Smoke-free Legislation Research Articles

Up in smoke. The unravelling of world-leading policy changes in Smokefree legislation in Aotearoa New Zealand

Up in smoke. The unravelling of world-leading policy changes in Smokefree legislation in Aotearoa New Zealand

Analyzing the Diversity and Impacting Factors of Smoke-Free Legislation and Implementation in Mainland China: A Case Qualitative Research.

Since the ratification of the Framework Convention on Tobacco Control in 2005, mainland China has experienced notable delays in implementing the Framework Convention on Tobacco Control. This study aims to examine the legislation and implementation of smoke-free laws in different cities in mainland China, with a particular focus on identifying factors that contribute to these differences. Through a literature review and policy mapping, we gathered information on the variations in smoke-free laws' legislation and implementation across mainland China. To delve deeper into the local specifics of implementation and the factors contributing to these variations, qualitative interviews were conducted with 16 key stakeholders in two selected cities. This group included former policy makers, policy experts, enforcement officers, and public venue owners. Although the revision of Healthy Cities standards advocates for the enactment of smoking bans post-2021, less than half of these cities have implemented comprehensive smoke-free laws. This phenomenon can be partly attributed to the tobacco industry's significant influence in the legislative process and to policy makers' limited understanding of smoking rooms/areas being temporary measures without setting clear end dates for transition periods. We also identified inconsistent implementation across selected cities, attributed to inadequate coordination and workforce shortages. Our study reveals significant variations and delays in the adoption of smoke-free laws across different cities in mainland China. We identify key factors contributing to this disparity, underscoring the urgent need for targeted measures to address these challenges, such as setting up a coordinated department and promoting policy advocacy. This study reveals geographical disparities in the legislative progress and enforcement effectiveness of smoke-free laws in mainland China. Persistent interference from the tobacco industry has obstructed the establishment of comprehensive smoke-free laws. Additionally, policy makers' limited awareness of the harm caused by designated smoking areas, regional economic disparities, and inadequate interdepartmental coordination have impeded effective policy implementation. These findings underscore the urgent need to set enforcement goals aligned with local economic contexts and strengthen policy dialogue to empower policy makers and stakeholders to mitigate tobacco industry influence and achieve successful implementation.

Quitting tobacco through quitline services: impact in India.

Tobacco quitline services offer telephone-based counseling to assist tobacco users in quitting through behavioral modification. It is a sponsored scheme by the Ministry of Health and Family Welfare, Government of India. The present study has two objectives: primarily, to study the correlation between socio-demographic variables and tobacco abuse, and secondly, to study the impact of National Tobacco Quit-Line Services (NTQLS) in India. The data for the study was collected from the registered callers who have completed at least one year of follow-ups at NTQLS, Vallabhbhai Patel Chest Institute, University of Delhi, between May 2016 and May 2021. The questionnaire was directly administered to the people who had called NTQLS for the first time to quit tobacco use. Callers were provided one year of continuous follow-up to ensure they remain long-term abstinent from tobacco and permanently quit. All the data were managed through an electronic database. A total of 85,807 individuals' data was taken for the study. The maximum number of callers were from Uttar Pradesh (28.03%), followed by Rajasthan (24.67%) and Madhya Pradesh (7.59%). The female population represented only 1.43%; the male population was significantly higher (98.57%). Youth (44.83%) and adults (53.78%) were more than seniors (0.9%) and adolescents (0.4%). Smokeless tobacco users (67.32%) were more common than smoking tobacco users (20.11%). Duration of tobacco use among the 71.74% of callers was found to be between 1 and 10 years; the remaining 24.03% had been using tobacco for over 10 years, while 4.23% were novice users. The abstinence rate achieved by NTQLS was 33.42% after one month of quitting and 21.91% after one year of quitting. We found a significant association between tobacco users' socioeconomic and demographic status. The number of male tobacco users was significantly higher than the number of female tobacco users. Among all the tobacco users, youth was persistently using tobacco the most. Individuals from low socio-economic status were more likely to use tobacco as compared to those from high socioeconomic status. These associations indicate the need for strengthening the enforcement of tobacco control policies and developing and monitoring comprehensive smoke-free legislation.

