Smoke-free Policies Research Articles

Effects of smoke-free government policy in Qingdao, China: Evidence from the path analysis.

Smoke-free government(SFG), as a key tobacco control measure, has been added in Healthy China 2030 blueprint and Qingdao started the establishment of the demonstrative SFG in 2020.This study examined the effects of SFG policy on smoking and smoke-free(SF) environment after establishing the demonstrative SFG. This cross-sectional survey selected participants by simple random sampling from party and government agencies in Qingdao (N = 3625) and the participants filled in questionnaires online from November 31 to December 15, 2020. We utilized AMOS to set up models to analyze the direct and indirect effects of SFG policy. The findings showed that knowledge of SFG policy was positively associated with SF environment(β = 0.29, P<0.001) and negatively associated with smoking(β = -0.14,P<0.001). Knowledge of SFG policy had indirect effects on SF environment through four channels: independent mediation of discouraging smoking and attitude towards SFG policy, as well as chain mediation of these two factors, and perception of tobacco hazards and discouraging smoking, with indirect effects accounting for 33.5% of the total effect. Knowledge of SFG policy had indirect effects on smoking reduction via SF environment and two chain mediation: SF environment and attitude towards SFG policy, perception of tobacco hazards and intention to quit smoking, with indirect effects accounting for 50.2% of the total effect. The results provided the evidence that SFG policy not only had positive effects on creating SF environment but also on reducing smoking. The efficient policy infiltration to individuals played a vital role in the establishment of SFG. Attitude towards SFG policy, discouraging smoking and SF environment were the potential mediators for SFG policy. Findings in this study added more evidence related to effect mechanism of SFG policy and had a positive influence on promoting the implementation SFG policies for China and other countries.

Smoke-free home restrictions in Armenia and Georgia: motives, barriers and secondhand smoke reduction behaviors.

Promoting smoke-free homes (SFHs) in Armenia and Georgia is timely given high smoking and secondhand smoke exposure (SHSe) rates and recent national smoke-free policy implementation. This study examined theoretical predictors (e.g. motives, barriers) of SFH status, and among those without SFHs, past 3-month SFH attempts and intent to establish SFHs in the next 3 months. Multilevel logistic regression analyzed these outcomes using 2022 survey data from 1467 adults (31.6% past-month smokers) in Armenia (n = 762) and Georgia (n = 705). Correlates of interest included SHSe reduction behaviors and SFH motives and barriers; models controlled for country, community, age, sex, smoking status and other smokers in the home. In this sample, 53.6% had SFHs (Armenia: 39.2%; Georgia: 69.2%). Among those without SFHs, one-fourth had partial restrictions, no smokers in the home and/or recent SFH attempts; 35.5% intended to establish SFHs; and ∼70% of multiunit housing residents supported smoke-free buildings. We documented common SHSe reduction behaviors (opening windows, limiting smoking areas), SFH motives (prevent smell, protect children/nonsmokers) and barriers (smokers' resistance). Correlates of SFHs were being from Georgia, other smokers in the home, fewer SHSe reduction behaviors, greater motives and fewer barriers. Among participants without SFHs, correlates of recent SFH attempts were other smokers in the home, greater SHSe reduction behaviors and SFH motives, and fewer barriers; correlates of SFH intentions were being female, greater SHSe reduction behaviors, greater motives, and fewer barriers. SFH interventions should address motives, barriers and misperceptions regarding SHSe reduction behaviors. Moreover, smoke-free multiunit housing could have a great population impact.

Impact of Alcohol Use, Traumatic Stress, and Cigarette Smoking on Cognitive Functioning in Veterans With Co-occurring Alcohol Use Disorder and Posttraumatic Stress Disorder.

