Smoke-free homes: Effect of a community based health promotion program in the Dominican Republic

Background. Increasing prevalence of households with smoking bans is central to reducing passive smoke exposure. A community based trial assessed the effect of a community tobacco cessation intervention on smoking bans among Dominican Republic communities, historically a tobacco-growing country with few tobacco control regulations. Methods. Baseline (2004) and two post-intervention (2006, 2007) surveillance surveys (each wave n >1000 randomly selected households) conducted in six economically disadvantaged communities (three tobacco-growing; community type: two each urban, peri-urban, rural) assessed household demographics, health status and smoking restrictions. The multi-faceted intervention included raising community awareness about health effects and providing cessation resources and support to smokers but nothing specific to establishing household bans. Results. Prevalence of household smoking bans increased in both intervention and control communities (24% to 45%). Households with smokers (vs. those without) adopted bans at lower rates (6 to 17%; 35 to 58%). Logistic regression analyses among households without smokers, showed good model fit. Allowing household smoking was associated with tobacco-growing community (AdjustedOR(95%CI): 3.77 (2.73-5.22)), household member with a cardiovascular problem (1.71(1.22-2.40)) and being Catholic (1.84(1.19-2.86)). The model differed by community type. Child or household member with a respiratory condition were not retained in the model. Conclusions. Increases occurred in both intervention and control communities (possibly due to surveillance process). For communities early in tobacco control, small measures may lead to significant increases in household bans, particularly among non-smoking households. Tobacco-growing community and possibly lack of knowledge of smoking's health effects may mitigate against household smoking bans in households with smokers.