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Determinants and consequences of smoke-free homes: findings from the International Tobacco Control (ITC) Four Country Survey
  1. R Borland1,
  2. H-H Yong1,
  3. K M Cummings2,
  4. A Hyland2,
  5. S Anderson3,
  6. G T Fong4
  1. 1The Cancer Council Victoria, Australia
  2. 2Roswell Park Cancer Institute, Buffalo, New York, USA
  3. 3Centre for Tobacco Control Research, University of Stirling/Open University, Stirling, UK
  4. 4University of Waterloo, Waterloo, Ontario, Canada
  1. Correspondence to:
 Ron Borland
 PhD, Cancer Control Research Institute, The Cancer Council Victoria, 1 Rathdowne Street, Carlton, VIC 3053, Australia; Ron.Borland{at}


Objective: To report on prevalence, trends and determinants of smoke-free home policies in smokers’ homes in different countries and to estimate the effects of these policies on smoking cessation.

Design: Two waves of the International Tobacco Control (ITC) Four Country Survey (ITC-4), a cohort survey of smokers conducted by telephone. Wave 1 was conducted in October/December 2002 with broadly representative samples of over 2000 adult (⩾ 18 years) cigarette smokers in each of the following four countries: Canada, the United States, the United Kingdom, and Australia, 75% of whom were followed up at Wave 2 on average seven months later.

Key measures: Levels of smoking restrictions in homes (both waves).

Results: Australian smokers were most likely to live in smoke-free homes and UK smokers least likely (34% v 15% at Wave 1). Levels of smoke-free homes increased between waves. Logistic regressions indicated that the main independent predictors of smokers reporting smoke-free homes or implementation of a smoke-free policy between waves included household factors such as having a child, particularly a young child, and having other non-smoking adults in the household. Positive attitudes to smoke-free public places and/or reported presence of smoke-free public places were independent predictors of having or implementing smoke-free homes, supporting a social diffusion model for smoking restrictions. Intentions to quit at Wave 1 and quitting activity between survey waves were associated with implementing bans between Waves 1 and 2. Presence of bans at Wave 1 was associated with significantly greater proportions of quit attempts, and success among those who tried at Wave 2. There was no significant interaction between the predictive models and country.

Conclusions: Smoke-free public places seem to stimulate adoption of smoke-free homes, a strategy associated with both increased frequency of quit attempts, and of the success of those attempts.

  • CATI, computer assisted telephone interview
  • HSI, heaviness of smoking index
  • ITC, International Tobacco Control
  • ITC-4, International Tobacco Control Four Country Survey
  • SES, socioeconomic status
  • TSP, tobacco smoke pollution
  • smoke-free homes
  • household composition
  • young children
  • prospective prediction
  • smoking cessation
  • International Tobacco Control survey

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  • The authors have no conflicts of interest

  • The paper was conceived by Ron Borland who did the bulk of the writing assisted by Hua Yong, especially with respect to the results. The other co-authors, Hyland, Cummings, Anderson and Fong, all read and commented on drafts and added content.

    Ethics approval: The study protocol was cleared for ethics by the Institutional Review Boards or Research Ethics Boards in each of the countries: the University of Waterloo (Canada), Roswell Park Cancer Institute (USA), the University of Illinois-Chicago (USA), the University of Strathclyde (UK), and the Cancer Council Victoria (Australia).