Social Disparities in Voluntary Adoption of Smoke-Free Homes Among South African Smokers

BACKGROUND: Smoking in public places is banned in South Africa, but only limited information is available on adoption of smoke-free policies in homes.

OBJECTIVES: To report on the social determinants of smoking restrictions in South African smokers’ homes and to explore the effects of such restrictions on quitting activities.

METHODS: This cross-sectional study involved a national representative sample of South African Smokers (n=587) aged >=16 years who participated in the 2010 South African Social Attitude Survey (N=3,110). Data on socio-economic status, smoking history, past-year quit attempts, self-efficacy to quit smoking and smoking restrictions were obtained through an interviewer-administered questionnaire. OUTCOME MEASURE: Reporting smoking was never allowed in the home. Data analysis included logistic regression analysis.

RESULTS: Of the smokers, only 26.9% (n=130) reported smoke-free home policy. Compared to those who reported smoke-free homes, those who did not were less likely to have made a quit attempt in the past year (72.3% vs. 45.9%; p<0.001). Compared to men, women were less likely to report a smoke-free home (31.3% vs. 15.6%; p=0.001). Those classified as coloureds were least likely to report smoke-free homes (14.1%), while black Africans were most likely to report smoke-free homes (33.6%). Even after controlling for potential confounders, among others, reporting smoke-free home was associated with reporting having strict rules against smoking at work (OR=4.19; 95%CI=2.13-8.23) and higher subjective social position (OR=1.31; 1.10-1.55).

CONCLUSIONS: South Africans with the highest smoking prevalence and of lower socio-economic status were less likely to experience smoke-free homes with implications for adverse health outcomes.