The behavioral ecology of secondhand smoke exposure: A pathway to complete tobacco control.
BACKGROUND
This article outlines a theoretical framework for research concerning secondhand smoke exposure (SHSe) prevention as a means to curtail the tobacco industry.


METHODS
The Behavioral Ecological Model (BEM) assumes interlocking social contingencies of reinforcement (i.e., rewards or punishments) from the highest level of society (e.g., taxing cigarette sales) to physiological reactions to nicotine that influence smoking and SHSe. We review selected research concerning both policy and clinical efforts to restrict smoking and/or SHSe.


RESULTS
Research to date has focused on smoking cessation with modest to weak effects. The BEM and empirical evidence suggest that cultural contingencies of reinforcement should be emphasized to protect people from SHSe, especially vulnerable children, pregnant women, the ill, the elderly, and low-income adults who have not "elected" to smoke. Doing so will protect vulnerable populations from industry-produced SHSe and may yield more and longer-lasting cessation.


CONCLUSIONS
Interventions that reduce SHSe may serve as a Trojan horse to counter the tobacco industry. Future studies should: (a) guide policies to restrict SHSe; (b) develop powerful community and clinical interventions to reduce SHSe; (c) test the degree to which policies and other contexts enhance the effects of clinical interventions (e.g., media programs disclosing the disingenuous marketing by the industry); and (d) investigate the effects of all health care providers' ability to reduce SHSe and generate an antitobacco culture, by advising all clients to avoid starting to smoke, to protect their children from SHSe, and to quit smoking.
Hovell
Melbourne F
MF
Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, 9245 Sky Park Court, Suite 230, San Diego, CA 92123, USA. mhovell@projects.sdsu.edu
Hughes
Suzanne C
SC
D002648:Child; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D011247:Pregnancy; D012907:Smoking / Q000009:adverse effects; D012931:Social Environment; D019460:Tobacco Industry; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*
D014028:Tobacco Smoke Pollution