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Exposure to secondhand tobacco smoke (SHS) is a global health threat that causes diseases and kills more than 1.2 million people each year, including 65000 children1-4. The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) urges countries to establish comprehensive smoke-free environments5. Although European Union (EU) member states have implemented smoke-free laws, challenges persist with designated smoking rooms (e.g. in hospital venues and in airports) and neglect of emerging products, such as electronic cigarettes (e-cigarette) and heated tobacco products (HTP)6,7. This editorial provides concise recommendations on smoke- and aerosol-free environments (SAFE) in the EU, focusing on evidence-based strategies for SAFE. Promoting the expansion of SAFE throughout EU countries was a key objective of the JATC-2, a project co-funded by the European Commission. To address this objective, WP8 focused on the current framework and potential expansion of SAFE in Europe. As part of this effort, a consultation was conducted in 2022, engaging 110 experts from 27 EU member states, along with Norway, Serbia, and the United Kingdom. The sources to identify experts were the JATC-2 contact list of all authorities and stakeholders working with tobacco regulation (policymakers and regulators, researchers and tobacco inspectors) for countries of the EU; the Catalan Institute of Oncology/WHO Collaborating Center for Tobacco Control list of contacts, including speakers and attendees to five editions of ICO-WHO Symposia on tobacco control; and lists of contacts from Smoke-Free Partnership and the European Network for Smoking and Tobacco Prevention. The responses from these experts provided valuable information on the barriers, opportunities, and best practices associated with SAFE policies across different countries. This collective knowledge, combined with findings from a systematic literature review (covering articles published between January 2010 and August 2022) and dedicated discussions (including a symposium satellite of the 9th European Conference on Tobacco or Health), forms the basis for recommendations on effective strategies and interventions to safeguard individuals from SHS and secondhand aerosol (SHA). The expert consultations are summarized in the following recommendations. [ABSTRACT FROM AUTHOR]

Background: Heated tobacco product (HTP) use continues in Japan as the second most common product after cigarettes. While the health effects of HTPs and their secondhand emissions are not well-studied, the tobacco industry has actively marketed HTPs as a smokeless, health-conscious alternative to cigarettes to encourage home consumption. We investigated the prevalence of current tobacco product use and usage at home. Methods: The present study conducted a cross-sectional analysis of data from the 2023 wave of a nationwide, Internet-based, self-reported survey. 29,354 individuals aged 16–74 were included in the analysis. We assessed the prevalence of current (past-30-day) use for HTPs, cigarettes, non-cigarette combustible tobacco, and dual (combustible plus HTP) use. The frequency of use (daily or more than monthly) in the home was calculated for both HTPs and combustible tobacco. Multivariable Poisson regression models were employed to identify factors associated with home usage. Adjusted prevalence ratios (APRs) and 95% confidence intervals (CIs) were computed. All analyses were weighted to address the Internet-based sample's selectivity and yield nationally representative estimates. Results: In 2023, the prevalence of current use was 12.4% (HTPs), 18.9% (cigarettes), 3.6% (non-cigarette combustible tobacco), and 7.4% (dual use). Among current users of any tobacco (N = 5,818), 49.8% reported daily tobacco usage within their homes, and 67.1% reported monthly or more frequent home usage. Compared to exclusive combustible tobacco smokers, exclusive HTP users exhibited higher prevalence of daily home usage (APR = 1.54; 95% CI = 1.43–1.67), as did dual users (APR = 1.10; 95% CI = 1.01–1.20). Daily home usage prevalence was notably higher for those without complete tobacco-free rules at home or workplaces, older individuals, and those with lower education levels. Those living with adult or child household member and current drinkers showed significantly lower daily home usage prevalence. Conclusion: Home usage was more common among HTP users than among combustible tobacco smokers. Ongoing efforts to assess and address the impact of indoor tobacco product use, including HTPs, on health are warranted. Regulatory and educational strategies should be considered to discourage tobacco consumption in both public and private spaces.

