National and state prevalence of smoke-free rules in homes with and without children and smokers: Two decades of progress

Objective. The home is the primary source of secondhand smoke (SHS) exposure for children. We assessed national and state progress in smoke-free home (SFH) rule adoption in homes with and without children and adult smokers. Methods. Data came from the 1992-1993 and 2010-2011 Tobacco Use Supplements to the Current Population Survey, a U.S. national probability household survey. Households were defined as having a SFH rule if all household respondents aged >= 18 indicated no one was allowed to smoke inside the home at any time. Households with children were those with occupants aged <18. Smokers were those who smoked >= 100 lifetime cigarettes and now smoked everyday or some days. Results. From 1992-1993 to 2010-2011, SFH rule prevalence increased from 43.0% to 83.0% (p <.05). Among households with children, SFH rules increased overall (44.9% to 88.6%), in households without smokers (59.7% to 95.0%), and households with >= 1 smokers (9.7% to 61.0%) (p <.05). Among households without children, SFH rules increased overall (40.8% to 81.1%), in households without smokers (53.4% to 90.1%), and households with >= 1 smokers (6.3% to 40.9%) (p <.05). Prevalence increased in all states, irrespective of smoker or child occupancy (p <.05). In 2010-2011, among homes with smokers and children, SFH rule prevalence ranged from 36.5% (West Virginia) to 86.8% (California). Conclusions. Considerable progress has been made adopting SFH rules, but many U.S. children continue to be exposed to SHS because their homes are not smoke-free. Further efforts to promote adoption of SFH rules are essential to protect all children from this health risk. Published by Elsevier Inc.