Harvard School of Public Health, Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA 02138, USA.
Matern Child Health J. 2012 Apr;16 Suppl 1:S70-7. doi: 10.1007/s10995-012-0996-9.
To examine the impact of cigarette excise taxes and smoke-free legislation on tobacco use among households with school-age children and adolescents as well as disparities in children's secondhand smoke exposure. We compare the results from models using causal inference techniques to those from cross-sectional models. We linked families of 6-17-year-olds from the 2003 (N = 67,607) and 2007 (N = 62,768) contacts of the National Survey of Children's Health with state-level cigarette excise taxes and smoke-free legislation total score (0 [none]-32 [very strong]) in 2001 and 2005. Parents reported whether anyone in the household used tobacco products. In adjusted causal inference models every $1.00 increase in cigarette excise tax between 2001 and 2005 was associated with a 4 percentage point decrease in household tobacco use between 2003 and 2007 (p = 0.008); however, there was no effect of smoke-free legislation on household tobacco use. Significant interactions revealed that cigarette tax increases were only associated with reductions in household tobacco use for parents of white children and, separately, lower income households. In contrast, in adjusted cross-sectional models, a higher smoke-free legislation total score was associated with a lower prevalence of household tobacco use. Stronger cigarette excise taxes decrease tobacco use among households with school-age children and adolescents, but smoke-free legislation at the state level does not change parental smoking. Since cross-sectional models cannot assess the direction of causality, evaluations should employ causal inference methods to help inform policy decisions to reduce disparities in adult smoking and, ultimately, protect children from secondhand smoke.
为了考察香烟消费税和无烟立法对有学龄儿童和青少年家庭的烟草使用以及儿童二手烟暴露的差异的影响。我们将使用因果推理技术的模型结果与横截面模型的结果进行比较。我们将 2003 年（N=67607）和 2007 年（N=62768）全国儿童健康调查中 6-17 岁儿童的家庭与 2001 年和 2005 年的州级香烟消费税和无烟立法总得分（0[无]-32[非常强]）相联系。父母报告家庭中是否有人使用烟草制品。在调整后的因果推理模型中，2001 年至 2005 年香烟消费税每增加 1 美元，家庭烟草使用量就会减少 4 个百分点（p=0.008）；然而，无烟立法对家庭烟草使用没有影响。显著的交互作用表明，香烟税的增加仅与白人和低收入家庭的父母的家庭烟草使用减少有关。相比之下，在调整后的横截面模型中，较高的无烟立法总得分与家庭烟草使用的较低患病率相关。更强的香烟消费税降低了有学龄儿童和青少年的家庭的烟草使用，但州级无烟立法并没有改变父母的吸烟行为。由于横截面模型无法评估因果关系的方向，因此评估应采用因果推理方法，以帮助为减少成人吸烟差异的政策决策提供信息，并最终保护儿童免受二手烟的危害。
