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This study evaluates the association between smoking rates and mortality from circulatory system diseases (CSD) after implementing a series of smoking bans in Macao (China). (1) Background: Macao phased in strict total smoking bans since 2012. During the past decade, smoking rates among Macao women have dropped by half. CSD mortalities in Macao also show a declining trend. (2) Method: Grey relational analysis (GRA) models were adopted to rank the importance of some key factors, such as income per capita, physician density, and smoking rates. Additionally, regressions were performed with the bootstrapping method. (3) Results: Overall, smoking rate was ranked as the most important factor affecting CSD mortality among the Macao population. It consistently remains the primary factor among Macao’s female population. Each year, on average 5 CSD-caused deaths were avoided among every 100,000 women, equivalent to about 11.45% of the mean annual CSD mortality. (4) Conclusions: After the implementation of smoking bans in Macao, the decrease in smoking rate among women plays a primary role in the reduction in CSD mortality. To avoid excess CSD mortality due to smoking, Macao needs to continue to promote smoking cessation among the male population.

BACKGROUND: Studies are needed to understand the association between self-reported home smoking bans and objective measures of in-home smoking according to smokers’ ethnicity/nativity. METHODS: Data came from a trial that used air particle monitors to reduce children’s secondhand smoke exposure in smokers’ households (N = 251). Linear regressions modeled (a) full home smoking bans by ethnicity/nativity, and (b) objectively measured in-home smoking events, predicted by main and interaction effects of self-reported home smoking bans and ethnicity/nativity. RESULTS: Among smokers reporting < a full ban, U.S.-born and foreign-born Latinos had fewer in-home smoking events than US-born Whites (p

BackgroundConcerns about smoking displacement from public places to private amenities aroused following smoking ban implementation in Bavaria in 2008. We analysed children’s exposure to second-hand smoke (SHS) before and after the ban, its effect on children’s health and prevalence of active smoking in adults.MethodsSix cross-sectional surveys (n = 32,443) on pre-school children in Bavaria were analysed, two surveys before the smoking ban in years 2004 and 2005 (S1 and S2) and four after the ban in 2008, 2012, 2014 and 2016 (S4, S6, S7 and S8). Using multivariable logistic regression, we analysed change in children’s intra- and extrauterine SHS exposure and its adverse health effects (Asthma, wheezing, bronchitis and neurodermatitis) as well as change in parental active smoking.ResultsThe response rates were 78% for S1, 73% for S2, 61% for S4, 62% for S6, 56% for S7 and 54% for S8. Odds of parents never smoked at home in presence of children increased significantly from before to after the ban with odds ratios (OR) 1.17 (CI95%1.01–1.35), 1.65 (CI95%1.39–1.95), 2.85 (CI95%2.32–3.51), 2.24 (CI95%1.84–2.72) and 3.66 (CI95%2.89–4.63) for S2, S4, S6, S7 and S8, respectively with S1 as reference. Compared to S4, odds of parents who were not actively smoking is significantly higher in S7 (OR = 1.13 (CI95%1.03–1.24)) and S8 (OR = 1.24 (CI95%1.13–1.36)). The odds of mothers who never smoked during pregnancy increased over time with OR = 1.22 (CI95%1.06–1.40) for S2 and 1.57 (CI95%1.33–1.86) for S8 compared to S1. Adverse health effects related to children’s exposure to SHS are significantly less in S8 compared to S1.ConclusionAfter 11 years of smoking ban in Bavaria, smoking displacement to homes was disproved. Exposure of children to SHS intrauterine and at home is decreasing. Number of parents who are not actively smoking is increasing over time. Prevalence of health problems in children related to exposure to SHS is decreasing.

Introduction Thirdhand smoke (THS) is the toxic residue of tobacco smoke that persists long after tobacco smoking on the clothing and hair of smokers and in the surrounding environment. This study aimed to assess parents’ beliefs about THS in terms of harm and persistence in the environment and evaluate associations between parents’ THS beliefs and home smoking rules. Methods A sample of parents living in Kuwait were enrolled in a cross-sectional study. Parents reported home smoking rules (strict, partial, and no, home smoking ban) and completed the 9-item Beliefs About ThirdHand Smoke (BATHS) scale that assessed parents’ overall, health, and persistence beliefs about THS. Associations between the quartiles of THS overall, health, and persistence beliefs scores and home smoking rules were evaluated using a modified Poisson regression, and adjusted prevalence ratios (APR) and 95% confidence intervals (CI) were estimated. Results In total, 536 parents (404 females) were enrolled in the study, with 42.0% (n=225) and 43.6% (n=234) reporting a strict or partial home smoking ban, respectively. The prevalence of a strict home smoking ban was higher among never smokers than among ever smokers (49.1% vs 25.2%, p

Objective The present study developed a measure assessing the emotional responses, "Displacement Imposition," of cigarette and e-cigarette users on a college campus with a smoking/vaping ban. It also examined the relationship between Displacement Imposition and readiness to quit smoking/vaping, and how this relationship differed between cigarette and e-cigarette users. Participants Participants (N = 297) were from a large, Midwestern university. Methods Participants completed online questionnaires assessing demographics, cigarette and e-cigarette use, Displacement Imposition, and readiness to quit. Results All six Displacement Imposition items loaded onto a single factor. A significant interaction emerged between Displacement Imposition and product use in predicting readiness to quit. At high levels of Displacement Imposition, cigarette users were less ready to quit than e-cigarette users. Conclusions Findings suggest restrictions imposed on cigarette and e-cigarette users were associated with reduced readiness to quit. Findings inform tobacco control policies as tobacco denormalization may increase the burden placed on tobacco users.

BackgroundAn end date for smoking has been adopted in several countries and is now being discussed by governments all over the world. However, little is known about temporal changes in citizens’ support for a future smoking ban.AimTo examine temporal changes in support for a future smoking ban and for increasing taxes on tobacco in Denmark, and to explore whether these changes differ across sex, age, educational attainment, smoking status and between smokers with/without intention to quit.MethodThe study was based on two waves of ‘The Danish Capital Region Health Survey’ conducted in 2013 and 2017. The pooled study sample included 96 521 citizens aged ≥16 years old.ResultsPublic support for a future smoking ban increased from 30.6% in 2013 to 50.3% in 2017, whereas support for increasing tobacco taxes remained unchanged at 59%. Support for a future smoking ban increased significantly in almost all subgroups from 2013 to 2017: Support among daily smokers increased by 27% between 2013 and 2017. Support among never smokers was almost 2.63 times higher than among smokers in 2013 and increased further in 2017 (OR: 2013=2.63; 2017=5.13).ConclusionThis study indicates a readiness to support a future smoking ban and increasing tobacco taxes. Support for a future smoking ban has increased from 2013 to 2017 among both young people and adults. By 2017, about half of the population supported a future smoking ban and increasing tobacco taxes. Findings may help inform policy-making related to endgame strategies.

