Adoption Of Smoke-free Policies Research Articles

Outdoor smoke-free policies at sports clubs across Europe: Current status, recent evidence, and future challenges

ObjectiveThis commentary emphasizes the importance of implementing outdoor smoke-free policies at sports clubs, particularly highlighting their limited adoption across Europe. The primary aim was to assess the progress made in the Netherlands, explore the strategies employed, and outline future challenges. MethodsOur methodology involved an examination of national regulations and the voluntary adoption of smoke-free policies at sports clubs throughout Europe. We also assessed the adoption and implementation of these policies using recent evidence, leading to the identification of impending challenges in their implementation across Europe. ResultsWhile only a few European countries currently have national legislation prohibiting outdoor smoking at sports clubs, voluntary initiatives promoting such policies have emerged in various nations. Experiences from the Netherlands have demonstrated the feasibility of implementing outdoor smoke-free policies at sports clubs. To expand these policies across Europe, five key challenges need to be addressed: 1) encouraging smoke-free policies at sports clubs that are less inclined to adopt them, 2) ensuring consistent compliance and enforcement of outdoor smoke-free policies, 3) preventing smoking just outside the sports club, 4) garnering support from various stakeholders to ensure widespread adoption of smoke-free sports clubs, and 5) establishing monitoring and evaluation mechanisms for policy implementation. ConclusionThe Dutch experiences serve as a testimony to the feasibility of outdoor smoke-free policies at sports clubs. By addressing the remaining challenges, we can create healthier sports environments for children and take substantial steps towards realizing a smoke-free Europe.

Community coalitions for smoke-free environments in Armenia and Georgia: A mixed methods analysis of coalition formation, implementation and perceived effectiveness.

Effective models for aligning public health and civil society at the local level have the potential to impact various global health issues, including tobacco. Georgia and Armenia Teams for Healthy Environments and Research (GATHER) is a collaboration between Armenia, Georgia and U.S. researchers involving a community randomized trial testing the impact of community coalitions to promote smoke-free policy adoption and compliance in various settings. Community Coalition Action Theory (CCAT) was used to guide and describe coalition formation, implementation and effectiveness. Mixed methods were used to evaluate 14 municipality-based coalitions in Georgia and Armenia, including semi-structured interviews (n = 42) with coalition leaders and active members, coalition member surveys at two timepoints (n = 85 and n = 83), and review of action plans and progress reports. Results indicated successful creation of 14 multi-sectoral coalitions, most commonly representing education, public health, health care, and municipal administration. Half of the coalitions created at least one smoke-free policy in specific settings (e.g., factories, parks), and all 14 promoted compliance with existing policies through no-smoking signage and stickers. The majority also conducted awareness events in school, health care, and community settings, in addition to educating the public about COVID and the dangers of tobacco use. Consistent with CCAT, coalition processes (e.g., communication) were associated with member engagement and collaborative synergy which, in turn, correlated with perceived community impact, skills gained by coalition members, and interest in sustainability. Findings suggest that community coalitions can be formed in varied sociopolitical contexts and facilitate locally-driven, multi-sectoral collaborations to promote health. Despite major contextual challenges (e.g., national legislation, global pandemic, war), coalitions were resilient, nimble and remained active. Additionally, CCAT propositions appear to be generalizable, suggesting that coalition-building guidance may be relevant for local public health in at least some global contexts.

Multi-Level Influences of Smoke-Free Policies in Subsidized Housing: Applying the COM-B Model and Neighborhood Assessments to Inform Smoke-Free Policies.

