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Title: Association between smokefree laws and voluntary smokefree-home rules

Authors: K Cheng, S Glantz, J Lightwood

Reference: Am J Prev Med 2011; 41(6):566-571
http://bit.ly/ztSm06

Reviewer: Joaquin Barnoya, MD, MPH, Contributing Editor, ProCor; Research Assistant, Professor of Surgery, Washington University in St. Louis, Missouri, USA; Director, Research and Education, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala

Reviewer comments: Smokefree laws are a clear example of the population strategy of preventive medicine. As this study yields, a county law will increase the odds of having a smokefree home rule, even with a smoker at home. Noteworthy is their finding of a dose-response relationship: The stronger the county law, the higher the odds of a smokefree-home rule.

Purpose of study: To investigate the influence of smokefree workplace and public places laws on the presence of smokefree rules in US homes.

Location of study: US

Methods: This study used individual data from the US Tobacco Use Supplements to Current Population Survey (TUS-CPS). This is a household survey that provides directly observed information on several household members as well as surrogate response for others in the household. The TUS-CPS for 1991-1993, 1995-1996, 1998-1999, 2001-2002, 2003, and 2006/2007 were used to obtain individual characteristics and smoking status as well as the smoking status of smoking restrictions at home. Data on smokefree workplace and public place laws were obtained from the American Nonsmokers' Rights Foundation Local Ordinance database. Counties were classified as full, partial, or no-coverage depending on the type of law they had (based on bars and restaurants inclusion).

Results: The percentage of adults living in the homes with a 100% smokefree-home rule increased over time in household with smokers and nonsmokers. From 1992 to 2007, an average 52% of adults lived in homes with 100% smokefree rules. Those living under this type of rules had a higher family income, and more were living with children and nonsmoking adults than those who do not have this rule at home. After controlling for potential confounders, living in a county with a full coverage was significantly associated with having 100% home rules for both people living in smoker (OR=7.76, 95% CI 5.27, 11.43) and in nonsmoker households (OR=4.12, 95% CI 3.28, 5.16). In addition, there is a dose-response relationship. Full coverage laws were associated with higher odds of having a smokefree-home rule than partial coverage laws. Presence of children and nonsmoking adults were associated with higher odds of having a smokefree-home rule.