Objectives It is especially difficult for hospitality workers to avoid secondhand smoke (SHS), meaning that they are likely particularly vulnerable to the effects of SHS. The authors aimed to determine the degree to which smoke-free laws protect hospitality workers from SHS exposure, by examining biochemical markers of such exposure. Material and Methods This was a cross-sectional study examining SHS exposure in non-smoking employees working in hospitality settings where smoking is prohibited or permitted. The following biomarkers were selected: cotinine and tobaccospecific nitrosamines, which are known to measure SHS exposure, and 2 representative carcinogens: 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK). The authors compared these biomarkers between 3 hospitality settings. A descriptive analysis was performed. In addition, they conducted 1-way and 2-way analysis of covariance (ANCOVA) to compare the biochemical markers. Results Smoking substances were identified by smoking ban levels. In the case of hair nicotine and urine cotinine, their concentrations were lower in areas with a complete smoking ban than in both areas with a separate smoking room and no smoking ban; however, there was no statistically significant difference between these. In the case of dust NNK, its level was the lowest in areas with a complete smoking ban. To confirm the smoking ban effect by hospitality settings, the authors checked the results of the 2-way ANCOVA. In karaoke and billiard halls, the dust NNK concentrations were significantly higher in areas with no smoking ban than in areas with a separate smoking room. Conclusions Exposure to SHS is more prevalent in places that are more lenient when it comes to smoking (e.g., Internet cafés) than in places that are not (e.g., restaurants and cafés), even when smoking is similarly prohibited in both types of places. Int J Occup Med Environ Health. 2021;34(1):53–67

Introduction The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) was the first health treaty that requires state parties to adopt and implement the MPOWER package. The aim of this study is to review the current status of tobacco control policies in Tunisia according to the WHO FCTC recommendations. Methods This paper is a critical narrative literature review in which information was obtained from peer-reviewed articles, official government documents, reports, decrees and grey literature in French, Arabic and English. Results Modest progress in FCTC implementation in Tunisia was noted. The smoking ban in public places is not regularly or largely enforced. The advertising and promotion for tobacco and its products is prohibited by law, but, the ban does not cover the display and visibility of tobacco products at points-of-sale, through the internet, and the depiction of tobacco or tobacco use in entertainment media products. Health warnings on tobacco products consist only of text and do not exceed 30% of the main display areas but are expected to increase to 70% with graphics and text when the new law is passed. Conclusions Effective intervention efforts are urgently required. These actions should include accelerating the adoption of a new law, enforcing the present law and the new one once adopted, developing an advocacy and argument about the positive impact on state budget balance, increasing taxes, combating smuggling and illicit manufacturing and counterfeiting, increased education, increased smoking cessation support and implementing periodic surveillance.

Introduction Enclosed designated smoking areas (DSAs) and smoking zones are allowed in food-serving venues in Kazakhstan. Air quality in smoke-free foodserving venues, in venues with smoking throughout, in those with DSAs and those with smoking zones, is not fully understood. Methods A cross-sectional study with aim to evaluate PM 2.5 concentrations in the venues with mixed smoking was conducted from September to October 2017 in Almaty, the largest city of Kazakhstan. A total of 44 rooms within the selected 29 venues were evaluated: 100% smoke-free (5), non-smoking zones (7), smoking zones (7), non-smoking venues with DSAs (8), venues that allow smoking throughout (9), and DSAs (8). Real-time PM 2.5 measurement was conducted by TSI SidePak AM510 Personal Aerosol Monitor and used to rank health-risk assessment using the Air Quality Index developed by the U.S. Environmental Protection Agency. Results Smoke-free food-serving venues had moderate levels of air quality with mean PM 2.5 of 26.2 μg/m 3 while non-smoking zones inside venues that also permitted smoking had a mean of 56.5 μg/m 3 , corresponding to unhealthy air quality. Venues restricting smoking only to DSAs also had unhealthy air quality in non-smoking areas (mean PM 2.5 = 87.6 μg/m 3 ) while DSAs had hazardous levels of air quality (mean PM 2.5 = 647.9 μg/m 3 ). Smoking zones inside the venues and venues allowing smoking throughout had a mean PM 2.5 of 180.3 and 182.0 μg/m 3 , respectively, ranking as very unhealthy. On average 3.5 persons were observed in DSAs with mean volume of 38.9 m 3 . Cigarette and/or hookah were the major source of PM 2.5 . The higher the smoker density the poorer the air quality in the venue. Conclusions Hazardous level of PM 2.5 due to tobacco products inside DSAs demonstrated the low efficiency of a smoking ban with exemptions. A complete smoking ban in food-serving venues should be in place to fully protect people from hazardous air quality conditions.

ObjectivesThis study quantified the secondhand smoke (SHS) concentration in a sample of public places in Vietnam to determine changes in SHS levels 5 years after a public smoking ban was implemented.MethodsTwo monitoring campaigns, one in 2013 (before the tobacco control law was implemented) and another in 2018 (5 years after the implementation of the law) were conducted in around 30 restaurants, cafeterias and coffee shops in major cities of Vietnam. Concentrations of PM2.5, as an indicator of SHS, were measured by portable particulate matter monitors (TSI SidePak AM510 and Air Visual Pro).ResultsThe geometric mean PM2.5 concentration of all monitored venues was 87.7 µg/m3 (83.7–91.9) in the first campaign and 55.2 µg/m3 (53.7–56.7) in the second campaign. Pairwise comparison showed the PM2.5 concentrations in the smoking observed area was triple and double those in the non-smoking area and the outdoor environment. After adjusting for sampling locations and times, the SHS concentration 5 years after the implementation of the tobacco control law reduced roughly 45%.ConclusionThe study results indicate an improvement in air quality in public places in Vietnam via both the reduction in PM2.5 levels and the number of people observed smoking. However, greater enforcement of the free-smoke legislation is needed to eliminate SHS in public places in Vietnam.

Smoking is recognized as the major cause of lung cancer. Healthcare professionals play an important role in lung cancer prevention policies, as they act as a source of guidance for patients and advocates. The following survey evaluated prevalence, knowledge, and attitudes toward tobacco smoking among a sample of workers in "IRCCS Istituto Tumori "Giovanni Paolo II" of Bari, an Italian cancer hospital. An anonymous questionnaire was completed by 104 healthcare professionals to collect personal and occupational data about smoking status, knowledge about the harms of smoking, current legislation in place, Second-Hand Smoke (SHS) awareness, and, for ex-smokers, the reasons for quitting. Among participants, 17.8% were current smokers, 26.2% former smokers, and 56% never smoked. Only 40% acknowledged that the smoking ban is generally respected, and 63.2% reported that they smoke during working hours. Most of the participants perceived tobacco control policy as an efficient way to protect public health. Currently, the implementation of Italian anti-smoking legislation has so far improved neither smoking cessation rates nor the will to quit smoking completely. Our experience highlights that to date the anti-smoking strategies have limited efficacy even in a cancer center; in fact, there is still a large prevalence of smokers among hospital personnel. Therefore, it is strongly suggested that interventions be shared with all healthcare workers, specifically aimed at developing a culture of health promotion.

Objectives Prisons in Scotland were one of the few workplaces exempt from the 2006 comprehensive smoking ban in indoor public places, excluding the prison workforce from the health benefits of smokefree workplaces. The November 2018 introduction of comprehensive restrictions on smoking in Scottish prisons aimed to protect prison staff and people in custody from the harmful impacts of second-hand smoke (SHS) exposure. This study presents SHS exposure data gathered after smokefree policy implementation and compares these with data gathered during and before policy development. Methods Dylos DC1700 monitors were used to measure concentrations of fine particulate matter (PM2.5) derived from SHS across Scotland’s 15 prisons. Six days of fixed-site monitoring (09.00 22 May 2019 to 09.00 28 May 2019) were conducted in residential halls in each prison 6 months post-smokefree policy implementation. Prison staff task-based measurements were conducted to assess concentrations of SHS in various locations (e.g. gyms and workshops) and during specific activities (e.g. cell searches, maintenance, and meal service). Utilizing the fixed-site monitoring data, typical daily PM2.5 exposure profiles were constructed for the prison service and time-weighted average (TWA) exposure concentrations were estimated for the typical shift patterns of residential staff pre- and post-smokefree policy implementation. Staff perceptions of changes to SHS exposure were assessed using online surveys. Results Analysis of both fixed-site and mobile task-based PM2.5 measurements showed the smokefree policy implementation was successful in reducing SHS exposures across the Scottish prison estate. Measured PM2.5 in residential halls declined markedly; median fixed-site concentrations reduced by more than 91% compared with measures in 2016 before policy announcement. The changes in the TWA concentrations across shifts (over 90% decrease across all shifts) and task-based measurements (89% average decrease for high-exposure tasks) provide evidence that prison staff exposure to SHS has significantly reduced. Following smokefree policy implementation, the majority of staff reported no longer being exposed to SHS at work. Conclusions To our knowledge, this is the first comprehensive international study to objectively measure SHS levels before, during, and after implementation of a smokefree policy across a country’s prison system. The findings confirm that such a policy change can be successfully implemented to eliminate occupational exposures to SHS. The results are highly relevant for other jurisdictions considering changes to prison smoking legislation.

