Abstract
Objective
To assess the prevalence and characteristics of smoke-free home and vehicle rules by tobacco use.
Methods
Data came from the 2012–2013 National Adult Tobacco Survey, a telephone survey of adults aged ≥18. Respondents who reported smoking is ‘never allowed’ inside their home or any family vehicle were considered to have smoke-free home and vehicle rules, respectively. Prevalence and characteristics of smoke-free rules were assessed overall and by current tobacco use (combustible only, noncombustible only, combustible and noncombustible, no current tobacco use). Assessed characteristics included: sex, age, race/ethnicity, education, marital status, income, region, and sexual orientation.
Results
Nationally, 83.7% of adults (n = 48,871) had smoke-free home rules and 78.1% (n = 46,183) had smoke-free vehicle rules. By tobacco use, prevalence was highest among nonusers of tobacco (homes: 90.8%; vehicles: 88.9%) and lowest among combustible-only users (homes: 53.7%; vehicles: 34.2%). Prevalence of smoke-free home and vehicle rules was higher among males, adults with a graduate degree, and adults living in the West.
Conclusions
Most adults have smoke-free home and vehicle rules, but differences exist by tobacco use. Opportunities exist to educate adults about the dangers of secondhand smoke and the benefits of smoke-free environments, particularly among combustible tobacco users.
Keywords: Smoke-free transactions, Nonsmoking homes, Vehicles, Public places
Introduction
Secondhand smoke (SHS) exposure causes disease and death among nonsmoking adults and children (USDHHS, 2006, 2012, 2014). The Surgeon General has concluded there is no risk-free level of SHS exposure, and that completely eliminating smoking in indoor settings is the only way to fully protect nonsmokers (USDHHS, 2006). In the past decade, considerable progress has occurred in the implementation of comprehensive state and local smoke-free laws that prohibit smoking in worksites, bars, and restaurants; as of January 2015, 26 states and the District of Columbia had implemented such laws (CDC, 2015).
Historically, the voluntary adoption of smoke-free policies has increased, however, homes and vehicles remain significant sources of SHS exposure, particularly for children (USDHHS, 2006). One international study from New Zealand demonstrated that youth SHS exposure rates in vehicles and homes decreased between 2006 and 2012 (Healey et al., 2015). A US study from 2009–2010 found the prevalence of SHS exposure in vehicles to be 73.6% (King et al., 2013) and another national study reported the prevalence of smoke-free home rules increased from 43.0% in 1992–1993 to 83.0% in 2010–2011 (CDC, 2014a).
Although cigarette smoking has declined (USDHHS, 2014), more Americans are using other tobacco products, including combustible (e.g., cigars, cigarillos, and little cigars), noncombustible (e.g., chewing tobacco and snus), and emerging products (e.g., electronic cigarettes) (USDHHS, 2014; CDC, 2014b). As highlighted in the 2014 Surgeon General’s report, this diversification of the tobacco product landscape has made it increasingly important to assess tobacco control interventions in the context of all forms of tobacco use (USDHHS, 2014).
In addition to protecting nonsmokers from SHS (USDHHS, 2006, 2014), implementing smoke-free rules in private settings can encourage smoking cessation (USDHHS, 2012), prevent relapse, and reduce the social acceptability of tobacco use (Hopkins et al., 2010). To date, studies of smoke-free home and vehicle rules have been assessed by cigarette smoking; however, no studies have assessed such rules by other tobacco use (King et al., 2013). Therefore, we assessed the prevalence and characteristics of smoke-free home and vehicle rules among US adults by tobacco use.
Methods
Data source
Data came from the 2012–2013 National Adult Tobacco Survey (NATS), a landline and cellular telephone survey of noninstitutionalized civilian US adults aged ≥18 (CDC, 2013). The sampling design was composed of independent samples drawn from households in the 50 US states and District of Columbia. During October 2012 to July 2013, 60,192 interviews were completed (landline: 57,999; cellular: 2193); the response rate was 44.9% (landline: 47.2%; cellular: 36.3%).