Introduction Smoke-free environments have already been successfully introduced in hospitals world-wide. But despite convincing evidence of their success, many countries still struggle to make the necessary changes. Not only is the smoking prevalence higher amongst people with mental health problems and staff working in psychiatric units, but employees in psychiatry often resist the implementation of smoke-free policies. This study explores staff attitudes towards smoke-free environments in psychiatric hospitals in Germany and tries to identify barriers and opportunities for implementation. Methods This cross-sectional online survey was carried out at eight psychiatric units of the state-owned healthcare company Vivantes Netzwerk für Gesundheit GmbH in Berlin, Germany, in 2019. A total of 448 members of staff were surveyed on their views towards creating a smoke-free environment in their workplace. Results Psychiatric staff present contradictory attitudes towards implementing smoke-free regulations. On the one hand, a majority recognizes the need for smoke-free environments as they promote physical well-being of staff and patients. On the other hand, a majority opposes comprehensive restrictions like a complete smoking ban. Smokers are more likely than non-smokers to resist restrictive measures and show a tendency to only support those measures which they deem unlikely to affect their own smoking habits. Conclusions The contradictory attitudes towards implementing smoke-free regulations present an entry point to elicit behavior change and a shift in attitudes, for example in staff training on smoke-free environments. Staff who smoke, in particular, should be motivated to reflect on the contradiction that is presented by their private smoking behavior and their role as healthcare professionals.

Summary: Background: Second-hand smoke exposure is prevalent amongst adolescents, despite of being a preventable risk factor associated with unfavourable outcomes. The distribution of this risk factor varies by underlying determinants and public health officers need contemporary evidence to update policies. Using the most recent data available from adolescents in Latin America and the Caribbean (LAC), we described the prevalence of second-hand smoking. Methods: Pooled analysis of Global School-based Student Health (GSHS) surveys conducted from 2010 to 2018 was conducted. Two indicators were analysed based on information from the 7 days prior to the survey: a) any exposure to second-hand smoking (0 vs ≥1 days of exposure); and b) daily exposure (

Background: The second term Health Japan 21 aims at eliminating unwanted exposure to secondhand smoke (SHS) in society; however, the ambiguity of the term “unwanted exposure” complicates the evaluation of the program. In this study, we examined SHS exposure that occurred despite the efforts to avoid it (i.e. unavoidable SHS exposure) as a proxy for “unwanted SHS exposure”. Methods: Individuals aged 16–74 responded to a nationwide, Internet-based, self-reported survey. Frequency (daily/≥monthly) of SHS exposure in the past month was assessed for specific places (home/car/restaurant/cafe/bar/workplace/school/pachinko parlor) and any place. Unavoidable SHS was identified when respondents always tried to avoid but were exposed to SHS. The observed prevalence was compared to the target of Health Japan 21 (“Eliminate unwanted SHS exposure”, =0%). Analyses were weighted to account for the selectivity of the Internet-based sample. Results: Among overall (N = 25,672), those who always tried to avoid SHS (N = 14,971), and never smokers of combustible tobacco who always tried to avoid SHS (N = 10,416), the prevalence of daily SHS exposure was 12.4%, 5.7%, and 4.2%; ≥monthly SHS exposure was 34.0%, 21.4%, and 17.5%, respectively. Among never smokers, the adjusted prevalence ratio (APR) of daily unavoidable SHS exposure was significantly high in adolescents (age 16–19) (APR = 4.97, vs. age 60–74), less-educated individuals (APR = 2.37, vs. ≥some college education), and heated tobacco product (HTP) users (APR = 8.27, vs. nonusers). Among never smokers, daily unavoidable SHS exposure was highest in the home (3.4%), workplaces (2.3%), and pachinko parlors (1.3%); ≥monthly unavoidable SHS exposure was highest in workplaces (11.4%), restaurants/cafes/bars (10.0%), and the home (7.6%). Conclusions: Daily unavoidable SHS exposure was disproportionately high among adolescents, less-educated individuals, and HTP users. The prevalence of unavoidable SHS exposure did not reach the national target in any of the assessed indoor places; home and workplace were the dominant sources of unavoidable SHS exposure. The lack of comprehensive smoke-free laws provides inadequate protection against SHS that cannot be complemented by individual efforts. The authorities must ensure smoke-free environments for all.

