Smokeless tobacco use 1992-2002: trends and measurement in the Current Population Survey-Tobacco Use Supplements

Background

As smoking prevalence declines in the United States, it is important to understand if smokeless tobacco (SLT) use is also changing and if so, among what groups.

Methods

We examine the prevalence of SLT use and smoking, 1992–2002, using the Current Population Survey‐Tobacco Use Supplements (CPS‐TUS), which used US nationally representative samples based on stratified clusters of households.

Results

Consistent with declines in smoking, the prevalence of current SLT use declined over the period 1992–2002 for males and females ages 18 and older. The overall separate declines in SLT use and in smoking are mirrored by a decline in concurrent use of SLT and cigarettes. SLT use is becoming more associated with white males, but use is declining faster among the youngest males.

Conclusions

The findings indicate that relative reductions in smoking prevalence are exceeded by relative reductions in SLT use, with sizeable reductions in concurrent use. These results suggest that the stricter cigarette policies of recent years may not only reduce cigarette use, but also the use of alternative tobacco products. In light of potential policy implications of SLT use as a potential reduced exposure product (PREP), current survey methods require more careful measurement of SLT use in terms of initiation, duration, quantity, and cessation.     

The relationship of smoking cessation to sociodemographic characteristics, smoking intensity, and tobacco control policies.

The present study examined the relationship between recent smoking cessation activities and sociodemographic characteristics, smoking intensity, and tobacco control policies among daily smokers in the United States. The study used the U.S. Current Population Survey 1998-1999 Tobacco Use Supplement, supplemented with information on state-level tobacco control policies. The sample was limited to individuals aged 25 years or older who were smoking daily 1 year ago. We estimated frequencies and multivariate logistic equations for making a quit attempt and remaining abstinent at least 3 months. These measures were related to demographic characteristics, smoking intensity, and tobacco control policies. Younger, higher socioeconomic status (SES), and less intense (fewer cigarettes per day) daily smokers were more likely to make quit attempts, but the likelihood of remaining abstinent for those making a quit attempt was greater for older, higher SES, and heavy daily smokers. We found evidence that cessation behaviors were related to higher cigarette prices and the presence of state-level media/comprehensive campaigns, but less clear evidence exists for an association with bans restricting workplace smoking. The results indicate that certain types of smokers are more likely to attempt to quit and to have success and that the characteristics of these smokers differ. Price policies can have an important role in helping daily smokers to quit. Further research is needed regarding the role of quantity smoked.     

Tobacco industry consumer research on socially acceptable cigarettes

Objective: To describe tobacco industry consumer research to inform the development of more "socially acceptable" cigarette products since the 1970s. Methods: Analysis of previously secret tobacco industry documents. Results: 28 projects to develop more socially acceptable cigarettes were identified from Philip Morris, RJ Reynolds, British American Tobacco, and Lorillard tobacco companies. Consumer research and concept testing consistently demonstrated that many smokers feel strong social pressure not to smoke, and this pressure increased with exposure to smoking restrictions. Tobacco companies attempted to develop more socially acceptable cigarettes with less visible sidestream smoke or less odour. When presented in theory, these product concepts were very attractive to important segments of the smoking population. However, almost every product developed was unacceptable in actual product tests or test markets. Smokers reported the complete elimination of secondhand smoke was necessary to satisfy non-smokers. Smokers have also been generally unwilling to sacrifice their own smoking satisfaction for the benefit of others. Many smokers prefer smoke-free environments to cigarettes that produce less secondhand smoke. Conclusions: Concerns about secondhand smoke and clean indoor air policies have a powerful effect on the social acceptability of smoking. Historically, the tobacco industry has been unable to counter these effects by developing more socially acceptable cigarettes. These data suggest that educating smokers about the health dangers of secondhand smoke and promoting clean indoor air policies has been difficult for the tobacco industry to counter with new products, and that every effort should be made to pursue these strategies.     

Current situation and future challenges of tobacco control policy in Thailand

In Thailand, the prevalence of smoking has steadily declined over the past 20 years, suggesting an effective tobacco control policy. However, the prevalence has recently stabilised and youth smoking now appears to be on the rise. Tobacco use is the third highest risk factor contributing to the burden of disease in the country. This is an issue of concern and led to the present review of tobacco control measures in Thailand. The present evidence-based review shows that Thailand's tobacco control measures are relatively strong and comply well with the WHO Framework Convention on Tobacco Control in terms of taxation, advertisement through popular media, and warning labels on cigarettes and other tobacco product packages. However, challenges remain in dealing with highly prevalent roll-your-own cigarettes, strict prohibition of tobacco sale to underage youths, household smoking, illicit trade of tobacco products, viable tobacco crop diversification for domestic tobacco growers and liability. If these challenges are met, the prevalence of tobacco consumption could possibly be further reduced.     

