Search tips
Search criteria 


Logo of tobcontTobacco ControlVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Tob Control. 2005 October; 14(5): 300–306.
PMCID: PMC1748108

Effect of local restaurant smoking regulations on progression to established smoking among youths


Background: While smoke-free restaurant laws are intended to protect the public from secondhand smoke exposure, they may also discourage smoking among adolescents. There is no evidence from longitudinal studies to test this hypothesis.

Objective: To examine the effect of local restaurant smoking regulations on progression to established smoking among adolescents.

Design, setting, and subjects: A cohort of 2623 Massachusetts youths, ages 12–17 years at baseline, was interviewed via random digit dial telephone survey in 2001–2002 and followed up two years later. A generalised estimating equations (GEE) logistic regression analysis was used and controlled for potential individual, household, and town level confounding factors.

Main outcome measure: Progression to established smoking during the two year follow up period (defined as having smoked 100 or more cigarettes in one's life).

Results: Compared to youths living in towns with weak regulations, those living in towns with strong regulations (complete restaurant smoking bans) had less than half the odds of progression to established smoking (odds ratio (OR) 0.39, 95% confidence interval (CI) 0.24 to 0.66). The association was stronger for youths in towns with strong regulations in effect for two or more years (OR 0.11, 95% CI 0.03 to 0.37), although it was still present for those in towns with strong regulations in effect for less than two years (OR 0.55, 95% CI 0.33 to 0.90). No relationship was found between living in a town with a medium restaurant smoking regulation (restriction of smoking to enclosed, separately ventilated areas) and rates of progression to established smoking.

Conclusions: Local restaurant smoking bans may be an effective intervention to prevent youth smoking.

Full Text

The Full Text of this article is available as a PDF (85K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • KLISIECKI A, WIKTOR Z, PYTASZ M, DEC L. [Alkalization, ammonia and urea in urine in kidney diseases]. Pol Tyg Lek. 1961 Dec 25;16:2001–2004. [PubMed]
  • Albers AB, Siegel M, Cheng DM, Biener L, Rigotti NA. Relation between local restaurant smoking regulations and attitudes towards the prevalence and social acceptability of smoking: a study of youths and adults who eat out predominantly at restaurants in their town. Tob Control. 2004 Dec;13(4):347–355. [PMC free article] [PubMed]
  • Glantz SA. Preventing tobacco use--the youth access trap. Am J Public Health. 1996 Feb;86(2):156–158. [PubMed]
  • Mokdad Ali H, Marks James S, Stroup Donna F, Gerberding Julie L. Actual causes of death in the United States, 2000. JAMA. 2004 Mar 10;291(10):1238–1245. [PubMed]
  • Chaloupka FJ, Pacula RL. Sex and race differences in young people's responsiveness to price and tobacco control policies. Tob Control. 1999 Winter;8(4):373–377. [PMC free article] [PubMed]
  • Wakefield MA, Chaloupka FJ, Kaufman NJ, Orleans CT, Barker DC, Ruel EE. Effect of restrictions on smoking at home, at school, and in public places on teenage smoking: cross sectional study. BMJ. 2000 Aug 5;321(7257):333–337. [PMC free article] [PubMed]
  • Wasserman J, Manning WG, Newhouse JP, Winkler JD. The effects of excise taxes and regulations on cigarette smoking. J Health Econ. 1991 May;10(1):43–64. [PubMed]
  • Skeer M, Siegel M. The descriptive epidemiology of local restaurant smoking regulations in Massachusetts: an analysis of the protection of restaurant customers and workers. Tob Control. 2003 Jun;12(2):221–226. [PMC free article] [PubMed]
  • Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Berry CC. Tobacco industry promotion of cigarettes and adolescent smoking. JAMA. 1998 Feb 18;279(7):511–515. [PubMed]
  • Pierce JP, Choi WS, Gilpin EA, Farkas AJ, Merritt RK. Validation of susceptibility as a predictor of which adolescents take up smoking in the United States. Health Psychol. 1996 Sep;15(5):355–361. [PubMed]
  • Choi WS, Pierce JP, Gilpin EA, Farkas AJ, Berry CC. Which adolescent experimenters progress to established smoking in the United States. Am J Prev Med. 1997 Sep-Oct;13(5):385–391. [PubMed]
  • Siegel M, Biener L. The impact of an antismoking media campaign on progression to established smoking: results of a longitudinal youth study. Am J Public Health. 2000 Mar;90(3):380–386. [PubMed]
  • Siegel M, Biener L, Rigotti NA. The effect of local tobacco sales laws on adolescent smoking initiation. Prev Med. 1999 Nov;29(5):334–342. [PubMed]
  • Choi Won S, Ahluwalia Jasjit S, Harris Kari J, Okuyemi Kolawole. Progression to established smoking: the influence of tobacco marketing. Am J Prev Med. 2002 May;22(4):228–233. [PubMed]
  • Wellman RJ, DiFranza JR, Savageau JA, Dussault GF. Short term patterns of early smoking acquisition. Tob Control. 2004 Sep;13(3):251–257. [PMC free article] [PubMed]
  • Skeer Margie, George Sarah, Hamilton William L, Cheng Debbie M, Siegel Michael. Town-level characteristics and smoking policy adoption in Massachusetts: are local restaurant smoking regulations fostering disparities in health protection? Am J Public Health. 2004 Feb;94(2):286–292. [PubMed]
  • Hedeker D, Gibbons RD, Flay BR. Random-effects regression models for clustered data with an example from smoking prevention research. J Consult Clin Psychol. 1994 Aug;62(4):757–765. [PubMed]
  • Skeer Margie, Land Michelle L, Cheng Debbie M, Siegel Michael B. Smoking in Boston bars before and after a 100% smoke-free regulation: an assessment of early compliance. J Public Health Manag Pract. 2004 Nov-Dec;10(6):501–507. [PubMed]

Articles from Tobacco Control are provided here courtesy of BMJ Publishing Group