Smoke-free policies in multi-unit housing are associated with reduced exposure to secondhand smoke (SHS); however, attitudes toward comprehensive smoke-free policies among residents in subsidized multi-unit housing are unknown. In this mixed-methods study, we explored the socio-ecological context for tobacco and cannabis use and attitudes toward policies restricting indoor use of these products through interviews with residents (N = 134) and staff (N = 22) in 15 federally subsidized multi-unit housing in San Francisco, California. We conducted a geo-spatial and ethnographic environmental assessment by mapping alcohol, cannabis, and tobacco retail density using ArcGIS, and conducted systematic social observations of the neighborhood around each site for environmental cues to tobacco use. We used the Capability, Opportunity, and Motivation behavior (COM-B) model to identify factors that might influence implementation of smoke-free policies in multi-unit housing. Knowledge and attitudes toward tobacco and cannabis use, social norms around smoking, neighborhood violence, and cannabis legalization were some of the social-ecological factors that influenced tobacco use. There was spatial variation in the availability of alcohol, cannabis, and tobacco stores around sites, which may have influenced residents' ability to maintain smoke-free homes. Lack of skill on how to moderate indoor smoking (psychological capability), lack of safe neighborhoods (physical opportunity), and the stigma of smoking outdoors in multi-unit housing (motivation) were some of the barriers to adopting a smoke-free home. Interventions to increase adoption of smoke-free policies in multi-unit housing need to address the co-use of tobacco and cannabis and commercial and environmental determinants of tobacco use to facilitate smoke-free living.

Smoke-Free Policies and Resident Turnover: An Evaluation in Massachusetts Public Housing From 2009‒2018

Smoke-free policies (SFP) in multi-unit housing are a promising tool for reducing exposure to tobacco smoke among residents. Concerns about increased housing instability due to voluntary or involuntary transitions induced by SFPs have been a primary barrier to greater widespread adoption. The impact of SFP implementation on transitions out of public housing in federally funded public housing authorities in Massachusetts was evaluated. Tenancy data from the Department of Housing and Urban Development were used to determine the time from admission to transitioning out of public housing based on a cohort study design. Periods of exposure to SFPs were defined based on dates of SFP implementation at each PHA. Multi-level Cox regression models were fit to estimate the effects of SFPs on the hazard of transitioning, adjusting for household- and PHA-level characteristics. Analyses were conducted in 2021‒2022. There were 44,705 households with a record of residence in Massachusetts PHAs over 2009‒2018. Over this period, despite increasing adoption of SFPs among the PHAs, rates of transition remained steady at around 5‒8 transitions per 1,000 household-months. There was no overall association between exposure to SFPs and transitions among the full sample (adjusted HR=0.99, 95% CI=0.95, 1.04, p=0.794). However, the association varied significantly by age group, race/ethnicity, timing of SFP adoption, and era of admission. Adoption of SFPs in public housing had a minimal overall impact on turnover for households in Massachusetts, though disparities in the impact were observed between different demographic and PHA-level subgroups.

Smoke-Free Policy Adoption in Horizon City and El Paso Community College: A Strategic Campaign Approach That Turns a "No" Into a "Yes".

Coalitions in Horizon City in El Paso County, Texas and the El Paso Community College (EPCC) had previously attempted to pass smoke-free policies in 2008 and 2016, respectively; however, both policies failed to pass at those times. The coalitions refocused their activities and were successful in passing policies in EPCC in 2020 and in Horizon City in 2021. We employed a participatory case study method to understand what factors changed between the first and second attempts at smoke-free policy adoption in Horizon City and EPCC. Using the Advocacy Coalition Framework as a basis for analysis, we identified the role of coalitions, their beliefs, use of power resources, role of policy brokers, and external events. We identify best practices and make recommendations for coalitions seeking to adopt smoke-free policies in other locations.

Self-reported secondhand smoke exposure following the adoption of a national smoke-free policy in Poland: analysis of serial, cross-sectional, representative surveys, 2009–2019

ObjectiveWe assessed changes in secondhand smoke (SHS) exposure in workplaces and public venues in Poland over a 9-year period following the adoption of a smoke-free policy in Poland in 2010.DesignSix...

Geographic distribution, socio-economic disparity and policy determinants of smoke-free policy adoption in Indonesia.

BACKGROUND: Indonesia has the second highest smoking prevalence among adult males in the world, and smoking prevalence is increasing among youths.OBJECTIVE: To evaluate the smoke-free policy (SFP), a flagship national tobacco control programme, by providing evidence on geographic distribution, socio-economic disparities and policy determinants of SFP adoption by district in Indonesia.METHODS: We employed spatial and quantitative methods to obtain data respectively on geographic distribution of SFP adoption, and on disparities and associations between national and provincial SFP regulations and SFP adoption by the districts.RESULTS: Twenty-one of 34 provinces, and 345 of 514 districts adopted SFP. We found significant geographic disparities: all districts outside of Papua were up to 6.3 times more likely to adopt the policy and to implement it for a period of up to 3 years longer in duration. We also found significant socio-economic disparities: urban districts, those that were wealthiest and those most educated were respectively 3.9, 9.1 and 2.8 times more likely to adopt the policy. Moreover, districts in provinces that had SFP regulation were 3.2 times more likely to adopt. Finally, the adoption rate in the period after the 2012 national regulation was up to 7.8 times higher than that before.CONCLUSION: In addition to geographic and socio-economic disparities, national and provincial regulations and policies were determinants of SFP adoption.

