BACKGROUND AND OBJECTIVES:

Since 2000, tobacco control efforts have greatly increased state and local protections from childhood tobacco smoke exposure. The objective of this study is to examine changes in attitudes and practices regarding smoking bans in multiple public and private settings from 2000 to 2015, as well as to examine the changes in pediatrician and family practitioner screening and counseling for tobacco smoke exposure.

METHODS:

Cross-sectional data from the annual Social Climate Survey of Tobacco Control were analyzed.

RESULTS:

The majority of adults, 69.3%, reported household smoking restrictions in 2000, and these restrictions increased to 79.5% through 2015 (P < .05). Car smoking prohibitions increased from 68.3% to 81.8% (P < .05). A growing majority of adults supports smoke-free policies in public settings, and tobacco counseling by child health care providers also increased. However, members of 1 in 5 households still permit smoking inside the home and family vehicle, and half of the US population is not protected by state or local laws prohibiting smoking inside of hospitality venues.

CONCLUSIONS:

Despite dramatic progress since 2000, these trend data reveal potential areas where child health care clinicians might focus effort at the family and community level to accelerate the protection of children from tobacco smoke exposure.

Tobacco is the leading cause of preventable death in the United States.1 Although most of the attributable mortality occurs among adults, children’s prenatal and passive tobacco smoke exposure negatively impacts their health during childhood and subsequent adulthood. These harms include higher rates of low birth weight and birth complications, sudden infant death syndrome, asthma prevalence and severity, lower respiratory infections, otitis media, and lung cancer as adults, as well as deleterious effects on behavior and cognition.2,6 Moreover, most tobacco smokers begin smoking during middle and high school, putting child health care clinicians in a unique position to influence their patients’ tobacco use behaviors directly and to influence the whole household’s experiences with tobacco from the time of the first clinical visit.1,7,9 

Parental smoking is a potent predictor of smoking in adolescents who go on to be adult smokers,10,15 and household smoke-free rules are associated with a reduced risk of adolescent smoking.16 In recognition of the harms of tobacco use and tobacco smoke exposure to children, the American Academy of Pediatrics (AAP) established the Tobacco Consortium, a group of clinicians and scientists working on research to prevent tobacco use and exposure. In 2005, the AAP emphasized tobacco control as a strategic priority. Shortly thereafter, in 2007, the AAP established the Julius B. Richmond Center of Excellence, dedicated to the elimination of children’s exposure to tobacco and tobacco smoke, to foster tobacco-control initiatives within the AAP.17 Since 1997, the AAP has issued 5 policy statements that offer guidance on tobacco-related counseling and advocacy efforts.2,17,20 The most recent policy statements recognize tobacco use as a pediatric disease because of the harms to children caused by tobacco use and secondhand smoke exposure, the influence of exposure to adult tobacco use on pediatric tobacco use,17,21 and the fact that 80% to 95% of all adult tobacco users began smoking before age 21.22 The statement frames the issue in terms of the unique position of pediatricians to assist patients and families with tobacco use prevention and treatment.

Declines in the prevalence of youth smoking after “The 1964 Report on Smoking and Health” was issued by the Surgeon General23 stalled in 1990s24 as tobacco companies introduced marketing strategies such as Joe Camel, Marlborough Miles, and Camel Bucks. However, events at the end of the 20th century helped to reinvigorate tobacco control efforts. In the late 1990s, a lawsuit initiated by the Attorney General to recoup Medicaid expenses for diseases caused by tobacco and the subsequent Master Settlement Agreement with the tobacco industry created funds to launch national and statewide campaigns to educate people about the harms of tobacco and tobacco smoke. These state and national programs targeted the initiation of smoking among youth and young adults and were focused on the elimination of exposure to secondhand smoke while promoting quitting among adults and youth.25 

Over the past 16 years, clinical practitioners and municipality officials have implemented programs such as the Clinical and Community Effort Against Secondhand Smoke Exposure to reduce tobacco use and tobacco smoke exposure among youth.8,26,27 Tobacco control policies have also experienced substantial growth in the past 16 years. In 2000, only 22 municipalities had comprehensive indoor smoke-free ordinances,28 and no states had implemented comprehensive indoor smoke-free laws.29 This changed after 2000. As of July 2016, 25 states and the District of Columbia have implemented comprehensive indoor smoke-free laws.29 State and local smoke-free legislation currently protects 58.7% of the US population.29 These policies had an additional impact on protecting children from tobacco smoke because clean indoor air laws provide the additional benefit of encouraging voluntary adoption of smoke-free rules in homes and cars.30 

