Smoke-free Rules Research Articles

Status and correlates of home smoking bans after the implementation of the smoke-free legislation in public places: A survey in Chongqing.

INTRODUCTIONSecondhand smoke exposure in many countries decreased dramatically after the implementation of smoke-free legislation in public places, but the exposure at home did not change to the same degree. The aim of this study was to describe the status and correlates of a home smoking ban in Chongqing, China.METHODSFrom June to August 2021, we selected two healthcare centers in the East, West, North, South and Middle regions of Chongqing. We investigated the family smoke-free situation in the selected region using a stratified random sampling method. A chi-squared test was performed to compare the totally and partially smoke-free homes, and a binary logistic regression model was used to analyze the correlates of smoke-free rules at home.RESULTSThe study investigated 2121 families, among which 884 (41.7%) implemented a total ban on smoking at home. The covariates included age (OR=1.54; 95% CI: 1.18–2.01), living with children aged <14 years (OR=1.51; 95% CI: 1.20–1.90), no smokers in the family (OR=2.37; 95% CI: 1.78–3.17), awareness of the hazards of secondhand smoke (OR=1.30; 95% CI: 1.07–1.59), worrying about the impact of smoking in the presence of children on health (OR=1.92; 95% CI: 1.25–2.95), no difficulty (OR=1.34; 95% CI: 1.07–1.67) and confidence (OR=1.73; 95% CI: 1.41–2.13) in stopping others from smoking, no smoking rules in cars (OR=3.67; 95% CI: 2.58–5.22), and frequency of entertaining guests with cigarettes (OR=0.41; 95% CI: 0.28–0.59).CONCLUSIONSIt is common for households in Chongqing to have smoking bans, especially those with children. If a family has members that are smokers, education researchers should pay more attention to the hazards of secondhand smoke on the health of family members, and to adopt more tobacco control measures and enhance the self-efficacy of implementing a home smoking ban. Helping smokers to quit is a vital way to decrease the hazards of cigarettes.

Assessing Smoke-Free Housing Implementation Approaches to Inform Best Practices: A National Survey of Early-Adopting Public Housing Authorities.

Secondhand smoke (SHS) exposure causes chronic illness and occurs at a higher prevalence in low-income communities than the general public. In 2018, the U.S. Department of Housing and Urban Development (HUD) instituted a smoke-free housing rule for Public Housing Authorities (PHAs) to address persistent health inequities. However, the success of smoke-free housing requires evidence to inform effective implementation approaches. A mixed-methods, cross-sectional survey was conducted in a national sample of PHAs. Questions focused on housing officials’ use of specific implementation strategies. Adjusted odds ratios were used to assess associations between implementation approaches and variations among PHAs (i.e., region, size, or recency of policy adoption). Qualitative analyses were conducted to assess the perceived effectiveness of implementation strategies. Resident engagement, staff training, and smoking cessation support were the most frequently used implementation strategies. Engagement with local stakeholders was cited less frequently. Enforcement actions were limited with no violations referred to housing court. Support for policy adherence was identified as a sixth implementation strategy. While most PHAs used at least some evidence-informed implementation strategies, a lack of a systematic approach may limit overall effectiveness. Further research is required to resolve implementation barriers experienced disproportionately by a subset of PHAs, and to inform a best practice implementation framework that meets the needs of a heterogeneous population.

Changes in Reported Secondhand Smoke Incursions and Smoking Behavior after Implementation of a Federal Smoke-Free Rule in New York State Federally Subsidized Public Housing.

