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of the behavior of many people on multiple levels, and a broad systems approach to understanding both the individual ' s and the population ' s behavior is critical to achieving health promotion for all. Investigators cannot ignore the behavior of politicians who enact legislative policies that infl uence public health research, the behavior of medical care providers and insurers, and the behavior of industries (e.g., pharmaceuticals, tobacco) that may profi t from behavior that prevents disease or that harms the public. The confl uence of these many agencies defi nes complex behavioral ecological subcultures that determine health-related behavior and morbidity outcomes. We have used a Behavioral Ecological Model (BEM), where social ecological systems are emphasized and integrated with individual factors (e.g., genetic and personal learning histories) to understand and engineer change in the populations ' behavior ( Hovell, Wahlgren, & Adams, 2009 ;Hovell, Wahlgren, & Gehrman, 2002 ). In this context, we discuss the role of secondhand smoke exposure (SHSe) in the overarching process of tobacco control.This article describes the BEM, how it applies to SHSe research, and how elevating SHSe as the key target within the overarching tobacco control science may be a means of preventing tobacco addiction in whole populations. Need for a new modelThe tobacco industry creates more smokers and disease than clinicians can prevent by clinical services alone. The focus on clinical care is understandable, as it helps seriously damaged members of society, but it only indirectly contributes to prevention. Alternatively, smoke-free policies and increased taxation hold promise for complete tobacco control, where no one uses tobacco products. Such policies are consistent with the BEM and illustrate a more comprehensive prevention model. Popular theories offer " rational " or cognitive models of decision making that depend on understanding the health AbstractIntroduction: This article outlines a theoretical framework for research concerning secondhand smoke exposure (SHSe) prevention as a means to curtail the tobacco industry. Methods:The Behavioral Ecological Model (BEM) assumes interlocking social contingencies of reinforcement (i.e., rewards or punishments) from the highest level of society (e.g., taxing cigarette sales) to physiological reactions to nicotine that infl uence smoking and SHSe. We review selected research concerning both policy and clinical efforts to restrict smoking and/or SHSe. Results:Research to date has focused on smoking cessation with modest to weak effects. The BEM and empirical evidence suggest that cultural contingencies of reinforcement should be emphasized to protect people from SHSe, especially vulnerable children, pregnant women, the ill, the elderly, and low-income adults who have not " elected " to smoke. Doing so will protect vulnerable populations from industry-produced SHSe and may yield more and longer-lasting cessation. Conclusions:Interventions that reduce SHSe may serve as a Trojan horse to...

Interventions are needed to protect the health of children who live with smokers. We pilot-tested a real-time intervention for promoting behavior change in homes that reduces second hand tobacco smoke (SHS) levels. The intervention uses a monitor and feedback system to provide immediate auditory and visual signals triggered at defined thresholds of fine particle concentration. Dynamic graphs of real-time particle levels are also shown on a computer screen. We experimentally evaluated the system, field-tested it in homes with smokers, and conducted focus groups to obtain general opinions. Laboratory tests of the monitor demonstrated SHS sensitivity, stability, precision equivalent to at least 1 µg/m3, and low noise. A linear relationship (R2 = 0.98) was observed between the monitor and average SHS mass concentrations up to 150 µg/m3. Focus groups and interviews with intervention participants showed in-home use to be acceptable and feasible. The intervention was evaluated in 3 homes with combined baseline and intervention periods lasting 9 to 15 full days. Two families modified their behavior by opening windows or doors, smoking outdoors, or smoking less. We observed evidence of lower SHS levels in these homes. The remaining household voiced reluctance to changing their smoking activity and did not exhibit lower SHS levels in main smoking areas or clear behavior change; however, family members expressed receptivity to smoking outdoors. This study established the feasibility of the real-time intervention, laying the groundwork for controlled trials with larger sample sizes. Visual and auditory cues may prompt family members to take immediate action to reduce SHS levels. Dynamic graphs of SHS levels may help families make decisions about specific mitigation approaches.

The prevalence and pattern of early pregnancy alcohol consumption in this sample of Latinas is similar to patterns noted in other race/ethnic groups in the U.S. Level of knowledge about FAS and awareness of warning messages was not protective for early pregnancy alcohol consumption, suggesting that specific knowledge was insufficient to prevent exposure or that other factors reinforce maintenance of alcohol consumption in early pregnancy. Selective interventions in low-income Latinas are warranted, and should be focused on women of reproductive age who are binge or frequent drinkers and who are at risk of becoming pregnant.