The adoption of tobacco taxes is another policy used to discourage and denormalize tobacco use. In 2000, the federal tax on a pack of cigarettes was $0.34, and the average state tax was $0.42.31 In the past 16 years, 47 states and the District of Columbia have implemented more than 130 state tax increases. The federal tax is now $1.01, and the average state tax is $1.61.32 Research ties each of these actions to reductions in youth smoking rates.16,33,35 

We published an early assessment of the social climate surrounding tobacco smoke in 2003. We found modest improvements in household smoke-free practices from 2000 to 2001, but we found substantial disconnects between public support for smoke-free policies in public places and actual policies.36 The objective of this study was to build on our previous Pediatrics study examining changes in attitudes and practices. In the current study, we monitored these changes from 2000 to 2015, as well as monitoring changes in pediatrician and family practitioner screening and counseling for tobacco smoke.

The annual cross-sectional Social Climate Survey of Tobacco Control is a national survey that contains items pertaining to normative beliefs, practices and/or policies, and knowledge regarding tobacco control. We have administered this survey to representative samples of US adults since 2000. From 2000 to 2009, these data were collected via automated, random-digit-dialing (RDD) telephone surveys. We added an additional probability-based Internet panel frame in 2010 to address noncoverage issues arising from wireless substitution. Respondents were recruited from nationally representative dual-frame samples in 2010 through 2015.37 The RDD frame included households with listed and unlisted landline telephones; 5 attempts were made to contact those selected adults who were not home. The Survey Research Laboratory at Mississippi State University’s Social Science Research Center administered the surveys via computer-assisted telephone interviews to respondents in this frame. The probability-based panel frame included an online survey administered to a randomly selected sample from a nationally representative research panel.38,39 This panel is based on a sampling frame that includes both listed and unlisted numbers not associated with landlines, does not accept self-selected volunteers,38,39 and provides sample coverage for 99% of US households.40 The institutional review board at Mississippi State University approved this study, informed verbal consent was obtained, and the institutional review board provided a waiver of documentation of the written consent process.

Smoking Bans

In Table 1, we describe the 8 items that measured the prevalence of smoking bans in private and public places. Each respondent reported the degree of smoking restrictions in the home and provided an assessment of smoking restrictions in public places within his or her community.

TABLE 1

Smoking Bans: Variable Definitions

VariableSurvey QuestionResponses
Household smoking ban Which of the following best describes your household’s rules about smoking? • Smoking is allowed in all parts of the home. 
• Smoking is allowed in some parts of the home. 
• Smoking is not allowed in any part of the home.a 
Smoking is never allowed in the presence of children In your home, is smoking in the presence of children always allowed, sometimes allowed, or never allowed? • Always allowed 
• Sometimes allowed 
• Never alloweda 
Smoking is never allowed in the respondent’s vehicle with children present Please tell me which best describes how cigarette smoking is handled in your car when children are present. • No one is allowed to smoke in my car.a 
• Only special guests are allowed to smoke in my car. 
• People are allowed to smoke in my car only if the windows are open. 
• People are allowed to smoke in my car at any time 
Convenience stores in the community are smoke-free Convenience stores in your community: Are they completely smoke-free, do they have designated smoking and nonsmoking areas, or do they permit smoking anywhere? • Completely smoke-freea 
• Designated areas 
• Permit smoking anywhere 
Fast-food restaurants in the community are smoke-free Fast-food restaurants in your community: Are they completely smoke-free, do they have designated smoking and nonsmoking areas, or do they permit smoking anywhere? • Completely smoke-freea 
• Designated areas 
• Permit smoking anywhere 
Restaurants in the community are smoke-free Restaurants in your community: Are they completely smoke-free, do they have designated smoking and nonsmoking areas, or do they permit smoking anywhere? • Completely smoke-freea 
• Designated areas 
• Permit smoking anywhere 
Outdoor parks in the community are smoke-free Outdoor parks in your community: Are they completely smoke-free, do they have designated smoking and nonsmoking areas, or do they permit smoking anywhere? • Completely smoke-freea 
• Designated areas 
• Permit smoking anywhere 
VariableSurvey QuestionResponses
Household smoking ban Which of the following best describes your household’s rules about smoking? • Smoking is allowed in all parts of the home. 
• Smoking is allowed in some parts of the home. 
• Smoking is not allowed in any part of the home.a 
Smoking is never allowed in the presence of children In your home, is smoking in the presence of children always allowed, sometimes allowed, or never allowed? • Always allowed 
• Sometimes allowed 
• Never alloweda 
Smoking is never allowed in the respondent’s vehicle with children present Please tell me which best describes how cigarette smoking is handled in your car when children are present. • No one is allowed to smoke in my car.a 
• Only special guests are allowed to smoke in my car. 
• People are allowed to smoke in my car only if the windows are open. 
• People are allowed to smoke in my car at any time 
Convenience stores in the community are smoke-free Convenience stores in your community: Are they completely smoke-free, do they have designated smoking and nonsmoking areas, or do they permit smoking anywhere? • Completely smoke-freea 
• Designated areas 
• Permit smoking anywhere 
Fast-food restaurants in the community are smoke-free Fast-food restaurants in your community: Are they completely smoke-free, do they have designated smoking and nonsmoking areas, or do they permit smoking anywhere? • Completely smoke-freea 
• Designated areas 
• Permit smoking anywhere 
Restaurants in the community are smoke-free Restaurants in your community: Are they completely smoke-free, do they have designated smoking and nonsmoking areas, or do they permit smoking anywhere? • Completely smoke-freea 
• Designated areas 
• Permit smoking anywhere 
Outdoor parks in the community are smoke-free Outdoor parks in your community: Are they completely smoke-free, do they have designated smoking and nonsmoking areas, or do they permit smoking anywhere? • Completely smoke-freea 
• Designated areas 
• Permit smoking anywhere 
a