Measures
Smoke-free rules
Smoke-free home rules were determined by the question, “Not counting decks, porches, or garages, inside your home, is smoking always allowed, allowed only at some times or in some places, or never allowed?” Respondents who selected never allowed were classified as having a smoke-free home rule. Smoke-free vehicle rules were determined by the question, “Not counting motorcycles, in the vehicles that you or family members who live with you own or lease, is smoking always allowed in all vehicles, sometimes allowed in at least one vehicle, or never allowed in any vehicle?” Respondents who selected never allowed in any vehicle were classified as having a smoke-free vehicle rule. Missing responses, refusals, and responses of ‘don’t know’ or ‘family doesn’t own or lease a vehicle’ (vehicle only) were excluded (homes: n = 2402; vehicles: n = 3220).
Tobacco use
Tobacco use was categorized as: 1) any tobacco; 2) combustible only; 3) noncombustible only; 4) both combustible and noncombustible; and 5) no current tobacco use. Current combustible use was defined as smoking ≥100 cigarettes, cigars/cigarillos/filtered little cigars ≥50 times, regular pipes ≥1 time, or water pipes/hookahs ≥1 time during their lifetime, and now using these respective products ‘everyday’ or ‘some days’. Current noncombustible use was defined as using chewing tobacco, snuff, or dip ≥20 times during their lifetime, or snus or dissolvable tobacco products on 1 or more days, and now using these products ‘everyday’ or ‘some days.’ Any tobacco use was defined as current combustible use, and/or noncombustible use, and/or electronic cigarettes use (use ≥1 time during lifetime and now use ‘everyday’ or ‘some days’). Based on conclusions of the 2014 Surgeon General’s report, electronic cigarettes were categorized as a noncombustible product as they provide doses of nicotine and other additives to the user in an aerosol nicotine delivery systems (USDHHS, 2014). No current tobacco use was defined as not currently using combustible tobacco, noncombustible tobacco, or electronic cigarettes.
Sociodemographics
Sociodemographics included: sex, age, race/ethnicity, education, marital status, annual household income, US region, and sexual orientation.
Analysis
Descriptive statistics were calculated using SAS-callable SUDAAN v10 (SAS Institute Inc.) to assess smoke-free home and vehicle rule prevalence by sociodemographics and tobacco use. Chi-square tests were performed to determine overall significance for each tobacco use category (i.e., any tobacco; combustible only; noncombustible only; both combustible and noncombustible; and no current tobacco use) and sociodemographic variable (p < 0.05). Data were weighted to adjust for selection and nonresponse.
Results
Smoke-free home rules
Overall, 83.7% of adults had smoke-free home rules. By tobacco use, prevalence was highest among nonusers (90.8%), followed by noncombustible-only users (82.5%), both combustible and noncombustible users (54.9%), and combustible-only users (53.7%) (Table 1). Irrespective of tobacco use, prevalence was generally higher among males and respondents aged 44 years and less, married or partnered, with a graduate degree, income of ≥$100,000, or living in the West (Table 1).
Table 1.
Percentage of adults who reported having 100% a smoke-free home rule, by tobacco use and selected sociodemographic characteristics—NATS, 2012–2013.