A policy proposal to ban public housing smoking indoors has received support, but it is unclear how certain affected groups, specifically smokers in housing units, perceive such a policy. To review the literature on attitudes and perceptions of housing unit tenants towards an indoor smoke-free housing policy, using various databases, we searched articles for attitudes towards smoking ban enforcement in housing units. We identified fourteen articles. Non-smokers heavily favored indoor policies and current smokers heavily opposed them. Current smokers represented a substantial minority in the reviewed articles, resulting in overall outcomes of the surveys driven by non-smokers. Studies investigating attitudes about housing smoking bans largely represent the views of non-smokers and lack data about barriers and concerns of tenants who do not support a smoke-free policy. Future studies should investigate if such a discrepancy impacts the efficacy of smoke-free housing policies.

Objective: This study evaluates the effectiveness of a smoke- and tobacco-free campus policy by examining the volume, density, and location of discarded cigarette butts before and after the impleme...

The objective of this study was to determine the effect of smoking ban in eateries on smoking behaviors and intention to quit smoking among adult smokers in Klang Valley. A validated questionnaire was utilized for this study whereby three variables of the study (socio-demographic characteristics, smokers attitude, and intention to quit smoking) were measured. The structured questionnaire contained closed ended questions where present of dichotomous(yes/no), multiple choice questions and 7-point likert scale questions. 600 questionnaires were distributed to target respondents in eateries of Klang Valley. The inclusion criteria were local citizen of Malaysia, those who gave consent to take part in the study, literate in English, smokers aged 18 years old and above. The data were analyzed utilizing SPSS software version 21.0. There were 504 completed and usable responses received, which represented an 84% response rate. Majority of smokers in Klang Valley were male which constituted around 78.2% of the respondents. Manufactured cigarette, 75.2% was the most preferred type of nicotine among smokers. Smokers attitude and social support with a smoking ban in restaurants and eateries was significantly associated with intention to quit smoking. 73.8% of smokers agree that the smoking ban in eateries and restaurants have reduced their daily smoking frequency and 58.3% of smokers agreed that the nationwide smoking ban at eateries and public places aspire them to quit smoking.Smoking ban is beneficial to help reduce prevalence of smoking among smokers that in turn helps to reduce secondary smoking and burden of non-communicable diseases in the long run. Though only a little over half of the respondents claimed that the ban inspires them to quit smoking, this is a positive start as the ban was just introduced. When effectively implemented, they are seen as an important element of policy to support behavior change in favor of a healthy lifestyle. The Ministry of Health should push forward with the ban on public smoking as soon as possible. The ban should be in tandem with efforts to help smokers quit. Implementing this scheme nationwide would be a remunerative move to help strive for a better health and cleaner environment for this country.

OBJECTIVES: This study aimed to assess the impact of the latest smoke-free legislation on hospital admission rates due to smoking-related diseases in Spain. STUDY DESIGN: A retrospective cohort study was conducted to evaluate changes in hospital admission rates for cardiovascular, respiratory diseases, and smoking-related cancer in Valencia, Spain, during the period 1995-2013. Law 28/2005 and then law 42/2010 prohibited smoking in bars and restaurants as well as playgrounds and access points to schools and hospitals. METHODS: General population data by age and sex were obtained from the National Institute of Statistics census. Data on hospital admissions were obtained from the Minimum Basic Data Set. Diagnoses were codified according to the International Classification of Diseases-9th revision. Data from all hospitals of the Valencian Community from 1995 to 2013 were analysed. Trend analyses in the periods before and after the approval of the 2005 law were conducted using least-squares linear regression models. RESULTS: Adjusted hospital admission rates per 100,000 inhabitants for cardiovascular diseases significantly decreased after the 2005 Law (from 550.0/100,000 in 2005 to 500.5/100,000 in 2007), with a further decrease (to 434.6/100,000) in 2013, after the 2010 Law. Reductions in hospital admissions were seen in men and women, although declining trends were more marked in men. Hospital admission rates for respiratory diseases showed a reduction of a lower magnitude, whereas for smoking-related cancer admissions there was a slight decline only among men. CONCLUSIONS: The Spanish comprehensive smoking ban resulted in a remarkable reduction of the adjusted rate of hospital admissions mainly associated to cardiovascular diseases. The decrease in the number of persons requiring in-patient care is relevant and may be viewed as an improvement of the public's health.

This study aims to determine whether previous exposure to a total prison smoking ban is associated with a reduction in daily smoking postrelease and to identify the factors associated with daily tobacco use. Demographics, incarceration history, and substance use data were collected from the 2016 National Prisoner Entrants' Blood Borne Virus Survey for 389 Australian prison entrants. Predictors of daily smoking among those exposed to a smoking ban were illicit drug use and Indigenous status. No significant association was found between current daily smoking and recent exposure to a prison smoking ban, suggesting that the majority of Australian prisoners exposed to a tobacco ban while incarcerated will return to smoking once released. Complementary and culturally specific interventions supporting abstinence postrelease should be considered.

Objectives:Whereas smoke-free housing (SFH) has the potential to protect residents from tobacco smoke, evidence suggests that SFH could lead to increased indoor smoking. In this study, we examine how perceptions of a residential smoking ban could be related to non-compliance.Methods:We conducted 8 focus group interviews of low-income housing residents living in Norfolk, Virginia (N=53). Interviews were semi-structured and based on a list of guided questions related to SFH compliance, developed in partnership with a standing community advisory board comprised of low-income housing residents.Results:Several themes emerged, including pervasive non-compliance, perceived unfairness and shame, barriers to compliance, and distrust of the housing authority. Smokers reported behavior primarily motivated by punishment avoidance, rather than out of any perceived obligation to comply with the ban.Conclusions:Results led us to consider Procedural Justice Theory as a conceptual framework, in which compliance is directly related to perceptions about the legitimacy of a rule or authority. When compliance is low due to a lack of perceived legitimacy, SFH should be adapted to promote changes in smoking behavior. We offer specific theory-supported adaptations to SFH focused on trust-building and improving perceived fairness.

