The Impact of Tobacco Control Policies on Disparities in Children’s Secondhand Smoke Exposure: A Comparison of Methods
- 437 Downloads
To examine the impact of cigarette excise taxes and smoke-free legislation on tobacco use among households with school-age children and adolescents as well as disparities in children’s secondhand smoke exposure. We compare the results from models using causal inference techniques to those from cross-sectional models. We linked families of 6–17-year-olds from the 2003 (N = 67,607) and 2007 (N = 62,768) contacts of the National Survey of Children’s Health with state-level cigarette excise taxes and smoke-free legislation total score (0 [none]–32 [very strong]) in 2001 and 2005. Parents reported whether anyone in the household used tobacco products. In adjusted causal inference models every $1.00 increase in cigarette excise tax between 2001 and 2005 was associated with a 4 percentage point decrease in household tobacco use between 2003 and 2007 (p = 0.008); however, there was no effect of smoke-free legislation on household tobacco use. Significant interactions revealed that cigarette tax increases were only associated with reductions in household tobacco use for parents of white children and, separately, lower income households. In contrast, in adjusted cross-sectional models, a higher smoke-free legislation total score was associated with a lower prevalence of household tobacco use. Stronger cigarette excise taxes decrease tobacco use among households with school-age children and adolescents, but smoke-free legislation at the state level does not change parental smoking. Since cross-sectional models cannot assess the direction of causality, evaluations should employ causal inference methods to help inform policy decisions to reduce disparities in adult smoking and, ultimately, protect children from secondhand smoke.
KeywordsSecond hand smoke Health status disparities Parents Policy
Summer Sherburne Hawkins is a Robert Wood Johnson Foundation Health & Society Scholar at the Harvard University site in Boston, Massachusetts. Lisa Berkman is co-director of the Robert Wood Johnson Foundation Health & Society Scholar program at the Harvard University site in Boston, Massachusetts. There was no additional funding source for this study.
- 1.US Department of Health and Human Services. (2006). The health consequences of involuntary exposure to tobacco smoke: A report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services.Google Scholar
- 5.Chaloupka, F., & Warner, K. (2000). The economics of smoking. In A. Culyer & J. Newhouse (Eds.), Handbook of health economics. Elsevier: Amsterdam, The Netherlands.Google Scholar
- 9.Callinan, J. E., Clarke, A., Doherty, K., Kelleher, C. (2010). Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews, 4, CD005992.Google Scholar
- 10.International Agency for Research on Cancer. (2009). The effect of mandated smoking restrictions on smoking behaviour. In IARC handbooks of cancer prevention, tobacco control, Vol. 13: Evaluating the effectiveness of smoke-free policies. WHO Press: Lyon, France.Google Scholar
- 16.Child and Adolescent Health Measurement Initiative (CAHMI). DRC 2003 National Survey of Children’s Health Indicator Data Set. Data Resource Center for Child and Adolescent Health. Available from: http://www.childhealthdata.org.
- 17.Child and Adolescent Health Measurement Initiative (CAHMI). DRC 2007 National Survey of Children’s Health Indicator Data Set. Data Resource Center for Child and Adolescent Health. Available from: http://www.childhealthdata.org.
- 18.Blumberg, S. J., Olson, L., Frankel, M. R., Osborn, L., Srinath, K. P., & Giambo, P. (2005). Design and operation of the National Survey of Children’s Health, 2003. National Center for Health Statistics. Vital and Health Statistics, 1(43).Google Scholar
- 19.Orzechowski, W., & Walker, R. C. (2008). Tax burden on tobacco: Historical compilation, Vol. 43. Arlington, VA: Orzechowski and Walker.Google Scholar
- 21.Blumberg, S. J., Foster, E. B., Frasier, A. M., Satorius, J., Skalland, B. J., Nyssee-Carris, K. L., et al. (Forthcoming) Design and operation of the National Survey of Children’s Health, 2007. National Center for Health Statistics. Vital and Health Statistics, 1.Google Scholar
- 22.Stock, J. H., & Watson, M. W. (2006). Introduction to econometrics (2nd ed.). Boston: Addison-Wesley.Google Scholar
- 23.International Agency for Research on Cancer. (2009). Reductions in exposure to secondhand smoke and effects on health due to restrictions on smoking. In IARC handbooks of cancer prevention, tobacco control, Vol. 13: Evaluating the effectiveness of smoke-free policies. Lyon, France: WHO press.Google Scholar
- 24.Dove, M. S., Dockery, D. W., Connolly, G. N. (2010). Smoke-free air laws and secondhand smoke exposure among nonsmoking youth. Pediatrics, 126, 80–87.Google Scholar
- 25.Healton, C., Green, M., Haviland, M. L., Allen, J. A., Farrelly, M. C., Girlando, M. E., et al. (2004). American Legacy Foundation. Policy Report 2, Secondhand Smoke Tearing Families Apart. The Health and Economic Burden of Smoking on Children. UC San Francisco: Center for Tobacco Control of Research and Education.Google Scholar
- 28.National Conference of State Legislatures. (2010). Enacted state cigarette excise tax rates effective July 2010. http://www.ncsl.org/IssuesResearch/Health/StateCigaretteExciseTaxes/tabid/14349/Default.aspx. Accessed November 5, 2010.
- 29.American Nonsmokers’ Rights Foundation. (2010). Overview list—how many smokefree laws? http://www.no-smoke.org/pdf/mediaordlist.pdf. Accessed November 5, 2010.
- 30.US Department of Health and Human Services. (2010). Developing Healthy People 2020. Tobacco use. http://www.healthypeople.gov/hp2020/Objectives/TopicArea.aspx?id=47&TopicArea=Tobacco+Use. Accessed November 5, 2010.