This study assessed changes in smoking behavior and secondhand smoke (SHS) exposure after implementation of the U.S. Department of Housing and Urban Development (HUD) rule prohibiting the use of cigarettes, cigars, pipes, and waterpipes in all federally subsidized public housing, including within residential units (apartments). Using quantitative data from a repeated cross-sectional mail survey of New York State residents of five public housing authorities (N = 761 at Wave 1, N = 649 at Wave 2), we found evidence of policy compliance (99% decrease in odds of self-reported smoking in units, OR = 0.01, p < 0.01, CI: 0.00–0.16), reduced SHS incursions (77% decrease in odds of smelling smoke within developments, OR = 0.23, p < 0.01, CI: 0.13–0.44), and lower reported smoking rates in July 2018 (9.5%, down from 16.8%), 10 months after implementation of the rule. Despite evident success, one-fifth of residents reported smelling smoke inside their apartment at least a few times per week. This study provides insights into how the policy was implemented in selected New York public housing authorities, offers evidence of policy-intended effects, and highlights challenges to consistent and impactful policy implementation.

Changes in harm perception of ENDS and their predictors among US adolescents: findings from the population assessment of tobacco and health (PATH) study, 2013–2018

Electronic nicotine delivery systems (ENDS) use has dramatically increased in the US. This study aimed to characterize changes in ENDS harm perception over time and associated predictors among US adolescents. Data from the 2013–2018 Population Assessment of Tobacco and Health Study (PATH) for adolescents (12–17 years) were utilized. Trend analyses were employed to delineate changes in comparative and absolute ENDS harm perception over a four-year interval. We applied a time-varying effect model (TVEM) to examine the associations between the changes in harm perception and associated predictors. The results suggest that perception of ENDS as less harmful than cigarettes significantly decreased from 54.3% at Wave 1 (2013) to 30.4% at Wave 4 (2018) (P < 0.001). Perception of ENDS as no or little harm decreased from 35.9% at Wave 1 to 16.9% at Wave 4 (P < 0.001). These changes in harm perception were less robust among males, adolescents who did not have positive tobacco-related attitudes, and those with smoke-free home rules (P's < 0.05). Additionally, having ever used ENDS or alcohol were more likely to be associated with reduced ENDS-related harm perception over time (P's < 0.05). Our results show that while ENDS-related harm perception have generally increased, this does not appear to be equally experienced across all adolescents, potentially highlighting the importance of at-risk groups and targets for intervention. This study can help identify individuals at risk of ENDS initiation because of their favorable ENDS harm perception profile, as well as guide the development of ENDS risk communication interventions for adolescents.

Process and impact of implementing a smoke-free policy in prisons in Scotland: TIPs mixed-methods study

BackgroundPrisons had partial exemption from the UK’s 2006/7 smoking bans in enclosed public spaces. They became one of the few workplaces with continuing exposure to second-hand smoke, given the high levels of smoking among people in custody. Despite the introduction of smoke-free prisons elsewhere, evaluations of such ‘bans’ have been very limited to date.ObjectiveThe objective was to provide evidence on the process and impact of implementing a smoke-free policy across a national prison service.DesignThe Tobacco in Prisons study was a three-phase, multimethod study exploring the periods before policy formulation (phase 1: pre announcement), during preparation for implementation (phase 2: preparatory) and after implementation (phase 3: post implementation).SettingThe study was set in Scotland’s prisons.ParticipantsParticipants were people in custody, prison staff and providers/users of prison smoking cessation services.InterventionComprehensive smoke-free prison rules were implemented across all of Scotland’s prisons in November 2018.Main outcome measuresThe main outcome measures were second-hand smoke levels, health outcomes and perspectives/experiences, including facilitators of successful transitions to smoke-free prisons.Data sourcesThe study utilised cross-sectional surveys of staff (total,n = 3522) and people in custody (total,n = 5956) in each phase; focus groups and/or one-to-one interviews with staff (n = 237 across 34 focus groups;n = 38 interviews), people in custody (n = 62 interviews), providers (n = 103 interviews) and users (n = 45 interviews) of prison smoking cessation services and stakeholders elsewhere (n = 19); measurements of second-hand smoke exposure (e.g. 369,208 minutes of static measures in residential areas at three time points); and routinely collected data (e.g. medications dispensed, inpatient/outpatient visits).ResultsMeasures of second-hand smoke were substantially (≈ 90%) reduced post implementation, compared with baseline, largely confirming the views of staff and people in custody that illicit smoking is not a major issue post ban. Several factors that contributed to the successful implementation of the smoke-free policy, now accepted as the ‘new normal’, were identified. E-cigarette use has become common, was recognised (by both staff and people in custody) to have facilitated the transition and raises new issues in prisons. The health economic analysis (lifetime model) demonstrated that costs were lower and the number of quality-adjusted life-years was larger for people in custody and staff in the ‘with smoke-free’ policy period than in the ‘without’ policy period, confirming cost-effectiveness against a £20,000 willingness-to-pay threshold.LimitationsThe ability to triangulate between different data sources mitigated limitations with constituent data sets.ConclusionsTo our knowledge, this is the first study internationally to analyse the views of prison staff and people in custody; objective measurements of second-hand smoke exposure and routine health and other outcomes before, during and after the implementation of a smoke-free prison policy; and to assess cost-effectiveness. The results are relevant to jurisdictions considering similar legislation, whether or not e-cigarettes are permitted. The study provides a model for partnership working and, as a multidimensional study of a national prison system, adds to a previously sparse evidence base internationally.Future workPriorities are to understand how to support people in custody in remaining smoke free after release from prison, and whether or not interventions can extend benefits to their families; to evaluate new guidance supporting people wishing to reduce or quit vaping; and to understand how prison vaping practices/cultures may strengthen or weaken long-term reductions in smoking.Study registrationThis study is registered as Research Registry 4802.FundingThis project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full inPublic Health Research; Vol. 10, No. 1. See the NIHR Journals Library website for further project information.