Responses indicate how items were dichotomized in the analysis.

Support for Restrictions on Smoking

We examined support for restricting smoking in private and public places with the variables described in Table 2. These variables included attitudes about smoking bans in public places and normative beliefs about exposing children to secondhand smoke in private places.

TABLE 2

Support for Smoking Bans: Variable Definitions

VariableSurvey QuestionResponses
Smoking should not be allowed in child care centers Smoking should be allowed in child care centers. Do you strongly agree, agree, disagree, or strongly disagree? • Strongly agree 
• Agree 
• Disagreea 
• Strongly disagreea 
It is unacceptable for parents to smoke in front of children It is acceptable for parents to smoke in front of children. Do you strongly agree, agree, disagree, or strongly disagree? • Strongly agree 
• Agree 
• Disagreea 
• Strongly disagreea 
Hospitals should be smoke-free In hospitals, do you think that smoking should be allowed in all areas, some areas, or not at all? • All areas 
• Some areas 
• Not at alla 
Shopping malls should be smoke-free In shopping malls, do you think that smoking should be allowed in all areas, some areas, or not at all? • All areas 
• Some areas 
• Not at alla 
Convenience stores should be smoke-free In convenience stores, do you think that smoking should be allowed in all areas, some areas, or not at all? • All areas 
• Some areas 
• Not at alla 
Fast-food restaurants should be smoke-free In fast-food restaurants, do you think that smoking should be allowed in all areas, some areas, or not at all? • All areas 
• Some areas 
• Not at alla 
Restaurants should be smoke-free In restaurants, do you think that smoking should be allowed in all areas, some areas, or not at all? • All areas 
• Some areas 
• Not at alla 
Indoor sporting events should be smoke-free At indoor sporting events, do you think that smoking should be allowed in all areas, some areas, or not at all? • All areas 
• Some areas 
• Not at alla 
Outdoor parks should be smoke-free In outdoor parks, do you think that smoking should be allowed in all areas, some areas, or not at all? • All areas 
• Some areas 
• Not at alla 
VariableSurvey QuestionResponses
Smoking should not be allowed in child care centers Smoking should be allowed in child care centers. Do you strongly agree, agree, disagree, or strongly disagree? • Strongly agree 
• Agree 
• Disagreea 
• Strongly disagreea 
It is unacceptable for parents to smoke in front of children It is acceptable for parents to smoke in front of children. Do you strongly agree, agree, disagree, or strongly disagree? • Strongly agree 
• Agree 
• Disagreea 
• Strongly disagreea 
Hospitals should be smoke-free In hospitals, do you think that smoking should be allowed in all areas, some areas, or not at all? • All areas 
• Some areas 
• Not at alla 
Shopping malls should be smoke-free In shopping malls, do you think that smoking should be allowed in all areas, some areas, or not at all? • All areas 
• Some areas 
• Not at alla 
Convenience stores should be smoke-free In convenience stores, do you think that smoking should be allowed in all areas, some areas, or not at all? • All areas 
• Some areas 
• Not at alla 
Fast-food restaurants should be smoke-free In fast-food restaurants, do you think that smoking should be allowed in all areas, some areas, or not at all? • All areas 
• Some areas 
• Not at alla 
Restaurants should be smoke-free In restaurants, do you think that smoking should be allowed in all areas, some areas, or not at all? • All areas 
• Some areas 
• Not at alla 
Indoor sporting events should be smoke-free At indoor sporting events, do you think that smoking should be allowed in all areas, some areas, or not at all? • All areas 
• Some areas 
• Not at alla 
Outdoor parks should be smoke-free In outdoor parks, do you think that smoking should be allowed in all areas, some areas, or not at all? • All areas 
• Some areas 
• Not at alla 
a

Responses indicate how items were dichotomized in the analysis.