Smoking status and interventions among children and adolescents in China

Abstract. Tobacco use is the leading cause of preventable death globally. China is the Worlds large tobacco-producing and consuming country, and the burden of death and disease caused by tobacco use will continue to increase .The "Healthy China 2030" Planning Outline proposes to reduce the smoking rate of the population over the age of 15 to 20% by 2030. Taxation and price measures are recognized as the single most effective tobacco control policy measures. A variety of interventions are needed for adolescents, including China can carry out tobacco control according to the comprehensive tobacco control policy of WHO MPOWER (monitor,protect,offer,warm,enforce,raise),smoking ban in public places, cigarette sales to minors, prohibiting advertising promotion, raising the tobacco tax, adding health warnings to the cigarette packaging, use new media to expand coverage.

Effects of comprehensive smoke-free legislation on smoking behaviours and macroeconomic outcomes in Shanghai, China: a difference-in-differences analysis and modelling study

China has one of the highest levels of tobacco consumption globally, and there is no national smoke-free legislation. Although more than 20 Chinese cities have passed local smoke-free laws since 2008, evidence on their effectiveness in reducing smoking behaviours and their economic benefits is scarce. By exploiting a natural quasi-experiment, whereby a comprehensive public smoking ban was implemented in Shanghai in March, 2017, this study aims to assess the impact of the policy on individual smoking behaviours and quantify its effect on macroeconomic outcomes. In this difference-in-differences analysis and modelling study, we used data on smoking behaviours from the 2012, 2014, 2016, and 2018 waves of the China Family Panel Studies. We used a difference-in-differences approach to investigate trends in smoking prevalence in respondents in Shanghai, relative to respondents from other direct-administered municipalities, provincial capital cities, and subprovincial municipalities (control group), after the implementation of a smoking ban in 2017. All respondents aged 18 years or older were included, with the exception of people who lived in Beijing and rural areas. The primary variable of interest in the difference-in-differences analysis was self-reported smoking status. Based on the difference-in-differences estimation of reduction in smoking prevalence, we then used a health-augmented macroeconomic model to estimate the potential macroeconomic gains if such a ban was implemented across China for the period 2017-35. 14 688 respondents were included in the analysis: 5766 from Shanghai and 8922 from the control group. After the implementation of the smoking ban in Shanghai in 2017, smoking prevalence decreased by 2·2 percentage points (95% CI 2·1-2·3), equivalent to an 8·4% reduction in the number of current smokers. The smoking ban had a larger effect on men, people with a higher level of education, unmarried people, and younger people when compared with their respective counterparts. The modelling analysis showed that implementing a nationwide comprehensive public smoking ban similar to that in Shanghai would result in a 0·04-0·07% increase in the national gross domestic product in China between 2017 and 2035, outweighing the economic costs of smoking ban enforcement. The smoking ban in Shanghai shows that a comprehensive public smoking ban with strict enforcement is effective in curbing smoking behaviours. Moreover, the implementation of a comprehensive public smoking ban across China would be cost-effective. National Social Science Fund of China.

Implementing comprehensive nationwide smoke-free legislation in China

Implementing comprehensive nationwide smoke-free legislation in China

Impact of smoke-free legislation on stroke risk: A systematic review and meta-analysis.

