Factors associated with smoke-free homes in NSW: results from the 1998 NSW Health Survey

Smoking Behavior and Cigarette Expenditure in a Household: Evidence for Smoke-Free Houses Initiation in Indonesia

Background

The household is considered as a private area that is untouched tobacco control policies in developing countries, especially in Indonesia, which has not ratified the Framework Convention on Tobacco Control (FCTC) treaty.

Objectives

This study aims to identify smoking behavior and expenditure on cigarettes in the household, which are part of the initiation of a policy including a smoke-free home, so it assumes that the home is a public domain in Tegal Regency, Central Java Province, Indonesia.

Methods

This research is an observational study with a quantitative descriptive design. A total of 225 subjects in the seven regions designated as smoke-free areas were all selected as samples in this study and were willing to be the subject of research.

Results

The results found that 76.1% of smokers smoked with their nuclear family (wife/children/husband) present. Smoking behavior with the nuclear family inside the home (39.13%) and outside the home (36.96%) was more common than not smoking with the nuclear family. Expenditure for cigarettes per month was one-third of household revenue (IDR 607,521.74) based on the regency minimum wage (UMR) set by the local government.

Conclusions

The study concludes that smokers who smoke with family still lack knowledge on smoking's impact on health and household economics. The smoke-free regulation that is initiated should include households as a parameter.

The Effect of a Pilot Pediatric In-Patient Department-Based Smoking Cessation Intervention on Parental Smoking and Children's Secondhand Smoke (SHS) Exposure in Guangxi, China

Children's exposure to secondhand smoke (SHS) at home has numerous adverse health effects. This study evaluated the effects of a pediatric in-patient department-based pilot smoking cessation intervention for household members to reduce children's SHS exposure and encourage smoking cessation. A pre-post test design study was designed to assess the effectiveness of a telephone counseling intervention on household members of hospitalized children in pediatric departments. Data were collected with a standardized Chinese language questionnaire. At the three-month follow-up survey, the proportions of household members who reported adopting complete smoking restriction at home (55%), did not smoke at home at all (37%), did not allow others to smoke in the car (70%), or did not allow others to smoke around the child (57%) were significantly higher than the self-reported responses at the baseline survey. The proportions of household members who reported smoking at home (49%) and in the car (22%) were significantly lower than the baseline survey. Overall, 7% of the participants had reported quitting smoking after three months. Pediatric in-patient department-based telephone counseling for smoking cessation was found to be acceptable to Chinese parents. The intervention encouraged few parents to quit smoking, but encouraged more parents to take measures to reduce children's SHS exposure.

Plain packaging: a logical progression for tobacco control in one of the world's 'darkest markets'

The Australian approach to tobacco control has been a comprehensive one, encompassing mass media campaigns, consumer information, taxation policy, access for smokers to smoking cessation advice and pharmaceutical treatments, protection from exposure to tobacco smoke and regulation of promotion. World-first legislation to standardise the packaging of tobacco was a logical next step to further reduce misleadingly reassuring promotion of a product known for the past 50 years to kill a high proportion of its long-term users. Similarly, refreshed, larger pack warnings which started appearing on packs at the end of 2012 were a logical progression of efforts to ensure that consumers are better informed about the health risks associated with smoking. Regardless of the immediate effects of legislation, further progress will continue to require a comprehensive approach to maintain momentum and ensure that government efforts on one front are not undermined by more vigorous efforts and greater investment by tobacco companies elsewhere.

Smoke-free homes and home exposure to secondhand smoke in Shanghai, China

Few studies have examined home exposure to secondhand smoke (SHS) in China. This study aimed to document: (1) the prevalence and correlates of exposure to SHS in homes (in adult non-smokers) in Shanghai, and (2) enforcement of rules, harm reduction behaviors, and self-efficacy for maintaining smoke-free homes in Shanghai. A total of 500 participants were recruited using a multistage proportional random sampling design in an urban and suburban district to complete a survey. Among the total 355 nonsmokers, 127 (35.8%) participants reported being exposed to SHS in the past 7 days. Participants living with smokers in the home, with no smoking restriction at home, and having children younger than 18 were more likely to be exposed to SHS at home. Higher self-efficacy in maintaining a smoke-free home was negatively associated with home SHS exposure. Having visitors who smoke was the greatest policy enforcement challenge. Ineffective measures such as opening windows were more commonly used in homes with partial bans. Educational initiatives to protect against SHS exposure in the home should promote smoke-free homes, address challenges to implementing such policies, and address misconceptions regarding the effectiveness of supposed harm reduction behaviors.