Progress of smoke-free policy adoption at district level in Indonesia: A policy diffusion study

BackgroundEven though Indonesia has not ratified the Framework Convention on Tobacco Control (FCTC), district and provincial stakeholders are increasingly adopting smoke-free policies (SFPs). This study aimed to 1) assess whether local SFP adoption in Indonesia followed a horizontal or vertical diffusion pattern and 2) identify district characteristics that are associated with the SFP adoption. MethodsPolicy documents enacted during 2004–2015 were compiled from 33 provinces and 510 districts in Indonesia. First, we described the geographical distributions of the policy adoption. Second, we ran logistic regression to assess the associations of district SFP adoption with having adjacent districts that had adopted SFPs (i.e. horizontal diffusion) and being situated in a province that had adopted SFPs (i.e. vertical diffusion). Third, the associations between district characteristics (population density, GDP, tobacco production) and SFP adoption were assessed using logistic regression. ResultsBy 2015, a total of 17 provinces and 143 districts had adopted SFPs. Districts with SFPs were more concentrated in the western part of Indonesia. Adoption was more likely in districts of which adjacent districts had already adopted SFPs (OR: 2.02; 95%CI: 1.26–3.23), and less likely when the province had already adopted SFPs (OR: 0.19; 95%CI: 0.11 – 0.34). Adoption was more likely in districts with higher GDP (OR high vs low GDP: 3.28; 95%CI: 1.80–5.98) and higher population density (OR high vs low density: 6.57; 95%CI: 3.63–11.9). High tobacco production showed a strong inverse association with SPF adoption (OR high vs. no production: 0.36; 95%CI: 0.17–0.74). ConclusionsSmoke-free policy adoption in Indonesian districts followed a horizontal diffusion pattern, with poorer and rural districts lagging behind in their policy adoption. Our results indicate that local-level policy development is important for smoke-free policy adoption in countries with decentralised governments, but that effective advocacy is needed to counteract tobacco industry interference.

Increased adoption of smoke-free policies on campuses with schools of nursing

BackgroundIn 2015, the majority of U.S. American Association of Colleges of Nursing (AACN)-accredited schools of nursing resided on campuses without smoke-free policies. PurposeTo determine the presence of smoke-free policies at AACN-accredited after resolutions from AACN and the American Academy of Nursing, and the creation of online resources. MethodsSmoke-free policies (2015-2017) were determined through listings on the ANRF College Campus Policy Database© and survey responses from nursing deans. ResultsSmoke-free policies for 689 schools of nursing increased from 36% in 2015 to 91% in 2017. There were no significant differences by nursing program types or geographic area. Twenty percent of deans reported using the resources, with over 1700-page views. ConclusionSmoke-free policies increased after support from two national nursing organizations. Learning in a smoke-free environment should be an expectation for nursing students to protect their own health, and to support their future critical role in tobacco control.

'If I pay rent, I'm gonna smoke': Insights on the social contract of smokefree housing policy in affordable housing settings.

Smoke-free housing policy in multi-unit housing has emerged as a promising tobacco control initiative, yet full compliance remains elusive and is a critical impediment to policy effectiveness. There is a gap in existing research on potential factors preventing optimal smoke-free policy adoption and corresponding solutions. Using qualitative and quantitative data from resident surveys (N = 115) as well as key informant interviews, a focus group, and observational fieldwork, this study 1) assesses smoking behaviors and experience with secondhand smoke in buildings after adoption of a smoke-free policy; 2) examines resident and property management perceptions of the policy; and 3) identifies socioecological factors that influence the policy's effectiveness in affordable housing settings in New York City. Findings indicate that residents view smoking regulations within the context of broader relationships with the housing provider and other residents. We argue that these "social contracts" strongly influence the effectiveness of smoke-free housing policies and must be acknowledged to maximize compliance.

