Associations of Bar and Restaurant Smoking Bans With Smoking Behavior in the CARDIA Study: A 25-Year Study

Abstract

Indoor smoking ban policies have often been associated with reductions in smoking prevalence. However, few studies have evaluated their association with within-person changes in smoking behaviors. We linked longitudinal data from 5,105 adults from the Coronary Artery Risk Development in Young Adults study (1985–2011, aged 18–35 at baseline) to state, county, and local 100% smoke-free policies in all bars and restaurants by census tract. We used fixed effects models to examine the association of smoking bans with within-person change in current smoking risk, smoking intensity (smoking ≥10 cigarettes per day on average versus <10) and quit attempts, using both linear and non-linear adjustment for secular trends. In models assuming a linear secular trend, smoking bans were associated with a decline in current smoking risk and smoking intensity and an increased likelihood of a quit attempt. The association with current smoking was greatest among participants with a bachelor's degree or higher. In models with a non-linear secular trend, pooled results were attenuated (confidence intervals included null), but effect modification results were largely unchanged. Findings suggest that smoking ban associations may be difficult to disentangle from other tobacco control interventions, and emphasize the importance of evaluating equity throughout policy implementation.