Contribution of clean indoor air policy in reducing cigarette smoking during pregnancy: A multilevel analysis of the impact of restaurant/bar restrictions on perinatal smoking in Massachusetts

The public health burden of chronic illness and complicated births attributable to smoking during pregnancy is large. In 2004, the US prevalence is 10.2% which is far higher than the 1% target established in Healthy People 2010. Although clean indoor air laws are enacted to protect against the adverse effects of second hand smoke, recent research suggests that these regulations may also affect smoking by reducing social acceptability of public smoking. Massachusetts towns have enacted restaurant/bar restrictions before the 2004 statewide ban and despite the key achievement of a reduction in perinatal smoking by 62% from 19.3% in 1990 to 7.2% in 2005 toted by the Massachusetts Tobacco Control Program, no empirical study has tested whether local tobacco ordinances are associated with the decline. The objective of this study is to test the association between town-level restaurant regulations and perinatal smoking in Massachusetts, as well as to examine the relationship between the strength of local restaurant restrictions and the time of policy adoption. A multilevel analytic method is used which will account for individual characteristics as well as town-level clustering including an indicator for baseline community smoking social norms. The study utilizes multiple data sources to provide a rich analysis to show whether these policies have an independent effect on perinatal smoking beyond individual factors; specifically, socio-demographic and smoking data from all women who gave birth in the state in 2002 will be linked to a database of all restaurant regulations adopted from 1993-2002 and to US Census-derived town characteristics.