Counseling to Parents

Respondents who had a child under the age of 18 in the home were asked the following questions: “In the past 12 months, did your child’s doctor ask if anyone in the household smokes?”; “In the past 12 months, did your child’s doctor ask if you have a smoke-free home?”; and “In the past 12 months, did your child’s doctor ask if you have a smoke-free car?”

The samples were weighted to be representative of the US population. Data from all years were weighted to adjust for age, race, sex, and region. Data from the 2015 frame were also weighted to account for the frame overlap among Internet panel respondents who also had a landline telephone and were therefore also eligible for the RDD frame.

Cross-sectional data from the annual Social Climate Survey of Tobacco Control were analyzed for changes in knowledge, attitudes, and practices regarding tobacco by using bivariate χ2 procedures.

Sample sizes in 2000 and 2009 were ∼1500. More funds were available in 2015 and the sample size was 3070. Unweighted and weighted sample characteristics demonstrate the representativeness of each sample (see Table 3).

TABLE 3

Sample Characteristics

2000 Unweighted, N = 1503, %2000 Weighted, %2009 Unweighted, N = 1506, %2009 Weighted, %2015 Unweighted, N = 3070, %2015 Weighted, %
Smoking status 
 Never smokers 47.8 47.0 54.8 55.5 57.6 60.7 
 Former smokers 28.2 28.8 30.9 27.1 27.9 26.1 
 Current smokers 23.9 24.1 14.2 17.3 14.6 13.2 
Region 
 Northeast 18.4 18.8 15.3 17.4 16.3 18.1 
 Midwest 24.4 22.6 26.3 20.9 22.8 21.4 
 South 39.6 35.4 40.9 40.3 40.4 37.0 
 West 17.6 23.2 17.4 21.4 20.5 23.5 
Race 
 White 80.4 76.5 86.7 84.4 72.9 65.0 
 African American 9.7 11.8 10.0 11.3 10.4 11.8 
 Other 9.8 11.7 3.3 4.3 16.7 23.3 
Age, y 
 18–24 11.6 12.0 3.5 11.1 10.6 13.1 
 25–44 36.4 37.2 22.4 36.5 31.7 34.0 
 45–64 34.1 33.8 42.0 34.6 36.4 35.5 
 65+ 17.9 17.0 32.1 17.8 21.3 17.4 
Sex 
 Male 39.6 49.5 34.7 45.9 49.7 48.3 
 Female 60.3 50.4 65.3 54.1 50.3 51.7 
Education 
 Less than high school 9.4 9.1 7.0 5.5 7.4 7.4 
 High school 31.7 30.6 26.9 26.5 25.3 19.7 
 Some college 25.2 25.7 30.1 31.3 30.7 29.0 
 College degree 33.7 34.6 36.0 36.8 36.6 44.0 
2000 Unweighted, N = 1503, %2000 Weighted, %2009 Unweighted, N = 1506, %2009 Weighted, %2015 Unweighted, N = 3070, %2015 Weighted, %
Smoking status 
 Never smokers 47.8 47.0 54.8 55.5 57.6 60.7 
 Former smokers 28.2 28.8 30.9 27.1 27.9 26.1 
 Current smokers 23.9 24.1 14.2 17.3 14.6 13.2 
Region 
 Northeast 18.4 18.8 15.3 17.4 16.3 18.1 
 Midwest 24.4 22.6 26.3 20.9 22.8 21.4 
 South 39.6 35.4 40.9 40.3 40.4 37.0 
 West 17.6 23.2 17.4 21.4 20.5 23.5 
Race 
 White 80.4 76.5 86.7 84.4 72.9 65.0 
 African American 9.7 11.8 10.0 11.3 10.4 11.8 
 Other 9.8 11.7 3.3 4.3 16.7 23.3 
Age, y 
 18–24 11.6 12.0 3.5 11.1 10.6 13.1 
 25–44 36.4 37.2 22.4 36.5 31.7 34.0 
 45–64 34.1 33.8 42.0 34.6 36.4 35.5 
 65+ 17.9 17.0 32.1 17.8 21.3 17.4 
Sex 
 Male 39.6 49.5 34.7 45.9 49.7 48.3 
 Female 60.3 50.4 65.3 54.1 50.3 51.7 
Education 
 Less than high school 9.4 9.1 7.0 5.5 7.4 7.4 
 High school 31.7 30.6 26.9 26.5 25.3 19.7 
 Some college 25.2 25.7 30.1 31.3 30.7 29.0 
 College degree 33.7 34.6 36.0 36.8 36.6 44.0 

