Research articleHome Smoking Bans Among U.S. Households with Children and Smokers: Opportunities for Intervention
Introduction
For children, the home is the primary site of exposure to secondhand smoke (SHS),1, 2 which is known to cause premature disease and death.3 Children living in a home with an adult smoker are up to twice as likely to take up smoking themselves.4, 5 In 1994, an estimated 35% of U.S. children lived with regular smoking in the home.6 By 2000, this had decreased to 25%.7 There is a wide variation in recent estimates of SHS exposure from 7.6%8 of all children to 17%–18% of children aged 3–19 years,9 suggesting that SHS exposure may differ markedly across the country. Strong evidence exists indicating declines in childhood exposure to SHS in the home, likely because of the spread of anti-tobacco social norms, associated reductions in adult smoking prevalence and cigarette consumption levels, and increased prevalence of complete home smoking bans (“smokefree homes”).7, 9, 10, 11 However, these factors vary across states and racial/ethnic groups, and there remain demographic subgroups whose children have high exposure to SHS.8 Effective strategies to address these disparities are urgently needed.
In households with a smoker, implementation of a complete home smoking ban will reduce SHS exposure among nonsmoking residents.10 An estimated 98% of children living with a smoker in the home have serum cotinine levels greater than 0.05 ng/mL, compared with 40% of children not living with a smoker.9 The number of cigarettes smoked inside the home is a predictor of cotinine levels for children,9, 12 and in families with smokers, a smokefree home has been shown to reduce cotinine levels in infants by up to 85%.13 Among preadolescent and adolescent children, living in a home with a complete home smoking ban also promotes anti-smoking attitudes and reduces the risk of future tobacco use.4, 14, 15, 16 However, despite these benefits, households that include a current smoker are much less likely than nonsmoking households to have a complete home smoking ban.17
In addition to presence/absence of a smoker in the home, other established predictors of a home smoking ban include race/ethnicity, income, educational level, presence of children in the home,8, 9, 10, 11, 12, 13, 17, 18 and exposure to smokefree legislation, tobacco-control programs, or media campaigns.10, 19, 20 The public health approach to reduce sudden infant death syndrome recommends forbidding smoking around infants, and thus households with infants may be more likely to have a home smoking ban than those with older children. At the state level, smoking prevalence is associated with prevalence of home smoking bans.8, 10
Previous estimates of children's exposure to SHS in the home have asked the parent most engaged in the child's health care Does anyone smoke in the home?8, 9 However, smokers and nonsmokers in the same household tend to report home smoking rules differently,21 and this assessment strategy has potential to underestimate SHS exposure in households with smokers. In addition, given the evidence that complete, as opposed to partial, home smoking bans are associated with lower levels of urine cotinine in children,22, 23 it may be important to assess the specific rules regarding smoking in the home.
The Tobacco Use Supplements to the U.S. Current Population Survey (TUS-CPS) are conducted by the U.S. Census Bureau under sponsorship from the National Cancer Institute, and their large sample sizes and representative nature allow reliable estimates by demographic groups within states. From 1992/1993 to 2006/2007, the TUS-CPS includes detailed assessment of home smoking restrictions from all adult household members. It was hypothesized that the TUS-CPS could be used to identify demographic groups of smoking families with low prevalence of home smoking bans: from the 1992/1993 and 2006/2007 TUS-CPS, the presence or absence of a complete home smoking ban was determined among households with both children and smokers (“smoking families”), using a smoking adult as the household respondent. Although the prevalence of home smoking bans generally increased across the study period, it was hypothesized that this increase would not hold uniformly for smoking families of different racial/ethnic groups. It was expected that the likelihood of a home smoking ban might differ by household educational level and age of youngest child, but it was hypothesized that these factors might be more important for some racial/ethnic groups than for others. Understanding these differences among smoking families should help target effective interventions for different racial/ethnic groups and should inform future health policy.
Section snippets
Data Source
The CPS uses a monthly random sample of occupied housing units in the U.S., with response rates higher than 90%.24 The TUS is periodically included in three independent CPS monthly samples. The present study used data from households containing at least one child and at least one self-respondent adult smoker in the 1992/1993 and 2006/2007 TUS-CPS. The TUS-CPS self-response rate is more than 61%, among the highest in population survey research.25
Demographic and Smoking Measures
Following standard practice, current smokers were
U.S. Smoking in Households with Children
In 2006/2007, comparing U.S. households with children and smokers to all U.S. households with children, significantly more of the smoking households were of non-Hispanic white race/ethnicity (Table 1). Fewer of these smoking families had graduated from college, and they were more likely to be at or below the poverty line. Mean age of adult respondent and percentage of children in each age category were similar between smoking households and all U.S. households with children.
Prevalence of Smokefree Homes, by Race/Ethnicity and Education
In 1992/1993, only
Discussion
Among U.S. households with both children and adult smokers, the prevalence of complete home smoking bans more than tripled from 1992/1993 (14.1%) to 2006/2007 (50.0%). Although this is encouraging progress, gains were smallest among African-American households and among households with older versus younger children. There were fewer home smoking bans in households below the poverty line, in households with less educational attainment, and in states with high smoking prevalence. However, within
Conclusion
Half of U.S. households with children and smokers lacked a home smoking ban in 2007. Effective interventions to promote smokefree homes among smoking families are needed, especially for African-American families, all families with older children, and non-Hispanic white and Hispanic families in targeted states. The health consequences of exposure to SHS have been well documented in a recent Surgeon General's report3 and emphasize the urgent need for public health action to increase the rate of
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