Smoke-free Legislation Research Articles

Tobacco industry’s ‘behind the scenes’ tactics in Singapore

BackgroundTobacco companies have maintained a profitable business in Singapore, despite its strong anti-tobacco climate and commitment to protect public health policymaking from tobacco industry interference in line with Framework Convention...

Perceived effectiveness of four different cigarette health warning label themes among a sample of urban smokers and non-smokers in China

ObjectiveThis study, conducted in China, evaluated the effectiveness of four different themes of health warning labels (HWLs) that used both text and pictures: (1) self-harm from using cigarettes, (2) harming...

Secondhand Smoke Exposure in European Countries With Different Smoke-Free Legislation: Findings From the EUREST-PLUS ITC Europe Surveys.

Exposure to secondhand smoke (SHS) poses serious and extensive health and economic-related consequences to European society and worldwide. Smoking bans are a key measure to reducing SHS exposure but have been implemented with varying levels of success. We assessed changes in the prevalence of self-reported SHS exposure and smoking behavior in public places among smokers in six European countries and the influence of the country's type of smoking ban (partial or total ban) on such exposure and smoking behavior. The EUREST-PLUS ITC Europe Surveys were conducted among adult smokers in Germany, Greece, Hungary, Poland, Romania, and Spain in 2016 (Wave 1, n = 6011) and 2018 (Wave 2, n = 6027). We used generalized estimating equations models to assess changes between Waves 1 and 2 and to test the interaction between the type of smoking ban and (1) self-reported SHS exposure, (2) self-reported smoking in several public places. A significant decrease in self-reported SHS exposure was observed in workplaces, from 19.1% in 2016 to 14.0% in 2018 (-5.1%; 95% CI: -8.0%; -2.2%). Self-reported smoking did not change significantly inside bars (22.7% in Wave 2), restaurants (13.2% in Wave 2) and discos/nightclubs (34.0% in W2). SHS exposure in public places was significantly less likely (adjusted odds ratio = 0.35; 95% CI: 0.26-0.47) in the countries with total bans as compared to those countries with partial bans. The inverse association between smoking in public places and smoking bans indicates an opportunity for strengthening smoke-free legislation and protecting bystanders from exposure to SHS in public places. Prevalence of smokers engaging in and being exposed to smoking in public places varied by type of smoke-free legislation across six European Union countries in our study; those with total smoke bans reported significantly less exposure to SHS than those with partial or no bans. Our results indicate room for improvement, not only to decrease the prevalence of exposure to SHS in Europe but also to diminish the variability between countries through common, more restrictive smoke-free legislation, and importantly, strong and sustained enforcement.

Smoke-Free Laws and Disparities in Youth Smoking in the U.S., 2001–2018

This study examines whether smoke-free laws are differentially associated with youth smoking outcomes by parental education, race/ethnicity, sex, and college plans in a U.S. This study assessed the relationships between smoke-free laws in workplaces and hospitality venues (restaurants/bars) and past 30-day smoking participation, first cigarette initiation, and daily smoking initiation within a repeated cross-sectional sample of 8th, 10th, and 12th graders from the Monitoring the Future study. Data were collected between 2001 and 2018 and were analyzed in 2020-2021. Grade-stratified Poisson models were used to calculate prevalence ratios and average marginal effects, incorporating interaction terms to examine differential associations across groups. Hospitality smoke-free laws were significantly associated with lower probabilities of smoking participation in all grades as well as with first cigarette and daily smoking initiation in 8th and 10th grade. Workplace smoke-free laws were associated with lower probabilities of smoking participation among 10th and 12th graders as well as with first cigarette and daily smoking initiation among 10th graders. Average marginal effects ranged from -0.4 percentage points (hospitality laws and daily smoking initiation in 8th and 10th grades) to -2.2 percentage points (workplace laws and smoking participation in 10th grade). Associations between smoke-free laws and a lower probability of smoking participation were most pronounced among students who definitely planned to attend college. Other instances of effect modification suggested more pronounced associations for students who were female and from high-SES households; however, relationships varied by grade. Smoke-free laws were associated with reduced smoking among youth; however, associations varied by grade, sex, parental education, and college plans.

