Abstract
Introduction:Exposure to secondhand smoke causes premature death and disease in non-smokers and indoor smoke-free policies have become increasingly prevalent worldwide. Although socioeconomic disparities have been documented in tobacco use and cessation, the association between socioeconomic status (SES) and smoke-free policies is less well studied.Methods:Data were obtained from the 2006 and 2007 Waves of the International Tobacco Control Four Country Survey (ITC-4), a prospective study of nationally representative samples of smokers in Canada, the United States, the United Kingdom, and Australia. Telephone interviews were administered to 8,245 current and former adult smokers from October 2006 to February 2007. Between September 2007 and February 2008, 5,866 respondents were re-interviewed. Self-reported education and annual household income were used to create SES tertiles. Outcomes included the presence, introduction, and removal of smoke-free policies in homes, worksites, bars, and restaurants.Results:Smokers with high SES had increased odds of both having [OR: 1.54, 95% CI: 1.27–2.87] and introducing [OR: 1.49, 95% CI: 1.04–2.13] a total ban on smoking in the home compared to low SES smokers. Continuing smokers with high SES also had decreased odds of removing a total ban [OR: 0.44, 95% CI: 0.26–0.73]. No consistent association was observed between SES and the presence or introduction of bans in worksites, bars, or restaurants.Conclusions:The presence, introduction, and retention of smoke-free homes increases with increasing SES, but no consistent socioeconomic variation exists in the presence or introduction of total smoking bans in worksites, bars, or restaurants. Opportunities exist to reduce SES disparities in smoke-free homes, while the lack of socioeconomic differences in public workplace, bar, and restaurant smoke-free policies suggest these measures are now equitably distributed in these four countries.
Highlights
Exposure to secondhand smoke causes premature death and disease in non-smokers and indoor smoke-free policies have become increasingly prevalent worldwide
A similar trend was observed across socioeconomic status (SES) levels among former smokers in Canada, while a significant lack of trend was observed in Australia
The data indicate that smokers with higher SES are more likely to have, introduce, and retain total smoking bans in the home
Summary
Exposure to secondhand smoke causes premature death and disease in non-smokers and indoor smoke-free policies have become increasingly prevalent worldwide. Exposure to secondhand smoke (SHS) causes significant morbidity and mortality among both adults and children who do not smoke [1,2]. Restrictions on smoking in indoor public places are becoming increasingly normative in many countries [4,5]. The implementation of such policies significantly reduces SHS exposure [6] and can have an immediate and sustained impact on smoking-related health outcomes, including the reduced incidence of heart attacks in the general population [7]. There is evidence to suggest that public smoking restrictions stimulate the adoption of voluntary smoke-free policies in the home [8], both of which have been shown to have a beneficial impact on smoking behavior change [9,10,11]
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