Correlates of household smoking bans among Chinese Americans.

No population-based data are available on the degree to which Chinese Americans have adopted smoke-free household policies and whether these policies are effective in reducing environmental tobacco smoke (ETS) exposure. The present study examines the prevalence of smoke-free home rules among Chinese Americans living in New York City, describes predictors of adopting full smoking bans in the home, and explores the association between household smoking restrictions and ETS exposure at home. In-person interviews using a comprehensive household-based survey were conducted with 2,537 adults aged 18-74 years. Interviews were conducted in Mandarin, Cantonese, and other Chinese dialects. A total of 66% of respondents reported that smoking was not allowed inside the home, 22% reported a partial ban on smoking in the home, and 12% reported no smoking ban. Among current smokers, 38% reported a full household smoking ban. Current smoking status was the strongest predictor of less restrictive household smoking policies. Knowledge of the dangers of ETS, support of smoke-free air legislation, years in the United States, gender, income, and marital status also were associated with household smoking bans. Those living with a total household smoking ban were significantly less likely to report 30-day exposure to ETS than were those living in homes with a partial ban or no ban (7% vs. 68% and 73%, respectively). In homes of smokers and nonsmokers alike, exposure to ETS remains high. Smoke-free home rules and interventions among smokers and nonsmokers to raise awareness of the dangers of ETS have the potential to significantly reduce exposure to household ETS among this immigrant population.     

What public health strategies are needed to reduce smoking initiation?

Smoking initiation is a key behaviour that determines the future health consequences of smoking in a society. There is a marked difference in smoking patterns around the world, driven by initiation rates. While a number of high-income countries have seen smoking prevalence decline markedly from peak, many low-income and middle-income countries appear to still be on an upward trend. Unlike cessation where changes are limited by nicotine dependence, rates of smoking initiation can change rapidly over a short time span. Interventions that can be effective in achieving this include increases in the price of tobacco products, mass media anti-smoking advertising, smoke-free policies, smoking curricula in schools, restrictions on marketing opportunities for the tobacco industry as well as social norms that lead to restrictions on adolescents' ability to purchase cigarettes. Comprehensive tobacco control programmes that aim to denormalise smoking behaviour in the community contain all of these interventions. Rapid reductions in smoking initiation in adolescents have been documented in two case studies of comprehensive tobacco control programmes in California and Australia. Consistent and inescapable messages from multiple sources appear to be key to success. However, the California experience indicates that the rapid decline in adolescent smoking will not continue if tobacco control expenditures and the relative price of cigarettes are reduced. These case studies provide strong additional evidence of the importance of countries implementing the provisions of the Framework Treaty on Tobacco Control.     

Smoking policies in U.S. outpatient drug treatment facilities.

Most drug treatment patients smoke cigarettes, and some facilities are beginning to help patients quit. Facility smoking policies can help or hinder this effort. The present study describes smoking policies in outpatient drug treatment. It is a secondary analysis of a survey on smoking cessation treatment in outpatient methadone maintenance facilities in the United States. One clinic leader (a medical director, head nurse, or clinic director) from each of the 697 U.S. facilities was invited to participate in the study. Main outcome measures included whether clinics had a written smoking policy as well as the types of indoor and outdoor policies in place for patients and staff. A total of 408 (59%) of U.S. clinics responded. Most clinics (73%) had a written smoking policy for patients, and more (82%) had written policies for staff. Over 90% banned indoor smoking by staff and patients. Few totally banned outdoor smoking. Approximately half in some way restricted where patients (48%) and staff (55%) smoke outdoors. Compared with clinics that did not treat nicotine dependence, significantly more clinics that treated nicotine dependence had written policies on smoking and restricted outdoor smoking for patients and staff. Likewise, many public clinics and those affiliated with hospitals had outdoor smoking restrictions for patients and staff. Drug treatment facilities routinely ban alcohol use and drug dealing on their grounds. Only 1 in 10 ban smoking. Outpatient facilities should restrict or ban outdoor tobacco use in order to remain consistent with their mission and avoid sabotaging clinic efforts to treat, and patient and staff efforts to stop, smoking.     

