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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Smoking in the Household.

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Strategy. Smoking Policies/Bans/Legislation (Household)

Approach. 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 multiunit housing and cars.[1]

Evidence. Emerging Evidence. Strategies with this rating typically trend positive and have good potential to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Policy support activity logs and documentation
  • Partner engagement tracking
  • Educational material development and dissemination data

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Environmental Health. This strategy improves the impact of physical, chemical, and biological factors in the environment on health.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

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

  • Number of educational events held to inform about smoking ban policies. (Quantifies efforts to build support for policy change)
  • Number of media stories generated about the benefits of smoking ban policies. (Assesses public education and agenda-setting activities)

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

  • Percent of educational events that include testimony from individuals impacted by secondhand smoke. (Elevates voices of those most affected in policy debates)
  • Percent of media stories that include messages about protecting all children from smoke exposure. (Evaluates framing of the issue)

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

  • Number of smoke-free housing toolkits distributed to public housing authorities and property managers. (Provides resources to facilitate policy adoption)
  • Number of partnerships formed with medical, public health, and community groups to advance smoke-free policies. (Creates collective action for change)
  • Number of children living in smoke-free homes who have reduced exposure to secondhand smoke toxins. (Measures a key health outcome the policies aim to improve)
  • Number of property managers who report reduced smoke-related maintenance costs and tenant turnover. (Shows economic benefits of smoke-free policies)

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

  • Percent of smoke-free policies that are developed with input from community partners. (Institutionalizing community engagement in the policy process)
  • Percent of jurisdictions with smoking bans that collect data on policy implementation and impact. (Measures use of evidence to strengthen policy quality)
  • Percent decline in child emergency room visits for asthma in jurisdictions with smoking bans. (Evaluates a key child health outcome associated with smoke exposure)
  • Percent reduction in youth smoking initiation rates in communities with strong smoke-free policies. (Demonstrates prevention impact of reduced smoke exposure)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

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

References

1 Tynan 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.