Effect of restrictions on smoking at home, at school, and in public places on teenage smoking: cross sectional study

doi:10.1136/bmj.321.7257.333

BMJ 2000;321:333-337 ( 5 August )

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Effect of restrictions on smoking at home, at school, and in public places on teenage smoking: cross sectional study

Melanie A Wakefield, visiting research scientist, ^a Frank J Chaloupka, professor, ^b Nancy J Kaufman, senior vice president, ^c C Tracy Orleans, senior scientist, ^c Dianne C Barker, principal, ^d Erin E Ruel, research assistant. ^a

^a Health Research and Policy Centers, University of Illinois at Chicago, 850 West Jackson Boulevard, Chicago, IL 60607, USA, ^b Department of Economics, University of Illinois at Chicago, ^c Robert Wood Johnson Foundation, PO Box 2316, Princeton, NJ 08543, USA, ^d Barker Bi-Coastal Health Consultants, 3556 Elm Drive, Calabasas, CA 91302, USA

Correspondence to: M A Wakefield melaniew{at}uic.edu

Objective: To determine the relation between extent ofrestrictions on smoking at home, at school, and in public placesand smoking uptake and smoking prevalence among schoolstudents.
Design: Cross sectional survey with merged recordsof extent of restrictions on smoking in publicplaces.
Setting: UnitedStates.
Participants: 17 287 high schoolstudents.
Main outcome measures: Five point scale of smoking uptake; 30 daysmokingprevalence.
Results: More restrictive arrangements on smoking athome were associated with a greater likelihood of being in anearlier stage of smoking uptake (P<0.05) and a lower 30 day prevalence(odds ratio 0.79 (95% confidence interval 0.67 to 0.91), P<0.001).These findings applied even when parents were smokers. More pervasiverestrictions on smoking in public places were associated witha higher probability of being in a earlier stage of smoking uptake(P<0.05) and lower 30 day prevalence (0.91 (0.83 to 0.99), P=0.03).School smoking bans were related to a greater likelihood of beingin an earlier stage of smoking uptake (0.89 (0.85 to 0.99), P<0.05)and lower prevalence (0.86 (0.77 to 0.94), P<0.001) only whenthe ban was strongly enforced, as measured by instances when teenagersperceived that most or all students obeyed therule.
Conclusions: These findings suggest that restrictions onsmoking at home, more extensive bans on smoking in public places,and enforced bans on smoking at school may reduce teenagesmoking.

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