文章基本信息

标题：Battling Tobacco Use at Home: An Analysis of Smoke-Free Home Rules Among US Veterans From 2001 to 2011
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作者：Xiao Zhang ; Ana P. Martinez-Donate ; Jessica Cook 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2014
卷号：104
期号：Suppl 4
页码：S572-S579
DOI：10.2105/AJPH.2014.301975
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined national trends in smoke-free home rules among US veterans and nonveterans. Methods. We used data from the 2001–2002 and 2010–2011 Tobacco Use Supplement to the Current Population Survey to estimate and compare the existence of smoke-free home rules among veterans and nonveterans for each survey period. Results. The prevalence of a complete smoke-free home rule among veterans increased from 64.0% to 79.7% between 2001 and 2011 ( P < .01) but was consistently lower than were rates estimated for nonveterans (67.6% and 84.4%, respectively). Disparities between the 2 groups increased significantly over time ( P < .05). Conclusions. Despite the general increase in the adoption of smoke-free home rules, veterans lag behind the rest of the US population. Interventions promoting the adoption of complete smoke-free home rules are necessary to protect veterans and their families and to reduce disparities. Tobacco use imposes an enormous public health and financial burden and remains the single most preventable cause of mortality and morbidity in the United States. 1 US veterans use tobacco at a higher rate than do nonveteran civilians. 2 In 2007, the prevalence of cigarette smoking was estimated to be 25.0% among male and 22.0% among female veterans, compared with 20.0% and 18.0% among male and female nonveterans, respectively. 3 Many individuals initiate smoking after entering military service and report using tobacco as a coping mechanism to relieve stress, alleviate boredom, and calm down while on duty. 4 In addition, veteran tobacco use may be influenced by the high rates of mental health disorders following military deployment. 2 Smoking harms almost every organ of the body, and causal relations have been established between smoking and cancer, cardiovascular disease, stroke, and other diseases. 5 A previous study found that veterans were more likely to report fair or poor health and experience 2 or more chronic conditions than were their peers who had not served in the military. 6 Tobacco use adds to the health burden veterans already shoulder 2 and may contribute to health disparities in tobacco-related diseases between veteran and nonveteran populations. Furthermore, the detrimental effects of smoking extend to veterans’ families that are exposed to secondhand smoke (SHS). According to the 2006 surgeon general’s report, SHS has immediate adverse effects on the cardiovascular system and causes premature death. 7 There is no risk-free level of SHS exposure. 7 It is estimated that in 2011, there were about 22.7 million US veterans. 8 Together with their families, they represent a sizable population that is at high risk for the harmful effects of tobacco smoking and SHS exposure. One way to reduce the health impact of smoking and increase cessation is to implement a smoke-free home rule. Smoke-free home rules are policies household residents or other individuals establish to restrict or ban cigarette smoking inside the home. 9 Unlike public smoke-free policies that are enforced by laws, home rules are adopted and implemented on a voluntary basis by household members or landlords. Therefore, smoke-free home rules are an important indicator of changes in social norms regarding the acceptability of smoking. Previous studies indicate that smoke-free home rules provide multiple benefits to household residents. For nonsmokers, the presence of a smoke-free home rule is associated with lower levels of SHS exposure, regardless of household members’ smoking status. 9,10 Mills et al. found that, for adult smokers, adoption of smoke-free home rules is associated with smoking cessation, lower relapse rates, and reduced cigarette consumption. 11 It is possible that a smoker consumes less tobacco or quits smoking because a smoke-free home rule makes it inconvenient to smoke or provides pressure from other nonsmoking household members, or it may be that the individual is less dependent on tobacco. 11 Studies also found that smokers may adopt a smoke-free home rule in preparation for a quit attempt. 12 Additionally, existing literature shows that smoke-free home rules promote antismoking social norms and reduce smoking initiation among youths. 13 It should be noted that an incomplete home rule (allowing smoking somewhere in the home or at certain times) considerably undermines the protective effects of a home rule against SHS exposure. 14 The prevalence of smoke-free home rules among the general population in the United States has increased from 67.2% in 2001–2002 15 to 83.9% in 2010–2011. 16 Significant reductions in tobacco use and SHS exposure have been observed throughout this period. 17,18 A number of individual, interpersonal, community, and societal factors have been found to be associated with the likelihood of reporting a smoke-free home rule. Individuals who are younger, nonsmoking, Hispanic, of a higher socioeconomic status (individual) 9,19,20 ; are living with children and other nonsmokers; have been counseled by physicians (interpersonal) 21–23 ; are working in smoke-free workplaces (community) 24 ; and are exposed to formal tobacco control policies and an antismoking culture (societal) 25,26 are more likely to report having a smoke-free home rule. To date, no study to our knowledge has examined the adoption of smoke-free home rules among US veterans, a vulnerable population with high rates of tobacco use. It is unclear to what extent veterans and the people living with them benefit from this protective behavior. It is also unknown whether a gap exists between veterans and nonveteran civilians in the establishment of smoke-free home rules. Because of the role smoke-free home rules may play in reducing cigarette smoking and SHS exposure, it is important to examine this public health issue among the veteran population. Knowledge of rates of smoke-free home rules and their distribution among veterans and nonveterans may inform future intervention opportunities targeting veterans and their families to reduce cigarette smoking, SHS exposure, and tobacco-attributable diseases. We tracked national and state-level trends in smoke-free home rules among veterans from 2001 to 2011 and compared the likelihood of adopting home rules among veterans and nonveterans over this period. We also explored individual, interpersonal, and societal characteristics associated with the presence of smoke-free home rules among veterans for the 2010–2011 survey period.