TB patients learning about second hand smoke (TBLASS): a pilot individual randomised controlled trial

Background

Living with a smoker is a key determinant of exposure to Second Hand Smoke (SHS) and its exposure mainly occurs at home. Exposure to SHS from tobacco in the household predisposes to the development of tuberculosis (TB) and outcome of the disease gets worse. We aim to develop and evaluate a behavioural intervention 'Smoke Free Homes’ (SFH) for TB patients that encourages them to negotiate a smoke free environment within their homes.

Methods and design

The pilot individual randomised controlled trial of SFH will inform the design of a future definitive trial. We will first develop SFH intervention using taxonomy of behaviour change techniques aimed at encouraging families of non-smoking TB patients to implement smoking restrictions at home following a logic model of the intervention. This will be followed by conducting a pilot randomised controlled trial of intervention within the context of routine TB control programme. The eligible non-smoking TB patients will be randomised and allocated to one of the two trial arms consisting of “individual based care” and “individual based care” plus “supplementary support”. We aim to recruit 150 newly registered pulmonary TB patients from two selected TB centres with 75 cases in each arm. The Primary outcome measure will be SFH of non-smoker TB patient by validating through 'Urine Cotinine’ test. We will also determine qualitatively the barriers and key drivers to the creation of smoke free homes followed by developing a definitive trial.

Discussion

The male to female distribution of TB cases in Pakistan is almost equal whereas, tobacco use among males is much high as compared to females in Pakistan. This reflects a strong possibility that women health can be affected by men behaviour. Appropriate storage, restricted access and disposal arrangements for participant’s personal details will be implemented. All ethical issues will be addressed. There will be no extra burden, financial or otherwise, on the participants. They will not receive any financial incentive to participate in the study.

Trial registration

Trial Registration Number: ISRCTN83630841

Household smoking restrictions related to secondhand smoke exposure in Guangdong, China: a population representative survey

INTRODUCTION

China has a higher household secondhand smoke exposure rate than other countries. This study aims to estimate the prevalence rate of households implementing smoking bans in Guangdong and to identify factors correlated with household smoking bans.

METHODS

A cross-sectional, stratified random cluster sampling survey was conducted in Guangdong in 2010. A total of 2,114 adults aged 15 and older completed the face-to-face interviews with a response rate of 70%. The survey employed an adapted and validated questionnaire from the China Global Adult Tobacco Survey. Household smoking policy was divided into 3 groups: full ban, partial ban, and no ban. A multiple logistic regression model was employed to explore factors related to a full household smoking ban.

RESULTS

The survey found 14.2% of respondents reported a full ban, 23.6% reported a partial ban, and 62.2% reported no ban of smoking at home. Current smoking status was the strongest predictor for less restrictive household smoking policies (odds ratio [OR] = 4.9, 95% CI = 2.634-8.999). Our study suggested that people with a high level of education were more likely to implement a full household smoking ban (OR = 4.4, 95% CI = 2.388-8.178). Additionally, urban residents were significantly more likely to report a full household smoking ban than rural residents (OR = 1.67, 95% CI = 1.202-2.322).

CONCLUSIONS

Household smoking bans were not sufficiently established in Guangdong, China. Intensified efforts were called to promote home smoking bans, especially for those with a lower education level, with lower income, and living in rural areas.