Parental Perceptions and Behaviors about Children’s Exposure to Secondhand Smoke in Portugal

One of the sustainable development goals adopted by the United Nations is to ensure healthy lives and promote well-being for all. Tobacco consumption is a serious health problem that affects smokers and non-smokers exposed to secondhand smoke (SHS), particularly children. This study aims to describe parental perceptions of smoke-free rules, to analyze parental awareness about health risks associated with children’s exposure to SHS, and to describe the prevalence of avoidance behaviors related to tobacco smoke, according to parental smoking status. This study includes 1175 parents from a representative sample of 1511 Portuguese children aged 4 to 9 years old in 2016. Parents who were non-smokers reported a higher level of agreement regarding smoke-free rules at home, inside the car, at playgrounds, and near the school entrance than smokers. A higher percentage of nonsmoking parents agreed that children whose parents smoke at home are more likely to become smokers themselves. Nonsmoking parents reported adopting more avoidance behaviors regarding exposure to SHS. The findings indicate that parental exposure perceptions and avoidance behaviors towards SHS were lower and less frequent among smokers. Health education, smoking cessation programs and smoking bans are needed to raise parental awareness and to protect children from SHS exposure.

Effects of ordinances prohibiting smoking in private homes with children following smoke-free household rules in Tokyo

Objectives Exposure to secondhand smoke is harmful to children's health. Therefore, the Tokyo metropolitan area implemented an ordinance on April 1st, 2018 that prohibits smoking in private homes when children are present. To date, the effect of this ordinance has not been studied. In this study, we evaluated the change in the percentage of residents in the Tokyo metropolitan area who have smoke-free household rules using difference-in-difference (DID) analysis.Methods A one year, follow-up, longitudinal internet survey of the general Japanese population was conducted from 2018 to 2019 (Japan Society and New Tobacco Internet Survey, JASTIS). DID analysis was conducted using the percentage of residents who have smoke-free household rules in Tokyo metropolitan area and control groups in 2018 and 2019.Results We utilized three control groups (Control 1: residents in Japan except from Tokyo metropolitan area; Control 2: residents in Japan except from Kanto region; Control 3: residents in prefectures which have ordinance-designated city) for DID analysis. Covariate-adjusted DID estimates for each control group were -1.0 percentage points (Control 1, 95% Confidence Interval (CI)=-5.8, 3.9), -1.0 percentage points (Control 2, 95% CI=-5.9, 4.0), and -1.0 percentage points (Control 3, 95% CI=-5.9, 3.9) indicating that there was no significant difference for all control groups. Moreover, no significant difference was observed when respondents' answers were analyzed and stratified according to sex, age, household income, housing tenure, smoking status, education, or marital status.Conclusions DID analysis revealed no significant change in the percentage of residents of the Tokyo metropolitan area who have smoke-free household rules after the implementation of the ordinance. This study will be useful for local governments when planning and promoting more effective smoke-free ordinances.