The majority of adults reported household smoking restrictions in 2000, and these restrictions increased through 2015. Households prohibiting indoor smoking increased from 69.1% in 2000 to 79.5% in 2015, whereas car smoking prohibitions increased from 68.3% to 81.8% (P < .05). Support for smoke-free public places and implementation of smoke-free policies also increased. Most US adults supported smoke-free policies for indoor public places in 2000, yet there was a clear disconnect between public support and actual policies for these venues (see Table 4). By 2009, both support and implementation of smoke-free policies had increased, and the disconnect between public support and actual policy was greatly reduced.

TABLE 4

Support for Smoke-Free Public Places and Smoke-Free Policies, 2000 and 2009

2000, %2009, %
Convenience stores should be smoke-free* 86.3 93.5 
Fast food restaurants should be smoke-free* 76.8 91.0 
Restaurants should be smoke-free* 61.0 79.6 
Shopping malls should be smoke-free* 71.4 84.1 
Convenience stores in my community are smoke-free* 68.4 84.7 
Fast food restaurants in my community are smoke-free* 52.1 87.6 
Restaurants in my community are smoke-free* 24.5 76.8 
Shopping malls in my community are smoke-free* 75.4 90.5 
2000, %2009, %
Convenience stores should be smoke-free* 86.3 93.5 
Fast food restaurants should be smoke-free* 76.8 91.0 
Restaurants should be smoke-free* 61.0 79.6 
Shopping malls should be smoke-free* 71.4 84.1 
Convenience stores in my community are smoke-free* 68.4 84.7 
Fast food restaurants in my community are smoke-free* 52.1 87.6 
Restaurants in my community are smoke-free* 24.5 76.8 
Shopping malls in my community are smoke-free* 75.4 90.5 
*

P < .05.

In 2009, public support was associated with local and statewide smoke-free legislation. Although the strong majority of adults believed that these public venues should be smoke-free, support for smoke-free malls, convenience stores, fast food establishments, and restaurants was stronger among adults who live in places that had already implemented smoke-free policies than among those who did not (84.5% vs 76.8%, 94.6% vs 81.2%, 92.2% vs 71.5%, and 81.6% vs 66.0%, respectively, P < .05). We changed to a global measure in 2010 (“Would you favor or oppose a law that would prohibit smoking in all indoor workplaces, including offices, restaurants, and bars?”) to better assess support for comprehensive smoke-free policies.

Tobacco counseling by child’s health care provider also increased. Pediatrician and family practitioner screening and counseling for both parental smoking (50.6%–64.0%) and rules prohibiting smoking in the house (34.6%–57.1%) and car (21.7%–33.6%) increased from 2001 to 2015 (P < .05). In 2009, counseling by the child’s health care provider did not relate to parent’s support for smoke-free policies in malls, convenience stores, or fast food establishments. Moreover, the existence of smoke-free public policies for these venues did not increase parental reports of screening and counseling. However, parents who had been asked about household policies (89.7% vs 80.1%), vehicle policies (90.5% vs 80.3%), and smoking parents who were advised to quit (78.3% vs 43.9%) were more supportive of smoke-free policies for restaurants than those who had not received screening and counseling (P < .05 for all comparisons). Also, parents who lived in communities with smoke-free policies were less likely to be screened for household (24.8% vs 41.7%) and vehicle smoking rules (20.5% vs 31.9%) (P < .05). There were no differences in cessation counseling to parental smokers.

We also examined these changes in beliefs, practices, and knowledge across demographic categories. The observed changes occurred across sex, age, education, race, regional, and smoking status subsets.

Modest improvements in smoke-free protection for children in the home and family vehicles occurred from 2000 to 2015. Moreover, a growing majority of adults supports smoke-free policies in public settings, and many states and communities have implemented comprehensive smoking restrictions.

