Secondhand smoke exposure is associated with smoke-free laws but not urban/rural status

Abstract

The objective was to determine secondhand smoke (SHS) exposure with and without smoke-free laws in urban and rural communities. The research hypothesis was that SHS exposure in public places could be improved by smoke-free law regardless of urban and rural status. Indoor air quality in hospitality venues was assessed in 53 communities (16 urban and 37 rural) before smoke-free laws; 12 communities passed smoke-free laws during the study period. Real-time measurements of particulate matter with 2.5 µm aerodynamic diameter or smaller (PM_2.5) were taken 657 times from 586 distinct venues; about 71 venues had both pre- and post-law measurements. Predictors of log-transformed PM_2.5 level were determined using multilevel modeling. With covariates of county-level percent minority population, percent with at least high school education, adult smoking rate, and venue-level smoker density, indoor air quality was associated with smoke-free policy status and venue type and their interaction. The geometric means for restaurants, bars, and other public places in communities without smoke-free policies were 22, 63, and 25 times higher than in those with smoke-free laws, respectively. Indoor air quality was not associated with urban status of venue, and none of the interactions involving urban status were significant. SHS exposure in public places did not differ by urban/rural status. Indoor air quality was associated with smoke-free law status and venue type.

Implications: This study analyzed 657 measurements of indoor PM_2.5 level in 53 communities in Kentucky, USA. Although indoor air quality in public places was associated with smoke-free policy status and venue type, it did not differ by urban and rural status. The finding supports the idea that population in rural communities can be protected with smoke-free policy. Therefore, it is critical to implement smoke-free policy in rural communities as well as urban areas.

Acknowledgment

The authors appreciate Mark Travers for training data collectors and analyzing initial data on some of the communities reported here, and Songyi Joo for data management work.

Additional information

Notes on contributors

Kiyoung Lee

Kiyoung Lee is a professor in the Graduate School of Public Health at Seoul National University.

Yunhyung Hwang

Yunhyung Hwang is a doctoral candidate in the Graduate School of Public Health at Seoul National University.

Ellen J. Hahn

Ellen J. Hahn and Mary Kay Rayens are professors in the College of Nursing and direct the Tobacco Policy Research Program, University of Kentucky, Lexington, KY, USA.

Hilarie Bratset

Hilarie Bratset is a former data coordinator and Heather Robertson is a program administrator in the Tobacco Policy Research Program, College of Nursing, University of Kentucky, Lexington, KY, USA.