A geo-view into historical patterns of smoke-free policy coverage in the USA.

INTRODUCTIONAmple evidence shows that implementation of smoke-free policies can significantly reduce tobacco use. The indoor smoke-free policy coverage in the U.S. increased over the past 25 years. This study synthesized the available historical smoke-free policy data and achieved two complementary goals: 1) reconstructed historical patterns of indoor smoke-free policy coverage in the U.S., and 2) developed a web-based interactive tool for visualization and download of the U.S. historical smoke-free policy data for research.METHODSHistorical information on local and regional smoke-free policy was downloaded from the American Nonsmokers Rights Foundation (ANRF). Subsequent methodological processes included: geo-referencing of smoke-free policy data, spatial-temporal data linkage, spatial pattern analysis, data visualization, and the development of an interactive tool.RESULTSThe percentage of population covered by the smoke-free policies varies across the different geographic locations, scales, and over time. On average, the percentage of people covered by the smoke-free laws in the U.S. increased substantially in the recent decade. The Tobacco-Policy-Viewer reveals geographic patterns of increase in smoke-free policy adoption by cities, counties, and States over time.CONCLUSIONThe utility of visualizing the historical patterns of smoke-free policy coverage in the U.S. is to understand where and for how long smoke-free policies were in place for indoor facilities and to inform planning for education and interventions in the areas of need. The benefit of data provided for download, via the Tobacco-Policy-Viewer, is to catalyze future research on the impacts of historical smoke-free policy coverage on reduction in secondhand-smoke exposures, tobacco use, and tobacco related diseases.

Can Smoke-Free Policies Reduce Tobacco Use Disparities of Sexual and Gender Minorities in Missouri?

The purpose of this study is to explore the associations between smoke-free policies, current and former smoking status, personal smoking restrictions, and intention to quit among sexual and gender minority (SGM) and non-SGM individuals in Missouri. The current analysis derives from the Out, Proud and Healthy project. Chi-squares examined differences between SGM (N = 2210) and non-SGM (N = 586) respondents and former (N = 836) and current (N = 1960) smokers on smoking-related variables. Odds ratios and 95% confidence intervals from logistic regression identified variables associated with former (vs. current) smoking. SGM current smokers (25%) were significantly more likely than SGM former smokers (19%) to live in a community without a smoke-free policy. Among SGM current smokers, significantly greater intention to quit was seen in those living in a smoke-free community with a smoke-free policy of two or more years (94%) compared with those living in a community without a smoke-free policy (76%). Living in an area with smoke-free policies is related to greater intention to quit among SGM current smokers, greater support for smoke-free policies, and lower smoking prevalence for this community. The SGM community may collectively accrue greater public health benefits from the adoption of smoke-free policies than the non-SGM community. Prior to this study, no data are available regarding current and former smoking status among SGM individuals following the implementation of a local smoke-free policy. The purpose of this study was to explore the relationship between smoke-free policies, current and former smoking status, and intention to quit among SGM and non-SGM individuals in Missouri. This study finds evidence of lower current smoking prevalence and greater intentions to quit among SGM current smokers who live in communities with smoke-free policies. The SGM community may collectively accrue greater public health benefits from the adoption of smoke-free policies than the non-SGM community.

Advancing smoke-free policy adoption on the Navajo Nation

BackgroundComprehensive smoke-free laws are effective at protecting non-smokers and reducing tobacco use, yet they are not widely adopted by tribal governments.MethodsA series of smoke-free policy initiatives on the Navajo Nation,...