| Characteristics | Any tobaccoa (n = 4791) |
Combustible-onlyb (n = 3558) |
Noncombustible-onlyc (n = 618) |
Both combustible and noncombustibled (n = 155) |
No current tobacco usee (n = 43,717) |
Overallf (n = 48,871) |
|---|---|---|---|---|---|---|
| % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | |
| Overall | 56.4 (55.1–57.8) | 53.7 (52.2–55.3) | 82.5 (79.0–86.0) | 54.9 (47.5–62.4) | 90.8 (90.4–91.2) | 83.7 (83.2–84.1) |
| Sex | ||||||
| Male | 60.2 (58.4–62.0)g | 56.7 (54.6–58.9) | 82.2 (78.6–85.7) | 53.7 (45.9–61.5) | 90.2 (89.5–90.8)g | 82.3 (81.6–83.0) |
| Female | 50.6 (48.4–52.7) | 49.7 (47.4–52.1) | h | h | 91.3 (90.8–91.8) | 85.0 (84.4–85.6) |
| Age group (years) | ||||||
| 18–24 | 63.1 (58.8–67.3) | 59.5 (54.3–64.7) | 82.8 (72.8–92.8) | 60.0 (46.6–73.4) | 85.7 (83.9–87.5)g | 80.4 (78.6–82.1) |
| 25–44 | 65.4 (63.1–67.8) | 63.6 (60.9–66.3) | 89.0 (84.1–94.0) | 59.4 (48.3–70.5) | 92.6 (91.9–93.4) | 85.9 (85.1–86.8) |
| 45–64 | 46.8 (44.8–48.8) | 44.4 (42.1–46.6) | 76.7 (70.6–82.8) | 36.3 (22.1–50.4) | 91.6 (91.1–92.2) | 81.9 (81.1–82.6) |
| ≥65 | 43.4 (40.2–46.7) | 39.8 (36.2–43.3) | 78.8 (70.6–87.0) | h | 89.6 (89.0–90.2) | 85.3 (84.6–85.9) |
| Race/Ethnicity | ||||||
| White, non-Hispanic | 57.7 (56.0–59.3) | 54.7 (52.8–56.6) | 82.6 (78.8–86.4) | 55.8 (47.4–64.1) | 91.4 (91.0–91.9) | 84.4 (83.9–84.9) |
| Black, non-Hispanic | 41.0 (36.4–45.5) | 39.7 (34.9–44.5) | h | h | 86.6 (84.9–88.3) | 76.4 (74.5–78.2) |
| Asian, non-Hispanic | 80.6 (69.0–92.2) | 76.8 (63.1–90.5) | h | h | 92.6 (90.6–94.6) | 91.5 (89.2–93.4) |
| Other non-Hispanic | 49.1 (44.9–53.3) | 45.5 (40.7–50.3) | 82.0 (71.2–92.8) | 46.2 (26.8–65.5) | 88.7 (86.8–90.6) | 75.6 (73.5–77.6) |
| Hispanic | 69.5 (65.0–73.9) | 68.1 (63.2–73.0) | h | h | 91.0 (89.8–92.3) | 87.7 (86.3–88.9) |
| Educational attainment | ||||||
| 0–12 years (no diploma) | 46.5 (42.5–50.6) | 45.4 (40.9–49.9) | 77.3 (65.4–89.2) | h | 86.6 (84.9–88.3) | 75.1 (73.3 –76.9) |
| General educational diploma | 44.0 (37.1–50.8) | 44.9 (37.4–52.4) | h | h | 85.3 (81.7–88.9) | 67.6 (63.5–71.4) |
| High school graduate | 54.9 (52.4–57.5) | 51.0 (48.1–54.0) | 82.2 (76.2–88.1) | 53.7 (41.5–65.9) | 88.0 (87.0–89.0) | 80.0 (79.0–81.0) |
| Some college (no degree) | 59.6 (56.7–62.4) | 56.9 (53.6–60.1) | 84.6 (77.3–91.9) | h | 90.8 (89.8–91.8) | 83.4 (82.3–84.4) |
| Associate degree | 60.5 (57.4–63.7) | 57.7 (54.0–61.4) | 84.7 (76.4–92.9) | h | 92.0 (91.1–92.9) | 85.2 (84.2–86.2) |
| Undergraduate degree | 70.1 (67.0–73.2) | 66.7 (63.0–70.4) | 87.7 (81.5–93.9) | h | 94.2 (93.6–94.7) | 91.5 (90.9–92.1) |