However, members of 1 in 5 households still permit smoking inside the home and family vehicle, and a third of the US population is not protected by state or local laws prohibiting smoking inside of restaurants. Clinical and advocacy-driven tobacco control efforts continue to push for increased restrictions on where tobacco can be smoked. Pediatricians can help to prevent children’s tobacco smoke exposure through patient and family education. Screening smokers and then advising them to quit has been shown to be an effective intervention in a variety of clinical settings and screening forms first step of the effective 5 A’s (ask, advise, assess, assist, arrange) treatment strategy for adult tobacco dependence.41 Counseling to parents increased substantially over the past 16 years, yet there is room for improvement. A third of parents have reported that their child’s pediatrician did not screen for household tobacco use, and fewer parents have reported screening for household rules about smoking in the home and vehicle. Clinical screening and counseling for tobacco use and exposure did have a potentially important relationship with smoke-free policies in restaurants. Reports of screening and counseling in the past year appears to have increased parents’ support for smoke-free restaurants, but parents who live in communities with smoke-free restaurants are less likely to report receiving screening and counseling. Child health care providers in these communities may be underestimating tobacco smoke exposure, possibly because it is no longer an issue in their local public venues.

This study has at least 2 limitations. First, we designed our dual-frame methodology to reduce the potential for sample bias associated with either RDD or Internet panel samples alone, but we still cannot eliminate the potential for noncoverage bias. Also, the use of the Internet panel raises some concern about the representativeness of the sample. However, the authors of several studies have demonstrated that this probability-based panel can produce results similar to those of well-designed RDD surveys,42,43 and our use of this dual-frame methodology produced estimates for current smoking that did not differ from those of several large, government surveys of US adults.37 We examined the validity of this dual-frame approach to reduce noncoverage bias in tobacco surveys in a previous study.37 We assessed the comparability of self-reported smoking prevalence estimates from our 2010 dual-frame survey with those from the 2010 National Health Interview Survey and the 2009–2010 NHANES. These are both large-scale national surveys and serve as the principal sources of information about tobacco use in the US population. We found that our estimates of self-reported smoking were within the confidence intervals of those from both the National Health Interview Survey and the NHANES. This finding applied to overall estimates and those for sex, race, and age. Second, these data are self-reported, and we could not verify that responses concerning smoke-free practices and/or policies and physician counseling were not misrepresented.

The percentage of families who were screened and counseled for tobacco use and exposure has improved from 2000 to 2015. The percentage of children enjoying smoke-free homes, cars, and public indoor places has also increased. Additional counseling and treatment opportunities remain to help parents protect children from tobacco smoke exposure in homes and cars and to move local smoke-free policies forward at the community level.

     
  • AAP

    American Academy of Pediatrics

  •  
  • RDD

    random-digit-dialing

Dr McMillen conceptualized and designed the study, conducted the initial analyses, and drafted the initial manuscript; Drs Wilson, Tanski, Klein, and Winickoff conceptualized and designed the study and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

FUNDING: Supported by the Flight Attendant Medical Research Institute grant 052302 and the Truth Initiative grant 6033. The information, views, and opinions contained herein are those of the authors and do not necessarily reflect the views and opinions of these organizations.

