Health  Vol.2 No.11 , November 2010
Residential smoking restrictions are not associated with reduced child SHS exposure in a baseline sample of low-income, urban African Americans
Second hand smoke exposure (SHSe) relates to many chronic and acute illnesses. Low income African American (AA) maternal smokers and their children have disproportionately higher tobacco-use and child SHSe-related morbidity and mortality than other populations. While public health officials promote residential smoking restrictions to reduce SHSe and promote smoking cessation, little is known about the impact of restrictions in changing smoking behavior and SHSe in this population. Thus, the purpose of this study was to examine associations between residential smoking restrictions, maternal smoking, and young children’s SHSe in the context of other factors known to influence low income AA mothers’ smoking behavior. For this study, we used cross-sectional, baseline data from 307 AA maternal smokers’ pre-treatment interviews completed as part of a subsequent behavioral counseling trial to reduce their young (< 4 years old) children’s SHSe. Residential smoking restriction was dichotomized as 0 = no restrictions and 1 = some restrictions. Child urine cotinine provided a biomarker of SHSe. Mothers reported cigarettes/day smoked, cigarettes/day exposed to child, and intention to quit. Multivariate regressions modeled effects of restriction as the primary predictor of smoking and exposure outcomes. Maternal smoking patterns such as cigarettes per day (β = 0.52, p < 0.001) and years smoked (β = ?0.11; p = 0.03) along with presence of additional smokers in the home (β = 0.10; p = 0.04), but not residential restriction (β = ?0.09, p = 0.10), predicted reported SHSe. Restriction did not relate to baby cotinine or maternal intention to quit. Thus, residential smoking restrictions may contribute to efforts to reduce children’s SHSe and promote maternal smoking change; but alone, may not constitute a sufficient intervention to protect children. Multi-level intervention approaches that include SHSe-reduction residential smoking policies plus support and cessation assistance for smokers may be a necessary approach to smoke-free home adoption and adherence.

Cite this paper
nullCollins, B. , Ibrahim, J. , Hovell, M. , Tolley, N. , Nair, U. , Jaffe, K. , Zanis, D. and Audrain-McGovern, J. (2010) Residential smoking restrictions are not associated with reduced child SHS exposure in a baseline sample of low-income, urban African Americans. Health, 2, 1264-1271. doi: 10.4236/health.2010.211188.
[1]   U.S. Department of Health and Human Services (2006) The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

[2]   World Health Organization (2002) The World Health Report: Reducing Risks, Promoting Healthy Life, September 2010.

[3]   Carmichael, S.L. and Ahluwalia, I.B. (2000) Correlates of postpartum smoking relapse. Results from the pregnancy risk assessment monitoring system (PRAMS). American Journal of Preventive Medicine, 19(3), 193-196.

[4]   California-Environmental Protection Agency. (1997) Health effects of exposure to environmental tobacco smoke. Final draft for scientific, public, and SRP review, California Environmental Protection Agency, Office of Environmental Health Hazard Assessment.

[5]   Gergen, P.J., Fowler, J.A., Maurer, K.R., Davis, W.W. and Overpeck, M.D. (1998) The burden of environmental tobacco smoke exposure on the respiratory health of children 2 months through 5 years of age in the United States: Third national health and nutrition examination survey, 1988 to 1994. Pediatrics, 101(2), E8.

[6]   Cobanoglu, N., Kiper, N., Dilber, E., Gurcan, N., Gocmen, A., Ozcelik, U., et al. (2007) Environmental tobacco smoke exposure and respiratory morbidity in children. Inhalation and Toxicology, 19(9), 779-785.

[7]   Collins, B.N., Wileyto, E.P., Murphy, M.F. and Munafo, M.R. (2007) Adolescent environmental tobacco smoke exposure predicts academic achievement test failure. Journal of Adolescent Health, 41(4), 363-370.

[8]   Eskenazi, B. and Castorina, R. (1999) Association of prenatal maternal or postnatal child environmental tobacco smoke exposure and neurodevelopmental and behavioral problems in children. Environmental Health Perspectives, 107(12), 991-1000.