INTRODUCTION Smoke-free environments have already been successfully introduced in hospitals world-wide. But despite convincing evidence of their success, many countries still struggle to make the necessary changes. Not only is the smoking prevalence higher amongst people with mental health problems and staff working in psychiatric units, but employees in psychiatry often resist the implementation of smoke-free policies. This study explores staff attitudes towards smoke-free environments in psychiatric hospitals in Germany and tries to identify barriers and opportunities for implementation. METHODS This cross-sectional online survey was carried out at eight psychiatric units of the state-owned healthcare company Vivantes Netzwerk für Gesundheit GmbH in Berlin, Germany, in 2019. A total of 448 members of staff were surveyed on their views towards creating a smoke-free environment in their workplace. RESULTS Psychiatric staff present contradictory attitudes towards implementing smoke-free regulations. On the one hand, a majority recognizes the need for smoke-free environments as they promote physical well-being of staff and patients. On the other hand, a majority opposes comprehensive restrictions like a complete smoking ban. Smokers are more likely than non-smokers to resist restrictive measures and show a tendency to only support those measures which they deem unlikely to affect their own smoking habits. CONCLUSIONS The contradictory attitudes towards implementing smoke-free regulations present an entry point to elicit behavior change and a shift in attitudes, for example in staff training on smoke-free environments. Staff who smoke, in particular, should be motivated to reflect on the contradiction that is presented by their private smoking behavior and their role as healthcare professionals. [ABSTRACT FROM AUTHOR]

Introduction: Vietnam is among the countries with the highest smoking prevalence among male adults, as well as high prevalence of secondhand smoke exposure at indoor places. In many countries, including Vietnam, exposure to tobacco smoking is greatest in restaurants/bars and hotels. This study aims to analyze the compliance of hotels and restaurants to smoke-free environment regulations before and after an intervention. Methods: Direct observations were done at the receptions, conference rooms, designated smoking areas, restaurants, and lobbies of 140 hotels and the dining rooms, kitchens, and toilets of 160 restaurants before and after an intervention. The intervention was a training course conducted by police officers followed by 3 monthly supervision visits by police officers. Compliance with smoke-free enviornment regulations was observed and assessed to generate a compliance score for each location and overall. Tobit regression was used to examine the relationship between compliance scores and the intervention and other variables such as hotel and restaurant characteristics. Results: Before the intervention, the highest compliance rates were found for "no tobacco advertisement" and "no cigarette selling" regulations (95%-100%) in almost all sites in hotels and restaurants. The lowest compliance rates were found for "having nonsmoking signs." The rate of compliance with all regulations was only 5% for hotels and 0.06% of restaurants. Improvement after intervention was clearly observed, in the rate of compliance with all regulations by more hotels (15.7%) and overall compliance scores of hotels and restaurants. Conclusions: The intervention with participation of the police officers proved to be effective in improving compliance with smoke-free regulations. It is recommended to continue this intervention in the same areas as well as to expand the intervention to other areas. [ABSTRACT FROM AUTHOR]