Factors related to caregivers’ risk perception of secondhand smoke exposure on children’s health

INTRODUCTIONHome is one of the main places for children’s secondhand smoke (SHS) exposure. The implementation of smoke-free rules at home might be influenced by caregivers’ risk perception of SHS exposure. This study aimed to analyze factors related to caregivers’ risk perception of SHS exposure in children.METHODSWe conducted a cross-sectional telephone survey among a representative sample of 2411 parents or legal guardians of children aged <12 years in Spain in 2016. The main study variable was caregivers’ healthrisk perception of SHS exposure on children. We investigated correlates of risk perception using multivariate Poisson regression models with robust variance.RESULTSOverall, 59.6% reported SHS exposure negatively affects children’s health a lot, while 34.1% that it affects quite a bit, and 5.5% and 0.8% a little bit or not at all, respectively. The factors associated with a higher caregivers’ risk perception were high education level (adjusted prevalence ratio, APR=1.11; 95% CI: 1.01–1.24), living in a non-smoking family unit (APR=1.17; 95% CI: 1.07–1.27), in a home with smoke-free rules (APR=1.34; 95% CI: 1.19–1.51), and with girls only (APR=1.14; 95% CI: 1.06–1.22).CONCLUSIONSCaregivers’ risk perception of SHS exposure is influenced by social determinants and smoking habits in family units. These findings support the need for interventions with a social equity perspective to reduce children’s SHS exposure.

What Helps and What Hinders the Creation of a Smoke-free Home: A Qualitative Study of Fathers in Scotland.

IntroductionFew studies have explored fathers’ views and experiences of creating a smoke-free home, with interventions largely targeting mothers. This study aimed to identify barriers and facilitators to fathers creating a smoke-free home, to inform future intervention development.MethodsEighteen fathers who were smokers and lived in Scotland were recruited from Dads’ community groups, Early Years Centres and through social media advertising. Semi-structured interviews explored their views and experiences of creating a smoke-free home. A theory-informed thematic analysis using the COM-B model highlighted ways in which capability, opportunity, and motivations shaped fathers’ home smoking behaviors. ResultsSeveral fathers understood the health risks of second-hand smoke exposure through public health messaging associated with recent smoke-free legislation prohibiting smoking in cars carrying children. Limited understanding of effective exposure reduction strategies and personal mental health challenges reduced some fathers’ ability to create a smoke-free home. Fathers were keen to maintain their smoke-free home rules, and their motivations for this largely centered on their perceived role as protector of their children, and their desire to be a good role model.ConclusionsFathers’ abilities to create a smoke-free home are shaped by a range of capabilities, opportunities, and motivations, some of which relate to their role as a father. Establishing a fuller understanding of the contextual and gender-specific factors that shape fathers’ views on smoking in the home will facilitate the development of interventions and initiatives that fathers can identify and engage with, for the broader benefit of families and to improve gender equity and health.ImplicationsOur findings can inform future development of father-centered and household-level smoke-free home interventions. They identify fathers’ views and experiences and help reframe smoking in the home as a gendered family-wide issue, which is important in building consensus on how best to support parents to create a smoke-free home. Our findings highlight the need for additional research to develop understanding of the ways in which gender-related aspects of family structures, heterosexual relationships, and child living arrangements influence home smoking rules and how to tailor interventions accordingly.