[9]   Johansson, A., Ludvigsson, J. and Hermansson, G. (2008) Adverse health effects related to tobacco smoke exposure in a cohort of three-year olds. Acta Paediatrica, 97(3), 354-357.

[10]   Lannero, E., Wickman, M., van Hage, M., Bergstrom, A., Pershagen, G. and Nordvall, L. (2008) Exposure to environmental tobacco smoke and sensitisation in children. Thorax, 63(2), 172-176.

[11]   Shenkin, J.D., Broffitt, B., Levy, S.M. and Warren, J.J. (2004) The association between environmental tobacco smoke and primary tooth caries. Journal of Public Health and Dentistry, 64(3), 184-186.

[12]   Sundell, H.W. (2004) SIDS prevention-good progress, but now we need to focus on avoiding nicotine. Acta Paediatrica, 93(4), 450-452.

[13]   Weitzman, M., Byrd, R.S., Aligne, C.A. and Moss, M. (2002) The effects of tobacco exposure on children’s behavioral and cognitive functioning: Implications for clinical and public health policy and future research. Neurotoxicology and Teratology, 24(3), 397-406.

[14]   Hill, S.C. and Liang, L. (2008) Smoking in the home and children’s health. Tobacco Control, 17(1), 32-37.

[15]   Kegler, M.C. and Malcoe, L.H. (2002) Smoking restrictions in the home and car among rural Native American and white families with young children. Preventive Medi- cine, 35(4), 334-342.

[16]   Gonzales, M., Malcoe, L.H., Kegler, M.C. and Espinoza, J. (2006) Prevalence and predictors of home and automobile smoking bans and child environmental tobacco smoke exposure: a cross-sectional study of U.S.- and Mexico-born Hispanic women with young children. BMC Public Health, 6, 265.

[17]   Hopper, J.A. and Craig, K.A. (2000) Environmental tobacco smoke exposure among urban children. Pediat- rics, 106(4), E47.

[18]   Castro, M., Schechtman, K.B., Halstead, J. and Bloom- berg, G. (2001) Risk factors for asthma morbidity and mortality in a large metropolitan city. Journal of Asthma, 38(8), 625-635.

[19]   Claudio, L., Tulton, L., Doucette, J. and Landrigan, P.J. (1999) Socioeconomic factors and asthma hospitalization rates in New York City. Journal of Asthma, 36(4), 343- 350.

[20]   Crain, E.F., Weiss, K.B., Bijur, P.E., Hersh, M., West- brook, L. and Stein, R.E. (1994) An estimate of the prevalence of asthma and wheezing among inner-city children. Pediatrics, 94(3), 356-362.

[21]   Perera, F.P., Illman, S.M., Kinney, P.L., Whyatt, R.M., Kelvin, E.A., Shepard, P., et al. (2002) The challenge of preventing environmentally related disease in young children: Community-based research in New York City. Environmental Health Perspectives, 110(2), 197-204.

[22]   Tanne, J.H. (2001) Asthma “crisis” for black Americans. British Medical Journal, 323(7308), 302.

[23]   Ahijevych, K. and Garrett, B.E. (2004) Menthol phar- macology and its potential impact on cigarette smoking behavior. Nicotine and Tobacco Research, 6(Suppl 1), S17-28.

[24]   Benowitz, N.L., Perez-Stable, E.J., Fong, I., Modin, G., Herrera, B. and Jacob, P. (1999) Ethnic differences in N-glucuronidation of nicotine and cotinine. Journal of Pharmacology and Experimental Therapeutics, 291(3), 1196-1203.

[25]   U.S. Department of Health and Human Services. (1998) Tobacco Use among U.S. Racial/Ethnic Minority Groups- African Americans, American Indians and Alaska Natives, Asian Americans and Pacific Islanders, and Hispanics: A Report of the Surgeon General. Atlanta, Georgia: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health.