Introduction: The association between secondhand smoke and health outcomes, such as frequent respiratory infections, ischemic heart disease, lung cancer, asthma, and stroke, has long been established. The study aimed to estimate the prevalence of secondhand smoking exposure among higher secondary school students in Ernakulam district, Kerala, Southern India. Materials and Methods: A structured questionnaire was administered to all students from four randomly selected higher secondary schools in Ernakulam district. Descriptive statistics was done using frequencies and percentages. Univariate and multivariate analyses were done for factors associated with household exposure to tobacco smoke generating odds ratios (ORs) and 95% confidence intervals (CIs). Results: A total of 629 students participated in the study. The prevalence of ever smokers was 11.9% and of current smokers was 5.2%. Among the study participants, 23.2% were exposed to secondhand smoking from a family member and 18.8% from friends. Lower educational status of father was associated with the household exposure to secondhand smoke (adjusted OR 4.51 [95% CI 1.66–12.22]). More than half of the study participants (56.3%) reported that they were exposed to cigarette smoke in past 1 week in a public place and 10.2% in closed public places. Nearly one-third of the students reported that they have seen somebody smoking inside school campus in the past 30 days. Conclusion: Exposure to secondhand smoke at home, schools, and public places was higher among the late adolescent higher secondary school students in Ernakulam district. The findings underscore the urgent need for increased efforts to implement the strategies to reduce secondhand smoke exposure among adolescents.

Background: Heated tobacco product (HTP) use continues in Japan as the second most common product after cigarettes. While the health effects of HTPs and their secondhand emissions are not well-studied, the tobacco industry has actively marketed HTPs as a smokeless, health-conscious alternative to cigarettes to encourage home consumption. We investigated the prevalence of current tobacco product use and usage at home., Methods: The present study conducted a cross-sectional analysis of data from the 2023 wave of a nationwide, Internet-based, self-reported survey. 29,354 individuals aged 16-74 were included in the analysis. We assessed the prevalence of current (past-30-day) use for HTPs, cigarettes, non-cigarette combustible tobacco, and dual (combustible plus HTP) use. The frequency of use (daily or more than monthly) in the home was calculated for both HTPs and combustible tobacco. Multivariable Poisson regression models were employed to identify factors associated with home usage. Adjusted prevalence ratios (APRs) and 95% confidence intervals (CIs) were computed. All analyses were weighted to address the Internet-based sample's selectivity and yield nationally representative estimates., Results: In 2023, the prevalence of current use was 12.4% (HTPs), 18.9% (cigarettes), 3.6% (non-cigarette combustible tobacco), and 7.4% (dual use). Among current users of any tobacco (N = 5,818), 49.8% reported daily tobacco usage within their homes, and 67.1% reported monthly or more frequent home usage. Compared to exclusive combustible tobacco smokers, exclusive HTP users exhibited higher prevalence of daily home usage (APR = 1.54; 95% CI = 1.43-1.67), as did dual users (APR = 1.10; 95% CI = 1.01-1.20). Daily home usage prevalence was notably higher for those without complete tobacco-free rules at home or workplaces, older individuals, and those with lower education levels. Those living with adult or child household member and current drinkers showed significantly lower daily home usage prevalence., Conclusion: Home usage was more common among HTP users than among combustible tobacco smokers. Ongoing efforts to assess and address the impact of indoor tobacco product use, including HTPs, on health are warranted. Regulatory and educational strategies should be considered to discourage tobacco consumption in both public and private spaces.

Second-hand smoke, also known as environmental tobacco smoke (ETS), is one of the most harmful indoor pollutants. Exposure to ETS is a worldwide silent cause of mortality and morbidity. Although ETS had been decreased for 20 years, a lot of people who do not smoke still exposed to ETS at home, work, public places, and in vehicles. ETS is a risk factor for many important diseases such as lung cancer, chronic obstructive lung disease, asthma, cardiovascular diseases, upper and lower respiratory tract infections, and sudden infant death. In this article, the harmful effects of ETS and the effects of smoke-free environment regulation on ETS exposure were reviewed. [ABSTRACT FROM AUTHOR]

