title: Challenges in Enforcing Home Smoking Rules in a Low-Income Population: Implications for Measurement and Intervention Design.
abstract: BACKGROUND
  Smoke-free homes reduce exposure to secondhand smoke, contribute to lower levels of consumption, and help smokers to quit. Even when home smoking rules are established however, they may not be consistently enforced.
  
  
  METHODS
  This study uses data from a randomized controlled trial of a brief intervention to create smoke-free homes among callers to the United Way of Greater Atlanta 2-1-1. Participants with partial or full home smoking bans at 6-month follow-up were asked about enforcement challenges, rooms where smoking occurred, and exceptions to the rules. Air nicotine monitors were placed in a subset of homes.
  
  
  RESULTS
  Participants (n = 286) were mostly female (84.6%) and African American (84.9%). Most were smokers (79.0%) and reported at least half of their friends and relatives smoked (63.3%). Among those with a full ban, 4.3% reported their rules were broken very often whereas 52.6% stated they were never broken. Bad weather and parties were the most common exceptions to rules. Among nonsmokers with full bans, 16% reported exposure to secondhand smoke in the home 1-3 days in the past week. In multivariate analyses, having a partial ban, being a nonsmoker, and living with three or more smokers predicted higher levels of enforcement challenges.
  
  
  CONCLUSIONS
  Findings suggest the majority of households with newly adopted smoke-free rules had no or rare enforcement challenges, but about one-fifth reported their rules were broken sometimes or very often. Interventions to create smoke-free homes should address enforcement challenges as newly adopted rules may be fragile in some households.
  
  
  CONCLUSIONS
  Interventions that promote smoke-free homes should address enforcement challenges.
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA; mkegler@emory.edu.
authors.forename: Michelle C
authors.initials: MC
authors.lastname: Kegler
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA;
authors.forename: Regine
authors.initials: R
authors.lastname: Haardӧrfer
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA;
authors.forename: Carla
authors.initials: C
authors.lastname: Berg
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA;
authors.forename: Cam
authors.initials: C
authors.lastname: Escoffery
authors.affiliation: Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA;
authors.forename: Lucja
authors.initials: L
authors.lastname: Bundy
authors.affiliation: Cancer Prevention and Control Research Network, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC;
authors.forename: Rebecca
authors.initials: R
authors.lastname: Williams
authors.affiliation: Center for Health Promotion and Prevention Research, Department of Health Promotion and Behavioral Sciences, University of Texas School of Public Health, Houston, TX.
authors.forename: Patricia Dolan
authors.initials: PD
authors.lastname: Mullen
mesh_terms: D000328:Adult; D004784:Environmental Monitoring; D005191:Family Characteristics; D005260:Female; D005845:Georgia; D006801:Humans; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000032:analysis; D011203:Poverty; D016540:Smoking Cessation; D000074606:Smoking Prevention; D014028:Tobacco Smoke Pollution / Q000032:analysis*
chemical_list: D014028:Tobacco Smoke Pollution; D009538:Nicotine