Tobacco Use Among Adolescents Entering Quebec Youth Protection Centers

Abstract BACKGROUND: Every year between 4,000 and 5,000 adolescents reside in Quebec Youth Protection Centers (YPCs). Many of these adolescents use tobacco products and other psychotropic substances that impact their present and future well-being. OBJECTIVES: Document the prevalence of tobacco use among youth residing in YPCs and identify associated factors. Describe the measures taken to implement policies for smoke-free environments in YPCs and promote smoking cessation counseling for youth in care. DESIGN/METHODS: Between July 2008 and May 2009, adolescents aged 14-17 living in six YPCs across Quebec were recruited on a volunteer basis to participate in a surveillance study on health risk behaviors. Data on socio-demographics, lifetime substance use and sexual risk behaviors, as well as certain health consequences related to these behaviors were obtained during structured, face-to-face interviews. An analysis of factors associated with daily tobacco use was carried out. RESULTS: Data regarding behaviors reported during the year prior to admission were collected among 499 participants (boys: 59%; median age: boys: 16; girls: 15). Lifetime tobacco use was reported by 93% of girls and 91% of boys (median age at first cigarette was 12 years). During the year prior to admission, 15% of youth reported no tobacco use, and 20% smoked occasionally. Two thirds (65%) reported daily tobacco use, with 36% of girls and 43% of boys smoking 10 or more cigarettes a day. In univariate analysis, factors significantly (p<0.05) associated with daily smoking were: school failure or dropping out; family history of problematic alcohol or drug use; precocious initiation of alcohol use before age 13; history of regular use of alcohol or cannabis; problematic drug use (measured by DEP-ADO scale); having 6 or more lifetime sexual partners. Following dissemination of these results, measures were taken to develop a smoke-free policy and implementation plan for YPCs. Health professionals were trained to do brief interventions with all youth smokers entering care. In 2015 the YPC presented a brief to the provincial parlimentary committee on the Tobacco Act to support adoption of smoke-free policies for all health establishments in Québec. CONCLUSION: Daily tobacco use is very prevalent among adolescents entering YPCs and the majority report problematic use of other psychoac-tive substances. Youth entering care merit screening for tobacco and drug use so that appropriate counseling can be initiated. Promoting policies that encourage smoke-free environments in child protection centers for both youth and the professionals working with them may greatly improve the chances for youth to live tobacco-free.

An Examination of Two Policy Networks Involved in Advancing Smokefree Policy Initiatives

This study examines smokefree policy networks in two cities—Kansas City and St. Louis, Missouri—one that was successful in achieving widespread policy success, and one that was not. Descriptive social network analyses and visual network mapping were used to compare importance and contact relationships among actors involved in the smokefree policy initiatives. In Kansas City, where policy adoption was achieved, there was a higher level of connectivity among members, with network members being in contact with an average of more than five people, compared to just over two people for the St. Louis network. For both cities, despite being recognized as important, politicians were in contact with the fewest number of people. Results highlight the critical need to actively engage a variety of stakeholders when attempting city wide public health policy change. As evident by the success in smokefree policy adoption throughout Kansas City compared to St. Louis, closer linkages and continued communication among stakeholders including the media, coalitions, public health agencies, policymakers, and other partners are essential if we are to advance and broaden the impact of public health policy. Results indicate that the presence of champions, or those that play leadership roles in actively promoting policy by linking individuals and organizations, play an important role in advancing public health policy. Those working in public health should examine their level of engagement with the policy process and implement strategies for improving that engagement through relationship building and ongoing interactions with a variety of stakeholders, including policymakers.

Local Smoke-Free Policy Experiences in Appalachian Communities

In Appalachian areas, strong tobacco control policies are not in place, so residents are not adequately protected from secondhand smoke exposure. This area is predominantly rural, and residents experience a high burden of tobacco-related illnesses. There has been limited examination of elements that hinder smoke-free policy adoption in these vulnerable communities. Key informant interviews were conducted with individuals identified as being knowledgeable about local tobacco control policy activities within a random selection of Appalachian communities within 6 states with (n=15) and without (n=12) local smoke-free policies. Five key themes emerged from the qualitative interviews: (1) opposition to tobacco control, (2) need for local involvement, (3) role of community coalitions, (4) leveraging outside advocates, and (5) working with decision makers. In Appalachian communities, the local context and locally-based coalitions were critical to promote the adoption of smoke-free policies.