Alcohol use disorder (AUD) and PTSD have high rates of co-occurrence in U.S. Military Veterans resulting in incrementally worse functional outcomes relative to having either one of these disorders alone. Cognitive dysfunction can impede one's ability to benefit from standard behavioral AUD and PTSD treatments. Cigarette smoking is also highly prevalent among U.S. Military Veterans, and cognitive dysfunction is associated with chronic cigarette use among individuals with AUD and PTSD independently. However, much less is known about to what extent cigarette smoking further impairs cognitive functioning in individuals with both co-occurring AUD and PTSD. U.S. Veterans with co-occurring AUD and PTSD (n = 162) completed a comprehensive cognitive assessment covering various domains: working memory, processing speed, mental switching, cognitive inhibition, auditory-verbal learning, auditory-verbal memory, and verbal fluency. To examine the impact of alcohol use, traumatic stress, and cigarette smoking on cognitive function, we conducted a three-way interaction examining the moderated effects of smoking status on the association between alcohol use and PTSD symptoms on a composite domain of global cognition. Smoking status in Veterans with co-occurring AUD and PTSD moderated the relationship between alcohol use and global cognition (P = .042), such that higher levels of alcohol use in the past week were related to worse global cognitive function among Veterans cigarette smokers (P = .015) but not among nonsmokers (P = .833). On follow-up analyses of individual cognitive domains, greater alcohol use in the past week was associated with lower cognitive inhibition in smokers but not nonsmokers, with traumatic stress symptoms moderating this effect (P = .039). Additionally, smoking status moderated the relationship between alcohol use and auditory-verbal learning, such that there was a differential relationship between alcohol use and auditory-verbal learning between smokers and nonsmokers. Overall, results provide evidence for the compounding impact of alcohol use, traumatic stress, and cigarette smoking on cognitive functioning. Impaired cognitive performance on a global level as well as on individual domains of cognitive inhibition and auditory-verbal learning were evident. Cognitive dysfunction may impede a Veteran's ability to benefit from therapeutic treatment, and these cognitive domains may represent potential targets for cognitive training efforts. Further, study results support smoking cessation initiatives and smoke-free policies enacted at Veterans Affairs healthcare facilities and medical centers.

Passive exposure and perceptions of smoke-free policies in hospital and university campuses among nursing students: A cross-sectional multicenter study.

Outdoor smoke-free regulations reduce exposure to secondhand smoke (SHS) and help to denormalize tobacco use. As future key agents in health promotion, nursing students' attitudes should agree with tobacco-control policies. The objectives of this study were: 1) assess nursing students' exposure to SHS in nursing schools, 2) explore their perceptions of compliance with the existing smoke-free regulations in acute-care hospitals; and 3) describe their support for indoor and outdoor smoking bans on hospital and university campuses. This was a cross-sectional multicenter study conducted in 2015-2016 in all 15 university nursing schools in Catalonia, Spain. A questionnaire gathered information on SHS exposure, awareness of the smoke-free regulation in acutecare hospitals, and support for smoke-free policies in indoor and outdoor areas of hospitals and university campuses. Participants were nursing students attending classes on the day of the survey. We performed descriptive analyses and calculated adjusted prevalence ratios (APR) and 95% confidence interval (CI). Of 4381 respondents, 99.1% had seen people smoking in outdoor areas of their university campus, and 75.2% had been exposed to SHS on the campus (6.0% indoors and 69.2% outdoors). Nearly 60% were aware of the smoking regulation in place in acute-care hospitals. There was widespread support for smoke-free indoor hospital regulation (98.7%), but less support (64.8%) for outdoor regulations. Approximately 33% supported the regulation to make outdoor healthcare campuses smoke-free, which was higher among third-year students compared to first-year students (APR=1.41; 95% CI: 1.24-1.62), among never smokers (41.4%; APR=2.84; 95% CI: 2.21-3.64) compared to smokers, and among those who were aware of the regulation (38.4%; 95% CI: 1.37-1.75). Exposure to SHS on university campuses is high. Nursing students express low support for strengthening outdoor smoking bans on hospital and university campuses. Interventions aiming to increase their support should be implemented.

Disparities in Smokefree and Vapefree Home Rules and Smokefree Policy Attitudes Based on Housing Type and Cigarette Smoking Status, United States, 2019.

This study examined variations in cigarette smoking status, home smoking and vaping rules, and attitudes toward smoking rules among U.S. adults. We analyzed data from the 2019 U.S. Census Bureau's Current Population Survey Supplements (n = 40,296 adults) and calculated weighted prevalence estimates of adult cigarette smoking based on housing type. In 2019, multi-unit housing (MUH) residents who currently smoked were predominantly residents of privately rented housing (66.9%), followed by privately owned (17.6%) and public housing (15.5%). MUH residents who currently smoked had the highest proportions of allowing smoking (26.7%) or vaping (29.1%) anywhere inside their homes and were least likely to support rules allowing smoking inside all MUH apartments or living areas. In the adjusted models, MUH residents with a current smoking status were 92% less likely to have a complete smoking ban. More than one in four MUH residents with a current smoking status allowed all smoking inside the home and supported allowing smoking inside all MUH apartment or living areas, reinforcing how MUH residents may be at higher risk of experiencing secondhand smoke or aerosol exposure, or incursions within their places of residence. Our results can inform the development, implementation, and sustainment of strategies to reduce exposures from tobacco and nicotine products in all living environments.

