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Strengthening the evidence base for maternal and child health programs

New: MCH Best strategies database for sample ESMs

Evidence Tools
MCH Best. NPM 14.2: Smoking in the Household

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paper cutout people holding a used cigaretteSmoking Policies/Bans/Legislation

MCH Strategy. Support policies/legislation to establish smoking bans in homes, cars, and other family spaces.

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Overview. Over the last four decades, substantial progress has been made to control exposure to second-hand smoke in public places, workplaces, and homes, through legislation, education, and approaches to building designs and operations. The Pro-Children Act of 1994 prohibited smoking in facilities that routinely provide federally funded services to children. The Department of Housing and Urban Development published a final rule that was fully implemented in July 2018 that prohibits the use of cigarettes, cigars, pipes, and hookahs in public housing authorities. Many states and local governments have followed suit with laws prohibiting smoking in workplaces and public places. More than half of all states have implemented comprehensive smoke-free laws and enacted laws regulating smoking in multi-unit housing and cars. 1

Evidence. Emerging evidence. Initial research showed positive results for strategies to establish smoking bans in private residences and other areas where infants, children, and adolescents spend significant amounts of time. Further research is needed to identify critical components and confirm effects. Although US households are increasingly adopting private rules to limit exposure to second-hand smoke and prevalence rates are falling, there is a lack of clarity regarding interventions that effectively reduce child exposure at home. For a summary of the evidence and strategies for smoking ban legislations and study results, access The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. (Read more about understanding evidence ratings).

Target Audience. State/National..

Outcome. Reduction of secondhand tobacco smoke exposure in the home. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. There are currently 4 ESMs across all states/jurisdictions that align with components of this intervention strategy. Access descriptions of these ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the strategy “Support policies/legislation to establish smoking bans in homes, cars, and other family spaces,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of communities (cities, towns, etc.) with comprehensive smoke-free ordinances in multi-unit residences.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of communities (cities, towns, etc.) with comprehensive smoke-free ordinances in multi-unit residences.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of parents who report following a smoking ban in the house as a result of state policies.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of parents who report following a smoking ban in the house as a result of state policies.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


Reference:

1Tynan MA, Holmes CB, Promoff G, et al. State and local comprehensive smoke-free laws for worksites, restaurants, and bars - United States, 2015. Morbidity and Mortality Weekly Report 2016; 65(24):623-626.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.