Provision of smoke-free homes and vehicles for kindergarten children: associated factors

Many children continue to be exposed to environmental tobacco smoke (ETS) each day. To describe the factors associated with providing a smoke-free home (PSFH) and vehicle (PSFV) for kindergarten children, a cross-sectional descriptive study was conducted in Manitoba, Canada, with 551 mothers and primary caregivers responding. A social-ecologic model of health behavior guided the study. In the bivariate analysis, being better educated, living with a partner, and having a higher income were associated with PSFH. In the multivariable logistic regression analysis, the variables most predictive for PSFH were living with a partner and the mother's self-efficacy, and for PSFV, the most predictive variables were the mother's self-efficacy and ETS knowledge. Smoking behaviors are complex and must be considered broadly within all levels of influence if nurses are to assist parents in protecting their children.

Parental home smoking policies: the protective effect of having a young child in the household

OBJECTIVE

To examine selected social determinants of a home smoking policy among US households with children and whether these associations vary by the presence of a smoker and children's ages.

METHODS

In the 2006/2007 US Tobacco Use Supplement to the Current Population Survey there were 30,874 parents with 0-17-year-olds.

RESULTS

83.9% of parents reported that no one was allowed to smoke inside the home. However, a no smoking policy varied by the presence of a smoker (93.6% of non-smoking households; 55.8% of smoking households) and children's ages (87.1% of parents with any 0-5-year-olds; 82.1% with 6-17-year-olds only; 79.2% with 14-17-year-olds only). In smoking and non-smoking households, parents of 6-17-year-olds were 25%-46% less likely to have a no smoking policy than parents of younger children. Among smoking households, Hispanic and Asian parents were over twice as likely to not allow smoking inside the home as white parents, while Black parents were half as likely. Parents from more disadvantaged circumstances were less likely to have a no smoking policy.

CONCLUSIONS

Parents of 6-17-year-olds are less likely to have a no smoking policy than parents of younger children. Parents with children of all ages should enact a smoking policy that promotes a smoke-free home.

Changes in Exposure to Secondhand Smoke and Smoking Behavior

Aims: This study examines exposure to secondhand smoke and smoking behavior in the German general population before and after the introduction of new smoke-free laws in 2007 and 2008. Methods: Data came from the 2006 and 2009 German Epidemiological Survey of Substance Abuse (ESA). A propensity-score-matched subsample of n = 7,412 subjects between 18 and 64 years was used for the analysis. We employed multinomial logistic regression to examine changes in exposure to secondhand smoke at work, during leisure time, and at home among nonsmokers between 2006 and 2009. Logistic and ordinary least square regression were used to address changes in cigarette smoking prevalence and number of cigarettes smoked among smokers. Results: Exposure to secondhand smoke at work and during leisure time was substantially reduced in 2009 compared to 2006. The number of cigarettes smoked decreased in the same time period. No changes were found for exposure to secondhand smoke at home and cigarette smoking prevalence. However, sensitivity analysis revealed a moderate stability of the results for exposure to secondhand smoke at home and number of cigarettes smoked. Conclusions: Results indicate that smoke-free laws constitute an important step forward in the protection of nonsmokers in Germany. However, our findings suggest that specific preventive measures are still needed to reduce cigarette smoking prevalence.

Home and workplace smoking bans in Italy, Ireland, Sweden, France and the Czech Republic

The purpose of this study was to report predictors and prevalence of home and workplace smoking bans in five European countries. We conducted a population-based telephone survey of 4,977 females, ascertaining factors associated with smoking bans. Odds ratios and 95% confidence intervals were derived using unconditional logistic regression. A complete home smoking ban was reported by 59.5% of French, 63.5% of Irish, 61.3% of Italian, 74.4% of Czech and 87.0% of Swedish females. Home smoking bans were associated with younger age and being bothered by secondhand smoke, and among smokers, inversely associated with greater tobacco dependence. Among nonsmokers, bans were also related to believing smoking is harmful (OR 1.20, 95% CI 1.11-1.30) and having parents who smoke (OR 0.62, 95% CI 0.52-0.73). Workplace bans were reported by 92.6% of French, 96.5% of Irish, 77.9% of Italian, 79.1% of Czech and 88.1% of Swedish females. Workplace smoking bans were reported less often among those in technical positions (OR 0.64, 95% CI 0.50-0.82) and among skilled workers (OR 0.53, 95% CI 0.32-0.88) than among professional workers. Workplace smoking bans are in place for most workers in these countries. Having a home smoking ban was based on smoking behaviour, demographics, beliefs and personal preference.