| Graduate degree | 71.3 (66.3–76.3) | 70.6 (65.1–76.1) | h | h | 94.6 (94.0–95.2) | 93.1 (92.4–93.8) |
| Marital status | ||||||
| Married/living with partner | 61.7 (59.8–63.6)g | 58.9 (56.7–61.2)g | 84.0 (79.7–88.2) | 61.6 (51.1–72.1) | 93.0 (92.6–93.4)g | 87.4 (86.9–87.9) |
| Single/separated/divorced widowed | 51.4 (49.4–53.4) | 49.1 (46.8–51.4) | 79.9 (74.0–85.9) | 49.5 (39.2–59.8) | 87.6 (86.9–88.4) | 78.8 (78.0–79.6) |
| Annual household income | ||||||
| <$20,000 | 39.4 (36.0–42.8)g | 37.0 (33.3–40.8)g | 71.6 (57.3–86.0)g | h | 86.3 (84.7–87.8)g | 72.3 (70.5–73.4) |
| $20,000–$49,999 | 50.1 (47.7–52.5) | 48.5 (45.8, 51.2) | 75.6 (68.1–83.2) | 50.7 (38.4–62.9) | 88.0 (87.1–88.9) | 78.3 (77.3–79.3) |
| $50,000–$99,999 | 65.2 (62.5–67.9) | 63.0 (59.8, 66.1) | 83.4 (77.4–89.4) | 55.7 (40.6–70.7) | 92.2 (91.6–92.9) | 87.0 (86.2–87.8) |
| ≥$100,000 | 77.1 (73.8–80.5) | 75.3 (71.2, 79.5) | 92.2 (87.0–97.5) | 71.1 (55.0–87.2) | 95.3 (94.7–95.9) | 93.0 (92.2, 93.6) |
| Unspecified | 58.6 (54.6–62.5) | 56.5 (52.1, 60.8) | 85.6 (75.9–95.3) | h | 90.0 (88.9–91.1) | 84.7 (83.5–85.9) |
| US census region i | ||||||
| Northeast | 48.8 (45.2–52.5)g | 45.5 (41.5–49.5)g | 70.7 (57.4–84.0) | h | 90.4 (89.5–91.4)g | 82.8 (81.7–83.9) |
| Midwest | 51.0 (48.2–53.9) | 48.9 (45.6–52.2) | 80.4 (73.0–87.8) | 54.3 (38.9–69.7) | 89.1 (88.2–90.0) | 80.4 (79.3–81.4) |
| South | 57.2 (55.0–59.4) | 54.2 (51.6–56.7) | 84.0 (79.3–88.8) | 50.1 (39.7–60.5) | 90.4 (89.7–91.1) | 82.9 (82.1–83.6) |
| West | 67.4 (64.6–70.3) | 65.7 (62.4–68.9) | 88.0 (81.0–94.9) | 65.6 (47.0–84.2) | 93.1 (92.3–93.8) | 88.6 (87.8–89.4) |
| Sexual orientation | ||||||
| Heterosexual/Straight | 56.9 (55.5–58.4) | 54.1 (52.4–55.8) | 82.4 (78.9–86.0) | 55.7 (48.1–63.4) | 91.1 (90.7–91.5)g | 84.0 (83.5–84.5) |
| Lesbian/Gay/Bisexual | 51.0 (44.8–57.2) | 49.1 (42.2–56.1) | h | h | 85.6 (82.6–88.7) | 74.9 (71.8–77.8) |
| Unspecified | 54.4 (47.0–61.8) | 53.0 (45.0–60.9) | h | h | 89.6 (87.7–91.5) | 85.0 (82.9–86.9) |
Abbreviations: CI= confidence interval; NATS = National Adult Tobacco Survey.
Defined as ‘every day’ or ‘some day’ use of cigarettes, cigars/cigarillos/filtered little cigars, regular pipes, and water pipes/hookah, electronic cigarettes, or chewing tobacco/snuff/dip, snus, or dissolvable tobacco.
Defined as smoking at least 100 cigarettes during their lifetime and now smoking ‘every day’ or ‘some day’ and/or used ≥1 of the following tobacco product types and now use ‘everyday’ or ‘some day’: cigars/cigarillos/filtered little cigars, regular pipes, and water pipes/hookah ≥50 times in their lifetime and now smoked the product ‘every day’ or ‘some days’.
