摘要：Objectives. We assessed current home smoking behaviors and secondhand smoke (SHS) levels among parents of children in low-income, racial/ethnic minority communities in Massachusetts. Methods. We used a cross-sectional design to assess home smoking rules, smoking status, cigarettes smoked in the home, and barriers and benefits to attaining a smoke-free home among 138 caregivers (mean age = 30.0 years; 92% women) of children aged 0 to 6 years, between April 2010 and September 2012. Indoor SHS was assessed using a nicotine dosimeter. Results. Households with no ban reported a higher weekly mean number of cigarettes smoked in the home (114 cigarettes/week) than homes with partial (71 cigarettes/week) or complete (30 cigarettes/week) bans ( P < .01). Smoking occurred outside more than inside homes with partial or complete bans. Air nicotine levels were positively associated with no household smoking ban, current smoking by the caregiver, and smoking indoors. Conclusions. Strategies to reduce home SHS should focus on a “complete” home smoking ban and smoking cessation. SHS mitigation strategies such as smoking outside were associated with lower SHS among participants unable to maintain a complete ban, and might enhance the likelihood of longer term success while immediately reducing home SHS. Secondhand smoke (SHS) exposure is associated with serious pediatric illnesses, yet is entirely preventable. 1 Children’s exposure to SHS occurs chiefly in domestic environments, including the home and car. 2,3 SHS exposure varies by income, race, and parental education, 4 and the likelihood of exposure to SHS tends to be higher among African American and low socioeconomic status (SES) groups. 5 Children from low-income backgrounds are at greater risk for SHS exposure and share a disproportionate burden of disease. 6–8 Young children (aged 6 years and younger) from lower SES communities are 3 times more likely to be exposed to the highest levels of SHS in the home (≥ 4 days/week) as children from middle- and high-income groups. 9 Recent data indicate that the percentage of households with a voluntary smoke-free rule has risen nationwide. 3,10 In 1995, approximately 58% of homes in the United States were reportedly smoke-free, whereas more recent data suggest that this percentage now approaches 84%. 11 This figure may be higher in homes in which children are present. 10 Despite the increase in smoke-free homes, children’s cotinine levels (an index of SHS exposure) have remained steady since 2000. 12 This may be explained, in part, by incomplete or diminishing adherence to self-imposed home smoking bans. However, little research has been conducted to understand the factors associated with implementation and adherence to home smoking bans, including facilitators and barriers to the maintenance of a smoke-free home. Although efficacious interventions to help families establish smoke-free home rules have been widely reported, 13 strategies to tailor those interventions to the needs of low-income and minority race/ethnicity communities have so far been limited. 14,15 Complete home smoking bans are associated with lower SHS 16,17 ; however, a better understanding is needed of current home smoking behaviors and attitudes among parents of young children in low-income minority communities. Such questions might appropriately be posed in Massachusetts—a state in which the prevalence of children’s exposure to SHS in the home ranks well below the median of US states, 4 yet where public health efforts have so far failed to provide protection from SHS exposure for 4.3% (an estimated 61 000) of Massachusetts children. 4,18 Nevertheless, it is possible that microlevel changes directed at mitigating SHS exposure have occurred within homes that have not become completely smoke-free. Limiting the number of cigarettes smoked inside a home may directly reduce SHS, 17 which, in turn, may influence children’s exposure to SHS. 8 Behavioral strategies intended to mitigate SHS exposure, such as smoking outdoors, may be an underinvestigated (albeit suboptimal) 19 strategy used in households where a ban has either not been implemented or successfully maintained. To more fully understand home smoking practices among communities of low income and racial and ethnic diversity, we sought to identify who adopted and who adhered to a voluntary home smoking ban, the barriers and perceived benefits to adherence, and the impact of those bans on home smoking behaviors (including mitigation strategies), using a cross-sectional study design. In addition, the number of smokers in the household, their age, race and ethnicity, the number and location (within the home or attached external structure) of cigarettes smoked, and strategies employed to reduce SHS exposure were documented. Finally, indoor air quality was measured by nicotine levels to characterize factors associated with home SHS levels.