Several jurisdictions have introduced prison smoking bans, responding to concerns around the health of people in custody (hereafter ‘prisoner’ for brevity) and staff, legal challenges and maintenance costs.1 2 Fears of disorder following bans are often expressed in advance.3–5 Although generally unfounded,6 7 such fears may reduce the stakeholder support that is vital for successful implementation.8 A complete prisoner smoking ban (staff smoking was already banned) was introduced in all 15 Scottish prisons in November 2018, precipitating no significant incidents.9 It has been evaluated by the three-phase Tobacco In Prisons study (TIPs).3 4 10 TIPs Phase 1 occurred before the ban’s announcement; Phase 2 following the announcement, but before policy implementation (during which rechargeable e-cigarettes became available to prisoners); and Phase 3 following implementation. This novel analysis uses TIPs data to examine prisoners’ and prison staff’s opinions about prison smoking bans over the course of implementation. Prison staff surveys were administered online, with links and reminders circulated to staff contacts …

Introduction Exposure to secondhand smoke (SHS) poses serious and extensive health and economic-related consequences to European society and worldwide. Smoking bans are a key measure to reducing SHS exposure but have been implemented with varying levels of success. We assessed changes in the prevalence of self-reported SHS exposure and smoking behavior in public places among smokers in six European countries and the influence of the country’s type of smoking ban (partial or total ban) on such exposure and smoking behavior. Aims and Methods The EUREST-PLUS ITC Europe Surveys were conducted among adult smokers in Germany, Greece, Hungary, Poland, Romania, and Spain in 2016 (Wave 1, n = 6011) and 2018 (Wave 2, n = 6027). We used generalized estimating equations models to assess changes between Waves 1 and 2 and to test the interaction between the type of smoking ban and (1) self-reported SHS exposure, (2) self-reported smoking in several public places. Results A significant decrease in self-reported SHS exposure was observed in workplaces, from 19.1% in 2016 to 14.0% in 2018 (−5.1%; 95% CI: −8.0%; −2.2%). Self-reported smoking did not change significantly inside bars (22.7% in Wave 2), restaurants (13.2% in Wave 2) and discos/nightclubs (34.0% in W2). SHS exposure in public places was significantly less likely (adjusted odds ratio = 0.35; 95% CI: 0.26–0.47) in the countries with total bans as compared to those countries with partial bans. Conclusion The inverse association between smoking in public places and smoking bans indicates an opportunity for strengthening smoke-free legislation and protecting bystanders from exposure to SHS in public places. Implications Prevalence of smokers engaging in and being exposed to smoking in public places varied by type of smoke-free legislation across six European Union countries in our study; those with total smoke bans reported significantly less exposure to SHS than those with partial or no bans. Our results indicate room for improvement, not only to decrease the prevalence of exposure to SHS in Europe but also to diminish the variability between countries through common, more restrictive smoke-free legislation, and importantly, strong and sustained enforcement.

Background Increasing the proportion of adults living in smoke-free homes is a US Healthy People 2020 objective. Complete home smoking bans are associated with higher odds of smoking cessation attempts and cessation duration. Sexual minority adults have disproportionality higher rates of smoking. This study investigates correlates of having a complete home smoking ban among sexual minority adults in California. Methods Secondary data analyses of the California Behavioral Risk Factor Surveillance System (CA BRFSS), 2014–2016. The CA BRFSS telephone survey of adults was conducted in English and Spanish and used random digit dial for landline and cell numbers. Weighted descriptives were stratified by sexual orientation and biological sex. Weighted bivariate and multivariable logistic regression analyses included only sexual minorities (i.e., lesbian, gay, bisexual) and were analyzed as a group and separately by biological sex to account for intragroup variances. The final weighted total of sexual minority adults (N = 359,236) included sexual minority adult females (N = 163,490) and sexual minority adult males (N = 195,746). Results Sexual minority adults in California had a lower prevalence of complete home smoking bans (Female 76.2%; Male 75.7%), higher prevalence of current cigarette smoking (Female 23.3%; Male 17.4%) and of e-cigarette use (Female 5.8%; Male 6.4%) than their straight counterparts. Sexual minorities that smoke everyday (Female Adjusted Odds Ratio (AOR) 0.26, 95% Confidence Interval (CI) 0.11–0.63; Male AOR 0.24, 95% CI 0.01–0.56) or some days (Female AOR 0.28, 95% CI 0.09–0.90) had lower adjusted odds of having a complete home smoking ban compared to those who never smoked. Conclusions Smoking everyday was the only consistent predictor of not having a complete home smoking ban among sexual minority adults. Focused efforts to increase prevalence of complete home smoking bans should address smoking status to improve health equity among sexual minority adults.

Purpose: To evaluate changes in compliance with a smoke-free outdoor seating policy before and after passage of a local regulation in 2015, which reinterpreted Philadelphia’s Clean Indoor Air Worker Protection Law to include outdoor seating areas of food or beverage establishments. Design: Natural experiment. Setting: Philadelphia, Pennsylvania. Sample: Food or beverage establishments (N = 108). Establishments were comprised of sit-down restaurants, cafes, quick-service restaurants, and bars. Measures: Presence of outdoor smoking and smoking-related litter on a given day were measured as binary variables. A geographic information system–based survey developed for this study was used to collect observational data. Analysis: Logistic regressions were used to determine the change in odds of observing outdoor smoking and smoking-related litter on a given day from baseline (preregulation) to follow-up (postregulation). Results: Compliance with smoke-free outdoor seating increased from 84.5% to 95.4% after passage and implementation of the regulation. Results showed a significant 75% decrease (odds ratio [OR]: = 0.25, 95% confidence interval [CI]: 0.08-0.67) in odds of outdoor smoking and a slight decrease in smoking-related litter (OR: 0.81, 95% CI: 0.39-1.65) at follow-up in establishments overall. However, at baseline, bars had higher odds of outdoor smoking (OR: 2.68, 95% CI: 0.57-12.72) and smoking-related litter (OR: 4.09, 95% CI:, 1.87-9.49) compared to sit-down restaurants. Conclusion: Results suggest there is high compliance with low-cost, low-burden, smoke-free outdoor seating policy and that enforcement is best targeted toward bars.

To examine the association between changes in contextual economic factors on childhood obesity in the US. We combined data from 2003, 2007, and 2011/2012 National Surveys of Children’s Health for 129,781 children aged 10–17 with 27 state-level variables capturing general economic conditions, labor supply, and the monetary or time costs of calorie intake, physical activity, and cigarette smoking. We employed regression models controlling for demographic factors and state and year fixed effects. We also examined heterogeneity in economic effects by household income. Obesity risk increased with workforce proportion in blue-collar occupations, urban sprawl, female labor force participation, and number of convenience stores but declined with median household income, smoking ban in restaurants, and full service restaurants per capita. Most effects were specific to low income households, except for density of supercenters/warehouse clubs which was significantly associated with higher overweight/obesity risk only in higher income households. Changes in state-level economic factors related to labor supply and monetary or time cost of calorie intake may affect childhood obesity especially for children in low-income households. Policymakers should consider these effects when designing programs aimed at reducing childhood obesity.

Background From July 2013 to January 2015, the smoking ban instituted in restaurants in South Korea gradually expanded to cover all restaurants and bars, moving by size of restaurant (≤99 m2, 100–149 m2, ≥150 m2). This study measured the impacts of the smoking ban for restaurants. Methods This study examined credit, check, or debit card sales data for every September and October from 2012 to 2015 in 711 census tracts in Seoul, South Korea. We accounted for total restaurant sales in each census tract. Our model controlled for the sales amounts for each census tract, type of restaurant, monthly business survey index, number of restaurants, daily average temperature, daily precipitation, and day of the week, and a dummy for census tract. Results These were some positive associations with increase in total sales. However, the significance of the coefficients was not consistent over this period. Overall, our results showed no significant negative effects of smoking ban policy on restaurants. Conclusions Smoking ban policies produced benefits in terms of health outcomes, without causing significant negative impacts on sales. Implications Although the owners of restaurants anticipated negative impacts on sales from smoking ban policies, the results of this study suggest that restaurants experienced no negative economic impacts on sales from policies with health benefits, which suggest that it would be reasonable to promote and keep on the smoking ban. Also, it is important to apply smoking ban policy to all targets without exclusion.

