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回应是通过100%无烟禁令来限制吸烟。美国疾病控制与预防中心（CDC）和医学研究所（IOM）在有证据表明禁烟可以减少吸烟率和成年非吸烟者暴露于ETS的情况下，建议各州和地方颁布全面禁止在所有非住宅室内场所吸烟的禁令，包括工作场所、餐馆和酒吧。然而，包括CDC和IOM报告在内的文献中缺少了全面评估禁烟令有效性所必需的关键环节。具体而言，尚不清楚州和地方各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。制定无烟法律的基本原理隐含地假设，减少成人卷烟消费和减少成人接触碳排放化合物并延伸至儿童，会带来公共卫生收益。这些先验的收益将延伸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，由于禁烟令，成人吸烟率的下降可能会减少儿童、婴儿和孕妇暴露于ETS的机会。然而，如果吸烟者从在100%无烟的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。吸烟者的这种代偿行为可能会增加家庭吸烟的流行率，并导致儿童接触更多的ETS。如果没有关于禁止吸烟、吸烟可能转移到家庭以及对儿童和婴儿健康的影响之间的联系的资料，禁止吸烟的干预措施的成本或收益可能被低估，这反过来可能会影响对此类政策的适当评价。提出的研究旨在解决这一关键缺口的文献

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.