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of the behavior of many people on multiple levels, and a broad systems approach to understanding both the individual ' s and the population ' s behavior is critical to achieving health promotion for all. Investigators cannot ignore the behavior of politicians who enact legislative policies that infl uence public health research, the behavior of medical care providers and insurers, and the behavior of industries (e.g., pharmaceuticals, tobacco) that may profi t from behavior that prevents disease or that harms the public. The confl uence of these many agencies defi nes complex behavioral ecological subcultures that determine health-related behavior and morbidity outcomes. We have used a Behavioral Ecological Model (BEM), where social ecological systems are emphasized and integrated with individual factors (e.g., genetic and personal learning histories) to understand and engineer change in the populations ' behavior ( Hovell, Wahlgren, & Adams, 2009 ;Hovell, Wahlgren, & Gehrman, 2002 ). In this context, we discuss the role of secondhand smoke exposure (SHSe) in the overarching process of tobacco control.This article describes the BEM, how it applies to SHSe research, and how elevating SHSe as the key target within the overarching tobacco control science may be a means of preventing tobacco addiction in whole populations. Need for a new modelThe tobacco industry creates more smokers and disease than clinicians can prevent by clinical services alone. The focus on clinical care is understandable, as it helps seriously damaged members of society, but it only indirectly contributes to prevention. Alternatively, smoke-free policies and increased taxation hold promise for complete tobacco control, where no one uses tobacco products. Such policies are consistent with the BEM and illustrate a more comprehensive prevention model. Popular theories offer " rational " or cognitive models of decision making that depend on understanding the health AbstractIntroduction: 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 infl uence 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...

Interventions are needed to protect the health of children who live with smokers. We pilot-tested a real-time intervention for promoting behavior change in homes that reduces second hand tobacco smoke (SHS) levels. The intervention uses a monitor and feedback system to provide immediate auditory and visual signals triggered at defined thresholds of fine particle concentration. Dynamic graphs of real-time particle levels are also shown on a computer screen. We experimentally evaluated the system, field-tested it in homes with smokers, and conducted focus groups to obtain general opinions. Laboratory tests of the monitor demonstrated SHS sensitivity, stability, precision equivalent to at least 1 µg/m3, and low noise. A linear relationship (R2 = 0.98) was observed between the monitor and average SHS mass concentrations up to 150 µg/m3. Focus groups and interviews with intervention participants showed in-home use to be acceptable and feasible. The intervention was evaluated in 3 homes with combined baseline and intervention periods lasting 9 to 15 full days. Two families modified their behavior by opening windows or doors, smoking outdoors, or smoking less. We observed evidence of lower SHS levels in these homes. The remaining household voiced reluctance to changing their smoking activity and did not exhibit lower SHS levels in main smoking areas or clear behavior change; however, family members expressed receptivity to smoking outdoors. This study established the feasibility of the real-time intervention, laying the groundwork for controlled trials with larger sample sizes. Visual and auditory cues may prompt family members to take immediate action to reduce SHS levels. Dynamic graphs of SHS levels may help families make decisions about specific mitigation approaches.

The prevalence and pattern of early pregnancy alcohol consumption in this sample of Latinas is similar to patterns noted in other race/ethnic groups in the U.S. Level of knowledge about FAS and awareness of warning messages was not protective for early pregnancy alcohol consumption, suggesting that specific knowledge was insufficient to prevent exposure or that other factors reinforce maintenance of alcohol consumption in early pregnancy. Selective interventions in low-income Latinas are warranted, and should be focused on women of reproductive age who are binge or frequent drinkers and who are at risk of becoming pregnant.