Talking cigarette in cyberspace: Cyber community response to the implementation of smoke free area policy in Bandung, Indonesia

Background and purpose: The policy of implementing and expanding smoke free area (kawasan tanpa rokok/KTR) in several locations in the City of Bandung has become a topic that is highlighted by the community. Community response is an essential component in succeeding policy implementation. This study examines how the culture of cyber society responds to the implementation and extension of the KTR in the city of Bandung Methods: This study uses a qualitative method with a netnographic strategy. Three posts were selected according to the criteria for the research objectives, including: @prfmnews posts, @infobandungraya, and @infobdg.com. Instagram is selected as the research data source because, according to the Ministry of Communication and Information (Kominfo), it is the most popular social media in Indonesia. Indeed, every post and information on it has the potential to attract various groups. Several concepts and theories in this study relate to the diffusion of innovation, information literacy, cognitive dissonance theory, and selective process theory. Results: This study found some of the contra arguments were conducting tobacco control is false propaganda; other regulations are more urgent than KTR; the leading cause of dirty air is vehicles; local regulation on KTR is ambiguous, and smoking is part of individual rights. In the pro category, the communities are supportive, especially those who are passive smokers and feel discomfort with cigarette smoke conditions. Information and digital literacy related to cigarettes are factors that trigger individual responses to hoaxes and conspiratorial information about cigarettes. Denial to the reality of the dangers of smoking illustrates how the process of cognitive dissonance occurs in smokers who try to justify their actions for various reasons. The cyber community has experienced selective exposure to the KTR and the diffusion of innovations in the KTR should be considered. Conclusion: Based on the research findings, the researcher suggests that the government should pay attention to the stages of persuasion and promotion of KTR policies to achieve public obedience to the applicable local regulations.

A Qualitative Investigation of Staff Feedback on an Online Learning Module on Smoking Cessation in a German Healthcare Company.

Quitting smoking is a powerful way for patients to improve their own wellbeing and to significantly reduce the risk of health problems. Evidence shows that health professionals can effectively intervene in order to prevent and stop tobacco smoking in their patients. Online learning modules have proved to be effective in terms of transferring knowledge and skills. In an urban community hospital setting in Germany, a novel e-learning course for staff on the treatment of tobacco dependence was implemented in 2021. In this study, we analyzed free-text feedback of participants completing this online module in order to examine the feasibility and acceptance of this new format. We were able to reach a reasonable proportion of staff. Our qualitative analysis showed that most feedback was positive and described the module as well-designed and helpful. Some staff, however, expressed extremely negative views and did not see smoking cessation support as essential to their role in healthcare. We argue that in order to achieve a shift in attitude in healthcare staff, a change in German policy is required which includes the creation of smoke-free environments and the adherence to smoke-free policies on hospital sites. Furthermore, the provision of smoking cessation support in line with the WHO Framework Convention on Tobacco Control and a true understanding of the role of all healthcare professionals in promoting health of patients and staff will be essential.

Eliminating children's tobacco smoke exposure: a pathway to bioverified abstinence among low-income maternal smokers in the Babies Living Safe and Smokefree (BLiSS) trial.

