Research articleThe Effect of Smoke-Free Homes on Smoking Behavior in the U.S.
Introduction
As the health hazards of secondhand smoke became clear,1 the home was quickly identified as a major source of preventable exposure for children.2, 3 Living with a nonsmoker in the house, particularly a child, was strongly associated with the early adoption of a smoke-free home. Smokers living in a smoke-free home were more likely to have family members who preferred that they did not smoke, suggesting that many smokers may have acquiesced to the smoke-free home rather than have initiated it.4 Considerable evidence from cross-sectional, population-based surveys suggests that having a smoke-free home may be associated with increased successful quitting,4, 5, 6, 7, 8 reduced daily consumption levels among continuing smokers, 4, 9, 10, 11, 12, 13 and reduced smoking initiation.14, 15, 16 However, to date there has been no nationally representative longitudinal study of the adoption of a smoke-free home and subsequent smoking behaviors.
The U.S. Census Bureau's Current Population Survey (CPS) is a monthly, nationally representative household survey of the U.S. civilian, non-institutionalized population aged ≥15 years,17 and large, nationally representative Tobacco Use Supplements (TUS) have been regularly added to the CPS at 3-year intervals since 1992 (TUS-CPS). These TUS-CPSs have become the gold-standard for estimating state-level smoking behavior in the U.S.18 In 2003, an additional TUS-CPS was added to address population data on smoking cessation. This change in design created an overlap sample with the 2002 survey in which a sizeable group of respondents were re-interviewed, constituting the first longitudinal TUS study. During this period there was a 10% increase in the percentage of the U.S. population reporting a smoke-free home (66.3% vs 72.8%).19 Thus, this national longitudinal survey was undertaken during a time when many U.S. households were implementing a smoke-free home. Our hypothesis was that the adoption of a smoke-free home would be associated with increased successful quitting in this nationally representative sample.
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Study Population
Since 1953, the CPS has used the same rotating panel design, in which a household is interviewed for 4 consecutive months, rested for 8 months, and then re-interviewed for 4 consecutive months before leaving the sample. The TUS-CPS uses non-overlap samples that have been described previously5, 20 and are publicly available.18 The 2003 TUS-CPS was scheduled so that a total of 15,846 respondents were repeat interviews from the same month (February) in two separate years (2002 and 2003).
One-Year Changes in Smoking Consumption from 2002 to 2003
In 2002, 43.8% of recent smokers (n=3292) smoked ≥15+ cpd, 67.9% (43.8% + 24.1%) smoked ≥5 cpd, and 13.7% were currently quit (Table 1). Almost half (45.3%) of these recent smokers had changed their reported consumption category by 2003. Just over 16% were currently quit in 2003, and this was strongly related to the 2002 consumption level (p<0.001). Current smokers who did not report a consumption level in 2002 had a cessation rate higher than light smokers (<5 cpd), but lower than the rate of
Discussion
This study was conducted from February 2002 to February 2003, during a period that saw a considerable increase in smoke-free homes in the U.S. Among all recent smokers surveyed, the percentage with a smoke-free home increased from 33% to 39% within the 12-month follow-up period. During the year there was a 20% adoption rate among recent smokers without a smoke-free home at baseline; 29% of those with one removed that status during the year.
Smokers who adopted a smoke-free home during the year
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