Comprehensive smoke-free legislation and displacement of smoking into the homes of young children in Hong Kong

Objective To investigate the effect of comprehensive smoke-free legislation in 2007 on the exposure of children to secondhand smoke (SHS) in Hong Kong. Methods Two cross-sectional questionnaire surveys were conducted, before (2006) and after (2008) the implementation of smoke-free legislation, among primary 2-4 students (equivalent to US grades 2-4) from 19 and 24 randomly selected schools, respectively. Adjusted ORs for SHS exposure at home and outside home post-legislation compared with pre-legislation were calculated. The strength of the association between SHS exposure and respiratory symptoms in each survey was used as an indirect indicator of the intensity of exposure. Results Among 3243 and 4965 never smoking students in the 2006 and 2008 surveys, the prevalence of SHS exposure in the past 7 days increased both at home (from 10.2% to 14.1%) and outside home (from 19.8% to 27.2%). Post-legislation, students were 56% more likely (p<0.01) to report SHS exposure at home coupled with an insignificantly stronger association between SHS exposure and respiratory symptoms. Similarly, students were 60% more likely (p<0.001) to report SHS exposure outside home in 2008, but the association between SHS exposure and respiratory symptoms became insignificantly weaker. Parental smoking rates were similar before and after legislation. Conclusions The prevalence of exposure to SHS at home and outside home have both increased among primary school students in Hong Kong post-legislation. Comprehensive smoke-free legislation without strong support for smoking cessation might have displaced smoking into the homes of young children.