Identifying behavioral pathways to smoking cessation in high-risk populations, such as low-income maternal smokers, could reduce tobacco disparities. The previous"BLiSS" multilevel intervention trial demonstrated efficacy of the BLiSS intervention in facilitating low-income maternal smokers' bioverified abstinence. This present study examined four putative pathways measured at 3-month end of treatment (Time 2) that could account for the observed intervention effect on smoking abstinence through 12 months (Time 2 - Time 3). Nutritionists in community clinics delivering safety net nutrition promotion programs across Philadelphia, Pennsylvania, USA, were trained by trial principal investigators to deliver a brief tobacco intervention informed by the American Academy of Pediatrics best practice guidelines ("Ask, Advise, Refer [AAR]"). After referral, 396 eligible participants were randomized to either a multimodal behavioral intervention (AAR + MBI) or a parallel attention control (AAR + control). Random effects regression analysis tested mediation. Elimination of children's tobacco smoke exposure (TSE) at Time 2 was the only significant mediator of longitudinal smoking abstinence through Time 3. AAR + MBI mothers were more likely to eliminate their children's TSE by Time 2 (OR = 2.11, 95%CI 1.30, 3.42), which was significantly associated with Time 3 abstinence (OR = 6.72, CI 2.28, 19.80). Modeling showed a significant total effect of AAR + MBI on abstinence (OR = 6.21, CI 1.86, 20.71), a direct effect of AAR + MBI on abstinence (OR = 4.80, CI 1.45, 15.94) and an indirect effect through TSE elimination (OR = 1.29, CI 1.06, 1.57). Integrating smoking cessation interventions with counseling prior to the quit attempt that is designed to facilitate adoption of smokefree home policies and efforts to eliminate children's TSE could enhance the likelihood of long-term abstinence in populations of smokers with elevated challenges quitting smoking.

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.

The association between viewing cigarette health warning labels and intention to quit smoking among Chinese adult smokers: support for including health outcome content and culturally specific messages

BackgroundTailored themes of pictorial health warning labels (HWLs) that considers specific cultural dimensions and within a specific policy/historical context can motivate behavior change, such as provoking smokers to think about quitting. Currently in China, the HWLs on cigarettes are text-only. This study designed pictorial HWLs using different themes to explore and examine the association between viewing pictorial HWLs and participants’ intention to quit smoking. The themes included: (1) Self-harm from using cigarettes, (2) Harming family or children with secondhand smoke, (3) Complying with existing smoke-free policies, and (4) Cigarette gift giving practices.MethodsA cross-sectional randomized experimental survey was conducted among 1,625 smokers in Beijing (n = 545), Shanghai (n = 541), and Shenzhen (n = 539) during 2017. Before and after viewing eight pictorial HWLs of one theme, participants were asked if they had plans to quit smoking within the next month, within the next 6 months, beyond the next 6 months, or not at all. Ordinal logistic regression, Wilcoxon and Chi-square tests were used to analyze the data.ResultsAfter viewing the HWLs, 434 participants (26.9%) reported an intention to quit smoking sooner, 987 (61.2%) reported the same intention to quit, and 191 (11.8%) reported an intention to quit later. The pre-post change in intention to quit was statistically significant among all participants and participants under each theme (p > 0.05). Participants who rated the effectiveness of the HWL communicating how secondhand smoke harms children had 1.13 (95% CI 1.01–1.27) greater odds of reporting an intention to quit sooner compared to those viewing labels from the other themes, adjusting for covariates. Female participants and participants with annual household income more than 100,000RMB had 1.39 (95% CI 1.14–1.69) and 1.29 (95% CI 1.04–1.60) greater odds of reporting an intention to quit sooner compared to their counterparts across the entire sample.ConclusionsFindings of this study provide evidence of an association between all four pictorial HWL themes and smokers’ intention to quit smoking. These findings can help inform what HWL themes might be appropriate when China implements pictorial health warning labels.

Tobacco Product Use Among Adults – United States, 2021

Commercial cigarette smoking among U.S. adults has declined during the preceding 5 decades (1,2); however, tobacco product use remains the leading cause of preventable disease and death in the United States, and some populations continue to be disproportionately affected by tobacco use (1,2). To assess recent national estimates of commercial tobacco use among U.S. persons aged ≥18 years, CDC, the Food and Drug Administration (FDA), and the National Cancer Institute analyzed 2021 National Health Interview Survey (NHIS) data. In 2021, an estimated 46 million U.S. adults (18.7%) reported currently using any tobacco product, including cigarettes (11.5%), e-cigarettes (4.5%), cigars (3.5%), smokeless tobacco (2.1%), and pipes (including hookah)* (0.9%).† Among those who used tobacco products, 77.5% reported using combustible products (cigarettes, cigars, or pipes), and 18.1% reported using two or more tobacco products.§ The prevalence of current use of any tobacco product use was higher among the following groups: men; persons aged <65 years; persons of non-Hispanic other races; non-Hispanic White (White) persons¶; residents of rural (nonmetropolitan) areas; financially disadvantaged (income-to-poverty ratio=0-1.99); lesbian, gay, or bisexual (LGB) persons; those uninsured or enrolled in Medicaid; adults whose highest level of education was a general educational development (GED) certificate; who had a disability; and who had serious psychological distress. Continued surveillance of tobacco product use, implementation of evidence-based tobacco control strategies (e.g., hard-hitting media campaigns, smoke-free policies, and tobacco price increases), conducting linguistically and culturally appropriate educational campaigns, and FDA regulation of tobacco products will aid in reducing tobacco-related disease, death, and disparities among U.S. adults (3,4).