1
US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health
.
The Health Consequences of Smoking - 50 Years of Progress: A Report of the Surgeon General
.
Atlanta, GA
:
Centers for Disease Control and Prevention
;
2014
2
American Academy of Pediatrics Committee on Environmental Health
.
Environmental tobacco smoke: a hazard to children.
Pediatrics
.
1997
;
99
(
4
):
639
642
[PubMed]
3
California Environmental Protection Agency
.
Health Effects of Exposure to Environmental Tobacco Smoke: The Report of the California Environmental Protection Agency
.
Bethesda, MD
:
National Cancer Institute
;
1999
4
Office of Health and Environmental Assessment, Office of Research and Development, US Environmental Protection Agency
.
Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders
.
Washington, DC
:
US Environmental Protection Agency
;
1992
5
Weitzman
M
,
Byrd
RS
,
Aligne
CA
,
Moss
M
.
The effects of tobacco exposure on children’s behavioral and cognitive functioning: implications for clinical and public health policy and future research.
Neurotoxicol Teratol
.
2002
;
24
(
3
):
397
406
[PubMed]
6
Cook
DG
,
Strachan
DP
.
Health effects of passive smoking-10: summary of effects of parental smoking on the respiratory health of children and implications for research.
Thorax
.
1999
;
54
(
4
):
357
366
[PubMed]
7
US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health
.
Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General
.
Atlanta, GA
:
Centers for Disease Control and Prevention
;
2012
8
Winickoff
JP
,
Nabi-Burza
E
,
Chang
Y
, et al
.
Implementation of a parental tobacco control intervention in pediatric practice.
Pediatrics
.
2013
;
132
(
1
):
109
117
[PubMed]
9
Winickoff
JP
,
Tanski
SE
,
McMillen
RC
,
Klein
JD
,
Rigotti
NA
,
Weitzman
M
.
Child health care clinicians’ use of medications to help parents quit smoking: a national parent survey.
Pediatrics
.
2005
;
115
(
4
):
1013
1017
[PubMed]
10
Bricker
JB
,
Peterson
AV
 Jr
,
Sarason
IG
,
Andersen
MR
,
Rajan
KB
.
Changes in the influence of parents’ and close friends’ smoking on adolescent smoking transitions.
Addict Behav
.
2007
;
32
(
4
):
740
757
[PubMed]
11
Bricker
JB
,
Leroux
BG
,
Peterson
AV
 Jr
, et al
.
Nine-year prospective relationship between parental smoking cessation and children’s daily smoking.
Addiction
.
2003
;
98
(
5
):
585
593
[PubMed]
12
den Exter Blokland
EA
,
Engels
RC
,
Hale
WW
 III
,
Meeus
W
,
Willemsen
MC
.
Lifetime parental smoking history and cessation and early adolescent smoking behavior.
Prev Med
.
2004
;
38
(
3
):
359
368
[PubMed]
13
Farkas
AJ
,
Distefan
JM
,
Choi
WS
,
Gilpin
EA
,
Pierce
JP
.
Does parental smoking cessation discourage adolescent smoking?
Prev Med
.
1999
;
28
(
3
):
213
218
[PubMed]
14
Bricker
JB
,
Leroux
BG
,
Robyn Andersen
M
,
Rajan
KB
,
Peterson
AV
 Jr
.
Parental smoking cessation and children’s smoking: mediation by antismoking actions.
Nicotine Tob Res
.
2005
;
7
(
4
):
501
509
[PubMed]
15
Farkas
AJ
,
Gilpin
EA
,
White
MM
,
Pierce
JP
.
Association between household and workplace smoking restrictions and adolescent smoking.
JAMA
.
2000
;
284
(
6
):
717
722
[PubMed]
16
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
;
321
(
7257
):
333
337
[PubMed]
17
Committee on Environmental Health
;
Committee on Substance Abuse
;
Committee on Adolescence
;
Committee on Native American Child
.
From the American Academy of Pediatrics: policy statement–tobacco use: a pediatric disease [published correction appears in Pediatrics. 2010;125(4):861].
Pediatrics
.
2009
;
124
(
5
):
1474
1487
[PubMed]
18
American Academy of Pediatrics. Committee on Child Health Financing and Committee on Substance Abuse.
Improving substance abuse prevention, assessment, and treatment financing for children and adolescents.
Pediatrics
.
2001
;
108
(
4
):
1025
1029
[PubMed]
19
Committee on Substance Abuse
.
American Academy of Pediatrics: tobacco’s toll: implications for the pediatrician.
Pediatrics
.
2001
;
107
(
4
):
794
798
[PubMed]
20
Kulig
JW
;
American Academy of Pediatrics Committee on Substance Abuse
.
Tobacco, alcohol, and other drugs: the role of the pediatrician in prevention, identification, and management of substance abuse.
Pediatrics
.
2005
;
115
(
3
):
816
821
[PubMed]
21
Farber
HJ
,
Walley
SC
,
Groner
JA
,
Nelson
KE
;
Section on Tobacco Control
.
Clinical practice policy to protect children from tobacco, nicotine, and tobacco smoke.
Pediatrics
.
2015
;
136
(
5
):