Defined as using chewing tobacco, snuff or dip ≥20 times in their lifetime, snus or dissolvable tobacco products on ≥1 day, and used these products ‘every day’ or ‘some days’.
Defined as ‘every day’ or ‘some day’ use of any combustible tobacco product and any noncombustible tobacco product.
Defined as not currently using electronic cigarettes, combustible tobacco, or noncombustible tobacco.
Includes persons whose tobacco use status is unknown.
Significant chi-square test (p < 0.05) indicated difference across groups within the specified characteristic.
Excluded because relative standard error ≥30%.
Northeast: Connecticut, Maine, Massachusetts, New Jersey, New Hampshire, New York, Pennsylvania, Rhode Island, and Vermont; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
Chi-square findings revealed prevalence differences among adults who reported having 100% smoke-free home rules by tobacco use status and selected sociodemographic characteristics. Significant differences were noted in any tobacco users, combustible-only tobacco users, non-combustible-only tobacco users, and no current tobacco users by sex, age, marital status, annual household income, region and sexual orientation. Among any tobacco users, the prevalence of smoke-free rules in homes was greater for: men, married or partnered individuals, those with an annual household income of ≥$100,000, and residents of states in the West (p < 0.05). Among no current tobacco users, the prevalence of smoke-free rules in homes was greater for women, adults 25–44 years of age, married or partnered individuals, those with an annual household income of ≥$100,000, residents of states in the West, and heterosexual or straight individuals (p < 0.05).
Smoke-free vehicle rules
Overall, 78.1% of US adults had smoke-free vehicle rules (Table 2). By tobacco use, prevalence was highest among nonusers (88.9%), followed by noncombustible-only users, (69.1%), combustible-only users (34.2%), and both combustible and noncombustible users (24.2%). Irrespective of tobacco use, prevalence was generally higher among males and respondents aged ≥65, with a graduate degree, living in the West, or with unspecified sexual orientation.
Table 2.
Percentage of adults who reported having 100% smoke-free vehicle rules, by tobacco use and selected sociodemographic characteristics—NATS, 2012–2013.
| Characteristics | Any tobaccoa (n = 3186) |
Combustible-onlyb (n = 2290) |
Noncombustible-onlyc (n = 537) |
Both combustible and noncombustibled (n = 75) |
No current tobacco usee (n = 42,649) |
Overallf (n = 46,183) |
|---|---|---|---|---|---|---|
| % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | |
| Overall | 36.5 (35.1–37.8) | 34.2 (32.7–35.8) | 69.1 (64.7–73.6) | 24.2 (18.0–30.4) | 88.9 (88.4–89.3) | 78.1 (77.6–78.6) |
| Sex | ||||||
