Research article
Association Between Smokefree Laws and Voluntary Smokefree-Home Rules

https://doi.org/10.1016/j.amepre.2011.08.014Get rights and content

Background

More states and localities are passing restrictions on smoking in public places and workplaces.

Purpose

To determine what, if any, association exists between enactment of strong laws making public places or workplaces smokefree on adoption of voluntary smokefree-home policies, particularly whether such laws are associated with increased smoking at home.

Methods

Logistic regressions were used to estimate the OR of a person living with a 100% smokefree-home rule as a function of individual characteristics, household composition, and whether or not the residential region is covered by clean indoor air laws. The data came from successive waves of the Tobacco Use Supplement to Current Population Survey (TUS-CPS) for the years 1992–2007, and the American Nonsmokers' Rights Foundation database of state and local government clean indoor air laws. Analysis was conducted in 2010 and 2011.

Results

Living in a county fully covered by a 100% clean indoor air law in workplaces or restaurants or bars is associated with an increased likelihood of having a voluntary 100% smokefree-home rule both for people living with smokers (OR=7.76, 95% CI=5.27, 11.43) and not living with smokers (OR=4.12, 95% CI=3.28, 5.16).

Conclusions

Strong clean indoor air laws are associated with large increases in voluntary smokefree-home policies both in the homes with and without smokers. These results support the hypothesis of norm spreading of clean indoor air laws.

Introduction

Secondhand smoke (SHS) exposure among nonsmokers has declined substantially over time as clean indoor air laws have been adopted.1 Nevertheless, in 2007–2008, 88 million nonsmokers aged ≥3 years in the U.S. were still exposed to SHS.2 One objective of Healthy People 20203 is increasing the number of smokefree homes because the home is the major source of SHS exposure for children2 and some nonsmoking adults. Smokefree homes protect people from the health risks of SHS,4, 5, 6 encourage smokers to quit and stay smokefree,7 and reduce the likelihood children will start smoking.8

It has been argued smokefree workplace and public place laws will induce smokers to smoke more in their homes, or in other private venues, to satisfy their addiction to nicotine and compensate for smoking restrictions elsewhere (behavioral compensation).9 Alternatively, these laws might encourage people to implement smoking restrictions in their homes (norm spreading). Previous studies10, 11, 12 in Ireland, Scotland, and Australia concluded that after comprehensive smoking restrictions in public places the proportion of homes with voluntary smoking restrictions increased. The present study of the U.S. uses the individual-level data from the Tobacco Use Supplements to Current Population Survey (TUS-CPS), a large nationally representative sample, linked with the American Nonsmokers' Rights Foundation Local Ordinance Database to investigate the influence of smokefree workplace and public place laws on the presence of smokefree rules in U.S. homes.

Section snippets

Data

The TUS-CPS for 1992–1993, 1995–1996, 1998–1999, 2001–2002, 2003, and 2006/2007 were used to obtain individual characteristics (gender, race, education, family income, marital status, employment status) and smoking status as well as the status of smoking restrictions at home (smoking is allowed in every area, some areas or some times, or no areas at all). The TUS-CPS is a household survey that provides directly observed information on several household members as well as surrogate responses for

Clean indoor air laws and smokefree-home rules

The percentage of adults living in the homes with a 100% smokefree-home rule increased over time in households with smokers and nonsmokers (Figure 1). In 2006–2007, 44% of adults living in the smoker households were covered by a 100% smokefree-home rule compared with 88% living in the nonsmoker households.

From 1992 to 2007, on average 52% of adults lived in homes with 100%-smokefree rules. A higher proportion of people living in homes with a 100% smokefree-home rule were fully covered by at

Discussion

These results demonstrate that the prevalence of smokefree-home rules is increasing in both households with and without smokers and that the presence of smokefree laws is associated with adopting smokefree-home rules, with a higher likelihood in households with smokers than households with only nonsmokers. Contrary to theoretic predictions,9 smokefree laws were not associated with increased smoking at home.

These results are consistent with existing studies from outside the U.S. A study of

Conclusion

Although the aim of clean indoor air laws is to reduce the SHS exposure in public venues, our results provide evidence that these laws have the important additional effect of stimulating smokefree homes, with a larger association in homes occupied by smokers. There is no evidence that smokefree laws increase exposure to SHS by encouraging more homes to permit smoking in the home. The present findings also support the hypothesis of “norm spreading” effect of clean indoor air laws and represent

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