Comprehensive tobacco marketing restrictions: promotion, packaging, price and place

Evidence of the causal role of marketing in the tobacco epidemic and the advent of the WHO Framework Convention on Tobacco Control have inspired more than half the countries in the world to ban some forms of tobacco marketing. This paper briefly describes the ways in which cigarette marketing is restricted and the tobacco industry's efforts to subvert restrictions. It reviews what is known about the impact of marketing regulations on smoking by adults and adolescents. It also addresses what little is known about the impact of marketing bans in relation to concurrent population-level interventions, such as price controls, anti-tobacco media campaigns and smoke-free laws. Point of sale is the least regulated channel and research is needed to address the immediate and long-term consequences of policies to ban retail advertising and pack displays. Comprehensive marketing restrictions require a global ban on all forms of promotion, elimination of packaging and price as marketing tools, and limitations on the quantity, type and location of tobacco retailers.     

Delayed compensatory cigarette consumption after a workplace smoking ban

OBJECTIVES: To evaluate the impact of workplace smoking bans on cigarette consumption among continuing smokers over a two-year period. DESIGN: Two cross-sectional surveys and a longitudinal sample of smokers questioned about their smoking behaviour six months and two years after implementation of a workplace smoking ban. SUBJECTS: Workers in 46 government offices in Australia. The cross-sectional survey six months after the ban included 3388 workers, whereas the survey two years after the ban included 3982 workers. The longitudinal cohort study included 107 workers who were identified as current smokers in both surveys. MAIN OUTCOME MEASURES: Smokers were asked to report usual daily cigarette consumption on both workdays and leisure days one month before implementation of the ban, and six months, and two years afterwards. RESULTS: From six months to two years after the ban, the cross-sectional data showed an increase in cigarette consumption of 1.3 cigarettes per day. The longitudinal sample of smokers reported an increase in workday cigarette consumption of 1.7 cigarettes per day. A previous study of workers in the same worksites found a reduction in consumption of 5.2 cigarettes per day from before the ban to six months after. Over a two-year period we estimate that the net effect of the workplace smoking ban was to reduce cigarette consumption by about 3.5 cigarettes per day. CONCLUSIONS: Reductions in cigarette consumption among smokers frequently seen after implementation of a worksite smoking ban may diminish over time. This effect is more likely to occur when the initial response to a smoking ban is a large reduction in cigarette consumption.


     

European Union policy on smokeless tobacco: a statement in favour of evidence based regulation for public health

Rationale: This statement is an updated version of one released by the same authors in February 2003. The statement was produced to follow up the Royal College of Physicians (RCP) Tobacco Advisory Group report "Protecting smokers, saving lives: the case for a tobacco and nicotine regulatory authority",¹ which argued for an evidence based regulatory approach to smokeless tobacco and harm reduction and posed a series of questions that regulators must address in relation to smokeless tobacco.

The purpose of this statement is to provide arguments of fact and principle to follow the RCP's report and to outline the public health case for changing existing European Union (EU) regulation in this area. A review of regulation in relation to harm reduction and regulation of tobacco products other than cigarettes is required in Article 11 of EU directive 2001/37/EC,² and this is a contribution towards forming a consensus in the European public health community about what policy the EU should adopt in the light of this review, or following ongoing legal action that may potentially strike out the existing regulation altogether.

Public health case: We believe that the partial ban applied to some forms of smokeless tobacco in the EU should be replaced by regulation of the toxicity of all smokeless tobacco. We hold this view for public health reasons: smokeless tobacco is substantially less harmful than smoking and evidence from Sweden suggests it is used as a substitute for smoking and for smoking cessation. To the extent there is a "gateway" it appears not to lead to smoking, but away from it and is an important reason why Sweden has the lowest rates of tobacco related disease in Europe. We think it is wrong to deny other Europeans this option for risk reduction and that the current ban violates rights of smokers to control their own risks. For smokers that are addicted to nicotine and cannot or will not stop, it is important that they can take advantage of much less hazardous forms of nicotine and tobacco—the alternative being to "quit or die"... and many die. While nicotine replacement therapies (NRT) may have a role in harm reduction, tobacco based harm reduction options may reach more smokers and in a different, market based, way. Chewing tobacco is not banned or regulated in the EU but is often highly toxic, and our proposal could remove more products from the market than it permitted.

