A Multilevel Test of Constrained Choices Theory: The Case of Tobacco Clean Air Restrictions

Social contexts have proven to be profound influences on health. According to Bird and Rieker’s (2008) sociology of constrained choices, decisions and priorities concerning health are shaped by the contexts – including policy, community, and work/family – in which they are formulated. While each of these levels has received attention in the original and subsequent research, we contend the constrained choices theory provides a powerful multilevel framework for modeling health outcomes. We apply this framework to tobacco clean air restrictions, combining a database of all tobacco policies with the National Longitudinal Survey of Youth 1997 (n=8,984) from ages 19-31. Using multilevel panel models, we find that clean air policies lower the odds of past 30 day smoking (OR=0.788, p<.05) and dependence (OR=0.694, p<.05), while controlling for other policy, community, and individual-level constraints. We also find unique between- and within-person effects. The effect on any recent smoking has a within-person effect; that is, a clean air policy reduces a given person’s odds of any smoking over time (OR=0.770, p<.05). By contrast, we see a between-person effect on daily pack smoking, such that policies distinguish between individuals who smoke at this level (OR=0.497, p<.05), but do not affect a specific person’s use. Lastly, we find that clean air policies influence recent smoking for males (OR=0.627, p<.001) but not for females, supporting constrained choices theory’s argument that gender is not and does not operate as a fundamental cause of health disparities. These results demonstrate that policies restricting public smoking influence tobacco use over time even in the face of more proximal constraints. In sum, we argue for the broad applicability of the theory of constrained choices beyond commonly cited findings regarding gender and biological influences; it is a powerful theoretical framework that permits the simultaneous consideration of multiple contextual influences on health-related decisions.