Secondhand smoke at home

This work has had two main components:

  • Population-level policy options for smokefree homes
  • Exposure to second-hand smoke in the home

Government and Smoky Homes: Population-Level Policy Options for Smokefree Homes

Summary

The study identified and evaluated the options for population-level government policies to increase the prevalence of homes free of secondhand smoke (SHS). We used three criteria to evaluate the policy options: effectiveness, the reductions on inequalities in SHS exposure, and cost-effectiveness. Evidence indicates some association between relatively comprehensive tobacco control programmes and lower prevalence levels of smoking in homes. The evidence of the effect of such programmes on inequalities in smokefree home prevalence is limited. No published evidence was found of the cost-effectiveness of the programmes in achieving changes in smokefree homes.

Secondhand smoke (SHS) exposure is important as a cause of harm to human health and well-being. It is dangerous at very low levels, with immediate adverse effects in healthy adults. Homes are crucial sites of SHS exposure, and are one of the last frontiers of tobacco control efforts to reduce SHS in interiors. The social consequences of home SHS exposure include increased school absence, which may impact on educational experience. In addition, smoking in homes results in health care spending, lost pay, lost and lower production, higher cleaning and maintenance costs, lower home resale prices, fire-related costs and impacts, and higher insurance costs. Other indirect and intangible costs from children's sickness resulting from SHS include time off work for parents, transport, home care, support services, and the downstream financial and other costs of the psychological stress on parents.

In addition to the direct SHS exposure from burning cigarettes, further exposure occurs as the smoke particles deposited on clothes or household surfaces are mobilised back into the air, or absorbed by hand to mouth contact. Thus smoking inside, while other household members are outside, can subsequently result in SHS exposure to them. The higher rates of smoking and home SHS exposure in socially disadvantaged populations, and the lower likelihood of smokers in those populations being able to quit, means that a pro-equity approach requires options that particularly benefit these populations. Previous reviews of policies to increase the prevalence of smokefree homes (that is, where no one smokes inside) have largely focused on household and individual-level interventions. In contrast, we examine the options for population level government policies to increase the prevalence of smokefree homes. Our aim was to identify and evaluate the major options found in the literature, where evidence was available of direct effects, rather than to conduct a systematic review of all interventions.

Methods

The literature was searched for population-level policy options. We used three criteria to evaluate the policy options: effectiveness, the reductions on inequalities in SHS exposure, and costeffectiveness. The setting was four developed, English-speaking jurisdictions: Britain, United States, Australia, and New Zealand.

Results

Four population-based policy options merged from the search: comprehensive programs, policies that change public knowledge and actions on SHS, mass cessation programs and structural options. The only population-level policy option that we found for which there was some direct evidence of an association with the prevalence of smokefree homes, or evidence on the reduction of inequalities in exposure to SHS in homes, was comprehensive tobacco control programs. For this study, comprehensive programs were defined as those that at minimum included all of: active tobacco price policies, effective education, smokefree places policies and population-level cessation support. There is indirect evidence for the effects of other population-level interventions, such as media campaigns and mass cessation programs. All the other elements of comprehensive programs would need to be controlled for if such interventions were to be fully evaluated. In addition, some structural options that had such a potential to support smokefree homes were identified.

Read the research abstract of Government and Smoky Homes (PDF) presented at the International Healthy Buildings Conference, Portugal 2006.

Second-hand smoke and housing

This work looked at the exposure to secondhand smoke (SHS) of New Zealanders at home, and the health impacts, attitudes, and knowledge related to SHS. A survey was conducted in December 2004 (PDF) to estimate the exposure of, and behaviours regarding secondhand smoke in the flatting population. The smoking status and SHS exposure data from the Housing, Insulation and Health study was analysed to examine the relationships for that population between the presence of smoking and smokers, and health.

Papers to read on second-hand smoke in the home

See the links page for information and resources about second-hand smoke, from NZ and overseas websites.

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