Tobacco treatment clinics in urban public housing: feasibility and outcomes of a hands-on tobacco dependence service in the community

BackgroundAs a further extension of smoke-free laws in indoor public places and workplaces, the Department of Housing and Urban Development’s declaration to propose a regulation that would make housing units smoke-free was inevitable. Of note is the challenge this regulation poses to current tenants of housing units who are active smokers. We aimed to assess the efficacy of a tobacco treatment clinic in public housing. The utilization of the clinic by tenants and tenants’ respective outcomes regarding smoking status were used to determine the intervention’s effectiveness.MethodsTobacco treatment clinics were held in two urban-based housing units for 1-year. The clinics provided on-site motivational interviewing and prescriptions for pharmacological agents if warranted. Outcomes collected include the tenants’ clinic attendance and 3- and 6-month self-reported smoking status.ResultsTwenty-nine tobacco treatment clinic sessions were implemented, recruiting 47 tenants to participate in smoking cessation. The mean age of the cohort was 53 ± 12.3 years old. Of the 47 tenants who participated, 21 (44.7%) attended three or more clinic sessions. At the 3-month mark, five (10.6%) tenants were identified to have quit smoking; at 6-months, 13 (27.7%) tenants had quit smoking. All 13 of the tenants who quit smoking at the end of 6-months attended three or more sessions.ConclusionAn on-site tobacco treatment clinic to provide strategies on smoking cessation was feasible. Efforts are warranted to ensure more frequent follow-ups for tenants aiming to quit smoking. While further resources should be allocated to help tenants comply with smoke-free housing units’ regulations, we believe an on-site tobacco treatment clinic is impactful.

Effect of smoke-free legislation on respiratory health services use in children with asthma: a population-based open cohort study in Ontario, Canada

ObjectiveThis study will add to existing literature by examining the impact of smoke-free legislation in outdoor areas among children with asthma. We aimed to examine the effect of the 2015...

Protecting children from tobacco-related harm in private vehicles

Protecting children from tobacco-related harm in private vehicles

Associations between smoke-free vehicle legislation and childhood admissions to hospital for asthma in Scotland: an interrupted time-series analysis of whole-population data

In Scotland, childhood admissions to hospital for asthma fell from March, 2006, after legislation was introduced to prohibit smoking in public places. In December, 2016, new Scottish legislation banned smoking in vehicles containing a child. We aimed to determine whether the introduction of this new legislation produced additional benefits. We obtained data on all asthma emergency admissions to hospitals in Scotland between 2000 and 2018 for individuals younger than 16 years. We used interrupted time-series analyses to study changes in monthly incidence of asthma emergency admissions to hospital per 100 000 children after the introduction of smoke-free vehicle legislation, taking into account previous smoke-free interventions. We did subgroup analyses according to age and area deprivation, using the Scottish Index of Multiple Deprivation, and repeated the analyses for a control condition, gastroenteritis, and other respiratory conditions. Of the 32 342 emergency admissions to hospital for asthma among children younger than 16 years over the 19-year study period (Jan 1, 2000, to Dec 31, 2018), 13 954 (43%) were among children younger than 5 years and 18 388 (57%) were among children aged 5-15 years. After the introduction of smoke-free vehicle legislation, there was a non-significant decline in the slope for monthly emergency admissions to hospital for asthma among children younger than 16 years (-1·21%, 95% CI -2·64 to 0·23) relative to the underlying trend in hospital admissions for childhood asthma. However, children younger than 5 years had a significant decline in the slope for monthly asthma admissions (-1·49%, -2·69 to -0·27) over and above the underlying trend among children in this age group (equivalent to six fewer hospitalisations per year), but no such decline was seen in children aged 5-15 years. Monthly admissions to hospital for asthma fell significantly among children living in the most affluent areas (-2·27%, -4·41 to -0·07) but not among those living in the most deprived areas. We found no change in admissions to hospital for gastroenteritis or other respiratory conditions after the introduction of the smoke-free vehicle legislation. Although legislation banning smoking in vehicles did not affect hospital admissions for severe asthma among children overall or in the older age group, this legislation was associated with a reduction in severe asthma exacerbations requiring hospital admission among preschool children, over and above the underlying trend and previous interventions designed to reduce exposure to second-hand smoke. Similar legislation prohibiting smoking in vehicles that contain children should be adopted in other countries. None.

