Trends in exposure to secondhand smoke in the European Union, 2009-2014

Abstract

Introduction: Comprehensive legislation implementing smoke-free environments exists in the majority of European Union (EU) member states. However, level of enforcement varies. Aim: To explore trends in secondhand smoke (SHS) exposure in the EU between 2009-2014. Methods: We analysed responses from 27,788 individuals (2009) and 27,801 (2014) aged ≥15 years from 28 EU member states, who self-reported exposure to SHS in their workplace, as well as in bars and restaurants the last time they visited. We ran multi-level logistic regression models to assess changes in SHS exposure over time, adjusting for socio-demographic factors. Funding: Horizon2020 HCO-6-2015; EUREST-PLUS: 681109. Results: The proportion of respondents self-reporting exposure to SHS declined significantly across the EU between 2009 and 2014 in both bars (from 45.1% to 25.1%) and restaurants (from 30.2% to 11.8%). After adjusting for socio-demographic variables and smoking, people were less likely to have been exposed to SHS in bars (Odds Ratio [OR]=0.38; 95% Confidence Interval [CI]: 0.36-0.39) and restaurants (OR=0.27; 95% CI: 0.26-0.29) in 2014, compared to 2009. The change was driven by a number of countries, in which newly implemented smoke-free legislation led to substantial declines in SHS exposure. On the contrary, exposure to SHS in the workplace increased between 2009 and 2014 (from 23.8% to 27.5%; OR=1.27; 95% CI: 1.19-1.35), with several member states performing worse in the most recent survey. Conclusions: A large proportion of the EU population continue to be exposed to SHS, despite improvements in member states which have implemented smoke-free laws after 2009. Deterioration in workplace SHS exposure may indicate suboptimal enforcement.