The effect of smoke-free homes on adult smoking behavior: a review

INTRODUCTION

Smoke-free homes are known to reduce exposure to harmful secondhand smoke. Recent studies suggest that they may also positively affect smoking behavior among smokers themselves.

METHODS

We review the literature on the effect of smoke-free homes on adult smoking behavior. The literature search included database (PubMed) and manual searches of related articles and reference lists for English-language studies published from 1 January 1990 to 16 November 2008.

RESULTS

We identified 16 cross-sectional and 7 longitudinal studies of the population-level association of smoke-free homes with adult smoking behavior. Additional studies provided population estimates of trends in and correlates of smoke-free homes. Prevalence of smoke-free homes varies but has been increasing over time in the countries studied and was greater among smokers who were younger, of higher income or educational attainment, smoked fewer cigarettes per day, or lived with a nonsmoking adult or child. Both longitudinal and cross-sectional studies showed that smokers who had or who newly implemented a smoke-free home were significantly more likely to make a quit attempt and to be abstinent, after controlling for confounding factors. In longitudinal studies, those who continued to smoke had a modest, but significant, decrease in cigarette consumption at follow-up.

DISCUSSION

There is strong and consistent population-level evidence that a smoke-free home is associated with increased smoking cessation and decreased cigarette consumption in adult smokers. As they not only reduce exposure to secondhand smoke but also increase cessation rates, promotion of smoke-free homes should be a key element in tobacco control programs.

Smoke-free homes and smoking cessation and relapse in a longitudinal population of adults

INTRODUCTION

The present study reports on the prevalence of smoke-free homes, the characteristics of participants who adopted a smoke-free home policy, and the association between smoke-free homes and subsequent predictors of smoking cessation.

METHODS

Data are reported on 4,963 individuals who originally participated in the Community Intervention Trial for Smoking Cessation between 1988 and 1993 and completed follow-up surveys in 2001 and 2005. The relationship between home smoking policy and smoking behavior was examined with a multivariate regression model.

RESULTS

Among those who were smokers at the 2001 follow-up, the percentage reporting that no smoking was allowed in their home increased from 29% in 2001 to 38% in 2005. Smokers most likely to adopt smoke-free home policies between 2001 and 2005 were males, former smokers, and those who had lower levels of daily cigarette consumption (among those who continued to smoke), those with higher annual household incomes, and those with no other smokers in the household. Some 28% of smokers with smoke-free homes in 2001 reported that they had quit smoking by 2005 compared with 16% of those who allowed smoking in their homes (odds ratio [OR] = 1.7, 95% CI = 1.4-2.2), and baseline quitters with smoke-free homes also were less likely to relapse (OR = 0.6, 95% CI = 0.4-0.8).

DISCUSSION

Smoke-free homes are becoming more prevalent, and they are a powerful tool not only to help smokers stop smoking but also to help keep those who quit from relapsing back to smoking.

Home smoking restrictions among Koreans in Seoul

The prevalence and correlates of home smoking bans in the Republic of Korea were examined using population-based data from telephone interviews with 500 Seoul adult residents in 2002. Most (97%) respondents indicated that they smoked, or that their spouse, other family member, or a regular friend smoked. Nearly all indicated that environmental tobacco smoke (ETS) is harmful. Only 19% of homes banned smoking, 65% allowed smoking anywhere, and 16% allowed smoking by special guests or in certain areas. The odds of having a full ban were significantly greater for men, married individuals, those less than 35 years or more than 50 years of age, non-smokers, individuals whose nonspouse family members did not smoke, and individuals with more sources of anti-ETS messages. Home smoking bans should be promoted by media campaigns and other tobacco control activities, because knowledge of the effects of ETS was already high.

