The behavioral ecology of secondhand smoke exposure: A pathway to complete tobacco control

Abstract

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...

Complete Home Smoking Bans and Antitobacco Contingencies: A Natural Experiment

“…Logistic regression models regressed smoking ban on each of the demographic and theoretical mediator variables described above to examine the association between the DV bans and mediator variables. Finally, the relative contribution of theoretical mediators to the likelihood of having a smoking ban in the home was estimated by random intercept regression models in order to adjust for cluster sampling and to improve fit due to variation in intercepts among sample clusters (Hovell & Hughes, 2009;Rabe-Hesketh & Skrondal, 2008). Models were examined to test whether theoretical mediators remained associated with the DV, after controlling for city and demographics, and to determine if reduction in the direct effect between the independent variable and the DV was observed when controlling for mediation variables, consistent with evidence of mediation (Baron & Kenny, 1986;Kraemer, Kiernan, Essex, & Kupfer, 2008).…”

“…This model suggests that when antitobacco sentiments become normative, they are likely to support government regulations that restrict the sale and use of tobacco, leading to synergistic antitobacco policies that reflect contingencies (e.g., taxation, fines) that define a more complete and powerful antitobacco culture (Glantz, 1993). Hovell and Hughes (2009) have suggested that engineering changes in culture that result in fewer and fewer microenvironments in which smokers can smoke, may be the most powerful means of preventing smoking population wide.…”

Proactive recruitment predicts participant retention to end of treatment in a secondhand smoke reduction trial with low-income maternal smokers

“…Because our proactive recruitment components emphasized a research staff-WIC staff partnership that coordinated clinic-specific recruitment activities and incentivized WIC staff's recruitment efforts, we suggest that associative learning theories and the Behavioral Ecological Model (BEM) [38][39][40] provide a suitable framework for interpreting the results of this study. Associative learning theories assert that patient retention can be facilitated by implementing reinforcing consequences for ongoing participation that are delivered at individual, family, or clinic levels.…”

Smoking on Both Sides of the Pacific: Home Smoking Restrictions and Secondhand Smoke Exposure Among Korean Adults and Children in Seoul and California

“…Hovell and Hughes (2009) have taken these frames to their next logical extension with application to SHSe where more specific and testable deductions may be made. Herein, we extended these deductions by applying the logic of distal and proximal mediation and moderation to Koreans and Korean Americans, and their home smoking restrictions.…”