Regulatory options: We believe that the EU policy on smokeless tobacco should adapt to new scientific knowledge and that the European Commission should bring forward proposals to amend or replace Article 8 of directive 2001/37/EC with a new regulatory framework. Canada has developed testing regimens for tobacco constituents and these could be readily adapted to the European situation. A review of EU policy in this area is required no later than December 2004, and we believe the Commission should expedite the part of its review that deals with harm reduction and regulation of tobacco products other than cigarettes so as to reconsider its policy on smokeless tobacco. We held this view before Swedish Match brought its legal proceedings to challenge EU legislation and we will continue to hold these views if its action fails.

     

Consensus for tobacco policy among former state legislators using the policy Delphi method

OBJECTIVE: To test a novel approach for building consensus about tobacco control policies among legislators. DESIGN: A pilot study was conducted using a two-round, face-to-face policy Delphi method. PARTICIPANTS: Randomly selected sample of 30 former Kentucky legislators (60% participation rate). MAIN OUTCOME MEASURE: Consensus on tobacco control and tobacco farming policies. RESULTS: Former state legislators were more supportive of tobacco control policies than expected, and highly supportive of lessening the state's dependence on tobacco. Former state legislators were in agreement with 43% of the second-round items for which there was no agreement at the first round, demonstrating a striking increase in consensus. With new information from their colleagues, former lawmakers became more supportive of workplace smoking restrictions, limitations on tobacco promotional items, and modest excise tax increases. CONCLUSIONS: The policy Delphi method has the potential for building consensus for tobacco control and tobacco farming policies among state legislators. Tobacco control advocates in other states might consider using the policy Delphi method with policymakers in public and private sectors.     

Effect of policies directed at youth access to smoking: results from the SimSmoke computer simulation model

OBJECTIVES: To develop a simulation model to predict the effects of youth access policies on retail compliance, smoking rates, and smoking attributable deaths. METHODS: A model of youth access policies is developed based on empirical research and a theory of perceived risk. The model incorporates substitution into other sources as retail sales are restricted, and is used to project the number of smokers and smoking related deaths. Various policies to limit youth access to cigarettes are evaluated, and we explore how efficient policies may be developed. RESULTS: The model predicts that a well designed and comprehensive policy that includes sufficient compliance checks, penalties, and community involvement has the potential to reduce the number of young smokers. Because smoking related deaths occur later in life, the effects on health are largely delayed. CONCLUSIONS: A well designed youth access policy has the ability to affect youth smoking rates in the short term, and will lead to savings in lives in future years. The ability of retail oriented policies to reduce youth smoking, however, is limited. Other tobacco control policies, including those directed at non-retail sources of cigarettes, are also needed.     

The impact of workplace smoking bans: results from a national survey

OBJECTIVE: To estimate the impact of workplace smoking restrictions on the prevalence and intensity of smoking among all indoor workers and various demographic and industry groups. DESIGN: Detailed cross sectional data on worker self reported characteristics, smoking histories, and workplace smoking policies were used in multivariate statistical models to examine whether workplace smoking policies reduce cigarette consumption. After analysing the distribution of policies, four main types of workplace programme were defined: (1) 100% smoke-free environments, (2) work area bans in which smoking is allowed in some common areas, (3) bans in some but not all work and common areas, and (4) minimal or no restrictions. SETTING: After environmental tobacco smoke was identified as a health hazard in the mid-1980s, workplace smoking restrictions became more prevalent. By 1993, nearly 82% of indoor workers faced some restriction on workplace smoking and 47% worked in 100% smoke-free environments. PARTICIPANTS: The database included a nationally representative sample from the tobacco use supplements to the September 1992, January 1993, and May 1993 Current Population Surveys of 97,882 indoor workers who were not self employed. MAIN OUTCOME MEASURES: Prevalence of smoking and number of cigarettes smoked daily by smokers. RESULTS: Having a 100% smoke-free workplace reduced smoking prevalence by 6 percentage points and average daily consumption among smokers by 14% relative to workers subject to minimal or no restrictions. The impact of work area bans was lessened by allowing smoking in some common areas. Smoke-free policies reduced smoking for all demographic groups and in nearly all industries. CONCLUSIONS: Requiring all workplaces to be smoke free would reduce smoking prevalence by 10%. Workplace bans have their greatest impact on groups with the highest rates of smoking.     