Smoke-Free Policies and 30-Day Mortality Rates for Chronic Obstructive Pulmonary Disease.

Smoke-free policies have been shown to impact 30-day readmission rates due to chronic obstructive pulmonary disease (COPD) among adults aged ≥65 years. However, little is known about the association between smokefree policies and 30-day mortality rates for COPD. Therefore, we investigated the association between comprehensive smoke-free policies and 30-day mortality rates for COPD. We used a cross-sectional study design and retrospectively examined risk-adjusted 30-day mortality rates for COPD across US hospitals in 1171 counties. Data were sourced from Centers for Medicare and Medicaid Services (CMS) Hospital Value-Based Purchasing (HVBP) Program, American Hospital Association (AHA) Annual Surveys, US Census Bureau Current Population Survey, and US Tobacco Control Laws Database from the American Nonsmokers' Rights Foundation (ANRF). Data were averaged at the county level for years 2015-2018. Hierarchical Poisson models adjusted for differences in hospital characteristics and accounted for the clustering of hospitals within a county were used. Our findings show a consistent association between stronger smoke-free policies and a reduction in COPD mortality. When evaluating smoke-free policy, county characteristics, and hospital characteristics individually, we found that counties with full coverage or partial coverage had a reduced incidence rate of COPD mortality compared to no coverage counties. After adjusting for the county and hospital characteristics, counties with full coverage of smoke-free policies had a reduced rate of 30-day COPD mortality (adjusted incidence rate ratio [IRR]: 0.87, 95% CI: 0.79, 0.96) compared to counties with no policy coverage. Comprehensive smoke-free policies are associated with a reduction in 30-day mortality following hospital admission for COPD. Partial smoke-free legislation is an insufficient preventative measure. These findings have strong implications for hospital policy-makers, suggesting that policy interventions to reduce COPD-related 30-day mortality should include implementing smoke-free policies and public health policy-makers to incentivize comprehensive smokefree policies.

Fiyat Dışı Tütün Kontrol Önlemleri ve Çevresel Tütün Dumanına Maruz Kalma: Türkiye Örneği

Turkey introduced the public-place and workplace smoking regulation in 2008, which was expanded in 2009, including hotels, restaurants, bars, and teahouses. We study the predictors of smoking status, smoking intensity, and exposure to environmental tobacco smoke (ETS) at home in Turkey. We then examine the relationship between the smoking bans and exposure to ETS at workplaces, home, and public places such as restaurants, teahouses, bars, and public transportation, including taxis using data from Turkey’s Health Surveys about respondents’ ETS exposure. Our multivariate reg-ression analyses indicate that age, gender, marital status, employment status, income, and education have a statistically significant relationship with smoking status and smoking intensity. T-test results indicate that there has been an increase in exposure to ETS in public places between 2010 and 2012, which indicates weak enforcement of the law in the early years. Besides, exposure to ETS at workplaces have declined between 2010 and 2012. We also find that the public smoking ban did not lead to ETS displacement to private homes. We encourage policymakers to take more severe steps to enforce the law, especially in public places.

The Mexico SimSmoke tobacco control policy model: Development of a simulation model of daily and nondaily cigarette smoking.