Smoking cessation intentions and attempts one year after the federally mandated smoke-free housing rule

The present study examines public housing residents’ smoking cessation intentions, expectancies, and attempts one year after implementation of the Department of Housing and Urban Development’s mandatory smoke-free rule in public housing. The sample includes 233 cigarette smokers, ages 18–80, who reside in the District of Columbia Housing Authority. Data collection occurred between March and August 2019. Descriptive statistics, chi-square, and Wilcoxon two-sample test analyses assessed smoking cessation intentions, expectancies, and attempts across resident demographics and characteristics. Findings showed 17.2% of residents reported not thinking about quitting, 39.1% reported thinking about quitting, and 48.6% reported thinking about quitting specifically because of the rule. Residents ages 60–80 were more likely to consider quitting because of the rule, compared to residents ages 18–59. Of those thinking of quitting, 58.6% were sure they could quit if they tried. Those thinking of quitting due to the rule (62.0%) were more likely to have made at least one quit attempt in the past 3 months than those i not attributinging thinking of quitting to the rule. Res Residents trying to quit reported an average of 2.7 attempts in the last 3 months;; most perceived evidence-based cessation supports as not helpful. A A majority reported thinking about quitting and attempting to quit but continuing to smoke, indicating a significant gap between intent to quit and successfully quitting. Results suggest that the rule positively influenced smoking behaviors. However, additional interventions are needed to assist public housing residents with successfully quitting smoking.

Post-implementation perspectives on smokefree prison policy: a qualitative study with staff and people in custody.

BackgroundA comprehensive smokefree prison policy (SFPP) was introduced in Scottish prisons from November 2018, reflecting concern about inequalities in occupational exposures to second-hand smoke (SHS) and tobacco-related harms among people in custody (PiC). We aimed to address a gap, whereby few studies have sought to understand SFPP from the perspectives of people living and working in prisons.MethodsAs part of a comprehensive evaluation, focus groups and interviews with staff (n = 99) and interviews with PiC (n = 23) were conducted 6–9 months post-implementation of SFPP in Scotland. Data were analysed using the framework approach.ResultsOur study found that new restrictions on smoking had been widely accepted by PiC, after a period of adjustment which was less troublesome than participants had anticipated. Benefits of the SFPP for the safety and comfort of staff and PiC who were no longer exposed to SHS, and additionally for the health of PiC who were now smoking-abstinent, were widely acknowledged. Drawbacks of the SFPP, such as difficulties managing without tobacco and use of alternatives (e.g. e-cigarettes and changes in use of illegal drugs), were also reported. Contraband tobacco was not reported to be a major problem following prisons becoming smokefree.ConclusionsThe findings strengthen evidence that SFPPs can be implemented without causing major disruption and highlight the need for removal of tobacco to be underpinned by careful planning, partnership working and ensuring the availability of support for smokers. Experiences from Scotland may be of interest and some comfort, internationally for jurisdictions considering smoke-free rules in prisons.

Implementation of the Department of Housing and Urban Development's Smoke-Free Rule: A Socio-Ecological Qualitative Assessment of Administrator and Resident Perceptions.

In July 2018, the United States Department of Housing and Urban Development (HUD) implemented a mandatory smoke-free rule in public housing. This study assessed administrator and resident perceptions of rule implementation during its initial year in the District of Columbia Housing Authority (DCHA). Assessment included nine focus groups (n = 69) with residents and in-depth interviews with administrators (n = 7) and residents (n = 26) from 14 DCHA communities (family = 7 and senior/disabled = 7). Semi-structured discussion guides based on the multi-level socio-ecological framework captured dialogue that was recorded, transcribed verbatim, and coded inductively. Emerging major themes for each socio-ecological framework level included: (1) Individual: the rule was supported due to perceived health benefits, with stronger support among non-smokers; (2) Interpersonal: limiting secondhand smoke exposure was perceived as a positive for vulnerable residents; (3) Organizational: communication, signage, and cessation support was perceived as a need; (4) Community: residents perceived mobility, disability, weather, and safety-related issues as barriers; and (5) Public Policy: lease amendments were perceived as enablers of rule implementation but expressed confusion about violations and enforcement. A majority of administrators and residents reported favorable implications of the mandated HUD rule. The novel application of a socio-ecological framework, however, detected implementation nuances that required improvements on multiple levels, including more signage, cessation support, clarification of enforcement roles, and addressing safety concerns.