| Male | 38.5 (36.7–40.3)g | 35.5 (33.4–37.6) | 68.7 (64.1–73.2) | 22.9 (16.5–29.2) | 88.3 (87.6–89.0)g | 75.4 (74.6–76.1) |
| Female | 33.2 (31.1–35.3) | 32.5 (30.3–34.7) | 80.2 (63.3–97.2) | h | 89.4 (88.8 –89.9) | 80.7 (80.1–81.4) |
| Age Group (years) | ||||||
| 18-24 | 35.4 (31.2–39.6) | 33.1 (28.1–38.0) | 69.9 (57.3–82.6) | h | 80.7 (78.8–82.7)g | 70.3 (68.3–72.2) |
| 25-44 | 37.7 (35.3–40.0) | 36.1 (33.4–38.7) | 69.2 (61.4–77.0) | 26.2 (16.5–35.8) | 89.6 (88.8–90.5) | 76.9 (75.9–77.9) |
| 45-64 | 34.0 (32.0–35.9) | 31.2 (29.0–33.3) | 67.0 (60.2–73.7) | 29.3 (16.5–42.2) | 89.7 (89.1–90.3) | 77.8 (77.0–78.5) |
| ≥65 | 43.2 (39.9–46.5) | 40.6 (36.9–44.3) | 75.4 (66.6–84.1) | h | 91.2 (90.6–91.7) | 86.7 (86.0–87.3) |
| Race/Ethnicity | ||||||
| White, non-Hispanic | 32.4 (30.9–34.0) | 28.3 (26.6–30.1) | 68.6 (63.7–73.5) | 26.4 (19.0–33.7) | 88.3 (87.8–88.8) | 76.8 (76.2–77.4) |
| Black, non-Hispanic | 42.1 (37.4–46.7) | 40.6 (35.8–45.5) | 86.8 (72.6–100.9) | h | 87.2 (85.5–88.9) | 77.3 (75.4–79.1) |
| Asian, non-Hispanic | 51.9 (36.0–67.8) | 53.2 (35.5–70.9) | h | 94.5 (92.7–96.2) | 90.7 (87.7–93.0) | |
| Other non-Hispanic | 31.4 (27.5–35.3) | 29.6 (25.1–34.0) | 65.3 (50.7–79.9) | h | 86.4 (84.4–88.5) | 68.5 (66.2–70.7) |
| Hispanic | 58.4 (53.6–63.1) | 59.7 (54.6–64.8) | 64.7 (37.2–92.1) | h | 91.9 (90.7–93.1) | 86.7 (85.3–87.9) |
| Educational Attainment | ||||||
| 0-12 years (no diploma) | 39.6 (35.6–43.7) | 40.0 (35.5–44.5) | 58.8 (45.1–72.6) | h | 87.1 (85.4–88.8)g | 73.6 (71.7–75.5) |
| General educational diploma | 28.1 (21.9–34.3) | 27.2 (20.5–34.0) | 46.1 ( 8.5–83.7) | h | 84.9 (81.1–88.8) | 60.3 (55.9–64.5) |
| High school graduate | 36.1 (33.5–38.6) | 33.4 (30.6–36.3) | 67.2 (59.3–75.1) | 20.4 (10.3–30.4) | 86.1 (85.0–87.1) | 74.0 (72.9–75.1) |
| Some college (no degree) | 32.7 (29.8–35.5) | 30.6 (27.4–33.7) | 67.1 (56.1–78.0) | h | 87.5 (86.4–88.6) | 74.6 (73.3–75.8) |
| Associate degree | 34.5 (31.3–37.6) | 30.6 (27.1–34.2) | 72.0 (61.2–82.8) | h | 88.6 (87.6–89.7) | 77.0 (75.8–78.3) |
| Undergraduate degree | 43.2 (39.7–46.7) | 37.5 (33.5–41.4) | 80.2 (71.9–88.5) | h | 91.7 (91.0–92.3) | 86.4 (85.6–87.2) |
| Graduate degree | 48.7 (43.1–54.3) | 46.1 (39.9–52.3) | 92.1 (84.8–99.5) | h | 94.1 (93.5–94.8) | 91.2 (90.4–92.0) |
| Marital Status | ||||||
| Married/living with partner | 38.1 (36.2–40.0) | 35.1 (32.9–37.3) | 69.0 (63.3–74.6) | 28.1 (19.0–37.2) | 90.8 (90.3–91.3)g | 81.4 (80.8–82.0) |
| Single/separated/divorced widowed | 34.7 (32.8–36.7) | 33.4 (31.2–35.6) | 68.7 (61.4–76.1) | 21.0 (12.5–29.6) | 86.1 (85.3–86.9) | 73.7 (72.8–74.6) |
| Annual Household Income | ||||||
| <$20,000 | 36.3 (32.8–39.8) | 35.9 (32.1–39.7) | 55.1 (38.7–71.5) | h | 85.0 (83.4–86.7)g | 70.7 (68.9–72.5) |
| $20,000 - $49,999 | 33.0 (30.7–35.3) | 31.6 (29.0–34.2) | 64.3 (55.5–73.2) | 20.5 (10.7–30.3) | 87.0 (86.1–87.9) | 73.2 (72.2–74.2) |