Introduction: The association between secondhand smoke and health outcomes, such as frequent respiratory infections, ischemic heart disease, lung cancer, asthma, and stroke, has long been established. The study aimed to estimate the prevalence of secondhand smoking exposure among higher secondary school students in Ernakulam district, Kerala, Southern India. Materials and Methods: A structured questionnaire was administered to all students from four randomly selected higher secondary schools in Ernakulam district. Descriptive statistics was done using frequencies and percentages. Univariate and multivariate analyses were done for factors associated with household exposure to tobacco smoke generating odds ratios (ORs) and 95% confidence intervals (CIs). Results: A total of 629 students participated in the study. The prevalence of ever smokers was 11.9% and of current smokers was 5.2%. Among the study participants, 23.2% were exposed to secondhand smoking from a family member and 18.8% from friends. Lower educational status of father was associated with the household exposure to secondhand smoke (adjusted OR 4.51 [95% CI 1.66–12.22]). More than half of the study participants (56.3%) reported that they were exposed to cigarette smoke in past 1 week in a public place and 10.2% in closed public places. Nearly one‑third of the students reported that they have seen somebody smoking inside school campus in the past 30 days. Conclusion: Exposure to secondhand smoke at home, schools, and public places was higher among the late adolescent higher secondary school students in Ernakulam district. The findings underscore the urgent need for increased efforts to implement the strategies to reduce secondhand smoke exposure among adolescents. [ABSTRACT FROM AUTHOR]

Aims. To evaluate a web-based educational smoking cessation programme on changes in the frequency of hospital-based nurses' self-reported interventions to help smokers quit using the 5 As (i.e. Ask, Advise, Assess, Assist, Arrange), to reduce exposure to second-hand smoke and to change attitudes about nurses' involvement in tobacco control. Background. Few nurses in China support smokers' quit attempts using evidence-based smoking cessation interventions based on the 5 As. Limited knowledge is a barrier to intervention. Web-based tobacco cessation programs have the potential to reach a large population of nurses. Design. A prospective single-group design with pre-, 3- and 6-month follow-up after the educational programme evaluated the feasibility of conducting web-based educational programs in two cities in China in 2012-2013. Methods. Frequency of interventions was assessed using a valid and reliable web-based survey with a convenience sample of nurses from eight hospitals in Beijing and Hefei, China. Generalized linear models, adjusting for age, clinical setting, education and site were used to determine changes in the consistent (usually/ always) use of the 5 As from baseline to 3 and to 6 months. Results. Nurses (N = 1386) had baseline and/or 3- and 6-month data. At 6 months, nurses were significantly more likely to Assess, Assist and Arrange for smoking cessation and recommend smoke-free home environments. There was significant improvement in attitudes about tobacco control. Conclusions. Nurses receiving web-based smoking cessation education significantly increased self-reports of frequency of providing interventions to patients who smoke, including recommending smoke-free home environments to support quit attempts. [ABSTRACT FROM AUTHOR]

Background: Second-hand smoke exposure is prevalent amongst adolescents, despite of being a preventable risk factor associated with unfavourable outcomes. The distribution of this risk factor varies by underlying determinants and public health officers need contemporary evidence to update policies. Using the most recent data available from adolescents in Latin America and the Caribbean (LAC), we described the prevalence of second-hand smoking., Methods: Pooled analysis of Global School-based Student Health (GSHS) surveys conducted from 2010 to 2018 was conducted. Two indicators were analysed based on information from the 7 days prior to the survey: a) any exposure to second-hand smoking (0 vs ≥1 days of exposure); and b) daily exposure (<7 vs 7 days). Prevalence estimates were carried out accounting for the complex survey design, and reported overall, by country, by sex, and by subregion., Findings: GSHS surveys were administered in 18 countries, yielding a total of 95,805 subjects. Pooled age-standardised prevalence of second-hand smoking was 60.9% (95% CI: 59.9%-62.0%) with no substantial differences between boys and girls. The age-standardised prevalence of any second-hand smoking varied from 40.2% in Anguilla to 68.2% in Jamaica, and the highest prevalence was in the Southern Latin America subregion (65.9%). Pooled age-standardised prevalence of daily second-hand smoking was 15.1% (95% CI: 14.2%-16.1%), and was higher in girls than boys (16.5% vs 13.7%; p < 0.001). The age-standardised prevalence of daily second-hand smoking ranged between 4.8% in Peru to 28.7% in Jamaica, and the highest age-standardised prevalence was in Southern Latin America (19.7%)., Interpretation: The prevalence of any second-hand smoking is high among adolescents in LAC, though estimates changed substantially by country. While policies and interventions to reduce/stop smoking are implemented, attention should also be paid to avoid second-hand smoke exposure., Funding: Wellcome Trust International Training Fellowship (214185/Z/18/Z)., Competing Interests: The authors declare that no conflicts of interest exist., (© 2023 The Author(s).)

