Abstract
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.
Highlights
There is strong evidence that inhaling other people’s tobacco smoke is harmful to health.Exposure to second-hand smoke contributes to lung cancer and coronary heart disease in non-smoking adults, sudden infant death syndrome, and respiratory illnesses across the lifespan; any level of exposure to second hand smoke (SHS) is a risk for disease [1]
An important distinguishing feature is that smoke free policies are implemented and enforced by the service or staff at which they are based, whereas compliance with the policy usually refers to smokers’ adherence to the rule to not smoke at a specific location. It is common for smoke free policies to be implemented, with no enforcement strategies put into place
3729 studies were identified from electronic searches; 2994 in the included in the review
Summary
There is strong evidence that inhaling other people’s tobacco smoke is harmful to health.Exposure to second-hand smoke contributes to lung cancer and coronary heart disease in non-smoking adults, sudden infant death syndrome, and respiratory illnesses across the lifespan; any level of exposure to second hand smoke (SHS) is a risk for disease [1]. There is strong evidence that inhaling other people’s tobacco smoke is harmful to health. The way to reduce SHS exposure is to limit smoking in public and private spaces via smoke-free policies. A smoke-free policy can be defined by Article 8 of the World Health Organization Framework. Res. Public Health 2018, 15, 1386; doi:10.3390/ijerph15071386 www.mdpi.com/journal/ijerph. 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. 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.
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