Children are at risk for adverse health outcomes from occupant-controllable indoor airborne contaminants in their homes. Data are needed to design residential interventions for reducing low-income children's pollutant exposure. Using customized air quality monitors, we continuously measured fine particle counts (0.5 to 2.5 microns) over a week in living areas of predominantly low-income households in San Diego, California, with at least one child (under age 14) and at least one cigarette smoker. We performed retrospective interviews on home characteristics, and particle source and ventilation activities occurring during the week of monitoring. We explored the relationship between weekly mean particle counts and interview responses using graphical visualization and multivariable linear regression (base sample n = 262; complete cases n = 193). We found associations of higher weekly mean particle counts with reports of indoor smoking of cigarettes or marijuana, as well as with frying food, using candles or incense, and house cleaning. Lower particle levels were associated with larger homes. We did not observe an association between lower mean particle counts and reports of opening windows, using kitchen exhaust fans, or other ventilation activities. Our findings about sources of fine airborne particles and their mitigation can inform future studies that investigate more effective feedback on residential indoor-air-quality and better strategies for reducing occupant exposures.

Objective This study assesses the association of immediate social and legal reprimand and current smoking status among Californians of Korean descent. Design Data were drawn from a population-based probability sample using a telephone survey conducted by bilingual, professional interviewers (N=2085). About 85.0% of eligible respondents completed interviews and 86.3% of participants preferred to be interviewed in Korean. Main Outcome Measure Smoking status was measured using CDC criteria, ever smoked 100 cigarettes and currently smoke every day or some days. Results and Conclusion Reports of immediate criticism by others in several settings was associated with non-smoking, but likelihood of immediate legal penalties was unrelated. Participants were far less likely to expect legal than social sanction. Results were replicated after controlling for reinforcers of smoking and ecologically relevant variables including models of smoking, primary group social support for smoking, acculturation, gender, acculturation by gender (male) interaction, age, and education. It may be efficacious to target public health interventions encouraging appropriate social sanctions of smoking in public among persons of Korean descent, and to encourage strict enforcement of legal penalties for smoking in public places.

IntroductionInterventions are needed to prevent exposure to secondhand smoke (SHS), which persists in certain immigrant enclaves, including Koreans in the United States. A faith-based and culturally acceptable intervention was developed and pilot tested in collaboration with Korean churches to address SHS exposure among people of Korean descent.MethodsA pilot cluster randomized intervention trial was conducted with 11 Korean churches in southern California and 75 Korean adults who were exposed to SHS. Study participants received a multicomponent intervention, which consisted of motivational interviewing by telephone and educational materials tailored with related biblical messages; the intervention was bolstered by church-based group activities and environmental cues. The control group received the same type and frequency of intervention components, but the components related only to fruit and vegetable consumption. Data were collected on the feasibility of the intervention and study procedures. SHS exposure and awareness and knowledge of SHS exposure were assessed by telephone interviews at baseline and follow-up.ResultsAt follow-up, a larger percentage of the intervention group than the control group reported correct SHS knowledge and disapproval of SHS. The intervention group’s SHS exposure was reduced by 8.5 cigarettes per week (vs a reduction of 1 cigarette per week among the control group).ConclusionsInitial findings are promising for improving knowledge, attitudes, and protective behaviors surrounding SHS exposure. Results suggest that a faith-based intervention for Korean Americans who are exposed to SHS is feasible, acceptable, and potentially effective in reducing their exposure to SHS.

Introduction-Secondhand smoke (SHS) is hazardous to children's health. Designing interventions to reduce exposure requires understanding children's behavior in the presence of smokers, yet little is known about this behavior.Purpose-To determine whether children's avoidance of SHS is associated with lower exposure and to explore predictors of avoidance based on a behavioral ecological model.Method-Preteens aged 8-13 (N=358) living with a smoker identified their primary source of SHS exposure, and reported whether they left (avoided exposure) or stayed the last time they were exposed to that person's smoke. The SHS avoidance measure was validated by examining associations with SHS exposure. Multivariable Logistic Regression was used to determine predictors of SHS avoidance.Results-Based on urine cotinine and reported exposure, preteens who left the presence of SHS had lower exposure than those who stayed. Preteens were more likely to leave SHS if they were less physically mature, had not tried smoking, had a firm commitment not to smoke, did not assist family smoking, had family/friends who discouraged breathing SHS, or had friends who disliked smoking.Discussion-Most SHS exposure reduction interventions have targeted changes in smokers' behavior. Reductions can also be achieved by changing exposed nonsmokers' behavior, such as avoiding the exposure. Future studies should measure young people's SHS avoidance and test interventions to increase their avoidance practices.