Background: The second term Health Japan 21 aims at eliminating unwanted exposure to secondhand smoke (SHS) in society; however, the ambiguity of the term "unwanted exposure" complicates the evaluation of the program. In this study, we examined SHS exposure that occurred despite the efforts to avoid it (i.e. unavoidable SHS exposure) as a proxy for "unwanted SHS exposure"., Methods: Individuals aged 16-74 responded to a nationwide, Internet-based, self-reported survey. Frequency (daily/≥monthly) of SHS exposure in the past month was assessed for specific places (home/car/restaurant/cafe/bar/workplace/school/pachinko parlor) and any place. Unavoidable SHS was identified when respondents always tried to avoid but were exposed to SHS. The observed prevalence was compared to the target of Health Japan 21 ("Eliminate unwanted SHS exposure", =0%). Analyses were weighted to account for the selectivity of the Internet-based sample., Results: Among overall (N = 25,672), those who always tried to avoid SHS (N = 14,971), and never smokers of combustible tobacco who always tried to avoid SHS (N = 10,416), the prevalence of daily SHS exposure was 12.4%, 5.7%, and 4.2%; ≥monthly SHS exposure was 34.0%, 21.4%, and 17.5%, respectively. Among never smokers, the adjusted prevalence ratio (APR) of daily unavoidable SHS exposure was significantly high in adolescents (age 16-19) (APR = 4.97, vs. age 60-74), less-educated individuals (APR = 2.37, vs. ≥some college education), and heated tobacco product (HTP) users (APR = 8.27, vs. nonusers). Among never smokers, daily unavoidable SHS exposure was highest in the home (3.4%), workplaces (2.3%), and pachinko parlors (1.3%); ≥monthly unavoidable SHS exposure was highest in workplaces (11.4%), restaurants/cafes/bars (10.0%), and the home (7.6%)., Conclusions: Daily unavoidable SHS exposure was disproportionately high among adolescents, less-educated individuals, and HTP users. The prevalence of unavoidable SHS exposure did not reach the national target in any of the assessed indoor places; home and workplace were the dominant sources of unavoidable SHS exposure. The lack of comprehensive smoke-free laws provides inadequate protection against SHS that cannot be complemented by individual efforts. The authorities must ensure smoke-free environments for all.

The risks of exposure to environmental tobacco smoke (ETS) are well established and ‘harm reduction’ strategies such as smoking outside to protect infants and children from exposure to ETS have been advocated for some time. The aim of this study was to assess the validity of self-reported smoking levels in residential settings. The participants were families ( n = 92) randomly selected from lower socioeconomic areas of Perth, Western Australia. Each household was monitored for vapor phase nicotine and particulates with an aerodynamic diameter of ≤10 μm (PM10). Of the 42% (39) households who reported that someone smoked cigarettes at home, only four (4%) said that smoking occurred inside the house. There was a ‘moderate’ agreement between parental-reported tobacco smoking and levels of nicotine ( κ = 0.55, P < 0.01). There were significant differences in the median levels of air nicotine ( P < 0.01) and PM10 ( P < 0.05) between households in which smoking was reported as only occurring outside, and the smoke-free households. Practical Implications The study outcome suggests that a strategy based on the separation of children and smoking activity is inadequate to protect the former from ETS at home, and that health professionals should give parents unambiguous advice to give up smoking in order to make their homes a completely smoke-free environment. [ABSTRACT FROM AUTHOR]