| $50,000 - $99,999 | 35.3 (32.6–37.9) | 31.8 (28.7–34.8) | 63.5 (55.3–71.6) | 21.0 (10.4–31.7) | 88.5 (87.7–89.4) | 78.3 (77.3–79.2) |
| ≥$100,000 | 45.0 (41.0–48.9) | 39.8 (35.2–44.4) | 84.6 (77.0–92.2) | 41.0 (23.7–58.3) | 92.9 (92.2–93.7) | 86.8 (85.8–87.7) |
| Unspecified | 41.1 (37.1–45.1) | 40.1 (35.6–44.5) | 77.4 (66.4–88.4) | h | 89.6 (88.5–90.7) | 81.6 (80.3–82.8) |
| US Census Region i | ||||||
| Northeast | 39.0 (35.4–42.7)g | 37.2 (33.2–41.2) | 78.7 (66.6 –90.7) | h | 89.1 (88.1–90.1)g | 80.1 (78.9–81.2) |
| Midwest | 29.6 (26.9–32.3) | 27.5 (24.5–30.6) | 58.6 (49.1–68.2) | h | 86.3 (85.3–87.4) | 73.4 (72.2–74.6) |
| South | 35.8 (33.6–37.9) | 32.3 (29.8–34.7) | 70.2 (64.0–76.4) | 26.9 (17.8–35.9) | 87.8 (87.0–88.5) | 76.0 (75.1–76.9) |
| West | 43.7 (40.6–46.7) | 43.2 (39.8–46.7) | 76.4 (65.8–86.9) | h | 92.5 (91.7–93.2) | 84.2 (83.2–85.0) |
| Sexual Orientation | ||||||
| Heterosexual/Straight | 35.8 (34.4–37.3)g | 33.4 (31.8–35.1)g | 68.5 (63.9–73.1) | 24.4 (17.9–30.9) | 88.9 (88.5–89.4)g | 78.1 (77.5–78.6) |
| Lesbian/Gay/Bisexual | 31.7 (25.8–37.6) | 30.5 (23.9–37.1) | 80.3 (52.5–108.2) | h | 81.8 (78.4–85.3) | 66.5 (63.1–69.7) |
| Unspecified | 58.3 (50.9–65.7) | 56.6 (48.5–64.7) | 78.3 (59.7–96.9) | h | 92.2 (90.6–93.7) | 87.6 (85.7–89.2) |
Abbreviations: CI= confidence interval; NATS = National Adult Tobacco Survey.
Defined as ‘every day’ or ‘some day’ use of cigarettes, cigars/cigarillos/filtered little cigars, regular pipes, and water pipes/hookah, electronic cigarettes, or chewing tobacco/snuff/dip, snus, or dissolvable tobacco.
Defined as smoking at least 100 cigarettes during their lifetime and now smoking ‘every day’ or ‘some day’ and/or used ≥1 of the following tobacco product types and now use ‘everyday’ or ‘some day’: cigars/cigarillos/filtered little cigars, regular pipes, and water pipes/hookah ≥50 times in their lifetime and now smoked the product ‘every day’ or ‘some days’.
Defined as using chewing tobacco, snuff or dip ≥20 times in their lifetime, snus or dissolvable tobacco products on ≥1 day, and used these products ‘every day’ or ‘some days’.
Defined as ‘every day’ or ‘some day’ use of any combustible tobacco product and any noncombustible tobacco product.
Defined as not currently using electronic cigarettes, combustible tobacco, or noncombustible tobacco.
Includes persons who have unknown tobacco use status.
Significant chi-square test (p < 0.05) indicated difference across groups within the specified characteristic.
Excluded because relative standard error ≥30%.
Northeast: Connecticut, Maine, Massachusetts, New Jersey, New Hampshire, New York, Pennsylvania, Rhode Island, and Vermont; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South: Alabama, Arkansas, Delaware, District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia; West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, and Wyoming.