Familial secondhand smoke: Tobacco use and adoption of smoke-free home and car rules among US parents

Familial secondhand smoke: Tobacco use and adoption of smoke-free home and car rules among US parents

Smoke-Free Hospital Grounds

Smoke-free campus policies at inpatient health facilities are most effective when situated within comprehensive smoking cessation programs that include cessation support for staff and patients and effective communications and signage for staff, patients, and visitors. Canadian jurisdictions such as Ontario, New Brunswick, Prince Edward Island, Alberta, British Columbia, and Northwest Territories have provincial smoke-free legislation that applies to the grounds of health facilities. This approach permits public health inspectors and peace officers to enforce the smoke-free grounds rules with the option of issuing fines to individuals or hospital corporations for non-compliance. There is very little existing evidence on the effectiveness of issuing fines as a means of enforcing smoke-free policies. There can be unique considerations associated with implementing smoke-free policies in inpatient psychiatric facilities or units, given the relationship between mental health and substance use issues and tobacco use. Evidence shows that smoke-free policies are feasible and result in positive health outcomes in psychiatric facilities or units. Staff may require additional education and training in smoking cessation and tools to support productive conversations with patients, visitors, or colleagues who are not in compliance with smoke-free policies. Examples of tools and communications materials used in other jurisdictions are provided in Appendix 1.

'I Was Smoking a Lot More during Lockdown Because I Can': A Qualitative Study of How UK Smokers Responded to the Covid-19 Lockdown.

This study explored how Covid-19 lockdown restrictions affected people’s daily smoking routines and behaviours, including adherence and modifications to pre-established smoking restrictions in the home. Semi-structured telephone interviews were conducted with smokers and non-smokers from smoking households 19 to 27 weeks after the first full UK lockdown ended in May 2020. A non-probability purposive sample representing 25 adults aged 21 or over living in households with at least 1 smoker were recruited to the study. A quota sampling strategy was used, according to age, gender, smoking status, family status, household composition, householder access to outdoor space, and change to work-life status. Most participants found lockdown increased the amount of time spent at home, where stresses associated with confinement, curtailment of social routines, removal of barriers and distractions to smoking due to home working, and feelings of boredom all contributed to increased smoking. Fewer factors were identified as reducing smoking during lockdown. Prominent examples included disruption to habitual smoking patterns and distraction from smoking associated with spending more time doing outdoor activities. Pressures placed on physical space and lack of privacy due to the confinement at home were responsible for displacement of smoking within the home, leading to breaking of smoke-free rules and family tensions, and in some cases to greater awareness amongst parents that their children smoked. Changes in daily routines associated with lockdown affected and displaced smoking behaviour both positively and negatively. Health improvement interventions could seek to harness positive changes in smoking associated with any future lockdown approaches. New home-working norms highlight the need for employers to support staff to reduce their smoking and to remain smoke-free.

Effects of electronic cigarettes and hookah (waterpipe) use on home air quality

IntroductionA major site of secondhand smoke exposure for children and adults is the home. Few studies have evaluated the impact of e-cigarette or hookah use on home air quality, despite...

Smoke-Free Home Rules and Association with Child Secondhand Smoke Exposure among Mother-Child Dyad Relationships.

Smoke-free home rules restrict smoking in the home, but biomarkers of secondhand smoke exposure are needed to help understand the association between smoke-free homes and child secondhand smoke exposure. Participants (n = 346) were majority Black/African American mother–child dyads from a longitudinal study in North Carolina. Mothers completed questionnaires on household smoking behaviors and rules, and child saliva samples were assayed for secondhand smoke exposure. Regression models used smoke-free home rules to predict child risk for secondhand smoke exposure. Children in households with smoke-free home rules had less salivary cotinine and risk for secondhand smoke exposure. After controlling for smokers in the household, home smoking rules were not a significant predictor of secondhand smoke exposure. Compared to children in households with no smokers, children in households with at least one smoker but a non-smoking mother (OR 5.35, 95% CI: 2.22, 13.17) and households with at least one smoker including a smoking mother (OR 13.73, 95% CI: 6.06, 33.28) had greater risk for secondhand smoke exposure. Results suggest smoke-free home rules are not sufficient to fully protect children from secondhand smoke exposure, especially in homes with smokers. Future research should focus on how household members who smoke can facilitate the prevention of child secondhand smoke exposure.