Political Climate and Smoke-Free Laws in Rural Kentucky Communities

The purpose was to determine factors associated with rural communities' political readiness to enact smoke-free laws. Data from baseline assessment of a longitudinal intervention study to promote smoke-free policy in rural Kentucky communities; key informants (n = 144) and elected officials (n = 83) from 29 counties participated in cross-sectional telephone interviews. Controlling for population size and county-level smoking rate, the following factors predicted elected officials' perception of the likelihood of a local smoke-free law passing in the next 12 months: (1) support from the local board of health; (2) support from local leaders; and (3) smoke-free hospitals. Communities with lower adult smoking prevalence were more ready for smoke-free laws. Rural health advocates can increase political readiness for smoke-free laws by educating and engaging Board of Health members and local leaders, promoting the voluntary adoption of smoke-free policies in rural hospitals, and investing in effective population-based approaches to evidence-based tobacco treatment in rural communities.

A Systematic Examination of Smoke-Free Policies in Multiunit Dwellings in Virginia as Reported by Property Managers: Implications for Prevention

In most states, smoking has been curtailed to some extent in public buildings, workplaces, and restaurants. The next frontier for smoke-free policies is the multiunit dwelling industry. However, the extent to which smoke-free housing currently is available is unknown. The purpose of this study was to measure the market for smoke-free housing in Virginia and to identify barriers to adopting smoke-free policies. Telephone interviews were conducted with property managers of rental apartments, townhouses, senior housing, and public housing in four Virginia cities. Four cities in Virginia. Two hundred sixty-three property managers in four cities in Virginia (approximately 75 property managers per city). Property managers were administered a brief telephone survey. Only 33.8% of property managers reported some type of smoke-free policy, with only 15% of those policies prohibiting smoking in residential units. Most property managers without a smoke-free policy were not considering adopting such a policy for a variety of reasons. The availability of smoke-free multiunit dwellings is severely lacking. This study identified a number of science-based and legal misperceptions that may prevent the adoption of smoke-free policies. Correction of these misperceptions is warranted to increase the availability of smoke-free housing. Such policies will be useful in creating environments that support good health practices while simultaneously protecting tenants from exposure to secondhand smoke.

Intervention to Promote Smoke-Free Policies Among Multiunit Housing Operators

To assess the efficacy of an intervention to encourage the adoption of smoke-free policies among owners and managers of multiunit housing. A pretest-posttest quasi-experimental design was employed. The study population included 287 multiunit housing operators (MUHOs) from across New York State who were recruited to complete a baseline survey designed to assess policies about smoking in the housing units that they owned and/or managed. Subjects were surveyed between March and July 2008 (n = 128 intervention, n = 159 control) and recontacted 1 year later to complete a follow-up survey (n = 59 intervention, n = 95 control). An informational packet on the benefits of implementing a smoke-free policy was mailed to MUHOs in the New York State counties of Erie and Niagara between March and July 2008. For comparison purposes, a sample of MUHOs located outside of Erie and Niagara counties who did not receive the information packet were identified to serve as control subjects. Logistic regression was used to assess predictors of policy interest, concern, and implementation at follow-up. Predictors included: intervention group, baseline status, respondent smoking status, survey type, government-subsidy status, quantity of units operated, and average building size, construction type, and age. Multiunit housing operators who received the information packet were more likely to report interest in adopting a smoke-free policy (OR = 6.49, 95% CI = 1.44-29.2), and less likely to report concerns about adopting such a policy (OR = 0.16, 95% CI = 0.04-0.66) compared to MUHOs who did not receive the information packet; however, the rate of adoption of smoke-free policies was comparable between the groups. Sending MUHOs an information packet on the benefits of adopting a smoke-free policy was effective in addressing concerns and generating interest toward smoke-free policies but was not sufficient in itself to generate actual policy adoption.

The Clinical Assessment and Treatment of Nicotine Dependence

In the United States and around the world, nicotine dependence is a leading cause of preventable death. Smoking cessation results in immediate and enduring health benefits. A wide range of clinical interventions have been shown to facilitate smoking cessation and to have a favorable cost-benefit profile. Practice guidelines and national reports have issued calls to action and have made smoking cessation resources readily available. Yet utilization of smoking cessation interventions and resources is lagging. Health care systems and providers have a shared responsibility to ensure that all smokers are offered appropriate interventions. This article summarizes the epidemiology and pathophysiology of nicotine dependence as a background for reviewing the central components of clinical evidence-based smoking cessation interventions: screening, assessment, advice, assistance, and follow-up. Specific patient populations are discussed, as well as emerging strategies to address nicotine dependence.