Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
Am J Prev Med. 2020 Jan;58(1):97-106. doi: 10.1016/j.amepre.2019.08.025. Epub 2019 Nov 13.
Tobacco use remains the leading cause of preventable death worldwide. Though research on smoke-free policies in the U.S. exists at the state or national level, there is limited evidence on such policies at the county level. This study examined the association between changes in county-level comprehensive smoke-free laws and smoking behavior among U.S. adults.
Data were used from the 1995/1996 to the 2014/2015 Tobacco Use Supplement to the Current Population Survey, analyzed in 2019. Changes in county smoke-free law population coverage over time were used as a natural experiment. Quasi-experimental analyses were performed to examine the association between changes in county-level comprehensive smoke-free laws and smoking behavior (smoking status and number of cigarettes smoked).
During the study period, current smoking prevalence decreased from 21.6% to 11.9%. Specifically, the prevalence of every day smoking decreased from 17.1% to 9.1% and some days smoking decreased from 4.4% to 2.9%. The number of cigarettes smoked per day for every day smokers decreased from 18.5 to 13.6, and from 5.9 to 4.1 for those who smoked some days. Comprehensive smoke-free legislation was associated with lower odds of cigarette smoking (AOR=0.76, 95% CI=0.74, 0.79). Adults living in counties with comprehensive smoke-free policies smoked fewer cigarettes per day both for every day smokers (β= -1.55, p<0.0001) and some days smokers (β= -0.79, p<0.0001).
County smoke-free policies in the U.S. may have contributed significantly to the reduction in smoking prevalence as well as the reduction in the number of cigarettes smoked among continuing cigarette smokers.
烟草使用仍然是全球可预防死亡的主要原因。尽管美国在州或国家一级有关于无烟政策的研究，但在县一级的此类政策证据有限。本研究调查了县级综合无烟法律的变化与美国成年人吸烟行为之间的关系。
本研究使用了 1995/1996 年至 2014/2015 年“当前人口调查”烟草使用补充调查的数据，于 2019 年进行了分析。随着时间的推移，县无烟法律人口覆盖率的变化被用作自然实验。进行准实验分析以检验县级综合无烟法律变化与吸烟行为（吸烟状况和吸烟量）之间的关系。
在研究期间，当前吸烟率从 21.6%下降到 11.9%。具体而言，每天吸烟的流行率从 17.1%下降到 9.1%，有些天吸烟的流行率从 4.4%下降到 2.9%。每天吸烟的香烟数量对于每天吸烟者从 18.5 支减少到 13.6 支，对于有些天吸烟的人从 5.9 支减少到 4.1 支。全面无烟立法与较低的吸烟几率相关（AOR=0.76，95%CI=0.74，0.79）。居住在有全面无烟政策的县的成年人，无论是每天吸烟者（β=-1.55，p<0.0001）还是有些天吸烟者（β=-0.79，p<0.0001），每天吸烟的香烟数量都较少。
美国的县无烟政策可能对降低吸烟率以及减少继续吸烟的成年人的吸烟量做出了重大贡献。