Background Electronic gambling machines (EGMs) are in casinos and community venues (hotels and clubs) in all jurisdictions in Australia, except Western Australia (only in casino). EGMs have a range of features that can affect how people gamble, which can influence losses incurred by users. The Northern Territory Government recently changed two EGM policies – the introduction of note acceptors on EGMs in community venues, and an increase in the cap from 10 to 20 EGMs in hotels and 45 to 55 in clubs. This study evaluates two changes in EGM policy on user losses in community venues, and tracks changes in user losses per adult, EGM gambler, and EGM problem/moderate risk gambler between 2005 and 2015. Methods Trends in venue numbers, EGM numbers, user losses and user losses per EGM by venue type and size are presented to determine if EGM policy changes affected user losses. Data from the 2005 and 2015 NT gambling surveys are used to determine EGM user losses per adult, per EGM gambler, and per EGM problem and/or moderate risk gambler, with several assumptions applied. Results From 2010 (post smoking ban) to 2013 real user losses were stagnant, but from 2013 to 2017, real user losses in community venues increased 19, 9, 8 and 5% per annum, with increases higher in clubs and hotels with the maximum allowable number of EGMs. Over the same period user losses in the two casinos declined by 13%. Between 2005 and 2015, estimated user losses per EGM problem/moderate risk and problem gambler increased by 5 and 34% respectively. Conclusions The analysis demonstrates that reductions in how much money gamblers can insert into an EGM (load-up limit), and/or the abolition of note acceptors, and reductions in the number of EGMs in venues is likely to reduce harm from EGM use. Given the demonstrated inability for Australian jurisdictions to identify and implement effective harm prevention and minimisation interventions, a national approach to gambling regulation in Australia may be desirable. Similarly, national co-ordination of research, particularly on EGMs and online betting is required to better understand changes in gambling policy on related harms.

Home smoking bans may be an effective way to promote tobacco cessation among treatment seeking smokers. Few studies have examined this relationship in a quitline setting. Data were obtained from 14,296 adults who were enrolled in a state quitline between January 2011 and July 2016. This study investigated whether cessation rates varied by changes in home smoking ban implementation between enrollment and 7-month follow-up. The impact of changes in home smoking bans on cessation at follow-up was significantly modified by having other smokers living in the home at follow-up (P < 0.0001). Among callers who did not live with other smokers in the home, the highest odds ratio of 30-day cessation was for callers who reported bans at follow-up only (OR = 10.50, 95%CI: 8.00, 13.70), followed by callers who reported bans at both enrollment and follow-up (OR = 8.02, 95%CI: 6.27, 10.30) and callers who reported bans at enrollment only (OR = 2.06, 95% CI: 1.47, 2.89) compared with callers with no home smoking bans. When callers reported that they lived with other smokers in the home, the effect of home smoking bans on cessation was much smaller. Quitlines should support the implementation of home smoking bans as a part of callers’ goal setting activities to achieve tobacco cessation.

Home smoking bans can reduce tobacco smoke exposure, but little is known about the impact for Chinese American household pairs. In this study of 202 household pairs with low acculturation, 53.9% reported a home smoking ban, 31.7% had inconsistent reports, and 14.4% reported no ban. With decreasing home smoking ban enforcement, more nonsmokers had tobacco smoke exposure (66.1%–86.2%) as measured by the tobacco-specific nitrosamine biomarker urine NNAL (4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol). Despite reported bans, about one-quarter of nonsmokers still reported tobacco smoke exposure at home (23.6%–30%) within the past 2 months and three-quarters reported outdoor exposure. In adjusted regression analyses of geometric mean NNAL ratios, nonsmokers in households with no ban had over two times higher levels than nonsmokers in households with a ban: adjusted log NNAL ratio = 2.70 (95% CI 1.21, 6.03). Higher smoker NNAL level and nonsmoker English fluency were also significantly associated with nonsmoker NNAL levels. Nonsmoker levels in households with an inconsistent ban were not significantly different compared to those with a ban. Although home smoking bans were generally associated with lower NNAL levels, tobacco smoke exposure in this immigrant population with low English proficiency was higher than that of the general population. From a health equity standpoint, there is a need for broader implementation and enforcement of comprehensive smoke-free policies.

This study assessed the spatial dependence of daily tobacco consumption and how it is spatially impacted by individual and neighborhood socioeconomic determinants, and tobacco consumption facilities before and after a smoke-free implementation. Individual data was obtained from the Bus Sante ', a cross-sectional survey in Geneva. Spatial clusters of high and low tobacco consumption were assessed using Getis-Ord Gi*. Daily tobacco consumption was not randomly clustered in Geneva and may be impacted by tobacco consumption facilities independently of socioeconomic factors and a smoking ban. Spatial analysis should be considered to highlight the impact of smoke-free policies and guide public health interventions.

Introduction Smoking inside the home affects the health of both the smoker and family members via secondhand exposure. This research examined the impact of a community participation program on creating smoke-free homes in a suburban community in Thanyaburi district, Pathumthani province in Thailand. Methods The study involved families, with a smoker in the home, that were randomly assigned to intervention and control groups each containing 27 families. The intervention group was administered with the community participation program for smoke-free homes for 5 sessions during the 6-month period of study. The program included providing information on secondhand smoking and harms, knowledge about quitting smoking and healthcare support, practice skills, campaigns in the community, visiting and encouraging, and reflecting and evaluation. The control group was normally treated by the community committee and health volunteers. Data collection was undertaken at baseline and at 6 months after implementation by an interview with questionnaires. Results Our results show that after the implementation, the intervention group reported significantly higher mean score on skills in negotiating with smokers for a smoking-ban inside home and mean score on emotional support for non-smoking inside the home than those at baseline and those of the control group. The proportion having smoking ban home rules in the intervention group was significantly higher than at baseline and that of the control group (92.6% vs 18.5%). The proportion of smoke-free homes was higher in the intervention than in the control group (75% vs 0%). Conclusions These findings suggest that community participation programs for smoke-free home may be effective in raising awareness on the impact of secondhand smoke among family members and in working together to manage smoke-free home environments. The program may be applicable for further development within communities to achieve smoke-free homes.

Introduction: Tobacco use, often initiated in younger ages, is a serious health challenge worldwide. In Sweden, smoking has been prohibited on school grounds since 1994. Municipal environmental and health inspectors control the compliance of the ban. Nevertheless, the enforcement and maintenance of the ban are inadequate. The aim of the current study was to identify facilitators, barriers, and the potential for improved implementation of a 25-year outdoor school ground smoking ban in upper secondary schools.Materials and Methods: A process evaluation was conducted using semi-structured interviews with principals in upper secondary schools, local environmental and health inspectors, and local politicians (n = 30) in Stockholm County, with purposive sampling for informant recruitment. A qualitative content analysis of the transcribed interviews was performed.Results: Three main categories and 10 subcategories were generated from the interviews, revealing facilitators, barriers, and the potential for improvement of the implementation of the ban. A prominent facilitator of the ban was informed and engaged principals and inspectors. Prominent barriers were conflicting goals governing the schools, which reduce staffs' motivation to maintain the ban, unclear school ground boundaries, and lack of resources. Potential for improvement was found in a new tobacco act with an extended ban on smoking at school entrances, extended support for schools and staff to strictly enforce the ban, and a continued denormalisation of smoking in society.Conclusion: To achieve effective implementation of outdoor school ground smoking bans in upper secondary schools, authorities need to address conflicts between different goals governing the schools and give necessary support to the staff to strictly enforce the ban. Policies on smoke-free working hours in the municipalities along with tobacco restrictive policies in the surrounding society may increase the possibility to maintain the smoking ban in upper secondary school grounds.

