Disparities in trends of smoke-free home associated with socioeconomic disadvantages in the United States from 2001 to 2019

Objective: To examine disparities in trends of smoke-free home (SFH) rule prevalence in the United States from 2001 to 2019 by individuals' number of socioeconomic disadvantages.

Methods: Data were drawn from the 2001-2019 Tobacco Use Supplements to the U.S. Current Population Survey, a nationally representative cross-sectional survey. The sample comprised respondents (aged≥18 years) who answered items about SFH rules and socioeconomic disadvantage, defined as past-month unemployment, income below the federal poverty line, and/or education less than a high school diploma (N = 867,552). Multivariable logistic regressions estimated associations between adoption of an SFH rule and the number of socioeconomic disadvantages, including interaction terms between time and disadvantages, to assess changes in disparities over time.

Results: SFH prevalence increased substantially from 64.6 % in 2001-2002 to 89.0 % in 2018-2019. Differences in SFH prevalence by socioeconomic disadvantage narrowed somewhat over the 19 years among non-smokers but widened among smokers. Among non-smokers, SFH prevalence increased by 17.2 ppt (76.5 % to 93.7 %) for those without disadvantages, while it increased by 24.3 ppt (61.8 % to 86.1 %) among those with three disadvantages. In contrast, among smokers, increases in SFH prevalence over time were smaller among those with one (22.8 % to 51.5 %), two (19.5 % to 45.1 %), and three disadvantages (17.3 % to 37.1 %), compared with those without disadvantages (27.7 % to 61.4 %). The widened disparities were found even among smokers living with children.

Conclusion: Despite a large increase in the SFH prevalence, disparities remain. Our findings underscore the need for continued efforts to promote SFH, particularly among socioeconomically disadvantaged smokers.