[26]   Mannino, D.M., Moorman, J.E., Kingsley, B., Rose, D. and Repace, J. (2001) Health effects related to environmental tobacco smoke exposure in children in the United States: data from the Third National Health and Nutrition Examination Survey. Archives of Pediatric and Adoles- cent Medicine, 155(1), 36-41.

[27]   Tang, D., Warburton, D., Tannenbaum, S.R., Skipper, P., Santella, R.M., Cereijido, G.S., et al. (1999) Molecular and genetic damage from environmental tobacco smoke in young children. Cancer Epidemiology Biomarkers and Prevention, 8(5), 427-431.

[28]   Wilson, S.E., Kahn, R.S., Khoury, J. and Lanphear, B.P. (2005) Racial differences in exposure to environmental tobacco smoke among children. Environmental Health Perspectives, 113(3), 362-367.

[29]   Fiore, M.C, Jaen, C.R., Baker, T.B., Baker, C.R., Bailey, W.C., Benowitz, N.L., et al. (2008) Treating tobacco use and dependence: 2008 update. September 2010.

[30]   Bartecchi, C., Alsever, R.N., Nevin-Woods, C., Thomas, W.M., Estacio, R.O., Bartelson, B.B., et al. (2006) Re- duction in the incidence of acute myocardial infarction associated with a citywide smoking ordinance. Circulation, 114(14), 1490-1496.

[31]   Sargent, R.P., Shepard, R.M. and Glantz, S.A. (2004) Reduced incidence of admissions for myocardial infarcttion associated with public smoking ban: Before and after study. British Medical Journal, 328(7446), 977-980.

[32]   Americans for Nonsmokers’ Rights Foundation (2009) Smokefree lists, maps, and data. September, 2010.

[33]   Ashley, M.J. and Ferrence, R. (1998) Reducing children’s exposure to environmental tobacco smoke in homes: Issues and strategies. Tobacco Control, 7(1), 61-65.

[34]   Mannino, D.M., Siegel, M., Husten, C., Rose, D. and Etzel, R. (1996) Environmental tobacco smoke exposure and health effects in children: results from the 1991 National Health Interview Survey. Tobacco Control, 5(1), 13-18.

[35]   Dwyer, T., Ponsonby, A.L. and Couper, D. (1999) Tobacco smoke exposure at one month of age and subsequent risk of SIDS - A prospective study. American Journal of Epidemiology, 149(7), 593-602.

[36]   McMillen, R.C., Winickoff, J.P., Klein, J.D. and Weitzman, M. (2003) US adult attitudes and practices regarding smoking restrictions and child exposure to environmental tobacco smoke: Changes in the social climate from 2000-2001. Pediatrics, 112(1 Pt 1), e55-60.

[37]   World Health Organization (2009) IARC Handbooks of Cancer Prevention. Tobacco Control. Lyon, France, World Health Organization.

[38]   United States Census Bureau (2008) Population Estimates.

[39]   Jochelson, T., Hua, M. and Rissel, C. (2003) Knowledge, attitudes and behaviours of caregivers regarding children’s exposure to environmental tobacco smoke among Arabic and Vietnamese-speaking communities in Sydney, Australia. Ethnicity and Health, 8(4), 339-351.

[40]   Carlson, L.E., Goodey, E., Bennett, M.H., Taenzer, P. and Koopmans, J. (2002) The addition of social support to a community-based large-group behavioral smoking cessation intervention: improved cessation rates and gender differences. Addictive Behaviors, 27(4), 547-559.

[41]   Collins, B.N., Wileyto, E., Patterson, F., Rukstalis, M., Audrain-McGovern, J., Kaufmann, V., et al. (2004) Gender differences in smoking cessation in a placebo-controlled trial of bupropion with behavioral counseling. Nicotine and Tobacco Research, 6(1), 27-37.

[42]   Perkins, K.A., Donny, E. and Caggiula, A.R. (1999) Sex differences in nicotine effects and self-administration: review of human and animal evidence. Nicotine and Tobacco Research, 1(4), 301-315.

