Impact of National Smoke-Free Legislation on Educational Disparities in Smoke-Free Homes: Findings from the SIDRIAT Longitudinal Study

Association of household smoking status in childhood with young adults' educational attainment and smoking status: Results from a series of population-based cross-sectional surveys in Japan

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Smoking in young adulthood is more common among those from households with smokers.

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Being from smoking households is linked to low educational levels in young adulthood.

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More childhood household smokers corresponds to worse outcomes for young adults.

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Exposure to household smokers in childhood appears to perpetuate health inequality.

Smoking in young adulthood is a risk factor for future health-related disabilities and a cause of expanding health inequalities. Education and smoking are inversely associated. Using population-based representative data, this study aimed to clarify how the presence of household smokers during childhood related to both current smoking status and educational attainment among young adults. Surveys were distributed to young adults (19–20 years) invited to coming-of-age ceremonies in 2014–2017 in a rural area in Japan. Data were collected on low educational attainment (defined as ≤ 12 years of education), current smoking status, and childhood household smoking status. We used logistic regression models to calculate odds ratios (ORs) of low educational attainment for household smoking status. A total of 17.6% of men (n = 1077) and 3.8% of women (n = 1021) were current smokers. Current smoking was more common among participants from households with smokers (P < 0.001 for both men and women). The odds of low educational attainment were significantly higher for participants from smoking households (OR: 1.59, 95% confidence interval [CI]: 1.17–2.17 for men; OR: 2.29, 95% CI: 1.61–3.24, for women). All associations were characterized by a dose–response relationship with the number of household smokers. The number of household smokers in childhood was positively associated with current smoking and negatively associated with level of educational attainment among young adults. Controlling for year and geographical area, exposure to family smokers in childhood appears to be a risk factor for the intergenerational transmission of health inequalities.

A Qualitative Study about Creating Smoke-free Home Rules in American Indian and Alaska Native Households

Smoke-free homes can reduce exposure to secondhand smoke (SHS) and support smoking cessation. The current study seeks to understand perspectives, including barriers and facilitators, on smoke-free homes among five American Indian/Alaska Native (AI/AN) communities. Guided by a national work group of tribal partners, ten focus groups were conducted with AI/AN adult smokers and nonsmokers (n = 95) in Alaska, California, Michigan and Oklahoma, stratified by smoking status. The majority of participants lived in single unit detached homes (70.5%). Most of the nonsmokers had a smoke-free home rule (92.9%) and a majority of smokers did as well (64.7%). The most common reasons for smoke-free home rules were protecting children and grandchildren, including children with health problems. Challenges to a smoke-free home included weather and visitors who smoked, along with the inconvenience of going outside, the habit of smoking inside, the need to watch a young child, safety concerns, and smokers who break the rules. Respecting rules and respecting elders emerged as important themes. Traditional use of tobacco in the home was viewed as quite distinct from recreational or everyday use. Over half (58.2%) reported never using tobacco for ceremonial, prayer or traditional reasons in their homes. Given unique considerations for the adoption of smoke-free homes in AI/AN communities, particularly regarding the use of sacred tobacco for traditional, ceremonial, or medicinal purposes, it is important to learn which barriers and facilitators are similar to the general population and which may be unique to tribal communities in the U.S.

Impact of Public Smoking Bans on Social Inequalities in Children’s Exposure to Tobacco Smoke at Home: An Equity-Focused Systematic Review

Introduction

A systematic review was conducted to evaluate the impact of public smoking bans on social inequalities in children’s secondhand smoke (SHS) exposure at home.

Methods

Five databases were electronically searched for articles on children’s SHS exposure at home related to public smoking bans. In addition, the gray literature and German public health journals were considered. Search was restricted to English and German publications. Of 3037 records screened, 25 studies fulfilled the inclusion criteria by either measuring SHS exposure before and after public smoking ban introduction or by comparing exposure between regions with and without smoke-free legislation. Studies were further examined whether they additionally reported on impacts on social inequalities in SHS exposure. Information on children’s SHS exposure at home in relation to smoke-free legislation were extracted by one reviewer and checked for accuracy by a second reviewer. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity (PRISMA-E) guidelines for equity-focused systematic reviews, the PROGRESS-Plus framework was applied to data extraction and analysis with focus on social inequalities in SHS exposure. Results were visualized by a harvest plot.

Results

Eight studies gave results on the impact of public smoking bans on social inequalities in children’s SHS exposure. Whereas only one study indicated widening of the social gap in exposure, seven studies showed no impact or a reduction of social inequalities in exposure.

Conclusions

First evidence on short-term impact of public smoking bans does not support the assumption of intervention-generated inequalities in children’s SHS exposure at home. Future studies should focus on long-term equity impacts of smoke-free legislation.

Implications

There are substantial social inequalities in children’s SHS exposure in many countries. Both hypotheses on the effect of smoke-free legislation on children’s SHS exposure at home, the displacement hypothesis and the social diffusion hypothesis, did not take social inequalities into account. Up to now, only few studies analyzed the effects of smoke-free legislation on social inequalities in children’s SHS exposure at home. Public smoking bans had overall no negative impact on social inequalities in children’s SHS exposure at home. More consistent reporting of absolute and relative inequalities is needed to comprehensively assess equity impact of smoke-free legislation.