Household smoking bans and adolescents' perceived prevalence of smoking and social acceptability of smoking
Introduction
Household smoking bans are recommended to reduce children's exposure to environmental tobacco smoke (ETS) [1], [2], [3], [4], [5], [6], but may have other benefits. They might discourage smoking initiation by decreasing the visibility of smoking and fostering antismoking attitudes and norms among youth. Evidence derived mainly from cross-sectional studies links household smoking bans with a lower smoking prevalence and less tobacco consumption among youths [2], [7], [8], [9], [10], [11], [12]. Others have outlined important socioeconomic and demographic predictors of having a household smoking ban, such as higher income and education levels, two-parent households, non-white ethnicity, and parents who do not smoke [1], [2], [7], [13]. None of these studies assess whether changes in perceptions of the prevalence of smoking and social acceptability of smoking are mediating variables in these relationships, and no study adjusted for town-level anti-smoking sentiment.
Measures of tobacco-related social norms such as perceived smoking prevalence [14], [15], [16], [17], [18], [19], [20], [21], [22], [23] and the perceived social acceptability of smoking [18], [20], [24] have been shown to be strong predictors of adolescent smoking or smoking initiation. There are several levels of tobacco control programs and policies that may affect these outcomes, including media campaigns, clean indoor air laws, and household policies. This paper assesses the association of household smoking bans on adolescents' perceived prevalence of adult and youth smoking, as well as their perception of adult disapproval of adult and youth smoking. To our knowledge, this is the first paper to examine these associations, as well as to adjust for town-level anti-smoking sentiment. The evidence for an effect of household smoking bans on youth smoking behavior would be greatly strengthened if it were shown that these policies produce changes in youth attitudes that are known to influence smoking initiation.
Additionally, prior research has demonstrated that peer and parental smoking [12], [25], [26], [27] as well as parental antismoking norms and disapproval of smoking [7], [28], [29] are related to adolescent smoking behavior. We hypothesized that a household smoking ban might blunt the pro-smoking impacts of (1) parental smoking and (2) weak or absent parental disapproval of smoking. If so, it would provide an additional rationale for promoting household smoking bans to all parents.
Section snippets
Sample selection and data collection
We analyzed baseline data from an ongoing longitudinal study designed to examine the impact of community-based tobacco control interventions on adult and youth smoking behavior. Data are derived from a telephone survey of Massachusetts residents. Between January 2001 and June 2002, professional interviewers from the Center for Survey Research, University of Massachusetts-Boston, obtained a statewide random sample of Massachusetts households by random-digit-dialing. Initially, a household
Characteristics of the youth sample and household smoking bans
Table 1 displays the characteristics of the 3831 youths in the sample. Eighty-eight percent reported that their parents would disapprove a lot if they smoked. Fifty-seven percent of adolescents thought that less than half of adults in their town smoked and reported that less than half of youths in their school smoked. Seventeen percent of adolescents perceived that adults in their town disapproved a lot of other adults' smoking, whereas 69% perceived that adults in their town disapproved a lot
Discussion
This study provides strong evidence that the presence of a household smoking ban is associated with youths' perceptions that fewer adults smoke and that adults in their community disapprove more strongly of smoking by both adults and teenagers. These findings were significant in multi-level adjusted models that controlled for important confounders, including parental disapproval of smoking and parental smoking, as well as town-level antismoking sentiment. Perceived parental disapproval of
Conclusions
Youths living in households with a smoking ban were more likely to believe that fewer adults smoked in their community and to perceive more adult disapproval of smoking by either adults or youths. These perceptions have been previously linked to smoking outcomes, and this work provides an important connection between an intervention (implementation of a household smoking ban) and these perceptions, which may mediate the effect on smoking initiation. These findings remained after controlling for
Acknowledgments
This work was made possible through the National Cancer Institute grant CA 86257 and the Flight Attendant Medical Research Institute.
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