This study is the first to examine the prevalence and correlates of home and automobile smoking restrictions, and of child ETS exposure, among U.S.-born and Mexico-born Hispanics in the United States. We found that the adoption of complete home and automobile smoking bans were strongly associated with mother's country of birth after controlling for smoking behaviors and sociodemographic characteristics. In contrast with Mexico-born mothers, U.S.-born mothers in our sample had 6-fold greater odds of lacking a complete home smoking ban and 3-fold greater odds of lacking a complete automobile smoking ban. Given that complete smoking bans provide substantially greater protection from ETS exposure than partial bans, tobacco education programs designed to reduce child ETS exposure should consider maternal nativity an important parameter differentiating smoking restriction practices among U.S. Hispanics [20
Young children's ETS exposure occurs primarily in homes and automobiles [21
]. The overall prevalence (86%) of home smoking bans observed in our sample of U.S.- and Mexico-born Hispanic mothers in Albuquerque, New Mexico is somewhat higher than findings from studies of California Hispanics (79.9%) [13
]. Only a few studies have reported on automobile smoking bans. Our observed prevalence (81%) of complete smoking bans for the family automobile was also higher than rates reported by Norman et al. among Hispanics (67%) and African Americans (55%) in California, and more than double the 38% reported by Kegler and Malcoe among rural low-income families of Native American and White young children in Oklahoma [13
]. The higher rate of smoking bans observed in our study may reflect the presence of children in all study homes, as well as the lower smoking prevalence among U.S. Hispanic women in general and Mexico-born women in particular [11
]. However, despite the higher prevalence of home and automobile smoking bans observed in our study, substantial opportunity for improvement remains, especially among smoking and U.S.-born Hispanic mothers.
Previous studies have demonstrated that smokers are less likely to ban home and automobile smoking [11
]. Our study confirms these findings in a clinic-based sample of Hispanic families with young children. We found that complete bans were present in 63% of smoking households, in contrast with 96% of nonsmoking households. Further, our multivariate analyses showed that U.S.-born mothers and homes with adult smoker(s) other than the mother had much greater odds of lacking
complete home and automobile smoking bans. These latter findings suggest that interventions to increase smoke-free home environments for Hispanic children in the southwestern United States should focus on U.S.-born mothers in particular and utilize strategies that impact smoking practices of all household members [26
An important tobacco control objective of Healthy People 2010
is to reduce the proportion of U.S. children who are regularly exposed to tobacco smoke in the home [27
]. We found that 36% of Hispanic children in our sample lived with a smoker. Our analyses further showed that complete smoking bans were associated with seven to 10-fold lower odds of room or automobile ETS exposure among Hispanic children. Several randomized controlled trials have demonstrated the effectiveness of parent counselling and coaching for decreasing children's reported ETS exposure, but only one has shown significant decreases in objective ETS exposure measures greater than those observed among controls [26
]. Notably, Hovell and colleagues showed that coaching is effective in reducing ETS exposure among Latino asthmatic children where the majority of mothers were nonsmokers and of Mexican descent [26
]. However, no trials have investigated the effectiveness of interventions for reducing home ETS exposure among children of U.S.-born Hispanics. Our multivariate findings, which showed that Hispanic children of U.S.-born mothers (compared with Mexico-born mothers) had three-fold increased odds of room ETS exposure, indicate that future trials should design and test ETS interventions targeting U.S.-born Hispanics with young children.
Our study is not without limitations. First, smoking restrictions and child ETS exposure were self-reported by the mother. Studies including biomarker and environmental measures of ETS have found that objective ETS exposure measures are somewhat higher than those based on self-reports [31
]. However, we have no reason to believe that U.S.- compared with Mexico-born mothers would be more or less likely to incorrectly report their child's ETS exposure. Second, our study population was recruited from pediatric emergency/urgent care and primary care clinics that provide services to underserved populations, and not through a population-based sampling approach. To avoid selection bias, women presenting for clinic services were systematically screened for eligibility through use of appointment logs and sign-in sheets. Thus, our sample was generally representative of low-income, urban Hispanic women in the study area who utilize clinic services. Finally, we did not ask mothers if their child was exposed to ETS in their own
home or family car, or whether they were exposed to ETS in other locations not under the control of parental smoking bans. Future studies may wish to include these questions to more fully evaluate the impact of personal smoking restriction policies on child ETS exposure.