Hardening determinants among adult daily smokers in nine African countries: Data from the Global Adult Tobacco Survey

Little has been reported about hardening nor softening indicators in Africa where smoking prevalence is low. We aimed to examine the determinants of hardening in nine African countries. We conducted two separate analyses using data from the most recent Global Adult Tobacco Survey in Botswana, Cameroon, Egypt, Ethiopia, Kenya, Nigeria, Senegal, Tanzania, and Uganda (total sample of 72,813 respondents): 1) multilevel logistic regression analysis to assess individual and country-level factors associated with hardcore, high dependence, and light smoking.; 2) a Spearman-rank correlation analysis to describe the association between daily smoking and hardcore, high dependence, and light smoking at an ecological level. Age-standardized daily smoking prevalence varied from 37.3% (95 %CI: 34.4, 40.3) (Egypt) to 6.1% (95 %CI: 3.5, 6.3) (Nigeria) among men; and 2.3% (95 %CI: 0.7, 3.9) (Botswana) to 0.3% (95 %CI: 0.2, 0.7) (Senegal) among women. The proportion of hardcore and high-dependence smokers was higher among men whereas for light smokers the proportion was higher among women. At the individual level, higher age and lower education groups had higher odds of being hardcore smokers and having high dependence. Smoke-free home policies showed decreased odds of both being hardcore and highly dependent smokers daily smoking correlated weakly and negatively with hardcore smoking (r = −0.243, 95 %CI: −0.781, 0.502) among men and negatively with high dependence (r = −0.546, 95 %CI: −0.888, 0.185) and positively with light smokers (r = 0.252, 95 %CI: −0.495, 0.785) among women. Hardening determinants varied between the countries in the African region. Wide sex differentials and social inequalities in heavy smoking do exist and should be tackled.

Public support for smoke-free policies in outdoor areas and (semi-)private places: a systematic review and meta-analysis

Smoke-free policies are essential to protect people against tobacco smoke exposure. To successfully implement smoke-free policies that go beyond enclosed public places and workplaces, public support is important. We undertook a comprehensive systematic review of levels and determinants of public support for indoor (semi-)private and outdoor smoke-free policies. In this systematic review and meta-analysis, six electronic databases were searched for studies (published between 1 January 2004 and 19 January 2022) reporting support for (semi-)private and outdoor smoke-free policies in representative samples of at least 400 respondents aged 16 years and above. Two reviewers independently extracted data and assessed risk of bias of individual reports using the Mixed Methods Appraisal Tool. The primary outcome was proportion support for smoke-free policies, grouped according to location covered. Three-level meta-analyses, subgroup analyses and meta-regression were performed. 14,749 records were screened, of which 107 were included; 42 had low risk of bias and 65 were at moderate risk. 99 studies were included in the meta-analyses, reporting 326 measures of support from 896,016 individuals across 33 different countries. Support was pooled for indoor private areas (e.g., private cars, homes: 73%, 95% confidence interval (CI): 66-79), indoor semi-private areas (e.g., multi-unit housing: 70%, 95% CI: 48-86), outdoor hospitality areas (e.g., café and restaurant terraces: 50%, 95% CI: 43-56), outdoor non-hospitality areas (e.g., school grounds, playgrounds, parks, beaches: 69%, 95% CI: 64-73), outdoor semi-private areas (e.g., shared gardens: 67%, 95% CI: 53-79) and outdoor private areas (e.g., private balconies: 41%, 95% CI: 18-69). Subcategories showed highest support for smoke-free cars with children (86%, 95% CI: 81-89), playgrounds (80%, 95% CI: 74-86) and school grounds (76%, 95% CI: 69-83). Non-smokers and ex-smokers were more in favour of smoke-free policies compared to smokers. Support generally increased over time, and following implementation of each smoke-free policy. Our findings suggested that public support for novel smoke-free policies is high, especially in places frequented by children. Governments should be reassured about public support for implementation of novel smoke-free policies. Dutch Heart Foundation, Lung Foundation Netherlands, Dutch Cancer Society, Dutch Diabetes Research Foundation and Netherlands Thrombosis Foundation.