BackgroundNondaily smoking has been on the rise, especially in Mexico. While Mexico has strengthened its tobacco control policies, their effects on nondaily smokers have gone largely unexamined. We developed a simulation model to estimate the impact of tobacco control policies on daily and nondaily smoking in Mexico.MethodsA previously validated Mexico SimSmoke model that estimated overall trends in smoking prevalence from 2002 through 2013 was extended to 2018 and adapted to distinguish daily and nondaily smoking prevalence. The model was then validated using data from Mexican surveys through 2016. To gauge the potential effects of policies, we compared the trends in smoking under current policies with trends from policies kept at their 2002 levels.ResultsBetween 2002 and 2016, Mexico SimSmoke underestimated the reduction in male and female daily smoking rates. For nondaily smoking, SimSmoke predicted a decline among both males and females, while survey rates showed increasing rates in both genders, primarily among ages 15–44. Of the total reduction in smoking rates predicted by the model by 2018, tax policies account for more than 55%, followed by health warnings, cessation treatment, smoke-free air laws, and tobacco control spending.ConclusionsAlthough Mexico SimSmoke did not successfully explain trends in daily and nondaily smoking, it helps to identify gaps in surveillance and policy evaluation for nondaily smokers. Future research should consider appropriate measures of nondaily smoking prevalence, trajectories between daily and nondaily smoking, and the separate impact of tobacco control policies on each group.

Association Between Smoke-Free Legislation in Hospitality Venues and Smoking Behavior of Young People: A Systematic Review.

While evaluations of indoor smoke-free legislation have demonstrated major public health benefits among adults, their impact on the smoking behavior of young people remains unclear. Therefore, we performed a systematic review of the association between smoke-free legislation in hospitality venues and smoking behavior of young people. A systematic search was conducted in PubMed, Scopus, and Embase in June 2020. We searched for studies that assessed the association of any form of smoke-free legislation in any hospitality venue (eg, bar and restaurant) with a smoking behavior outcome (eg, initiation and current smoking) among young people (aged 10-24 years). . Our search yielded 572 articles of which 31 were screened based on full-text and 9 were included in the analysis. All studies were published between 2005 and 2016. The majority of studies used a quasi-experimental design. Four studies evaluated smoke-free legislation in hospitality venues specifically. Two studies reported that comprehensive, but not weaker, smoke-free legislation decreases progression to established smoking. Two other studies provided mixed results on which level of comprehensiveness of legislation would be effective, and which smoking outcomes would be affected. Five studies evaluated legislation that also included other workplaces. Out of these five studies, three studies found significant decreases in current smoking, smoking frequency, and/or smoking quantity, whereas two other studies did not. Most of the studies found that smoke-free legislation in hospitality venues is associated with a decrease in smoking behavior among young people. Their results indicate the need for comprehensive smoke-free legislation without exemptions. This is the first systematic review to provide insight into the relationship between smoke-free legislation in hospitality venues and smoking behavior of young people. Our findings show that there is a need for comprehensive smoke-free legislation without exemptions (such as designated smoking areas).

Smoke-Free Hospital Grounds

Smoke-free campus policies at inpatient health facilities are most effective when situated within comprehensive smoking cessation programs that include cessation support for staff and patients and effective communications and signage for staff, patients, and visitors. Canadian jurisdictions such as Ontario, New Brunswick, Prince Edward Island, Alberta, British Columbia, and Northwest Territories have provincial smoke-free legislation that applies to the grounds of health facilities. This approach permits public health inspectors and peace officers to enforce the smoke-free grounds rules with the option of issuing fines to individuals or hospital corporations for non-compliance. There is very little existing evidence on the effectiveness of issuing fines as a means of enforcing smoke-free policies. There can be unique considerations associated with implementing smoke-free policies in inpatient psychiatric facilities or units, given the relationship between mental health and substance use issues and tobacco use. Evidence shows that smoke-free policies are feasible and result in positive health outcomes in psychiatric facilities or units. Staff may require additional education and training in smoking cessation and tools to support productive conversations with patients, visitors, or colleagues who are not in compliance with smoke-free policies. Examples of tools and communications materials used in other jurisdictions are provided in Appendix 1.