Secondhand smoke significantly increases the risk of cerebrovascular diseases, prompting recent public smoking bans. We aimed to ascertain the effects of smoke-free legislation on stroke incidence and mortality. We systematically searched Medline, Embase, Cochrane Library, and Scopus up to August 13, 2023, for studies reporting changes in stroke incidence following partial or comprehensive smoking bans. A random-effects meta-analysis was conducted on hospital admissions and mortality for stroke, stratified based on comprehensiveness of the ban ((i) workplaces-only, (ii) workplaces and restaurants, (iii) workplaces, restaurants and bars). The effect of post-ban follow-up duration was assessed visually by a forest plot, while meta-regression was employed to evaluate for any dose-response relationship between ban comprehensiveness and stroke risk. Of 3987 records identified, 15 studies analysing bans across a median follow-up time of 24 months (range: 3-67) were included. WRB bans were associated with reductions in the rates of hospital admissions for stroke (nine studies; RR, 0.918; 95% CI, 0.872-0.967) and stroke mortality (three studies; RR, 0.987; 95% CI, 0.952-1.022), although the latter did not reach statistical significance. There was no significant difference in the risk of stroke admissions for studies with increased ban comprehensiveness and no minimum duration for significant post-ban effects to be observed. Legislative smoking bans were associated with significant reductions in stroke-related hospital admissions, providing evidence for its utility as a public health intervention.

Protecting Young Lives: A Systematic Review of the Impact of Secondhand Smoke Exposure and Legislative Measures on Children's Health.

Each year, a substantial number of global deaths are attributed to secondhand smoke (SHS) exposure, with children representing a significant proportion of these fatalities. This systematic review evaluates the effects of passive smoking, or SHS, on children's health outcomes, focusing on respiratory conditions, behavioral issues, cognitive impairment, growth retardation, and immune system effects. A comprehensive literature search was conducted from July 5 to July 18, 2024, across multiple databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines. Following the set inclusion and exclusion guidelines, 12 studies were chosen for the review, and their quality was measured using the Newcastle-Ottawa Scale. The findings indicate a strong association between SHS exposure and adverse health outcomes in children, including increased rates of asthma, low birth weight, and behavioral problems. Additionally, smoke-free legislation appears to mitigate some of these harmful effects, though results vary across different regions and populations. The review underscores the urgent need for effective smoking cessation strategies and improved healthcare communication to protect children from the dangers of passive smoking.

Best practices for expansion of smoke-free and aerosol-free environments in Europe: Protocol for the consultation to experts.

Smoke-free legislation has been shown to positively impact reducing secondhand smoke (SHS) exposure, especially in countries that have implemented comprehensive legislation rather than partial bans. Also, secondhand aerosols (SHA) that come from the heating of tobacco or liquids, with or without nicotine, in electronic nicotine delivery systems (ENDS) have been proven to increase levels of harmful substances in the air. Therefore, protection against SHS and SHA exposure and expansion of smoke- and aerosol-free environments (SAFE) should be taken into account when creating or trying to expand or enforce clean air policies. This article aims to present the protocol for a consultation with experts on tobacco and nicotine control in order to identify best practices, barriers, and opportunities for the expansion of SAFE in Europe. We identified experts among policymakers, researchers, and tobacco regulators in European countries and invited them to participate in the consultation by completing an online survey designed, programmed, and pilot-tested using Survey Monkey. The responses to the questionnaire contained quantitative and qualitative information that was thematically analyzed. The experts' consultation allowed us to produce a report on barriers and opportunities for SAFE, a report and a position paper on SAFE best practices, a web-based repository of best practices, and a weight of evidence paper that assembles evidence supporting the expansion of SAFE on indoor and outdoor spaces.

Smoke-free generation legislation in the United Kingdom

Smoke-free generation legislation in the United Kingdom

Medical students' tobacco consumption status and experiences with smoke-free law violations in enclosed spaces in Türkiye and Northern Cyprus

Medical students' tobacco consumption status and experiences with smoke-free law violations in enclosed spaces in Türkiye and Northern Cyprus

Secondhand smoke exposure among adolescents in the gulf cooperation council countries: analysis of global youth tobacco surveys