Multi-level drivers of tobacco use and purchasing behaviors during COVID-19 "lockdown": A qualitative study in the United States.

BackgroundThe COVID-19 pandemic and associated public health prevention measures (e.g., “stay at home” orders) may impact tobacco supply and demand among consumers. This qualitative study identified multi-level drivers of shifts in inhaled tobacco product use and access patterns during the initial COVID-19 “lockdown” period in the United States.MethodsBetween April and May 2020, we conducted semi-structured telephone interviews (n = 44) with adults who use cigarettes and/or electronic nicotine delivery systems (ENDS). Transcripts were thematically analyzed using a socioecological framework.ResultsNearly all participants reported changes in their product use during lockdown, though patterns varied. Increased use was most common and was predominantly driven by individual-level factors: pandemic-related anxiety, boredom, and irregular routines. Decreased use was common among social users who cited fewer interpersonal interactions and fear of sharing products. At the community level, retail access impacted cigarette and ENDS use differently. While cigarettes were universally accessible, ENDS access was more limited, driving some to purchase products online. Delayed deliveries led some ENDS users to compensate with readily-available cigarettes.ConclusionTo mitigate ways that the COVID-19 pandemic may exacerbate an existing public health crisis, multi-level policy strategies, such as expanded virtual cessation services and implementation and enforcement of smoke-free home rules, can better support population health during this critical period. Policies that facilitate access to lower risk products can help minimize harm among those who cannot or do not want to quit smoking.

Reducing Socioeconomic Disparities in Comprehensive Smoke-Free Rules Among Households with Children: A Pilot Intervention Implemented Through A National Cancer Program

Reducing Socioeconomic Disparities in Comprehensive Smoke-Free Rules Among Households with Children: A Pilot Intervention Implemented Through A National Cancer Program

Small-Area Estimation of Smoke-Free Workplace Policies and Home Rules in US Counties.

The workplace and home are sources of exposure to secondhand smoke, a serious health hazard for nonsmoking adults and children. Smoke-free workplace policies and home rules protect nonsmoking individuals from secondhand smoke and help individuals who smoke to quit smoking. However, estimated population coverages of smoke-free workplace policies and home rules are not typically available at small geographic levels such as counties. Model-based small-area estimation techniques are needed to produce such estimates. Self-reported smoke-free workplace policies and home rules data came from the 2014-2015 Tobacco Use Supplement to the Current Population Survey. County-level design-based estimates of the two measures were computed and linked to county-level relevant covariates obtained from external sources. Hierarchical Bayesian models were then built and implemented through Markov Chain Monte Carlo methods. Model-based estimates of smoke-free workplace policies and home rules were produced for 3134 (of 3143) US counties. In 2014-2015, nearly 80% of US adult workers were covered by smoke-free workplace policies, and more than 85% of US adults were covered by smoke-free home rules. We found large variations within and between states in the coverage of smoke-free workplace policies and home rules. The small-area modeling approach efficiently reduced the variability that was attributable to small sample size in the direct estimates for counties with data and predicted estimates for counties without data by borrowing strength from covariates and other counties with similar profiles. The county-level modeled estimates can serve as a useful resource for tobacco control research and intervention. Detailed county- and state-level estimates of smoke-free workplace policies and home rules can help identify coverage disparities and differential impact of smoke-free legislation and related social norms. Moreover, this estimation framework can be useful for modeling different tobacco control variables and applied elsewhere, for example, to other behavioral, policy, or health related topics.