Recent trends in home and work smoking bans

Objectives: Home and work smoking bans at the national and state level in the USA, and their relation to smoking prevalence and to tobacco control policies, are examined.

Data: The Current Population Survey's 1992/93 and 1998/99 tobacco use supplement surveys are the primary data source, supplemented with information on state level tobacco control policies.

Methods: The national and state rate of bans are estimated, and changes over the course of the 1990s and their relation to smoking rates and tobacco control policies are examined.

Results: The prevalence of work and home bans has increased considerably between 1992/93 and 1998/99. By 1999, over 65% of the population age 15 and above work in places with smoking bans, and over 60% live in homes with bans. We found that states with lower than average ban rates in 1993 tended to have had larger increases in ban rates between 1993 and 1999. We also found that home and work bans became more prevalent in states with initially low smoking rates, and that the growth in home bans coincided with a declining prevalence of smoking. States with higher levels of bans by 1999 also tended to have higher cigarette taxes, stricter clean air laws, and media/comprehensive campaigns in place.

Conclusions: The results indicate that lower smoking rates are associated with higher rates of work and home bans, although substantial progress has also been made by those states with initially low rates of bans. While further work is needed to establish the direction of causality, it would appear that reductions in smoking rates, either through stronger tobacco control policies or otherwise, may reduce exposure to tobacco smoke not only by reducing the number of smokers, but also through increasing the number of firms and homes with smoking restrictions.

     

Smoking in correctional facilities: a survey of employees

OBJECTIVE: To assess level of endorsement and expected consequences of worksite smoking restriction policies among correctional employees. DESIGN: Mailed survey to Vermont state correctional employees. MAIN OUTCOME MEASURES: Support for various policy alternatives for both staff and inmate smoking; expected consequences of restrictive smoking policies and smoking behaviour. PARTICIPANTS: 321 of 640 (50%) state correctional employees responded. RESULTS: Employees were somewhat receptive to smoking restrictions for inmates, but less supportive of staff smoking restrictions. A complete ban on inmate smoking both indoors and outdoors was supported by 56% and 49% of never and ex-smokers, respectively, but only 15% of current smokers (p < 0.01). A similar ban on employee smoking was supported by 38% of never and ex-smokers, but only 3% of current smokers (p < 0.01). Overall, employees were most supportive (52%) of a policy for themselves that banned indoor smoking and restricted it to certain areas outdoors. Current smokers were more likely to expect negative consequences as a result of further restrictions than were never or ex-smokers. CONCLUSIONS: Although our findings are limited by a low response rate, most employees support an indoor ban, but not a total ban on smoking. Employees generally favoured a policy that was slightly more restrictive than the current policy, but were less supportive of tighter smoking restrictions for themselves. However, a more restrictive smoking policy is likely to result in some degree of resistance among current smoking employees, who may require specific attention to address their opposition.     

Environmental tobacco smoke exposure among Korean American nonsmokers in California.

Information about the extent and patterns of environmental tobacco smoke (ETS) exposure among Korean Americans is sparse, despite the population's having one of the highest male smoking rates. This paper estimates the prevalence of ETS exposure among Korean American nonsmokers in California, and identifies demographic and other characteristics associated with exposure. Data were collected during 2001-2002 from telephone interviews (in English or Korean) with 2,328 nonsmoking Korean American adults. ETS was encountered by 31% of respondents during a typical day. Exposure was most common in "other locations," where 24% of respondents were exposed, compared with 6% at home and 9% at work. Among those exposed, the greatest dose of exposure occurred at work (6 cigarettes/day) and at home (5 cigarettes/day). Women were four times more likely than men to be exposed to ETS at home (8% vs. 2%, respectively). For both men and women, the odds of exposure were greater among those who were younger, who were unmarried, and whose friends smoked. Additionally, traditional men and bicultural women had greater odds of ETS exposure than those who were more acculturated. Women who were married to smokers, had no children at home, consumed more alcohol, and had no home smoking ban also had greater likelihood of exposure. The results indicate the need for a complete ban of smoking in workplaces and in private homes to prevent exposure, particularly for women whose husbands smoke.     