The impact of banning smoking in workplaces: what are the early effects?

Smoke-free workplace legislation reduces the exposure of both the general public and the workforce to second-hand smoke (SHS) without evidence of an increased exposure to SHS in children in the home. The reductions in exposure are linked to improved respiratory health in previously heavily exposed occupational groups such as bar, restaurant and casino staff. From some countries, there is evidence suggesting that smoking bans have led to declines in hospital admissions for myocardial infarction. There is general agreement that smoking bans, if associated with other tobacco control measures such as tax increases, together with provision of cessation supports, lead to a reduction in the numbers of cigarettes smoked and probably lower smoking rates. Most cities, regions and countries report neutral or positive economic impacts.

Determinants and consequences of smoke-free homes: findings from the International Tobacco Control (ITC) Four Country Survey

OBJECTIVE

To report on prevalence, trends and determinants of smoke-free home policies in smokers' homes in different countries and to estimate the effects of these policies on smoking cessation.

DESIGN

Two waves of the International Tobacco Control (ITC) Four Country Survey (ITC-4), a cohort survey of smokers conducted by telephone. Wave 1 was conducted in October/December 2002 with broadly representative samples of over 2000 adult (>or= 18 years) cigarette smokers in each of the following four countries: Canada, the United States, the United Kingdom, and Australia, 75% of whom were followed up at Wave 2 on average seven months later.

KEY MEASURES

Levels of smoking restrictions in homes (both waves).

RESULTS

Australian smokers were most likely to live in smoke-free homes and UK smokers least likely (34% v 15% at Wave 1). Levels of smoke-free homes increased between waves. Logistic regressions indicated that the main independent predictors of smokers reporting smoke-free homes or implementation of a smoke-free policy between waves included household factors such as having a child, particularly a young child, and having other non-smoking adults in the household. Positive attitudes to smoke-free public places and/or reported presence of smoke-free public places were independent predictors of having or implementing smoke-free homes, supporting a social diffusion model for smoking restrictions. Intentions to quit at Wave 1 and quitting activity between survey waves were associated with implementing bans between Waves 1 and 2. Presence of bans at Wave 1 was associated with significantly greater proportions of quit attempts, and success among those who tried at Wave 2. There was no significant interaction between the predictive models and country.

CONCLUSIONS

Smoke-free public places seem to stimulate adoption of smoke-free homes, a strategy associated with both increased frequency of quit attempts, and of the success of those attempts.

Population level policy options for increasing the prevalence of smokefree homes

OBJECTIVE

To identify and evaluate the options for population level government policies to increase the prevalence of homes free of secondhand smoke.

METHODS

The literature was searched for population level policy options and evidence on them. Three criteria were used to evaluate the policy options: effectiveness, the reductions on inequalities in secondhand smoke exposure, and cost effectiveness. The setting was four developed, English speaking jurisdictions: Britain, USA, Australia, and New Zealand.

RESULTS

Evidence from all four countries shows some association between relatively comprehensive tobacco control programmes and lower prevalence levels of smoking in homes. The evidence of the effect of such programmes on inequalities in smokefree home prevalence is limited. No published evidence was found of the cost effectiveness of the programmes in achieving changes in smokefree homes. Within comprehensive programmes, there is some indirect evidence that some mass media campaigns could increase the prevalence of smokefree homes. Structural options that have potential to support smokefree homes include smokefree places legislation, and laws for the protection of children.

CONCLUSION

The available evidence to date suggests that comprehensive tobacco control programmes (to reduce the prevalence of smoking in the total population) are likely to be the most effective and sustainable option for increasing the prevalence of smokefree homes.

Association between home smoking restrictions and changes in smoking behaviour among employed women

STUDY OBJECTIVE

Examine trends in home smoking restrictions among employed women not living alone and assess the associations of such restrictions with smoking behaviour.

DESIGN

Multivariate logistic regression analysis of major demographic variables and household composition characteristics.

STUDY PARTICIPANTS

128 024 employed female respondents to the Census Bureau's current population survey over the 10 year period 1992 to 2002.

