Researchers find disparities in smoke-free law coverage

Jidong Huang, research specialist, Institute for Health Research and Policy. Photo: Roberta Dupuis-Devlin/UIC Photo Services (click photo to download)

Communities with less education and lower per capita income are less likely to have laws that completely prohibit smoking in public places, according to a study published online in the American Journal of Public Health that examined community level disparities in smoke-free laws across 10 states.

“There are socioeconomic disparities when it comes to protection from secondhand smoke at the local level,” said study co-author Jidong Huang, senior research scientist at the University of Illinois at Chicago’s Institute for Health Research and Policy. “Understanding these disparities can help guide efforts to reduce these disparities and increase protection from secondhand smoke for non-smokers.”

Exposure to secondhand smoke is a known cause of sudden infant death syndrome, respiratory infections, ear infections, and asthma attacks in infants and children, as well as heart disease, stroke, and lung cancer in adult non-smokers.

However, despite reductions in secondhand smoke exposure over the last 25 years, millions of U.S. non-smokers continue to be exposed. The U.S. surgeon general has concluded that there is no risk-free level of secondhand smoke, and that eliminating smoking in indoor areas is the only effective way to fully protect non-smokers from exposure.

According to the American Nonsmokers’ Rights Foundation, as of June 2015, 24 states and the District of Columbia had comprehensive smoke-free laws in effect prohibiting smoking in indoor areas of non-hospitality workplaces, restaurants and bars. Additionally, 697 municipalities had local comprehensive smoke-free laws.

The researchers examined community-level characteristics of residents covered by local smoke-free laws, compared to those not covered by such laws, to determine whether certain populations are less likely than others to be covered by local smoke-free laws.

Huang and colleagues from the Centers for Disease Control and Prevention, and the American Nonsmokers’ Rights Foundation collected data on local smoke-free laws from the American Nonsmokers’ Rights Foundation’s U.S. Tobacco Control Laws Database. Data on population characteristics in smaller communities, including percent racial/ethnic minority, per capita income, level of education, percent of population working blue-collar jobs, and percent of workers that live and work in the same locality were obtained from the 2006-2010 American Community Survey 5-Year Estimates data file.

The 10 states included in the study were Alabama, Alaska, Indiana, Kentucky, Mississippi, Missouri, North Dakota, South Carolina, Texas and West Virginia. These states lacked a statewide comprehensive smoke-free law covering non-hospitality workplaces, restaurants and bars through July 2011; however, they had at least eight local communities with such laws.

The proportion of localities covered by local comprehensive smoke-free laws was less than 6 percent in North Dakota, Alabama, Missouri, Alaska, Texas, Indiana and Mississippi, but was greater than one third in West Virginia. In Kentucky and South Carolina, 14 percent and 15 percent of local communities were covered by comprehensive laws, respectively.

The researchers found that across several states, communities with less-educated, lower-income residents had a lower likelihood of having 100 percent smoke-free laws. Localities with a high proportion of workers living and working in the same locality had a higher likelihood of having 100 percent smoke-free laws.

However, patterns of local smoke-free law coverage varied across states by population size, income and occupation.

In Alabama, Indiana, Kentucky, South Carolina and Mississippi, communities located in urban areas were more likely to have 100 percent smoke-free laws, while in West Virginia, communities in urban areas were less likely to have 100 percent smoke-free laws.

Communities with greater ethnic/minority populations were more likely to be covered by smoke-free laws in Kentucky and Texas.

Communities with larger proportions of the population lacking a high school degree were less likely to be covered by smoke-free laws.

With the exception of those in West Virginia, communities with higher per capita incomes generally had greater odds of being covered by smoke-free laws.

“The findings have important implications for public health in that they identify disparities in protection from secondhand smoke in public places and highlight the need for increased policy protections at the state and local level,” said Huang.

Brian A. King, Stephen D. Babb, Xin Xu, from the Centers for Disease Control and Prevention, Office on Smoking and Health; and Cynthia Hallett and Maggie Hopkins, with the American Nonsmokers’ Rights Foundation, are co-authors on the paper.