Environmental Tobacco Smoke in Occupational Settings: Effect and Susceptibility Biomarkers in Workers From Lisbon Restaurants and Bars

Environmental tobacco smoke (ETS) has been recognized as a major health hazard by environmental and public health authorities worldwide. In Portugal, smoke-free laws are in force for some years, banning smoking in most indoor public spaces. However, in hospitality venues such as restaurants and bars, owners can still choose between a total smoke-free policy or a partial smoking restriction with designated smoking areas, if adequate reinforced ventilation systems are implemented. Despite that, a previous study showed that workers remained continuously exposed to higher ETS pollution in Lisbon restaurants and bars where smoking was still allowed, comparatively to total smoke-free venues. This was assessed by measurements of indoor PM2.5 and urinary cotinine, a biomarkers of tobacco smoke exposure, demonstrating that partial smoking restrictions do not effectively protect workers from ETS. The aim of the present work was to characterize effect and susceptibility biomarkers in non-smokers from those hospitality venues occupationally exposed to ETS comparatively to non-exposed ones. A group of smokers was also included for comparison. The sister chromatid exchange (SCE), micronucleus (MN) and comet assays in whole peripheral blood lymphocytes (PBLs) and the micronucleus assay in exfoliated buccal cells, were used as biomarkers of genotoxicity. Furthermore, a comet assay after ex vivo challenge of leukocytes with an alkylating agent, ethyl methanesulfonate (EMS), was used to analyze the repair capacity of those cells. Genetic polymorphisms in genes associated with metabolism and DNA repair were also included. The results showed no clear association between occupational exposure to ETS and the induction of genotoxicity. Interestingly, the leukocytes from non-smoking ETS-exposed individuals displayed lower DNA damage levels in response to the ex vivo EMS challenge, in comparison to those from non-exposed workers, suggesting a possible adaptive response. The contribution of individual susceptibility to the effect biomarkers studied was unclear, deserving further investigation.

Extension of Public Smoking Ban Was Not Associated with Any Immediate Effect on Stroke Occurrence in Finland.

We investigated the association between the widening of a nationwide restaurant smoking ban, enacted on 1 June 2007, and stroke admissions. All acute stroke admissions between 1 May 2005 and 30 June 2009 were retrieved from a mandatory registry covering mainland Finland. Patients aged ≥18 years were included. One annual admission per patient was included. Negative binomial regression accounting for the at-risk population was applied. We found no difference in stroke occurrence before and after the smoking ban within 7 days (p = 0.217), 30 days (p = 0.176), or the whole study period (p = 0.998). Results were comparable for all stroke subtypes (ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage). There was no sign of decreased occurrence in June 2007 compared to June in 2005–2006, and all subtypes of stroke occurred at least as frequently in both May and June of 2008 as in May and June of 2007. In conclusion, the nationwide restaurant smoking ban Finland enacted in June 2007 was not associated with any immediate reduction in stroke occurrence.

Compliance with North Dakota's smoke-free law among vape and tobacco specialty shops.

ObjectiveTo determine compliance with North Dakota's smoke‐free law in vape shops and other tobacco specialty shops selling electronic nicotine delivery systems (ENDS) or e‐liquids.DesignIn this 2019 descriptive study, shops (n = 35) were assessed for compliance with the smoke‐free law by observation of indoor and outdoor areas for smoking or vaping, or evidence of such activity in prohibited areas, and the presence of required no‐smoking signs.ResultsOnly two shops (5.7%) were fully compliant with the smoke‐free law. Full compliance for indoor and outdoor environments was 8.5% and 42.8%, respectively. Vaping occurred inside five shops (14.3%), and smoking occurred outdoors within required smoke‐free areas in two (5.7%) shops. Four (11.4%) and 17 (48.6%) shops complied with indoor and outdoor signage requirements, respectively.ConclusionsOverall compliance remained low, although much of the noncompliance was related to signage. Use or evidence of ENDS use occurred both indoors and outdoors where prohibited by law. Classifying ENDS as tobacco products would require tobacco licensure of shops selling ENDS and e‐liquids, aiding in identification of the shops for education and enforcement efforts to ensure compliance with the law and to improve public health protection.

