Short Communication
Influences on parents’ decisions for home and automobile smoking bans in households with smokers

https://doi.org/10.1016/j.pec.2008.09.001Get rights and content

Abstract

Objective

To understand clinician influence on use of home and automobile smoking bans in homes of children living with a smoker.

Methods

Parents were surveyed on tobacco use, smoking bans, demographics and opinions about tobacco, including harm from environmental tobacco smoke (ETS). Responses from 463 diverse households with smokers were analyzed.

Results

42% of respondents smoked; 50% had a home smoking ban and 58% an automobile smoking ban. Nonsmokers living with a smoker, those who strongly agreed in ETS harm, and those having a child ≤5 years more often had a home smoking ban. Those recalling their child's doctor ever asking the respondent about their smoking status and African American respondents less frequently had a home ban. Automobile smoking bans were more often held by those with strong agreement in ETS harm and less often found in families having a child receiving Medicaid/uninsured.

Conclusions

Having a strong perception of harm from ETS exposure was associated with having smoking bans. Aspects of health encounters not measured by this study may be negatively influencing adoption of home smoking bans or lead to recall bias.

Practice implications

Clinicians should examine the strength, focus, and response to their messages to parents about tobacco.

Introduction

Smoking bans reduce child environmental tobacco smoke (ETS) exposure [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11]. Most nonsmoking households ban smoking; households with smokers less frequently have a ban [12], [13], [14]. In homes with smokers, bans are more likely if the household includes children [9], [10], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22] or a nonsmoking adult [13], [14], [15], [16], [17], [22], and when a belief in ETS harm exists [11], [13], [16], [17], [18], [19]. Generally, parents less often ban smoking in automobiles than homes [10], [14], [19], [20], although some studies report similar rates [18], [23]. Automobile bans are more likely if the adult respondents’ friends are nonsmokers [18], [19], [20].

Most successful interventions to lower child ETS exposures include home-based counseling and repeated encounters [24]. While mandating smoke-free public places seems to increase adoption of smoke-free homes [22], little is known on how to promote adoption of smoking bans through counseling provided during busy pediatric primary care practice. Among minority, low-income parents, recall that the pediatrician had discussed health hazards of smoking was not significantly associated with having a total ban on smoking in the home or car [14]. How routine care received at pediatric primary care visits influences smoking bans in more diverse populations is not known. Therefore, we used data collected to inform clinicians about tobacco use among families they serve to study factors influencing smoking bans.

Section snippets

Population and sampling

Practices were asked to consecutively distribute 100 anonymous, 2-page surveys in April–August, 2001. Data were obtained from 24 practices (60% of invited). Participating practices are in the Chicago, IL, area; seven serve mostly low-income families and the others are privately owned practices having few families (<20%) with public health insurance. Institutional Review Boards at Children's Memorial Hospital and Evanston Northwestern Healthcare approved this study.

Data instrument

Questions were modeled after

Response

Among 2461 surveys submitted, 2341 (95%) had a parent respondent and complete data. A median 93 surveys per practice (range 10–245) were analyzed.

Most respondents (80%) did not smoke and lived in a nonsmoking household. Of these, 90% had a home smoking ban, 83% banned automobile smoking, and 45% recalled the child's doctor ever asking if they smoked.

Respondents in homes with smokers

Further analyses were limited to 463 respondents from households that included a smoker. Among these respondents, 42% smoked. Respondent

Discussion

Tobacco assessment and counseling is a recommended aspect of pediatric practice [28], [29]. The rate of recall of a query by the child's doctor about parental smoking in this sample of households with smokers was similar to that reported in a national sample [30] and rates of bans were similar to past reports [10], [12], [14], [15], [16], [23]. Hispanic and African American parents and those with a child on Medicaid/uninsured and with ≤high school education most often recalled a query from

Conflict of interest

None declared.

Acknowledgements

We gratefully acknowledge the dedicated efforts of Sherry Lyons, MA, for assistance with many aspects of this project. We thank the participating practices and particularly the physicians and staff who guided data collection at their sites. Stephen Brookstein, MD, Medical Pediatrics Limited, Arlington Heights, IL; Richard Burnstine, MD, North Suburban Pediatrics, Evanston, IL; Arnulfo Delgado, MD, San Rafeal Centro Medico, Chicago, IL; John Poncher, MD, Dianna Brogan, MD, Jeffrey Miller, MD,

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