Research article
The Effect of Smoke-Free Homes on Smoking Behavior in the U.S.

https://doi.org/10.1016/j.amepre.2008.05.023Get rights and content

Background

Evidence from longitudinal population surveys is needed to establish whether smoke-free homes might influence smoking behavior.

Methods

The Tobacco Use Supplement of the nationally representative U.S. Current Population Survey (TUS-CPS) interviewed 3292 adult recent smokers in 2002 and again 12 months later. Both surveys measured smoking status, rules on smoking in the home, and the number of cigarettes smoked per day (cpd). For the main study outcome, an early marker of successful cessation (≥90 days quit) was used. Analysis was completed in 2008.

Results

In the 12 months ending February 2003, the prevalence of smoke-free homes among recent smokers increased from 33% to 39%. A smoke-free home at baseline was associated with ≥90 days cessation at follow-up (10.9% vs 6.2%, AOR=1.44; 95% CI=0.97, 2.21), and those who maintained a smoke-free home were more likely to be ≥90 days quit than those who did not (12.9% vs 5.7%, AOR=1.99; 95% CI=0.93, 4.25). However, adopting a smoke-free home during the year was associated with a nearly fivefold increase in the percentage of ≥90 days quit (AOR=4.81; 95% CI=3.06, 7.59). This increase was seen among all smokers, including moderate-to-heavy smokers (≥90 days quit: a smoke-free home=13.0% vs no smoke-free home=2.9%, p<0.001). Among continuing smokers with a smoke-free home at baseline, maintenance of the smoke-free home was associated with a decline in consumption (μ=−2.18; 95% CI=−1.24; −3.10 cpd). Among continuing smokers with no smoke-free home at baseline, adoption of that status was also associated with a decline in consumption (μ=−1.72; 95% CI=−0.58; −2.85 cpd).

Conclusions

This study provides strong evidence that the adoption of a smoke-free home is associated with successful quitting among smokers 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.

Section snippets

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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