Environmentally relevant secondhand smoke and time‐dependent changes in cardiovascular regulation in mice

BACKGROUND Secondhand smoke (SHS), a significant source of indoor air pollution, is a significant risk factor for cardiovascular morbidity and mortality. SHS-induced autonomic dysfunction, evidenced as increased sympathetic nerve activity and decreased heart rate variability (HRV), has been implicated as an important underlying mechanism for cardiovascular consequences. Previously, we have demonstrated that acute exposure (3 d) to 30 mg/m3 of SHS was sufficient to reduce HRV in mice. Here, we sought to characterize the time course of SHS-induced changes to cardiovascular regulation resulting from chronic exposure to environmentally relevant SHS (3 mg/m3). METHODS Male C57BL/6J mice (11 wk) implanted with BP/ECG telemetry devices were exposed to either filtered air (FA, n=18) or SHS (3 mg/m3, 6 hr/d, 5 d/wk, n=17) for 12 weeks, followed by 4 weeks of FA (representing a SHS “recovery” window). Monthly, 36 hours of continuous BP and ECG recordings were obtained during non-exposure days. Data were divided into three 12-hour periods: The dark cycle (dark 1) immediately after the 5th day of exposure, and the following light and dark (dark 2) cycles. Spontaneous baroreflex sensitivity (BRS) was determined with the sequence method. Standard time domain HRV parameters were obtained during periods of low activity. RESULTS SHS decreased overall HRV (SDNN) during the dark 1 cycle (-15%, -7%, and -28% for 4, 8, and 12 wk, respectively, p < 0.05). Similarly, SHS significantly reduced short-term HRV (rMSSD) during the dark 1 cycle (-16%, -12%, and -20% for 4, 8, and 12 wk, respectively, p < 0.05). SHS exposure did not affect HRV beyond the initial 12 hours after exposure ended (light and dark 2 cycles). These data suggest that SHS attenuates cardiac vagal regulation. SHS also reduced pulse pressure (~2 mmHg, p < 0.05) for the entire 36-hr recording window after 4, 8, and 12 wks of exposure, an effect that persisted even after 4 wks of recovery. There was a trend for lower BRS after 12 wks of SHS exposure during the dark 1 cycle. Intriguingly, initial exposure to SHS significantly elevated diastolic BP (~3 mmHg) during the dark 1 cycle at 4 wks; this effect was not observed with longer exposure to SHS (8 or 12 wks). Taken together, these data suggest that SHS exposure poses a greater risk to cardiac function than vascular function, and that vasculature regulation may be more protected from SHS-induced autonomic effects. CONCLUSIONS Chronic SHS reduces autonomic regulation of the cardiovascular function, particularly the regulation of the heart. Except for reduced pulse pressure, these autonomic effects were transient, and reversed themselves in the absence of SHS exposure, underscoring the importance and efficacy of public smoking bans.

