked inside a home may directly reduce SHS,17 which, in turn, may influence children’s exposure to SHS.8 Behavioral strategies intended to mitigate SHS exposure, such as smoking outdoors, may be an underinvestigated (albeit suboptimal)19 strategy used in households where a ban has either not been implemented or successfully maintained.To more fully understand home smoking practices among communities of low income and racial and ethnic diversity, we sought to identify who adopted and who adhered to a voluntary home smoking ban, the barriers and perceived benefits to adherence, and the impact of those bans on home smoking behaviors (including mitigation strategies), using a cross-sectional study design. In addition, the number of smokers in the household, their age, race and ethnicity, the number and location (within the home or attached external structure) of cigarettes smoked, and strategies employed to reduce SHS exposure were documented. Finally, indoor air quality was measured by nicotine levels to characterize factors associated with home SHS levels.     

Restrictions on smoking at home and urinary cotinine levels among children with asthma

OBJECTIVES: The purpose of this study was to determine the extent to which various levels of restrictions on smoking in the home may be associated with children's exposure to environmental tobacco smoke (ETS). METHODS: The methodology consisted of a cross-sectional survey involving 249 children with asthma aged 1 to 11 attending hospital outpatient clinics, with at least one parent who smoked, linked to the child's urinary cotinine to creatinine ratios (CCR). RESULTS: After adjustment for child's age, mother's smoking status, and total parental daily cigarette consumption, a total ban was associated with significantly lower urinary CCR levels (7.6 nmol/mmol) than bans with exceptions or limited smoking in the home. Where exceptions to bans were made (14.9 nmol/mmol), children's urinary CCR levels were no different from homes in which smoking was allowed in rooms the child rarely frequented (14.1 nmol/mmol). These two intermediate levels of restriction were in turn associated with significantly lower CCR levels than unrestricted smoking in the home (26.0 nmol/mmol). CONCLUSIONS: Making exceptions to bans on smoking at home measurably undermines the protective effect of a ban. However, making some exceptions to a ban and limiting smoking to rooms where the child rarely goes may result in reduced exposure to ETS, compared with unrestricted smoking.     

The Impact of Smoking Bans on Smoking and Consumer Behavior: Quasi‐Experimental Evidence from Switzerland

In this paper, we exploit the progressive implementation of smoking bans in public venues at the state level in Switzerland to evaluate both the direct effects on smoking and the potential unintended consequences of these legislations on consumer behaviors as measured by visiting restaurants/bars and discos (‘going out’). Our results indicate that public venue smoking bans in Switzerland reduce smoking rates, but the findings do not emerge until 1 year following the ban. This pattern of results is consistent with delays in ban enforcement on the part of business owners, difficulties in changing addictive behaviors such as smoking, and/or learning on the part of smokers. We find evidence that smoking bans influence going‐out behavior and there is substantial heterogeneity across venue and consumer characteristics. Copyright © 2014 John Wiley & Sons, Ltd.     

Compliance and support for bans on smoking in licensed venues in Australia: findings from the International Tobacco Control Four‐Country Survey

Objective: To examine attitudes towards and compliance with the recent Australian bans on smoking in licensed venues, and to explore effects on smoking behaviour. Methods: Three Australian states (Queensland, Tasmania and Western Australia) implemented a total ban on smoking in all enclosed licensed premises in 2006, and two others (Victoria and New South Wales) did so in mid‐2007. We used data from smokers residing in these states for each of the six waves of the ITC‐4 country survey (2002–2007; average n=1,694). Results: Consistent with the majority of international findings, observed compliance was reported by more than 90% of smokers from a pre‐ban situation of indoor smoking being the norm. Attitudes became more positive in the year before the ban, but more than doubled in the year the bans were implemented. The associations found for the leading states were replicated by the lagging states a year later. We found no evidence for any increase in permitting smoking inside the home after the bans took effect. Further, we were unable to find any evidence of reductions in daily cigarette consumption or any increase in quitting activity due to the bans. Implications: These results add to a growing body of international research that suggests that smokers are readily able to comply with, and increasingly support, smoke‐free bars, though the bans may have limited effect on their smoking habits.     

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.     

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.     

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.