Introduction Workplaces are important settings for implementation of smoke-free environments. In this study, we follow a medical production company with 677 employees that implemented one of the most stringent tobacco policies legally possible in Denmark – smoke-free work hours – which means that employees are not allowed to smoke during work time. This study explores tobacco use restrictions during work hours regarding readiness of implementation, focusing specifically on middle managers’ perceptions and considerations, as well as their perceived responsibility in enforcing these. Methods A case study is presented. Two focus groups of 10 middle managers were conducted, seven months before smoke-free work hours were implemented. The facilitators used open-ended questions, which consisted of a structured section with specific themes related to the implementation of smoke-free work hours. Focus groups were recorded, transcribed, and analyzed thematically. Results We identified five main themes: 1) Benefits of the new policy due to better health, lower sickness-related absences, increased productivity, and improved branding value; 2) Social interactions across smoking status; 3) Smoking is a private matter with ethical dimensions; 4) The role of middle managers and concerns about enforcement; and 5) Limited experience with resistance from the smoking employees. Conclusions The findings suggest that workplaces in the preparation phase should ensure that: 1) The middle managers gain training on how to talk with employees about smoking cessation; 2) The middle managers are equipped to handle the new policy and have a joint vision and understanding of why and how they should enforce it; and 3) Room is made for discussions on resistance and enforcementrelated challenges as well as ethical issues.

Introduction Involuntary exposure to secondhand smoke most frequently occurs at home, which is problematic for residents of multiunit housing (MUH). The primary objective of this study was to estimate the extent of secondhand smoke incursions into the homes of MUH smokers who banned smoking in their homes but lived in buildings where smoking is allowed. Methods We used data from Wave 9 of the International Tobacco Control Four Country Survey. We estimated 1) the prevalence of complete smoking bans among smokers living in single-family homes vs MUH in the United States (n = 3,208), Canada (n = 1,592), and the United Kingdom (n = 1,403) from 2013 to 2015; 2) the extent of secondhand smoke incursions into the homes of MUH smokers who banned smoking in their units but lived in buildings that allow smoking; and 3) MUH smokers' preferences for complete smoking bans in MUH. Weighted multivariable logistic regression estimated the country-specific adjusted prevalence of all outcomes. Results Overall, 53.0% of smokers living in single-family homes completely banned smoking in their homes, compared with 44.8% of smokers in MUH. Across all 3 countries, only 27.8% of MUH smokers reported that smoking was completely prohibited in their building. A similar percentage of MUH smokers who banned smoking in their home but lived in buildings allowing smoking reported a secondhand smoke incursion into their home in the United States (29.9%; 95% CI, 20.4%-41.5%), Canada (38.4%; 95% CI, 26.7%-51.6%), and the United Kingdom (24.7%; 95% CI, 15.7%-36.7%). Across all 3 countries, 36.1% (95% CI, 33.4%-38.9%) of smokers in MUH reported they preferred a complete smoking ban in all building areas. Conclusion A need remains to educate MUH operators and residents about the benefits of comprehensive smoke-free policies.

Smoke-free policies have been shown to significantly reduce secondhand smoke (SHS) exposure in private and public places. The objectives of this study were to: (1) to assess the prevalence and characteristics of voluntary smoke-free home rules in Poland, and (2) assess the association of smoke-free rules with self-reported SHS exposure in private homes. A cross-sectional survey was conducted in September 2019 with a nationally representative sample of 1011 individuals aged 15 and over. Nationally, 66.1% of individuals had a 100% smoke-free home rule (78.9% of non-smokers and 18.6% of smokers, p &lt, 0.001), while a further 24.6% had adopted a partial home smoking rule. SHS exposure in the home during past month was reported by 6.1% of respondents (11.5% of smokers and 4.5% of non-smokers, 0.001). The lowest level of SHS exposure (1.8%) was observed among respondents who had implemented a full smoke-free home rule. Non-smokers had higher odds of having adopted a total smoke-free home rule compared with smokers (aOR: 19.17, 95% CI: 12.89–28.50). Moreover, non-smokers had lower odds (aOR: 0.35, 95% CI: 0.20–0.61, 0.001) of self-reporting SHS smoke exposure at home. Although two-thirds of the Polish population have adopted a full smoke-free home rule in their homes, smokers continue to lag in adoption rates relative to non-smokers.

The current study employed socio-demographic, health and lifestyle, and academic variables to assess the prevalence and independent predictors of daily smoking, attempts to quit smoking, and agreement with total smoking ban at university.Students at the University of Turku (1,177) completed an online questionnaire that assessed socio-demographic, health and lifestyle, and academic characteristics, and three smoking variables (smoking, attempts to quit, agreement with total smoking ban at university). Bivariate relationships and multiple logistic regression assessed relationships between student characteristics and the three smoking variables before and after controlling for all other variables.Slightly80% of students never smoked, 16% were occasional, and about 6% were daily smokers, and about 40% had attempted to quit. Nearly half the sample agreed to total smoking ban at university. Physical activity, consuming alcohol, illicit drug/s use and daily smoking were significant independent predictors across1 of the three smoking variables. Age, health awareness, importance of achieving good grades, academic performance compared to peers, study burden, and mother's educational level were significant independent predictors of one of the three variables examined.Universities need to assess smoking, with specific focus on the modifiable independent predictors that were associated with1 the variables examined, to encourage physical activity and pay attention to reduce alcohol consumption and illicit drug/s and daily smoking, whilst targeting at-risk students. University strategies should be part of the wider country-wide effective tobacco control policies.

Background Prisons were one of few workplaces where smoking was still permitted after the smoking ban in indoor public places in Scotland in 2006. This study compares SHS exposure assessments in Scotland's 15 prisons six months after smokefree policy was introduced (in Nov 2018) with levels measured in 2016 before the policy was announced. Methods In 2016, 128,431 mins of PM2.5 (marker of SHS) concentration data were collected from residential halls and 2,860 mins for 'task-based' measures; 2019 figures were 126,777 and 3,073 mins. Six days of fixed-site monitoring in halls in each prison commenced on 22.5.19. Task-based measurements were conducted to assess SHS for specific locations and activities (e.g. cell searches). Typical daily PM2.5 exposure profiles were constructed for the prison service and time-weighted average exposure concentrations were estimated for shift patterns for residential staff pre- and post-implementation of the policy. Staff self-reports of exposure to SHS were gathered via surveys. Results Measured PM2.5 in residential halls declined markedly; median fixed-site concentrations reduced by > 91% compared to baseline. Changes in the task-based measurements (89% average decrease for high-exposure tasks) and time-weighted average concentrations across shifts (>90% decrease across all shifts), provide evidence that staff exposure to SHS has significantly reduced. The percentage of staff reporting no exposure to SHS rose post-ban. Conclusions This is the first study to objectively measure SHS levels before, during and after implementation of smokefree policy across a country's prison system. The dramatic reduction in SHS exposures confirm complementary qualitative data and stakeholder reports of the ban's success in removing tobacco. The findings show that SHS can be effectively eliminated through a well-applied smoking ban in the challenging context of prisons; and are highly relevant for other jurisdictions considering changes to prison smoking rules.