[43]   Royce, J.M., Corbett, K., Sorensen, G. and Ockene, J. (1997) Gender, social pressure, and smoking cessations: the Community Intervention Trial for Smoking Cessation (COMMIT) at baseline. Social Science and Medicine, 44(3), 359-370.

[44]   Scharf, D. and Shiffman, S. (2004) Are there gender differences in smoking cessation, with and without bupropion? Pooled- and meta-analyses of clinical trials of Bupropion SR. Addiction, 99(11), 1462-1469.

[45]   Swan, G.E., Jack, L.M. and Ward, M.M. (1997) Subgroups of smokers with different success rates after use of transdermal nicotine. Addiction, 92(2), 207-217.

[46]   Wetter, D.W., Fiore, M.C., Young, T.B., McClure, J.B., de Moor, C.A. and Baker, T.B. (1999) Gender differences in response to nicotine replacement therapy: Objective and subjective indexes of tobacco withdrawal. Experimental and Clinical Psychopharmacology, 7(2), 135-144.

[47]   Hovell, M.F., Wahlgren, D.R. and Adams, M.A. (2009) The logical and empirical basis for the behavioral ecological model. In: DiClemente, R.J., Crosby, R. and Kegler, M. Eds., Emerging Theories and Models in Health Promotion Research and Practice, 2nd Edition, Jossey- Bass Inc., San Francisco.

[48]   Farkas, A.J., Gilpin, E.A., White, M.M. and Pierce, J.P. (2000) Association between household and workplace smoking restrictions and adolescent smoking. Journal of the American Medical Association, 284(6), 717-722.

[49]   Matt, G.E., Hovell, M.F., Zakarian, J.M., Bernert, J.T., Pirkle, J.L. and Hammond, S.K. (2000) Measuring secondhand smoke exposure in babies: The reliability and validity of mother reports in a sample of low-income families. Health Psychology, 19(3), 232-241.

[50]   Matt, G.E., Wahlgren, D.R., Hovell, M.F., Zakarian, J.M., Bernert, J.T., Meltzer, S.B., et al. (1999) Measuring environmental tobacco smoke exposure in infants and young children through urine cotinine and memory-based parental reports: Empirical findings and discussion. Tobacco Control, 8(3), 282-289.

[51]   Szabo, E., White, V. and Hayman, J. (2006) Can home smoking restrictions influence adolescents’ smoking be- haviors if their parents and friends smoke? Addictive Behaviors, 31(12), 2298-2303.

[52]   Benowitz, N.L., Ahijevch, K., Hall, S.M., Hanson, A., Henningfield, J., Hurt, R., et al. (2001) Biochemical verification of tobacco use and cessation. SRNT Subcommittee on Biochemical Verification.

[53]   Clark, P.I., Schooley, M.W., Pierce, B., Schulman, J., Hartman, A.M. and Schmitt, C.L. (2006) Impact of home smoking rules on smoking patterns among adolescents and young adults. Preventing Chronic Diseases, 3(2), A41.

[54]   Pomerleau, C.S., Carton, S.M., Lutzke, M.L., Flessland, K.A. and Pomerleau, O.F. (1994) Reliability of the Fagerstrom Tolerance Questionnaire and the Fagerstrom Test for Nicotine Dependence. Addictive Behaviors, 19(1), 33-39.

[55]   Radloff, L. (1977) A CES-D scale: A self-report depresssion scale for research in the general population. Applied Psychology Measurement, 1385-1401.

[56]   Copeland, A.L., Martin, P.D., Geiselman, P.J., Rash, C.J. and Kendzor, D.E. (2006) Predictors of pretreatment attrition from smoking cessation among pre- and postmenopausal, weight-concerned women. Eating Behaviors, 7(3), 243-251.

[57]   Brookings, J.B. and Bolton, B. (1988) Confirmatory factor analysis of the Interpersonal Support Evaluation List. American Journal of Community Psychology, 16(1), 137- 147.

