Home Smoking Bans and Urinary NNAL Levels to Measure Tobacco Smoke Exposure in Chinese American Household Pairs.

Emiley Chang,Elisa K Tong,Lei-Chun Fung,Anne Saw,Melanie Dove,Janice Y Tsoh

doi:10.3390/ijerph18147682

Abstract

Home smoking bans can reduce tobacco smoke exposure, but little is known about the impact for Chinese American household pairs. In this study of 202 household pairs with low acculturation, 53.9% reported a home smoking ban, 31.7% had inconsistent reports, and 14.4% reported no ban. With decreasing home smoking ban enforcement, more nonsmokers had tobacco smoke exposure (66.1%–86.2%) as measured by the tobacco-specific nitrosamine biomarker urine NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol). Despite reported bans, about one-quarter of nonsmokers still reported tobacco smoke exposure at home (23.6%–30%) within the past 2 months and three-quarters reported outdoor exposure. In adjusted regression analyses of geometric mean NNAL ratios, nonsmokers in households with no ban had over two times higher levels than nonsmokers in households with a ban: adjusted log NNAL ratio = 2.70 (95% CI 1.21, 6.03). Higher smoker NNAL level and nonsmoker English fluency were also significantly associated with nonsmoker NNAL levels. Nonsmoker levels in households with an inconsistent ban were not significantly different compared to those with a ban. Although home smoking bans were generally associated with lower NNAL levels, tobacco smoke exposure in this immigrant population with low English proficiency was higher than that of the general population. From a health equity standpoint, there is a need for broader implementation and enforcement of comprehensive smoke-free policies.

Highlights

We examined each covariate for potential confounding of the association between home smoking ban category and nonsmoker log NNAL level by including each in the model one at a time
Model 2 adjusted for smoker log NNAL. This is the first study demonstrating that home smoking bans were associated with lower tobacco-specific nitrosamine biomarker levels of tobacco smoke exposure among Chinese American nonsmokers living with a current smoker
Our study found higher proportions of nonsmokers exposed to smoke in households with inconsistent bans when compared with households with home smoking bans, but there was no difference between the geometric mean NNAL levels of nonsmokers

Summary

Introduction

As homes are an important source of tobacco smoke exposure, home smoking bans are a powerful method to encourage smokers to stop smoking and protect the health of nonsmokers [1,2,3]. The Surgeon General has concluded there is no safe level of tobacco smoke exposure, which increases the risk of cancer, respiratory, and cardiovascular diseases [4,5]. Only half of U.S households with at least one adult smoker reported having a home smoking ban in the 2014–2015 Tobacco Use Supplement to the Current.

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