Home Smoke-Free Policies as Children Age: Urban, Rural, and Suburban Differences

Parents/guardians can effectively reduce tobacco smoking and secondhand smoke exposure among youth by adopting and enforcing rules against indoor tobacco smoking (ie, home smoke-free policies). We investigate home smoke-free policies from childhood to adolescence in the United States and across rural, suburban, and urban households.

We analyzed 2019-2020 National Survey of Children's Health data from n = 5,955 parents of youth aged 0-17, living at home with a tobacco smoker in the United States (U.S). Geographical categories were: rural, suburban, and urban. Home smoke-free policy reflected prohibiting tobacco smoking inside the home. Weighted logistic regressions examined the (1) association between youth age and home smoke-free policies, (2) interaction between geographic category and youth age, and (3) differing associations between youth age and home smoke-free policies by geography. Models controlled for youth race, ethnicity, sex, parental education, household annual income, and home structure.

Approximately 13.2% of U.S. households with a smoker did not have a home smoke-free policy. Stratified analyses found one-year increase in youth age was associated with lower odds of having a home smoke-free policy in rural (aOR:0.91; 95%CI: 0.87-0.95) and urban (aOR: 0.96; 95%CI: 0.92-1.00; p = .039), but not suburban (aOR:1.00; 95%CI: 0.95-1.05) households, controlling for covariates.

Odds of having a smoke-free home in the U.S. declined significantly in rural (9% per year) and urban (4%) but not suburban (0%) households. We quantify declines in home smoke-free policies as children age and identify geographic disparities for this environmental determinant of health.

Health promotion efforts targeting secondhand smoke prevention is needed, particularly for parents of older youth. Furthermore, there is a clear geographic bias in secondhand smoke exposure among all youth particularly older youth. Tailored interventions are needed to address geographic disparities in secondhand smoke exposure among rural and urban youth.