Chi-square findings revealed prevalence differences among adults who reported having 100% smoke-free vehicle rules by tobacco use status and selected sociodemographic characteristics. Significant differences were noted in any tobacco users, combustible-only tobacco users, and no current tobacco users by sex, age, educational attainment, marital status, annual household income, region and sexual orientation. Among any tobacco users, the prevalence of smoke-free rules in vehicles was greater for men, residents of states in the West, and those with an unspecified sexual orientation (p < 0.05). Among no current tobacco users, the prevalence of smoke-free rules in vehicles was greater for women, adults aged ≥65 years of age, those with a graduate degree, married or partnered individuals, those with an annual household income of ≥$100,000, residents of states in the West, and those with an unspecified sexual orientation (p < 0.05).
Discussion
This study reveals that approximately 8 in 10 US adults report smoke-free rules at home (83.7%) and in their vehicle (78.1%). However, variations in such rules exist by tobacco use; about one-half of any tobacco users reported having smoke-free rules, while about one-third reported smoke-free vehicle rules. These findings indicate that opportunities exist to educate all tobacco users about the dangers of SHS and to promote voluntary adoption of smoke-free rules in private settings, particularly among combustible tobacco users. Additionally, jurisdictions with comprehensive policies prohibiting smoking in public places and worksites could extend SHS protections to include areas that are typically excluded from these policies. Continued efforts are critical to increase awareness of the hazards of SHS exposure in US adults and the benefits of smoke-free home and vehicle rules to help inform state and local level capacity.
Among combustible-only users, 53.7% reported having smoke-free home rules (Table 1) and 34.2% reported having smoke-free vehicle rules (Table 2), both of which are higher than previously reported estimates among cigarette smokers (King et al., 2013; Ayo-Yusuf et al., 2014). Reasons for the high level of prevalence of smoke-free homes rules among respondents 44 years of age and less may be related to shifting social norms around the acceptability of smoke-free policies in indoor settings. The higher prevalence of smoke-free rules may be due to the proliferation of comprehensive smoke-free laws, declines in cigarette smoking, and changes in public attitudes regarding the acceptability of smoking near nonsmokers (IARC, 2009; Cheng et al., 2011, 2015; Hyland et al., 2009; Callinan et al., 2010).
Differences in the prevalence of smoke-free rules were apparent by tobacco use status. For example, smoke-free home and vehicle rule prevalence was higher among nonusers than any tobacco users. Since research suggests that smoke-free homes can enhance cessation among adult smokers and prevent relapse among former smokers (Hyland et al., 2009), efforts to encourage the adoption of voluntary smoke-free rules in private settings, including homes and vehicles, could reduce tobacco use. These findings suggest that although a larger proportion of any tobacco users have implemented voluntary smoke-free rules in homes and household vehicles, within the subsample, disparity in voluntary smoke-free rules in private settings exists. Sociodemographic differences were also observed, which could be due to varying smoking rates among these groups, factors related to social disapproval of smoking, or receptivity toward tobacco-related health messages and understanding of the dangers of SHS (CDC, 2011; Siahpush et al., 2006).
Strengths of this study include the use of a large, nationally representative sample and the assessment of multiple tobacco products. Limitations include the use of cross-sectional data, which are subject to recall bias. Additionally, variables of interest that may affect smoke-free rules in homes and cars, such as presence of children in the home or vehicle, were not included in the NATS questionnaire. Finally, limited sample size prevented the presentation of estimates for certain groups (e.g., noncombustible-only users).
Conclusion
Most US adults have implemented smoke-free home and vehicle rules; however, variations exist by tobacco use status. Completely eliminating smoking in indoor spaces is the only way to fully protect non-smokers from SHS; separating smokers from nonsmokers, cleaning the air, and ventilating buildings cannot completely eliminate exposure (2). Continued efforts to educate all tobacco users about the importance of voluntary smoke-free rules in homes and vehicles are warranted as part of a comprehensive approach to reducing tobacco use and SHS exposure, particularly among combustible tobacco users.
Acknowledgments
The findings and conclusions in this report are those of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.
Footnotes
Conflict of interest statement
The authors declare that there are no conflicts of interests.
Author contributions
All authors contributed to the writing of this paper. JK drafted the manuscript. AJ analyzed the data. JK, DH, SB, BK designed the study and interpreted the data. All authors approved the final version to be submitted for consideration of publication.
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