Views on smoking free premise 2007, England; the gains so far

Smoking is one of the most avoidable cause of death and disability. Smoking not only affects smokers but also nonsmokers who are involuntarily exposed to smoke raising a serious concern for public health, safety, and welfare. Concerns regarding secondhand smoking came to the ground after various medical scientific researches and publications quantified and confirmed the health risk of passive smoking after exposure with it, which drew the public attention. The turning point for the government to introduce a ban of smoking at public and workplaces to protect the right of nonsmokers to enjoy fresh air, came as a 2006 Health Act in UK after it was strongly backed by the recommendation given by SCOTH regarding SHS. Through this policy, the government also supports internationally recognized comprehensive tobacco control standard. UK was first among the FCTC parties to introduce comprehensive smoke free legislation. The major objective of this policy is to limit the preventable epidemic of smoking. This policy is based on the Health Policy Triangle which considers the interaction of all four elements (Content, Context, Process and Actors) to structure policymaking. For agenda setting Kingdon model was used and for implementation phase of the policy Top-down approach was used. The major stakeholders that supported 2006 Health Act were Labour party, The Royal College of physicians (RCP), Action on smoking and Health (ASH) and research and evidence-based news while Tobacco industry and hospital trade was against the Act. The evidence suggested that risks of heart disease in secondhand smoker was double than what was known before. SHS became an agenda when in 2003, around 11,000 adults exposed in home and 617 people exposed in workplace died in UK because of exposure to SHS. People want to quit smoking and wanted help from government to make favorable environment. Following the public consultation white paper was published, Choosing Health: Making Healthy Choices Easier, in November 2004. It set the target that by 2008 all enclosed public places and workplace would be smoke free with some exceptions. Act was supported by labour party and department of Health Economist was of the view that ban would not have any immediate benefits on passive smoker instead it will discourage the young from starting. After publishing the white paper in 2004 there was the consultation period till 2005. There was a voting in parliament and majority of voted for ban on smoking in public places. As a result, Health Act 2006 was introduced on 1st July 2007. Smokers were against the ban, but the purpose of the ban was to focus on protecting health of people from SHS not make smokers quit. Reports disseminated after inspection from local bodies confirmed high levels of compliance with smoke free legislation. The data showed there were 2.4% reduction in hospital admission in a year for heart attack and almost 7000 fewer admission due to childhood asthma. Thus, Smoking ban policies have shown effective public health interventions for the prevention of cardiovascular, cerebrovascular, and respiratory mortality and preserve the health of children.

Impacts of local public smoking bans on smoking behaviors and tobacco smoke exposure.

This paper examines the immediate and long-term effects of public smoking bans on smoking prevalence, smoking regularity, smoking intensity, and secondhand tobacco smoke exposure. We supplement the extensive literature on the effects of various types of tobacco control legislation on smoking behavior in developed countries by studying the provincial smoking bans and more recent national ban of a middle-income country, Argentina. We focus on the difference between full and partial smoking bans, and take advantage of the time and province variation in ban implementation in order to determine the causal effects of each type of ban. We find that full bans reduce national smoking prevalence over time, especially among younger demographic groups, but have no significant impact on intensity of smoking among smokers. Full bans also benefit nonsmokers, as they are associated with a significant reduction in environmental tobacco smoke exposure. Partial bans do not significantly impact smoking prevalence, and are found to increase smoking intensity among individuals who smoke every day. These findings provide support for ratification of full bans by all provinces according to the National Tobacco Control Law of 2011.

A breath of fresh air: The effect of public smoking bans on Indigenous youth.

In general, past studies have estimated the average effect of public smoking bans on youth, ignoring differences across sub-populations. We extend the literature by considering Indigenous youth, who are a vulnerable and previously unexamined group (however, our analysis excludes First Nations youth who live on reserve). We also consider previously unexamined outcomes among youth: self-assessed health and subjective well-being. Our difference-in-differences estimates from Canada indicate that public bans reduced youth smoking and second-hand exposure in public places, on average. There was no displacement on the extensive margin, but the bans increased the number of people who smoke in the homes of youth, conditional on the presence of smokers in the household. Beyond average effects, however, we find that public bans reduced second-hand exposure in the homes of Indigenous youth (particularly Métis youth), on the extensive and intensive margins. The same youth experienced concurrent improvements in self-assessed health and life satisfaction. We conclude that public bans mitigate disparities in health and well-being between Indigenous and non-Indigenous youth, but the extent varies across Indigenous sub-populations, even within a particular country.