The effect of smoke-free homes on adult smoking behavior: A review
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. 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. 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. 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.
[Show abstract] [Hide abstract] ABSTRACT: Background: Persons with a mental illness are less likely to be successful in attempts to quit smoking. A number of smoking and environmental characteristics have been shown to be related to quitting behaviour and motivation of smokers generally, however have been less studied among smokers with a mental illness. This study aimed to report the prevalence of smoking characteristics and a variety of physical and social environmental characteristics of smokers with a mental illness, and explore their association with quitting behaviour and motivation. Methods: A cross-sectional descriptive study was undertaken of 754 smokers admitted to four psychiatric inpatient facilities in Australia. Multivariable logistic regression analyses were undertaken to explore the association between smoking and environmental characteristics and recent quitting behaviour and motivation. Results: Participants were primarily daily smokers (93 %), consumed >10 cigarettes per day (74 %), and highly nicotine dependent (51 %). A third (32 %) lived in a house in which smoking was permitted, and 44 % lived with other smokers. The majority of participants believed that significant others (68-82 %) and health care providers (80-91 %) would be supportive of their quitting smoking. Reflecting previous research, the smoking characteristics examined were variously associated with quitting behaviour and motivation. Additionally, participants not living with other smokers were more likely to have quit for a longer duration (OR 2.02), and those perceiving their psychiatrist to be supportive of a quit attempt were more likely to have had more quit attempts in the past six months (OR 2.83). Conclusions: Modifiable characteristics of the physical and social environment, and of smoking, should be considered in smoking cessation interventions for persons with a mental illness.
- "Further, differences between Australian smokers without a mental illness are also evident in comparison to smokers in the present study: 21 % residing in a home that was not smoke free (as compared to 32 %), and 42 % of those with a current partner reporting their partner to be a smoker (as compared to 51 %) (International Tobacco Control Policy Evaluation Study: Survey Data, unpublished 2013 and 2014). In line with research undertaken with smokers generally [24, 26, 56] , the potential influence of other smokers in the immediate environment was indicated by the finding in this study that participants who did not live with other smokers were more likely to have recently made a quit attempt of at least one month duration. With respect to the social environment, almost all participants (92 %) identified a key support person whom they relied on and/or who routinely provided assistance and support for their well-being and functioning; suggesting the potential to involve support persons, and possibly family carers  in smoking cessation interventions. "
[Show abstract] [Hide abstract] ABSTRACT: Introduction: The cigarette purchase task (CPT) is a method that can be used to assess the relative value of cigarettes. Based on cigarettes purchased across a price range, five derived metrics (Omax, Pmax, breakpoint, intensity, and elasticity) can assess cigarette demand. A study with adolescent smokers found that these could be reduced to two latent factors: persistence (price insensitivity) and amplitude (volumetric consumption). We sought to replicate this structure with adult smokers and examine how these variables relate to cessation efforts. Method: Web-based survey conducted in 2014 among adult (18 years and above) current daily cigarette smokers (N = 1194). Participants completed the CPT, Fagerstrom Test for Nicotine Dependence (FTND), reported past-year quit attempts, and future quit intentions. We included published scales assessing perceived prevalence of smoking, social reactivity, smoker identity, and risk perception. Results: Our analysis supported two latent variables, persistence and amplitude, which correlated positively with FTND. Persistence was correlated with several psychosocial factors and was higher among those intending to quit very soon, but did not vary by number of past-year quit attempts. Amplitude differed across quit attempts and intention (p < 0.001) and, in multivariable models, was significantly associated with lower 30-day quit intention (OR = 0.76, p = 0.001). Conclusions: Persistence and amplitude factors characterized CPT data in adults, discriminated known groups (e.g., smokers by intentions to quit), and were positively associated with nicotine dependence. Factor scores also appear to relate to certain psychosocial factors, such as smoker identity and perceptions of risk. Future research should examine the predictive validity of these constructs.
- "And, finally, smokers who perceive fewer health risks associated with tobacco use are less likely to make quit attempts (Costello et al. 2012; Savoy et al. 2014). Home smoking restrictions are also shown to relate to smoking cessation, often serving as an intermediate step (Borland et al. 2006; Hyland et al. 2009; Mills et al. 2009). Voluntarily placing an environmental restriction on behavior might indicate greater ability to regulate use. "
[Show abstract] [Hide abstract] ABSTRACT: We examined reasons for establishing smoke-free home policies, interpersonal processes by which they are established, and challenges in enforcing them in Shanghai, China. In 2013, we conducted 30 in-person semi-structured interviews among 13 male smokers and 17 female nonsmokers recruited from urban and a suburban communities in Shanghai. Reasons for adopting a smoke-free home included family's health, being a role model for children, cleaner environment, and potential impact on smoking behavior. Wives were credited with initiating discussion regarding the implementation of a smoke-free home most often and were reported to have decision-making authority. Some households had not discussed such a rule. Common responses to asking to establish a smoke-free home among husbands were agreeing not to smoke at home or in front of family members, ignoring the request, temporarily acquiescing, insisting on smoking in the home anyway, and devaluing the benefits of smoke-free homes. Challenges to enforcement included weather, social situations, the smoker being home alone, ineffective harm reduction behaviors such as smoking near windows, and addiction were challenges in enforcement. Specific factors (e.g. family's health) could be highlighted to assist women, men, and children in adopting and enforcing smoke-free home policies.
- "It was also interesting to note that, as children aged, some smokers were less vigilant about protecting them from SHS. In fact, prior research has found that having children under 18 years old was not associated with having a complete smoke-free home policy, which is consistent with other studies [10,16,17]. People tend to believe that older children may not be sensitive to SHS. "