This study aimed to analyze patterns and predictors of secondhand smoke (SHS) exposure among adolescents (12–16 years old) in Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Nationally representative data from the most recent Global Youth Tobacco Survey in each country were analyzed (N = 17,220). SHS exposure at home, in public places, and at school was assessed. Descriptive statistics summarized exposure prevalence overall and by sex. Multivariable logistic regression examined factors associated with each SHS exposure’s outcome. The results showed that SHS exposure was high overall, with exposure at home and school ranging from 12.7 to 20.7%, respectively, in Oman to 39.4% and 36.7%, respectively, in Kuwait. Almost half of the adolescents reported exposure to SHS in public places, with a prevalence of 40.8% in Saudi Arabia to 65.9% in Kuwait. The prevalence of exposure varied between countries, with the highest rates occurring in Kuwait. Girls had higher exposure at home, while boys had higher exposure in public and at school. Factors associated with higher exposure included parental smoking, friend smoking, and tobacco advertising. The belief that SHS is harmful was associated with lower home exposure. In conclusion, adolescents in the Gulf Cooperation Council countries are exposed to concerning levels of SHS, especially in public places. These findings underscore the urgent need for stronger tobacco control policies, including comprehensive smoke-free laws covering all public venues, to protect youth from SHS exposure. Additionally, the results support the development of targeted interventions promoting smoke-free homes and social norms against smoking.

Smoke-free legislation impact on the hospitality sector in the Republic of Georgia

IntroductionComprehensive smoke-free (SF) policies reduce secondhand smoke exposure and improve population-level health outcomes. However, some decision-makers heed the tobacco industry’s argument that SF policies negatively impact the hospitality sector. This...

Expansion of Smoke-Free Laws in Public Places and Support for Smoke-Free in Malaysia: Findings from the 2020 ITC Malaysia Survey.

Smoke-free laws (SFL) are more effective with public support. This study investigated the smoking prevalence, public perceptions of smoking rules, and support for comprehensive SFL among 1047 people who smoke (PWS) and 206 people who do not smoke (PNS) aged ≥18 in the 2020 International Tobacco Control Malaysia Survey. Smoking prevalence was highest in nighttime entertainment venues (85.7%), non-air-conditioned eateries (49.7%), and indoor workplaces (34.6%). Respondents reported that smoking was banned in most indoor workplaces (81.7% PNS, 69.2% PWS), air-conditioned eateries (84.7% PNS, 75.7% PWS), and non-air-conditioned eateries (81.2% PNS, 78.7% PWS), but much less so in nighttime entertainment venues (30.1% PNS, 24.6% PWS). Support for comprehensive SFL in public venues was highest among PNS (≥84.9%) but still substantial among PWS (≥49.9%). PWS under 40, Malay, married, and aware of smoking rules supported SFL more. Robust SFL enforcement is essential in Malaysia to reduce secondhand smoke exposure in public places.

Second-Hand Tobacco Smoke Exposure: Results of Particulate Matter (PM2.5) Measurements at Hospitality Venues in Addis Ababa, Ethiopia.

In Ethiopia, a comprehensive smoke-free law that bans smoking in all public areas has been implemented since 2019. This study aimed to evaluate compliance with these laws by measuring the air quality and conducting covert observations at 154 hospitality venues (HVs) in Addis Ababa. Indoor air quality was measured using Dylos air quality monitors during the peak hours of the venues, with concentrations of particulate matter <2.5 microns in diameter (PM2.5) used as a marker of second-hand tobacco smoke. A standardized checklist was used to assess compliance with smoke-free laws during the same peak hours. The average PM2.5 concentrations were classified as good, moderate, unhealthy for sensitive groups, unhealthy for all, or hazardous using the World Health Organization's (WHO) standard air quality index breakpoints. Only 23.6% of the venues complied with all smoke-free laws indicators. Additionally, cigarette and shisha smoking were observed at the HVs. Overall, 63.9% (95% confidence interval: 56-72%) of the HVs had PM2.5 concentrations greater than 15 µg/m3. The presence of more than one cigarette smoker in the venue, observing shisha equipment in the indoor space, and the sale of tobacco products in the indoor space were significantly associated with higher median PM2.5 concentration levels (p < 0.005). Hazardous level of PM2.5 concentrations-100 times greater than the WHO standard-were recorded at HVs where several people were smoking shisha and cigarettes. Most HVs had PM2.5 concentrations that exceeded the WHO average air quality standard. Stricter enforcement of smoke-free laws is necessary, particularly for bars and nightclubs/lounges.