Introduction: Designated smoking areas (DSAs) have become a common feature of public places in various developed and developing countries that have ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC). However, this situation is not in line with the WHO FCTC. In this context, this study was designed to explore the perception of stakeholders on the DSA prevailing in workplaces in Mauritius and to explore the feasibility of smoking cessation interventions in the workplace., Methods: A qualitative study using semi-structured, face-to-face interviews was conducted among the various stakeholders in tobacco control in Mauritius. Data collected were transcribed verbatim for analysis., Results: Three main themes emerged from this study: 1) a need for comprehensive smoke-free law, 2) a need for smoking cessation services, and 3) a need for stakeholders' involvement (local government, employers, and health professionals) in the promotion of tobacco cessation programs., Conclusions: We make a call for a workplace Designated Stop Smoking Area (DSSA) in order to phase out existing DSAs. DSSAs will be a therapeutic means to divert smokers away from DSAs, in order to change their behaviour with respect to tobacco use. Group therapy, individual counselling, and tobacco treatment will be made accessible in these DSSAs, which with a touch of innovation can become a VIP lounge for stop-smoking services. This innovative call for DSSAs is meant to sensitize policy makers of developing countries on how to proceed for the elimination of DSAs., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2020 Chan Sun M. and Rathoa L.)

Introduction: Tobacco control policies in Indonesia are still limited. This study aims to describe the process of the implementation of the smoke-free home (SFH) program in rural areas in Indonesia and to conduct a preliminary evaluation of its implementation., Methods: The development of SFH (or Rumah Bebas Asap Rokok ) applies the theory of diffusion of innovation with the following stages: innovation, dissemination, adoption, implementation, and evaluation. The preliminary evaluation of the SFH program used an observational method combined with a cross-sectional survey. The population of this study was all houses in Karet hamlet, in Bantul district, Yogyakarta province with 378 houses as population, from which 196 houses were selected as sample using the proportional random sampling technique. Quantitative data analysis used multiple linear regression in Stata 15.1., Results: SFH is a community-based tobacco control innovation program that began with a community declaration. Preliminary evaluation after one-year implementation showed that 55% and 45% of respondents were smokers and non-smokers, respectively. Among smokers, 95%, 78% and 56% reported not smoking near pregnant women, children, and non-smokers, respectively. Moreover, 52% of respondents reported having a front-door ashtray, and 46% reported guests not smoking; among non-smokers, the corresponding values were 56% and 60%., Conclusions: SFH implementation has an impact on the community's smoking pattern. Awareness of smokers to protect women and children from secondhand smoke is very high. While the results are promising, more political and resource support is needed from the local and national policymakers to support SFH initiatives., Competing Interests: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none was reported., (© 2019 Trisnowati H.)

Background . Smoke-free environment policies limit or eliminate the use of smoke-producing tobacco in designated areas thereby reducing second hand smoke. Enforcement is perceived as critical to the successful adoption of a smoke-free policy. However, there is limited guidance available regarding effective enforcement strategies. A systematic review was conducted to examine the effectiveness of enforcement strategies at increasing compliance with and enforcement of smoke-free policies; and to determine circumstances other than enforcement strategies that are associated with compliance with smoke-free policies. Design . Medline, Medline in Process, The Cochrane Library, Embase, PsycInfo and CINAHL databases were searched using MeSH and keywords for relevant studies published between January 1980 and August 2017. A narrative synthesis and methodological quality assessment of included studies was undertaken. Results . Policy promotion and awareness-raising activities, signage, enforcement officers, and penalties for violations were the enforcement strategies most frequently cited as being associated with successful policy enforcement. Additionally, awareness of the laws, non-smoking management and lower staff smoking rates, and membership of a network guiding the policy enforcement contributed to higher compliance with smoke-free policies. Conclusions . There is weak evidence of the effectiveness of strategies associated with compliance with smoke-free policies. Given the evidence base is weak, well-designed trials utilizing appropriate evaluation designs are needed. Overall enforcement strategies associated with total smoke-free bans resulted in higher levels of compliance than strategies for policies that had only partial smoke-free bans.