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