The objective of this study is to assess the impact of the California 1995 Smoke-Free Workplace Act (SFWA) on cigarette smoking prevalence in the population. We used survey responses related to cigarette smoking from the Behavioral Risk Factor Surveillance System (BRFSS) from 1990 to 2000. We utilize a synthetic control method which creates a weighted combination of control states to produce a single 'synthetic' control group to best approximate the counterfactual trend in California in the absence of the SFWA. Variables known to be associated with smoking were included to weight each state in the pre-intervention period as medians by state and included: distribution of race/ethnicity (White, Black, Asian, Hispanic), sex (Male/Female), marital status (married/unmarried), high school education (yes/no) and employment status (yes/no). We find evidence that there was a small decrease in population smoking prevalence in California in the year immediately following the SFWA, but this effect was not sustained beyond 1995. We hypothesize that one potential explanation for the lack of prolonged impact on population smoking prevalence is that there are sustained effects from the passage of 1989 California Proposition 99, which enacted an excise tax on tobacco products. Understanding how workplace smoking ban legislation affects population smoking behaviors is necessary to better inform policy development in other states and counties and to improve existing policies. Future work should consider the impact of smoking legislation impacts subgroups of the population by socioeconomic status, occupation or race/ethnicity.

Introduction The aim of the study is to assess the national level of compliance with the Chilean smoke-free legislation in the urban public transportation system. Material and Methods In this cross-sectional observational study, we studied a national representative sample of 475 vehicles obtained through a two-stage cluster sampling design in 2018. First, 57 municipalities were randomly selected, proportionally to the total number of public transportation vehicles. Second, within each municipality, a convenience sample of up to 4 taxis, 4 buses, and 2 metro coaches was observed. We determined the non-compliance level by systematic direct observation of smoking inside the cabin of the vehicle. We estimated the percentage of the visited vehicles where smoking was observed inside the cabin of the vehicle. Results The observation of metros, buses and taxis was completed in 24, 52, and 48, of the 57 sampled municipalities, respectively. Smoking was observed inside of about 2% of buses and 7% of taxis. Smoking was not observed in metro carriages. Overall, smoking was observed in almost 3% of the vehicles studied. A 3% noncompliance could expose a significant number of persons in public transportation to secondhand smoke, given that every 100 inhabitants results in about 84 rides a day of almost one hour duration. There are few comparable studies to put in an international context our results. In 2018, the year in which we collected the data, WHO considered that compliance with the law in public transportation was maximum. Our compliance estimate was lower, however WHO used a different methodology and its scope also included the inter-urban mobility, which we did not. Conclusions The study highlights the need to improve the enforcement of the smoke-free law in the transportation system in Chile, which presently is almost non-existent.

Objective: The current study tracked attitudinal and behavioral changes related to a campus-wide smoking ban. Participants: Students from 2 colleges in Massachusetts (N = 418; April 2014; N = 640 A...

BackgroundResearch on the effectiveness of school smoking policies on adolescents’ smoking behaviour remain inconclusive. This study evaluates the results of an outdoor school ground smoking ban at secondary schools on adolescents smoking behaviour, taking individual characteristics into account.MethodsData on 2684 adolescents from 18 Dutch secondary schools (nine with and nine without an outdoor smoking ban) were obtained at two moments. Associations between outdoor school ground smoking bans, individual characteristics, and smoking prevalence and frequency were measured. Multilevel logistic regression analyses were used. At schools with a ban implementation fidelity was checked.ResultsAlthough smoking prevalence and frequency appeared to make a slower increase at schools with an outdoor smoking ban compared with schools without an outdoor smoking ban, the differences were not significant. Differences between schools in the prevalence of smoking behaviour of students could mainly be explained by individual characteristics. Smoking prevalence and frequency were higher among adolescents with a positive attitude towards smoking and when significant others were more positive about smoking. Smoking prevalence and frequency were significantly lower when adolescents perceived it as easy not to smoke. Implementation fidelity was good at schools with a ban.ConclusionsNo short-term effects were found of an outdoor smoking ban. A longer follow-up time than 6 months is needed. In addition, future research should investigate effectiveness in relation to the enforcement of the ban, comprehensiveness of the ban and when it is prohibited to leave school grounds, as smoking behavior might be transferred off school grounds.

Introduction Ghana has a partial smoking ban with smoking allowed in designated smoking areas. Studies evaluating smoke-free laws are scarce in Sub-Saharan Africa. Evaluation of smoke-free laws is an effective means of measuring progress towards a smoke-free society. This study assessed the level of compliance to the provisions of the current smoke-free policy using air quality measurements for fine particulate matter (PM 2.5 ) in hospitality venues in Ghana. Methods This was a cross-sectional observational study conducted in 2019 using a structured observational checklist complemented with air quality measurements using Dylos monitors across 152 randomly selected hospitality venues in three large cities in Ghana. Results Smoking was observed in a third of the venues visited. The median indoor PM 2.5 concentration was 14.6 μg/m3 (range: 5.2–349). PM 2.5 concentrations were higher in venues where smoking was observed (28.3 μg/m3) compared to venues where smoking was not observed (12.3 μg/m3) (p

Background:Although outdoor smoking bans at school are becoming important, it remains unclear whether successful implementation is feasible and what conditions promote it. Therefore, this study evaluates the implementation process by identifying important factors.Methods:Interviews were held with directors of 24 secondary schools that had decided to implement an outdoor school ground smoking ban, to identify important factors during implementation. Additionally, observations were made before and (about 4 weeks) after implementation to evaluate adherence to guidelines. Data were analyzed using a thematic approach.Results:During implementation, the following items were important: smoking ban (eg, guidelines), school (eg, policy, enforcement, environmental factors, resources, etc), and external factors (eg, social environment). Four schools were unable to implement the ban, 20 schools implemented the ban but student adherence was low, and at 4 schools, staff members still smoked on school grounds.Conclusions:Although implementation is feasible, there are challenges. Schools need to apply a phased/dynamic process with ample lead time and clear communication of the policy. Directors should deal with offenders by strictly enforcing the ban and helping them stop smoking. This study offers information to help institutes implement an outdoor smoking ban to further protect adolescents from the harm of smoking.

Background Smoke-free laws aim at protecting against second-hand smoke and at contributing to change smoking behaviors. Impact evaluation studies can help understand to what extent they reach their goals. Simple before and after designs are often used but cannot isolate the effect of the policy of interest. Methods The short-term impact of the French smoking ban (2007-08) on smoking behavior outcomes was evaluated among smokers with data from the ITC project. We first conducted a before and after design on the French sample. Second, we added the UK (excluding Scotland) as a control group and finally used external pre-policy data from national surveys to control for bias arising from pre-policy trends. Results After one year post-implementation, the smoking ban led to a decrease in seeing people smoking in bars, restaurants and workplaces [estimated risk ratios (RR) of 8.81 IC95% (5.34-14.71), 2.02 (1.79-2.31) and 1.24 (1.16-1.33), respectively], as well as an increase in support for the smoke-free policy, but only in bars and restaurants [RR of 1.35 (1.15-1.61) and 1.25 (1.16-1.35)], respectively. No impact was found on smoking behaviors and on having a strict no smoking policy at home. The simple before and after design systematically overestimated the smoking ban's impact [e.g. RR of 29.9 (20.06-44.56) for observed smoking in bar, compared to 13.21 (7.78-22.42) with the control group, and 8.81 (5.34-14.71) with the correction from external data]. Conclusion When data are lacking to conduct quasi-experimental designs for impact evaluation, the use of external data could help understand and correct pre-policy trends.