1008
1017
[PubMed]
22
Elders
MJ
,
Perry
CL
,
Eriksen
MP
,
Giovino
GA
.
The report of the Surgeon General: preventing tobacco use among young people.
Am J Public Health
.
1994
;
84
(
4
):
543
547
[PubMed]
23
Garrett
BE
,
Dube
SR
,
Trosclair
A
,
Caraballo
RS
,
Pechacek
TF
;
Centers for Disease Control and Prevention (CDC)
.
Cigarette smoking - United States, 1965-2008.
MMWR Suppl
.
2011
;
60
(
1
):
109
113
[PubMed]
24
Zinman
J
,
Gruber
J
.
Youth Smoking in the US: Evidence and Implications
.
Cambridge, MA
:
National Bureau of Economic Research
;
2000
25
US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health
.
Best Practices for Comprehensive Tobacco Control Programs
.
Atlanta, GA
:
Centers for Disease Control and Prevention
;
1999
26
Winickoff
JP
,
Nabi-Burza
E
,
Chang
Y
, et al
.
Sustainability of a parental tobacco control intervention in pediatric practice.
Pediatrics
.
2014
;
134
(
5
):
933
941
[PubMed]
27
National Cancer Institute
. Research-tested intervention programs: clinical effort against secondhand smoke exposure (CEASE program). Available at: http://rtips.cancer.gov/rtips/programDetails.do?programId=24102596. Accessed August 23, 2016
28
American Nonsmokers’ Rights Foundation
.
Local 100% Smokefree Laws in All Workplaces, Restaurants, and Bars: Effective by Year
.
Berkeley, CA
:
American Nonsmokers’ Rights Foundation
;
2016
29
American Nonsmokers’ Rights Foundation
.
Summary of 100% Smokefree State Laws and Population Protected by 100% U.S. Smokefree Laws
.
Berkeley, CA
:
American Nonsmokers’ Rights Foundation
;
2016
30
Cheng
KW
,
Okechukwu
CA
,
McMillen
R
,
Glantz
SA
.
Association between clean indoor air laws and voluntary smokefree rules in homes and cars.
Tob Control
.
2015
;
24
(
2
):
168
174
[PubMed]
31
Boonn
A.
Cigarette Tax Increases vs. Cigarette Company Price Increases
.
Washington, DC
:
Campaign for Tobacco-Free Kids
;
2007
32
Boonn
A
. Cigarette tax increases by state per year 2000-2016. 2016. Available at: https://www.tobaccofreekids.org/research/factsheets/pdf/0275.pdf. Accessed June 10, 2017
33
Fichtenberg
CM
,
Glantz
SA
.
Effect of smoke-free workplaces on smoking behaviour: systematic review.
BMJ
.
2002
;
325
(
7357
):
188
[PubMed]
34
Tauras
JA
,
Chaloupka
FJ
,
Farrelly
MC
, et al
.
State tobacco control spending and youth smoking.
Am J Public Health
.
2005
;
95
(
2
):
338
344
[PubMed]
35
Levy
DT
,
Chaloupka
F
,
Gitchell
J
.
The effects of tobacco control policies on smoking rates: a tobacco control scorecard.
J Public Health Manag Pract
.
2004
;
10
(
4
):
338
353
[PubMed]
36
McMillen
RC
,
Winickoff
JP
,
Klein
JD
,
Weitzman
M
.
US adult attitudes and practices regarding smoking restrictions and child exposure to environmental tobacco smoke: changes in the social climate from 2000-2001.
Pediatrics
.
2003
;
112
(
1 pt 1
). Available at: www.pediatrics.org/cgi/content/full/112/1/e55
[PubMed]
37
McMillen
RC
,
Winickoff
JP
,
Wilson
K
,
Tanski
S
,
Klein
JD
.
A dual-frame sampling methodology to address landline replacement in tobacco control research.
Tob Control
.
2015
;
24
(
1
):
7
10
[PubMed]
38
Knowledge Networks, GfK
. KnowledgePanel design-summary description. 2013. Available at: www.knowledgenetworks.com/knpanel/docs/KnowledgePanel(R)-Design-Summary-Description.pdf. Accessed April 4, 2014
39
Knowledge Networks, GfK
. Methodological papers, presentations, and articles on KnowledgePanel. 2014. 2010. Available at: www.knowledgenetworks.com/ganp/reviewer-info.html. Accessed April 4, 2014
40
Dennis
JM
;
Knowledge Networks
. KnowledgePanel: processes & procedures contributing to sample representativeness & tests for self-selection bias. 2010. Available at: www.knowledgenetworks.com/ganp/docs/knowledgepanelr-statistical-methods-note.pdf. Accessed April 13, 2012
41
Fiore
MC
,
Jaén
CR
,
Baker
TB
, et al
.
Clinical Practice Guideline, Treating Tobacco Use and Dependence: 2008 Update
.
Washington, DC
:
US Department of Health and Human Services
;
2009
42
Chang
L
,
Krosnick
JA
.
National surveys via RDD telephone interviewing versus the Internet: comparing sample representativeness and response quality.
Public Opin Q
.
2009
;
73
(
4
):
641
678
43
Yeager
DS
,
Krosnick
JA
,
Chang
LC
, et al
.
Comparing the accuracy of RDD telephone surveys and internet surveys conducted with probability and non-probability samples.
Public Opin Q
.
2011
;
75
(
4
):
709
747

Competing Interests

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.