ORIGINAL ARTICLE Household smoking restrictions among urban residents in China: individual and regional influences Tingzhong Yang • Lingwei Yu • Shuhan Jiang • Xueying Feng • Hong Xian • Randall R. Cottrell • Ian R. H. Rockett Received: 10 June 2014 / Revised: 4 March 2015 / Accepted: 5 March 2015 Ó Swiss School of Public Health 2015 Abstract Objectives The present study examines individual and regional influences on household smoking restrictions (HSR) in China. Methods Participants were 16,866 urban residents, who were identified through a multistage survey sampling process conducted in 21 Chinese cities. The data collection instrument was a self-administered questionnaire. The sample was characterized in terms of the prevalence of complete HSRs. Multilevel logistic regression models were used to examine individual and environmental influences on HSR. Results Almost 22 % of respondents reported HSR. Both individual and regional-level restrictions on smoking in the workplace were associated with HSR. There was a negative association between individual household income and HSR, and positive associations between HSR awareness of secondhand smoking (SHS), and smoking in smoke-free public places, respectively. Conclusions This study revealed individual and regional influences on HSR in China. Findings underscore that ef- forts to restrict smoking in Chinese households should emphasize environmental smoking restrictions, while si- multaneously raising public awareness of the perils of SHS. This information should be considered in designing inter- ventions to sustain and promote the adoption of HSR in Chinese and other populations. Keywords Tobacco control Á Secondhand smoke (SHS) Á Environmental tobacco smoke (ETS) Á Household smoking restrictions (HSR) Introduction Ecological models have emphasized that household smoking restrictions (HSR) are influenced by both indi- vidual and environmental variables. Many studies have shown that demographic and social variables are associated with HSR (Gilpin et al. 1999; Pizacani et al. 2003; Shelley et al. 2006). Smokers and individuals who lack awareness that secondhand smoke (SHS) is harmful to health are less likely to report a complete household smoking ban com- pared to non-smokers and those who do believe SHS is harmful (Gilpin et al. 1999; Shelley et al. 2006). Other studies found that indoor clean air laws in public places or smoke-free workplaces are associated with large increases in voluntary HSR (Cheng et al. 2001; Akhtar et al. 2009). A better understanding of these connections would help im- prove the design and implementation of public health interventions and policies. However, most HSR studies only examined individual-level correlates (Shelley et al. 2006; Cheng et al. 2001; Akhtar et al. 2009). Furthermore, Chinese studies have focused on the description of HSR T. Yang (&) Á L. Yu Á S. Jiang Á X. Feng Center for Tobacco Control Research/Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou 310058, China e-mail: Tingzhongyang@zju.edu.cn H. Xian Department of Biostatistics, Saint Louis University, St. Louis, MO 63104-1314, USA R. R. Cottrell Public Health Studies Program, School of Health and Applied Human Sciences, University of North Carolina, Wilmington, NC 28403, USA I. R. H. Rockett Department of Epidemiology, School of Public Health, and Injury Control Research Center, West Virginia University, Morgantown, WV 26506-9190, USA Int J Public Health DOI 10.1007/s00038-015-0672-0 123