New Zealand's world-first smokefree legislation 'goes up in smoke': A setback in ending the tobacco epidemic

For several decades, Aotearoa New Zealand has maintained a relatively strict regulatory approach towards tobacco. In response to the significant impact of tobacco-related illnesses, many countries worldwide have worked to enhance tobacco control measures. These efforts include introducing plain tobacco packaging with graphic health warnings, improving access to smoking cessation services and offering supportive treatments for tobacco dependence. In December 2022, New Zealand enacted world-leading tobacco control legislation aimed at leading the nation towards a 'smokefree' future by 2025, a future where the smoking prevalence falls below 5 percent across all population groups. To achieve this goal, revolutionary measures were needed. These measures included denicotinising cigarettes, reducing the number of tobacco retail outlets, and implementing a generational ban on smoked products. Despite receiving support from academics, clinicians, leaders of local indigenous communities, and the general public, the sixth National-led coalition government remained resolute in repealing the law and did so through parliamentary urgency on 27 February 2024. The reversal of this health policy is anticipated to result in thousands of lives lost and widen life expectancy gaps between indigenous and non-indigenous populations. This decision, driven by political agenda objectives and interference from the tobacco industry, has not only impeded New Zealand's progress but also weakened global efforts in tobacco control.

Overview Smoking Behavior and Quality of Life of Sports Department Students, Faculty of Sports Science, Universitas Negeri Malang

According to the results of the Global Adult Tobacco Survey (GATS) in 2021, there has been a considerable increase in the number of adult smokers over the past ten years, rising from 60.3 million in 2011 to 69.1 million in 2021, an increase of 8.8 million individuals. This study aims to compare the quality of life between actively smoking students and those who are exposed to passive smoking, examining their physical, psychological, social, and environmental health effects. The study utilized a sample of 100 respondents who completed a questionnaire on cigarette use and the WHOQOL quality of life assessment, covering variables such as cigarette type, disruption in daily activities, desire to quit smoking, cigarette consumption, and attitudes towards smoking bans in public places. Calculation of the WHOQOL score revealed that 60 percent of non-smoking student respondents reported a good quality of life. These findings underscore the critical need for enhanced health awareness programs and stricter smoking regulations within the university to foster a healthier environment. The study's insights highlight the importance of developing targeted interventions and policies to reduce smoking rates among students to enhance their overall quality of life.According to the results of the Global Adult Tobacco Survey (GATS) in 2021, there has been a considerable increase in the number of adult smokers over the past ten years, rising from 60.3 million in 2011 to 69.1 million in 2021, an increase of 8.8 million individuals. This study aims to compare the quality of life between actively smoking students and those who are exposed to passive smoking, examining their physical, psychological, social, and environmental health effects. The study utilized a sample of 100 respondents who completed a questionnaire on cigarette use and the WHOQOL quality of life assessment, covering variables such as cigarette type, disruption in daily activities, desire to quit smoking, cigarette consumption, and attitudes towards smoking bans in public places. Calculation of the WHOQOL score revealed that 60 percent of non-smoking student respondents reported a good quality of life. These findings underscore the critical need for enhanced health awareness programs and stricter smoking regulations within the university to foster a healthier environment. The study's insights highlight the importance of developing targeted interventions and policies to reduce smoking rates among students to enhance their overall quality of life.

The inclusion of e-cigarettes and heated tobacco products in smoke-free home and car rules: A cross-sectional survey of adults in Armenia and Georgia.