MAIN RESULTS

The prevalence of smoke free homes has increased significantly over the past decade. This increase was evident across all demographic and household characteristics examined with the greatest rate of increase seen among smoking households. Nearly 90% of households consisting of all never smoking adult members reported having a smoke free home in 2001-02 compared with 22% of households consisting of all smokers. The extent of smoking restrictions in the home was the most powerful determinant of cessation of all the factors examined in the regression model. Odds of becoming a former smoker (any length) and quit for three months or more were seven to eight times greater among those women reporting their homes were smoke free compared with those whose homes permitted smoking anywhere in the home.

CONCLUSIONS

Smoke free homes were associated with a highly significant increase in quitting (p<0.0001). However, at this time it is not clear what proportion of the observed effect can be attributed to living in a smoke free home. None the less, the significantly increased probability of quitting correlated with having a smoke free home found in this analysis, are substantially higher than the odds reported in most workplace studies published to date; additional studies are needed to elucidate this relation.

Support for smoking restrictions in bars and gaming areas: review of Australian studies

OBJECTIVE

To document levels of public support in Australia for smoking restrictions in licensed premises, including trends over time, and to examine the potential effects of a ban on patronage.

METHOD

Systematic review of published and unpublished studies of community and staff attitudes towards smoking in bars, gaming areas and related venues were identified using Medline, Current Contents, PsycINFO and AUSTHealth prior to September 2002. State and Territory health departments, cancer organisations and branches of the National Heart Foundation were approached. Cross-sectional surveys reporting data on attitudes towards smoking restrictions and/or perceptions of effects on patronage were sought. Two reviewers assessed studies for inclusion. One extracted data using pre-coded categories with checking by the second.

RESULTS

Thirty-four community and seven staff surveys were synthesised qualitatively, with greater emphasis given to surveys using random selection. All surveys conducted since 1993, which included the separate smoking area response option, have demonstrated majority support for some form of smoking restriction on licensed premises. From 2000, surveys with the ban option alone report majority support for prohibiting smoking completely in bars (52-68%) and gaming areas (64-76%). Support increased significantly after the Sharp damages award. Customer preference data indicate banning smoking is most likely to have a neutral or positive effect on patronage.

CONCLUSIONS AND IMPLICATIONS

Support for a ban on smoking in licensed premises has increased by almost 20% in the past decade. State and Territory governments should introduce legislation banning smoking in all indoor drinking and gaming areas immediately.

Environmental tobacco smoke in homes, motor vehicles and licensed premises: community attitudes and practices

OBJECTIVE

To assess community knowledge, attitudes and practices in relation to environmental tobacco smoke (ETS) especially in homes, private motor vehicles and licensed premises, and to document levels of support for further government legislation.

METHODS

656 persons aged 18 years and over, a sub-sample in a computer-assisted telephone survey of 2,087 randomly selected respondents across NSW, answered 12 ETS-specific questions. The whole sample was asked demographic, smoking status and household membership questions. The overall response rate was 61.4% (consent rate 75.4%).

RESULTS

Overall, 32.8% (95% CI 27.8-37.8) of children aged 0-4 years in the households surveyed were reported to live with at least one smoker. Agreement about ETS hazards was lowest in relation to child ear problems (31.2%) and sudden infant death syndrome (50.6%). Complete bans on smoking were reported in 69.9% of homes and 77.1% of private motor vehicles. The percentages favouring total bans in homes (p < 0.001) and private motor vehicles (p < 0.001) were significantly lower among smokers than non-smokers. Overall, 55.8% supported legislation to ban smoking in private vehicles carrying children. The majority support restrictions on smoking in non-eating areas of licensed clubs (88.7%) and hotels (84.8%). Overall, the data indicate a ban on smoking in licensed premises is likely to increase business.

CONCLUSION

Smoking is banned in most NSW homes and private motor vehicles. Acceptance of ETS risks is high but there are important knowledge gaps. Considerable support exists for further government regulation of ETS. Media campaigns are likely to reinforce a public environment already receptive of the need for more government ETS restrictions.