Lesson-drawing in tobacco control: A qualitative study of stakeholder perceptions in five North-Western European countries.

The theory of 'family of nations' posits that countries draw policy lessons predominantly from similar countries. Lesson-drawing in tobacco control has, however, been primarily studied in the 'English-speaking' family. We examined in five diverse North-Western European countries whether the government engages in lesson-drawing regarding best practices in tobacco control, which countries they look at for guidance, and why these were chosen as a reference. Perceptions of 29 policy participants from civil society and government were assessed by means of interviews conducted in Belgium, Finland, Germany, Ireland, and the Netherlands. Relevant excerpts were grouped according to country and a bottom-up thematic analysis was performed. The tobacco control instruments described by the policy participants were tobacco marketing bans (display ban and plain packaging) and smoke-free policies. German interviewees stated that the German federal government is not inclined to engage in foreign lesson-drawing. All other governments were perceived to look at Australia for lessons because of its global leadership in tobacco control. At the same time however, lessons from Australia were easily dismissed because it is an 'island' and far away. Irish interviewees observed their government to primarily look at other English-speaking countries. Governments in Belgium, Finland and the Netherlands were observed to primarily look at nearby European countries for lessons. Countries in North-Western Europe seem to draw policy lessons based on proximity and similarity to other countries concerning marketing bans and smoke-free policies. Proponents of tobacco control may use these findings to facilitate effective lesson-drawing in their countries.

Tobacco-Free Areas Implementation at University X

Introduction: University X is one of the institutions where tobacco-free areas are required in a university setting where teaching and learning activities are highly regulated. However, the implementation of tobacco-free was only implemented in a few faculties, and, the whole academic community of University X has not entirely complied with the regulation. This study aimed to analyze the implementation of Tobacco-Free Areas at University X.Methods: This study used a qualitative research method to examine the implementation of smoke-free areas at University X. Data were gathered through in-depth interviews, observations, and other supporting documentation. There were 13 research informants, including Deans/Vice Deans from four faculties, the Academic Director of Student Affairs, alumni, lecturers, and students of University X. This study examined communication, resources, disposition, and bureaucratic organization policies.Results: This study found that university administrators never communicated directly or indirectly regarding Tobacco-Free Areas regulation. It is still neither excellent nor adequate, based on the resources available for human resource compliance and infrastructure availability. In terms of disposition, numerous parties fully support the execution of the smoke-free policy. However, the implementing officers/supervisors of the smoke-free areas at University X were less steadfast. This is demonstrated by the absence of a bureaucratic framework at University X in implementing and supervising Tobacco-Free compliances.Conclusion: Tobacco-free areas had been implemented at University X although they were not yet complete and optimal. It is possible to infer that this was not a priority at University X because conflicts of interest might hamper this regulation, resulting in lacking clarity, and sustainability.

Use of a Living Lab approach to implement a smoke-free campus policy

Use of a Living Lab approach to implement a smoke-free campus policy

Association between pro-tobacco and anti-tobacco media and messaging exposure and support for smoke-free policy among adults in Armenia and Georgia

Association between pro-tobacco and anti-tobacco media and messaging exposure and support for smoke-free policy among adults in Armenia and Georgia

