اجرای خانگی قوانین دود آزاد در خانه ها و ماشین ها: تمرکز بر رفتار سیگار کشیدن نوجوانان Household Implementation of Smoke-Free Rules in Homes and Cars: A Focus on Adolescent Smoking Behavior and Secondhand Smoke Exposure

Purpose Over 90% of smokers start smoking before age 18.1 Smoking initiation in adolescence increases risk of tobacco-related mortality and morbidity, regardless of smoking status in adulthood.2 Secondhand smoke (SHS) exposure also causes premature death and illness; large proportions of the population are still exposed to SHS, including nearly 50% of children.3,4 Peer smoking influences both tobacco use and SHS exposure among youth.5 Yet even though youth with close friends who smoke are more likely to be exposed to SHS and to use tobacco than youth with no close friends who smoke,6,7 caregiver or parental smoking can have a sizable influence on youth tobacco use and SHS exposure.8-10 As the American Academy of Pediatrics Section on Tobacco Control notes, it is a public health priority to address caregiver and parental tobacco use in order to reduce tobacco use and SHS exposure, as parental tobacco use can impact youth behavior as well as mental and physical health across the life course.8 It is difficult for many adult smokers to reach sustained tobacco cessation, and therefore, implementing voluntary, smoke-free rules in homes and cars is a desirable step for reducing tobaccorelated harm among youth.8,11 Smoke-free public policies are becoming more common but they rarely address private spaces,12 which are common locations for SHS exposure for children.13,14 Prevalence of voluntary smoke-free rules in the home has increased from 43% in 1992 to 1993 to 83% in 2010 to 2011, and these rules tend to be more common in households with children under the age of 18.15,16 However, recent evidence from Minnesota demonstrates that over 80% of smokers do not restrict smoking in both the home and car.14 This study also found that adults living with a child in the home were not more likely to implement smoke-free rules in cars,14 corroborating previous findings on the lack of smoke-free car rules among caregivers and parents who smoke.17 Implementing comprehensive smoke-free household rules (ie, smoke-free rules in the home and car14) could potentially help protect youth from the risk of early initiation of tobacco use as well as harms of SHS exposure.18-20 Yet there is a dearth of population-based research on how voluntary implementation of comprehensive smoke-free rules impacts tobacco use and SHS exposure among children and adolescents, particularly in the context of the changing tobacco landscape.21 In this study, we examine how household smoking restrictions relate to tobacco-related behavior and harm among adolescents who live with a smoker. We categorize household smoke-free rules according to comprehensive (home and car), partial (home or car only), and no (neither home nor car) smoke-free rules. We examine youth tobacco use—both combustible cigarette and other tobacco products in light of recent youth smoking trends22-26—as well as SHS exposure using data from the 2014 Minnesota Youth Tobacco Survey (MYTS).