Understanding who includes e-cigarettes and heated tobacco products (HTPs) in smoke-free home or car rules could inform public health interventions, particularly in countries with high smoking prevalence and recently implemented national smoke-free laws, like Armenia and Georgia. In 2022, we conducted a cross-sectional survey among 1468 adults in 28 Armenian and Georgian communities (mean age=42.92 years; 51.4% female, 31.6% past-month smoking). Multilevel regression (accounting for clustering within communities; adjusted for sociodemographics and cigarette use) examined e-cigarette/HTP perceptions (risk, social acceptability) and use intentions in relation to: 1) including e-cigarettes/HTPs in home and car rules among participants with home and car rules, respectively (logistic regressions); and 2) intention to include e-cigarettes/HTPs in home rules (linear regression, 1 = 'not at all' to 7 = 'extremely') among those without home rules. Overall, 72.9% (n=1070) had home rules, 86.5% of whom included e-cigarettes/HTPs; 33.9% (n=498) had car rules, 81.3% of whom included e-cigarettes/HTPs. Greater perceived e-cigarette/HTP risk was associated with including e-cigarettes/HTPs in home rules (AOR=1.28; 95% CI: 1.08-1.50) and car rules (AOR=1.46; 95% CI: 1.14-1.87) and next-year intentions to include e-cigarettes/HTPs in home rules (β=0.38; 95% CI: 0.25-0.50). Lower e-cigarette/HTP use intentions were associated with including e-cigarettes/HTPs in home rules (AOR=0.75; 95% CI: 0.63-0.88). While perceived social acceptability was unassociated with the outcomes, other social influences were: having children and no other household smokers was associated with including e-cigarettes/HTPs in car rules, and having children was associated with intent to include e-cigarettes/HTPs in home rules. Interventions to address gaps in home and car rules might target e-cigarette/HTP risk perceptions.

¿Hay alguna diferencia entre fumadores y no fumadores ingresados en un hospital psiquiátrico?

Objective: comparing the clinical profile, hospital indicators and psychiatric complications between smokers and non-smokers admitted to a psychiatric hospital. Methodology: this was a cross-sectional epidemiological study of the medical records of 573 patients admitted to a psychiatric hospital that complied with the smokefree law. Descriptive statistics, Fisher’s exact test and Mann-Whitney test was used. Results: of the 573 participants, 48% were smokers. The average age was 42.7 years. Smoking was more prevalent among those diagnosed with psychotic disorders (48.4%), those who used only first-generation antipsychotics (49.4%) and higher dosages of psychotropic drugs. The highest proportions of involuntary or court-ordered admissions occurred among smokers. The average number of attempted escapes, episodes of aggression and procedures to manage them was not high (ranging from 0.2 to 1.3 among smokers and from 0.1 to 0.9 among non-smokers). Conclusion: the data showed that smokers were more resistant to being hospitalized in a smoke-free environment. Although smoking cessation in this population is a challenge, neglecting it means devaluing the lives of people with mental disorders. Nurses and other professionals should be encouraged to discuss the scientific evidence about smoking in the psychiatric population.

What works to promote staff health in prison settings: a systematic review

PurposeGiven epidemiological data highlighting poor health outcomes for prison staff and correctional workers, this systematic review aims to understand what health promotion interventions, delivered in prison settings, are effective for prison staff health.Design/methodology/approachA systematic review was undertaken, with search parameters encompassing papers published over a ten-year period (2013–2023). Health promotion programmes; well-being programmes; and occupational health interventions to support prison staff health as part of a targeted approach or as part of a whole-prison approach were included in the review.FindingsThe review identified 354 studies, of which 157 were duplicates and 187 did not meet the inclusion criteria. This left ten studies in the review from five countries. Reducing the impact of tobacco smoke was the commonly cited intervention, with four studies focusing on smoke-free prison legislation, but other studies focused on stress reduction for staff and supporting holistic health. The papers were of poor methodological quality, with the exception of three included studies that had robust designs. Most studies showed limited or no impact of interventions to support prison staff health, the exception being policy interventions to reduce second-hand smoke exposure.Originality/valuePrison staff have poor health outcomes and yet limited attention has been paid to interventions to support their health. This review suggests a number of considerations for future policy and practice and direction for further research to improve prison staff health.