130 Awareness and Implementation of Tobacco Control Practices in Rural Louisiana Federally Qualified Health Centers

OBJECTIVES/GOALS: Tobacco use remains a significant problem in rural America. Federally Qualified Health Centers (FQHCs) can help reduce the burden of tobacco use in rural areas. Still, we know little about center awareness and implementation of best practices for tobacco control. We assessed the knowledge and existence of tobacco control strategies in rural FQHCs. METHODS/STUDY POPULATION: We electronically surveyed health administrators and providers (n=33) in three rural Louisiana FQHCs between March and April 2021. The assessment measured awareness of the U.S. Public Health Service Clinical Practice Guideline for Treating Tobacco Use, center priority given to smoking cessation programming, the presence of best practices for tobacco control programming such as having a tobacco control champion and team, treatment and smoke-free campus policies, and referral to external cessation services. Descriptive statistics characterize survey respondents and responses. RESULTS/ANTICIPATED RESULTS: The majority of the respondents were female (88.5%), White (53.8%), between 35 and 54 years of age (69.2%), and non-smokers (65.4%). Among all respondents, 69.7% reported awareness of the U.S. Public Health Service Clinical Practice Guideline for Treating Tobacco Use. Less than half (48%) said their health center gave smoking cessation high priority relative to other health priorities. Only a third (36%) reported having a tobacco champion, and a quarter (25%) had a tobacco control team at their facility. Although all centers had a smoke-free campus policy, a quarter (27%) were unaware of the policy. Only a quarter (27%) reported having a written policy for smoking cessation treatment at their center, and a little more than half (56.7%) knew about cessation services to which they could refer tobacco users. DISCUSSION/SIGNIFICANCE: Centers had limited knowledge of the U.S. guideline for tobacco use treatment. Smoking cessation lacked priority, and tobacco control best practices implementation was low. FQHCs serving rural populations can implement guideline-recommend policies and clinical treatments, and future studies should test strategies to increase implementation.

Use of a Living Lab Approach to Implement a Smoke-Free Campus Policy.

While universities have increasingly become tobacco-/smoke-free, to our knowledge, no campus has reported 100% policy compliance. Innovative approaches to encourage compliance and ongoing data collection are needed. This paper describes actions undertaken, framed within a Living Lab (LL) approach, to implement smoke-free campus policies in an Irish university. The action research comprised student-collected data on observed smoking on campus to evaluate adherence and compliance, first to a smoke-free zones policy (June 2016-March 2018), and then to a smoke-free campus policy (March 2019-February 2020). From June 2016-February 2020, 2909 smokers were observed. Adherence, defined as the average reduction in number of observed smokers from baseline in May 2016, reduced by 79% from 5.7 to 4.9 . Compliance, defined as the proportion of smokers who complied when reminded of the policy, was 90% (2610/2909). Additional activities included development of a broader health promotion programme; identification of a pattern of 'social smoking'; and promoting increased awareness of the environmental harms of tobacco. Ongoing policy implementation is essential for smoke-free policies and should include data collection and evaluation. Actions framed within the characteristics of a LL achieved fewer observed smokers. A LL approach is recommended to encourage policy adherence and compliance.

Effects of municipal smoke-free ordinances on secondhand smoke exposure in the Republic of Korea.

To reduce premature deaths due to secondhand smoke (SHS) exposure among non-smokers, the Republic of Korea (ROK) adopted changes to the National Health Promotion Act, which allowed local governments to enact municipal ordinances to strengthen their authority to designate smoke-free areas and levy penalty fines. In this study, we examined national trends in SHS exposure after the introduction of these municipal ordinances at the city level in 2010. We used interrupted time series analysis to assess whether the trends of SHS exposure in the workplace and at home, and the primary cigarette smoking rate changed following the policy adjustment in the national legislation in ROK. Population-standardized data for selected variables were retrieved from a nationally representative survey dataset and used to study the policy action's effectiveness. Following the change in the legislation, SHS exposure in the workplace reversed course from an increasing (18% per year) trend prior to the introduction of these smoke-free ordinances to a decreasing (-10% per year) trend after adoption and enforcement of these laws (β 2 = 0.18, p-value = 0.07; β 3 = -0.10, p-value = 0.02). SHS exposure at home (β 2 = 0.10, p-value = 0.09; β 3 = -0.03, p-value = 0.14) and the primary cigarette smoking rate (β 2 = 0.03, p-value = 0.10; β 3 = 0.008, p-value = 0.15) showed no significant changes in the sampled period. Although analyses stratified by sex showed that the allowance of municipal ordinances resulted in reduced SHS exposure in the workplace for both males and females, they did not affect the primary cigarette smoking rate as much, especially among females. Strengthening the role of local governments by giving them the authority to enact and enforce penalties on SHS exposure violation helped ROK to reduce SHS exposure in the workplace. However, smoking behaviors and related activities seemed to shift to less restrictive areas such as on the streets and in apartment hallways, negating some of the effects due to these ordinances. Future studies should investigate how smoke-free policies beyond public places can further reduce the SHS exposure in ROK.