[58]   Alm, B., Milerad, J., Wennergren, G., Skjaerven, R., Oyen, N., Norvenius, G., et al. (1998) A case-control study of smoking and sudden infant death syndrome in the Scandinavian countries, 1992 to 1995. The Nordic Epidemiological SIDS Study. Archives of Disease in Childhood, 78(4), 329-334.

[59]   Klonoff-Cohen, H.S., Edelstein, S.L., Lefkowitz, E.S., Srinivasan, I.P., Kaegi, D., Chang, J.C., et al. (1995) The effect of passive smoking and tobacco exposure through breast milk on sudden infant death syndrome. Journal of the American Medical Association, 273(10), 795-798.

[60]   Matt, G.E., Bernert, J.T. and Hovell, M.F. (2008) Measuring secondhand smoke exposure in children: an ecological measurement approach. Journal of Pediatric Psychology, 33(2), 156-175.

[61]   Matt, G.E., Quintana, P.J., Hovell, M.F., Bernert, J.T., Song, S., Novianti, N., et al. (2004) Households contaminated by environmental tobacco smoke: Sources of infant exposures. Tobacco Control, 13(1), 29-37.

[62]   Schuster, M.A., Franke, T. and Pham, C.B. (2002) Smoking patterns of household members and visitors in homes with children in the United States. Archives of Pediatric and Adolescent Medicine, 156(11), 1094-1100.

[63]   Evans, W.D., Crankshaw, E., Nimsch, C., Morgan-Lopez, A., Farrelly, M.C. and Allen, J. (2006) Media and secondhand smoke exposure: Results from a national survey. American Journal of Health Behaviors, 30(1), 62-71.

[64]   Gilpin, E.A., White, M.M., Farkas, A.J. and Pierce, J.P. (1999) Home smoking restrictions: which smokers have them and how they are associated with smoking behavior. Nicotine and Tobacco Research, 1(2), 153-162.

[65]   Horwitz, M.B., Hindi-Alexander, M. and Wagner, T.J. (1985) Psychosocial mediators of abstinence, relapse, and continued smoking: A one-year follow-up of a minimal intervention. Addictive Behaviors, 10(1), 29-39.

[66]   Pizacani, B.A., Martin, D.P., Stark, M.J., Koepsell, T.D., Thompson, B. and Diehr, P. (2004) A prospective study of household smoking bans and subsequent cessation related behavior: The role of stage of change. Tobacco Con- trol, 13(1), 23-28.

[67]   Shields, M. (2005) The journey to quitting smoking. Health Reports, 16(3), 19-36.

[68]   Shopland, D.R., Anderson, C.M. and Burns, D.M. (2006) Association between home smoking restrictions and changes in smoking behavior among employed women. Journal of Epidemiology and Community Health, 60 (Suppl 2), 44-50.

[69]   Collins, B.N., Levin, K.P. and Bryant-Stephens, T. (2007) Pediatricians’ practices and attitudes about environmental tobacco smoke and parental smoking. Journal of Pediatrics, 150(5), 547-552.

[70]   Mueller, D. and Collins, B.N. (2008) Pediatric otolayngologists’ actions regarding secondhand smoke exposure: Pilot data suggest an opportunity to enhance tobacco in- tervention. Journal of Otolaryncology-Head and Neck Surgery, 139(3), 348-352.

[71]   Hovell, M.F., Wahlgren, D.R. and Gehrman, C.A. (2002) The behavioral ecological model: Integrating public health and behavioral science. Jossey-Bass, San Francisco.

[72]   Associated Press (2008) State promotes its restrictions on smoking. The Boston Globe.

[73]   Haskell, M. (2008) Law prohibiting smoking in cars gets Baldacci OK. Bangor Daily News, Bangor.

[74]   Associated Press (2008) New smoking restriction ignites debate: Ban on lighting up with a child in car is part of trend to violate rights, foes say. The Sacramento Bee, 7 January 2008.

[75]   Collins, B.N., Levin, K.P. and Bryant-Stephens, T. (2007) Pediatrician practices and attitudes about environmental tobacco smoke and parental smoking. Journal of Pediatrics, 150(5), 147-152.