Responses to tobacco control policies among youth

OBJECTIVE: Explore adolescents' response to current and potential tobacco control policy issues. DESIGN: The 13 site Tobacco Control Network (TCN), sponsored by the Centers for Disease Control and Prevention, conducted 129 sex and ethnic homogeneous focus groups. PARTICIPANTS: 785 white, African American, Asian American/Pacific Islander, American Indian, and Hispanic adolescents who were primarily smokers from rural, urban, and suburban locations across the USA. MAIN OUTCOME MEASURES: Awareness, knowledge, opinions, and behaviour regarding laws and rules, prices, cigarette ingredients, and warning labels. RESULTS: Teenagers were generally familiar with laws and rules about access and possession for minors, but believed them ineffective. They were knowledgeable about prices, and reported that a sharp and sudden increase could lead them to adjust their smoking patterns but could also have negative consequences. They found a list of chemical names of cigarette ingredients largely meaningless, but believed that disclosing and publicising their common uses could be an effective deterrent, especially for those who were not yet smoking. They were aware of current warning labels, but considered them uninformative and irrelevant. CONCLUSIONS: Understanding teenagers' attitudes and behaviours before implementing policies that will affect them will likely increase their effectiveness. Disclosing and publicising the chemical contents of cigarettes, and increasing prices quickly and sharply, are potentially effective areas for policy change to impact adolescent tobacco use.     

Asian herbal‐tobacco cigarettes: “not medicine but less harmful”?

Objective

To describe the development and health claims of Asian herbal‐tobacco cigarettes.

Methods

Analysis of international news sources, company websites, and the transnational tobacco companies'' (TTC) documents. PubMed searches of herbs and brands.

Results

Twenty‐three brands were identified, mainly from China. Many products claimed to relieve respiratory symptoms and reduce toxins, with four herb‐only products advertised for smoking cessation. No literature was found to verify the health claims, except one Korean trial of an herb‐only product. Asian herbal‐tobacco cigarettes were initially produced by China by the 1970s and introduced to Japan in the 1980s. Despite initial news about research demonstrating a safer cigarette, the TTC analyses of these cigarettes suggest that these early products were not palatable and had potentially toxic cardiovascular effects. By the late 1990s, China began producing more herbal‐tobacco cigarettes in a renewed effort to reduce harmful constituents in cigarettes. After 2000, tobacco companies from Korea, Taiwan, and Thailand began producing similar products. Tobacco control groups in Japan, Taiwan, and Thailand voiced concern over the health claims of herbal‐tobacco products. In 2005, China designated two herbal‐tobacco brands as key for development.

Conclusion

Asian herbal‐tobacco cigarettes claim to reduce harm, but no published literature is available to verify these claims or investigate unidentified toxicities. The increase in Asian herbal‐tobacco cigarette production by 2000 coincides with the Asian tobacco companies'' regular scientific meetings with TTCs and their interest in harm reduction. Asia faces additional challenges in tobacco control with these culturally concordant products that may discourage smokers from quitting.     

The effects of household and workplace smoking restrictions on quitting behaviours

OBJECTIVE: To assess the association of household and workplace smoking restrictions with quit attempts, six month cessation, and light smoking. DESIGN: Logistic regressions identified the association of household and workplace smoking restrictions with attempts to quit, six month cessation, and light smoking. SETTING: Large population surveys, United States. SUBJECTS: Respondents (n = 48,584) smoked during the year before interview in 1992-1993, lived with at least one other person, and were either current daily smokers or were former smokers when interviewed. MAIN OUTCOME MEASURES: The outcome measures were an attempt to quit during the last 12 months, cessation for at least six months among those who made an attempt to quit, and light smoking (< 15 cigarettes a day). RESULTS: Smokers who lived (odds ratio (OR) = 3.86; 95% confidence interval (CI) = 3.57 to 4.18) or worked (OR = 1.14; 95% CI = 1.05 to 1.24) under a total smoking ban were more likely to report a quit attempt in the previous year. Among those who made an attempt, those who lived (OR = 1.65, 95% CI = 1.43 to 1.91) or worked (OR = 1.21, 95% CI = 1.003 to 1.45) under a total smoking ban were more likely to be in cessation for at least six months. Current daily smokers who lived (OR = 2.73, 95% CI = 2.46 to 3.04) or worked (OR = 1.53, 95% CI = 1.38 to 1.70) under a total smoking ban were more likely to be light smokers. CONCLUSIONS: Both workplace and household smoking restrictions were associated with higher rates of cessation attempts, lower rates of relapse in smokers who attempt to quit, and higher rates of light smoking among current daily smokers.