Introduction A systematic review was conducted to evaluate the impact of public smoking bans on social inequalities in children’s secondhand smoke (SHS) exposure at home. Methods Five databases were electronically searched for articles on children’s SHS exposure at home related to public smoking bans. In addition, the gray literature and German public health journals were considered. Search was restricted to English and German publications. Of 3037 records screened, 25 studies fulfilled the inclusion criteria by either measuring SHS exposure before and after public smoking ban introduction or by comparing exposure between regions with and without smoke-free legislation. Studies were further examined whether they additionally reported on impacts on social inequalities in SHS exposure. Information on children’s SHS exposure at home in relation to smoke-free legislation were extracted by one reviewer and checked for accuracy by a second reviewer. According to Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Equity (PRISMA-E) guidelines for equity-focused systematic reviews, the PROGRESS-Plus framework was applied to data extraction and analysis with focus on social inequalities in SHS exposure. Results were visualized by a harvest plot. Results Eight studies gave results on the impact of public smoking bans on social inequalities in children’s SHS exposure. Whereas only one study indicated widening of the social gap in exposure, seven studies showed no impact or a reduction of social inequalities in exposure. Conclusions First evidence on short-term impact of public smoking bans does not support the assumption of intervention-generated inequalities in children’s SHS exposure at home. Future studies should focus on long-term equity impacts of smoke-free legislation. Implications There are substantial social inequalities in children’s SHS exposure in many countries. Both hypotheses on the effect of smoke-free legislation on children’s SHS exposure at home, the displacement hypothesis and the social diffusion hypothesis, did not take social inequalities into account. Up to now, only few studies analyzed the effects of smoke-free legislation on social inequalities in children’s SHS exposure at home. Public smoking bans had overall no negative impact on social inequalities in children’s SHS exposure at home. More consistent reporting of absolute and relative inequalities is needed to comprehensively assess equity impact of smoke-free legislation.

Introduction In jurisdictions permitting prisoner smoking, rates are high (c75%), with smoking embedded in prison culture, leading to secondhand smoke exposures among staff and prisoners and challenges for smoking cessation. Momentum is building to ban smoking in prisons, but research on staff and prisoner views is lacking. We address this gap, providing evidence on staff and prisoner views throughout all Scottish prisons. Methods Data were collected prior to the announcement of a (November 2018) prison smoking ban throughout Scotland. Mixed methods were used: surveys of staff (online, N = 1271, ~27%) and prisoners (questionnaire, N = 2512, ~34%); 17 focus groups and two paired interviews with staff in 14 prisons. Results Staff were more positive than prisoners about bans and increased smoking restrictions, although prisoner views were more favorable should e-cigarettes be permitted. Nonsmokers were more positive than smokers. Whilst 74% staff and 22% prisoners agreed bans were a good idea, both groups acknowledged implementation and enforcement challenges. Staff views were influenced by beliefs about: acceptability of the policy in principle and whether/how bans could be achieved. Although some voiced doubts about smoke-free policies, staff likened a ban to other operational challenges. Staff raised concerns around needs for appropriate measures, resources and support, adequate lead-in time, and effective communication prior to a ban. Conclusion We recommend that regular and open opportunities for dialogue within and between different stakeholder groups are created when preparing for prison smoking bans and that specific measures to address staff and prisoner concerns are incorporated into plans to create and maintain smoke-free environments. Implications To our knowledge, this study is the first to research staff and prisoner views across a whole prison system prior to implementation of smoke-free policies. The results highlight potential challenges and suggest measures, which might help to maximize the success of bans. Our results are relevant for prison service managers responsible for the forthcoming introduction of a ban in Scottish prisons (November 2018) and for other prison systems and comparable institutions planning smoke-free initiatives. Given that prison smoking bans may be contentious, we recommend creating regular and open opportunities for dialogue between stakeholders when preparing for and maintaining smoke-free environments.

More than 58 million nonsmokers in the U.S. encounter secondhand smoke that leads to tobacco-related diseases and deaths every year, making voluntary household smoking bans an important public health goal. American Indians/Alaska Natives are rarely included in research related to household smoking bans. Further, most studies dichotomize household smoking bans into complete bans versus partial/no bans, rendering it impossible to determine if partial and no bans are associated with different or similar risk factors. Using the 2014 Cherokee Nation American Indian Adult Tobacco Survey, our study sought to identify prevalence of household smoking bans, their extent, and their correlates in an American Indian population. This cross-sectional analysis used multinomial logistic regression to determine correlates of complete, partial, and no household smoking bans. Results indicated that approximately 84% of Cherokee households have a complete ban. Younger age, female gender, higher education, higher household income, respondent's nonsmoking status, good health, better awareness of harms related to secondhand smoke, visits with a healthcare provider within the past year, and children in the home were positively and significantly associated with complete household smoking bans. Additionally, there were notable differences between correlates related to partial bans and no bans. These results provide insight for the development of more appropriate interventions for American Indian households that do not have a complete household smoking ban.

Background Parents with less formal education are more likely to smoke indoors, causing socioeconomic disparity in children’s exposure to second-hand smoke. However, little is known about the roles of social factors in the socioeconomic gradients of indoor smoking. We tested the potential mediating role of perceived smoking norms on the associations between education and indoor smoking among parents who smoke. Methods In this cross-sectional study, 822 smoking fathers and 823 smoking mothers, who lived with young children and were members of a Japanese online survey panel, participated. Structural equation modelling tested the mediating effects of perceived descriptive and subjective norms on the association between education and indoor smoking. Results Perceived pro-smoking norms, which were more prevalent among less-educated parents, mediated the association between education and indoor smoking. Household smoking status and worksite smoking ban also mediated this association via perceived norms, but only for fathers. Perceived descriptive norms explained 28.5% of the association for fathers and 37.6% for mothers; the corresponding percentages for perceived subjective norms were 9.8% and 26.6%, respectively. Conclusions Perceived smoking norms, household smoking status, and a worksite smoking ban could be vital targets of a strategy aimed at reducing the socioeconomic disparity in parental home smoking behaviours.

Using nationally representative longitudinal data from Wave 1 to Wave 4 of the Population Assessment of Tobacco and Health Study in the United States, we examined whether the association between menthol cigarette use and smoking cessation was modified by race/ethnicity and e-cigarette use. Multivariable discrete-time survival models were fit to an unbalanced person-period data set (person n = 7423, risk period n = 18,897) for adult respondents (ages 25+) who were current established cigarette smokers at baseline. We found that adults who smoke menthol cigarettes had lower odds of smoking cessation, but the effect was modified by race/ethnicity as non-Hispanic (NH) Black menthol smokers had lower odds of quitting smoking than NH White or Hispanic menthol smokers. We also found that e-cigarette use was associated with higher odds of smoking cessation among both menthol and non-menthol smokers, but the association was stronger among menthol smokers. Our results suggest that a menthol smoking ban may have a favorable impact on smoking cessation for NH Black adults. In addition, our results also suggest that a menthol smoking ban may be more effective if menthol smokers have access to e-cigarettes as a way to quit cigarette use.

Transit workers constitute a blue-collar occupational group that have elevated smoking rates relative to other sectors of employed adults in the United States. This study analyzed cross-sectional tobacco survey data from 935 workers (60% African American; 37% female) employed at an urban public transit agency in California. Prevalence of current and former smoking was 20.3% and 20.6%, respectively. Younger workers were less likely than older workers to be current or former smokers. Having a complete home smoking ban was associated with decreased likelihood of being a smoker [odds ratio (OR)Â =Â 0.04, 95% confidence interval (CI)Â =Â 0.01â0.17], as were neutral views about whether it is easy for a smoker to take a smoking break during their shift (ORÂ =Â 0.50, 95% CI 0.28â0.88). Current smoking among the sample is > 50% higher than the adult statewide prevalence. Potential points of intervention identified in this study include perceived ease of worksite smoking breaks and establishing home smoking bans. Tailored cessation efforts focusing on older transit workers more likely to smoke are needed to reduce tobacco-related disparities in this workforce. Keywords: blue-collar workers, health disparities, smoking