Impact of 100% Smoke-Free Laws on the Health of Children and Infants

描述（由申请人提供）：随着环境烟草烟雾（ETS）负面影响的证据越来越多，越来越受欢迎的公共政策反应是通过100%无烟禁令对吸烟进行限制。疾病控制和预防中心（CDC）和医学研究所（IOM），在证据表明，禁烟可以降低吸烟率和成年非吸烟者暴露于ETS的情况下，建议各州和地方在所有非住宅室内场所（包括工作场所，餐馆和酒吧）颁布全面禁烟令。然而，包括CDC和IOM报告在内的文献中缺少全面评估禁烟有效性所需的关键环节。具体而言，目前尚不清楚州和地方一级的禁烟令是否以及在多大程度上影响儿童和婴儿的健康。无烟法律的基本原理隐含地假定，减少成人香烟消费和减少成人ETS暴露（延伸至儿童）会带来公共卫生方面的好处。关于这些收益将先验地扩展到婴儿和儿童的假设可能是正确的，也可能是错误的。一方面，由于禁烟而导致的成人吸烟率下降可能会减少儿童、婴儿和孕妇的ETS暴露。然而，如果吸烟者从在100%无烟工作场所和其他公共场所吸烟转向在家中吸烟（当儿童，婴儿或孕妇在场时），那么这些政策可能会对儿童和婴儿产生有害影响。吸烟者的这种补偿行为可能会增加家庭吸烟的流行率，并导致儿童暴露于更高的ETS。如果没有关于禁烟之间的联系、吸烟可能转移到家庭以及对儿童和婴儿健康的影响的信息，禁止吸烟干预措施的成本或收益可能会被低估，这反过来又可能会扭曲对此类政策的正确评估。拟议的研究旨在解决文献中的这一关键空白 并提供100%无烟法规如何影响吸烟场所以及如何影响儿童和婴儿健康的初步估计。该研究将按类型（工作场所，餐馆和独立酒吧）和其他烟草控制政策将所有地方和州级100%无烟立法的信息与来自国家健康访谈调查（NHIS）的父母和子女记录以及来自美国出生档案（NF）的出生记录相匹配。这两个数据集都具有全国代表性，样本量大，从而最大限度地提高了统计能力和精确度，并允许评估各种社会经济因素的不同影响。NHIS包括与ETS相关的不良呼吸系统健康指标的信息，NF包括出生体重和妊娠信息，发现这两者都受到自身吸烟和ETS暴露的影响。拟议研究的估计数将解决文献中缺失的环节，并为全面评估州和地方对各种场所吸烟的限制提供有价值的投入。 公共卫生相关性：这项拟议的研究旨在提高对100%无烟法律的理解，以及这些法律对儿童和婴儿健康的影响。目前，这种好处被认为延伸到儿童和婴儿，没有任何直接的证据，因为文献已经发现在各种环境中对成人的积极健康影响的支持。如果不了解这些法律对婴儿和儿童健康的影响，就无法完成对100%无烟法律的全面评估。

DESCRIPTION (provided by applicant): As evidence of the negative effects of environmental tobacco smoke (ETS) has mounted, an increasingly popular public policy response has been to impose restrictions on smoking through 100% smoke-free bans. The Centers for Disease Control and Prevention (CDC) and the Institute of Medicine (IOM), amidst evidence that smoking bans reduce smoking prevalence and adult non-smokers' exposure to ETS, recommend that states and localities enact complete bans on smoking in all non-residential indoor locations, including worksites, restaurants, and bars. However, a key link necessary for a comprehensive evaluation of the effectiveness of smoking bans has been missing from the literature including the CDC and IOM reports. Specifically, it is not known whether and to what extent smoking bans at the state and local levels impact the health of children and infants. The rationale for smoke-free laws implicitly presumes there are public health gains from reducing adult cigarette consumption and declines in adult ETS exposure that extend to children. The presumption that these gains, a priori, will extend to infants and children may or may not be correct. On the one hand, decreases in adult smoking prevalence as a result of the smoking bans may reduce ETS exposure among children, infants, and pregnant women. However, if smokers shift from consuming cigarettes at 100% smoke free work and other public places to smoking at home (when children, infants, or pregnant women are present) then these policies may have a harmful effect on children and infants. Such compensatory behavior by smokers can potentially increase the prevalence of smoking at home and lead to higher ETS exposures among children. Without information on the link between smoking bans, potential shifts in smoking to the home, and the impact on child and infant health, either the costs or benefits of interventions banning smoking may be understated, which in turn may skew the proper evaluation of such policies. The proposed study aims to address this critical gap in the literature and provide the first estimates of how 100% smoke-free regulations impact the venue of smoking and how they impact the health of children and infants. The study will match information on all local and state-level 100% smoke-free legislation by type (workplace, restaurant, and freestanding bar) and other tobacco-control policies to parent and child records from the National Health Interview Surveys (NHIS) and birth records from the U.S. Natality Files (NF). Both datasets are nationally-representative and have large sample sizes, thus maximizing statistical power and precision, and allowing an assessment of differential effects across various socio-economic factors. The NHIS includes information on ETS-related measures of adverse respiratory health and the NF includes information on birth- weight and gestation, both of which have been found to be impacted by own smoking and ETS exposure. The estimates from the proposed research will address the missing link in the literature and provide valuable inputs towards a comprehensive evaluation of state and local restrictions on smoking in various venues. PUBLIC HEALTH RELEVANCE: The proposed study seeks to improve the understanding of 100% smoke-free laws and the impact of these laws on the health of children and infants. Currently, such benefits are presumed to extend to children and infants, without any directly-bearing evidence, since the literature has found support of positive health effects for adults in various settings. A comprehensive evaluation of 100% smoke-free laws cannot be completed without understanding the impact of these laws on infant and child health.