Abstract
IntroductionSuccessful smoke-free legislation is dependent on political will, enforcement and societal support. We report the success and pitfalls of a non-enforced nationwide smoke-free legislation in Greece, as well as ways in which compliance and enforcement-related factors, including ashtrays and signage, may impact indoor secondhand smoke (SHS) concentrations.MethodsA follow-up study of venues (n = 150, at baseline, n = 75 at 2-year follow-up) in Greece assessed indoor particulate matter with a diameter less than 2.5 micrometers (PM2.5) concentrations attributable to SHS smoke every six months for two years (n = 455 venue/measurements).ResultsFollowing the implementation of the 2010 smoke-free legislation, mean PM2.5 concentrations attributable to SHS fell from 175.3 µg/m3 pre-ban to 84.52 µg/m3 immediately post-ban, increasing over subsequent waves (103.8 µg/m3 and 158.2 µg/m3 respectively). Controlling for potential influential factors such as ventilation, time of day, day of week, city and venue type, all post-ban measurements were still lower than during the pre-ban period (Wave 2 beta: −118.7, Wave 3 beta: −87.6, and Wave 4 beta: −69.9). Outdoor or indoor signage banning smoking was not found to affect SHS concentrations (beta: −10.9, p = 0.667 and beta: −18.1, p = 0.464 respectively). However, ashtray or ashtray equivalents were strong determinants of the existence of indoor SHS (beta: +67 µg/m3, p = 0.017).ConclusionsWhile the public may be supportive of smoke-free legislation, adherence may decline rapidly if enforcement is limited or nonexistent. Moreover, enforcement agencies should also focus on the comprehensive removal of ashtray equivalents that could act as cues for smoking within a venue.
Highlights
Successful smoke-free legislation is dependent on political will, enforcement and societal support
Study Design The Hellenic Air Monitoring Study (HAMS) is a national longitudinal cohort of hospitality venues within five regions of Greece, within which indoor air pollution attributable to secondhand smoke (SHS) is assessed at six-month intervals within the cities of Athens, Heraklion, Serres, Larissa and Thessaloniki
Measurements began during the pre-ban period of March–May 2010 (Wave 1), and we followed up using the same venues 6 months later (Wave 2) immediately after the implementation of the smoking ban (October– December 2010)
Summary
Successful smoke-free legislation is dependent on political will, enforcement and societal support. We report the success and pitfalls of a non-enforced nationwide smoke-free legislation in Greece, as well as ways in which compliance and enforcement-related factors, including ashtrays and signage, may impact indoor secondhand smoke (SHS) concentrations. Exposure to secondhand smoke (SHS) has been linked to disease, premature death and disability. In response to the plethora of evidence supporting the need to minimize exposure to SHS, a number of countries around the world have proceeded to adopt smoke-free legislation with clear health benefits. A 2010 US, Institute of Medicine report reviewed 11 key epidemiologic studies evaluating the incidence of acute coronary events before and after the introduction of smoke-free policies in public areas and workplaces. Studies examining the immediate effects on the pulmonary system after the passage of smoke-free laws have indicated reductions in respiratory symptoms and hospitalization [4]
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