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Park E, Cho SI, Seo HG, Kim Y, Jung HS, Driezen P, Ouimet J, Quah ACK, Fong GT. Attitudes of Korean smokers towards smoke-free public places: findings from the longitudinal ITC Korea Survey, 2005-2010. BMJ Open 2019; 9:e025298. [PMID: 31401589 PMCID: PMC6701818 DOI: 10.1136/bmjopen-2018-025298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Prior to December 2012, restaurants in South Korea were required to implement only partial smoking bans. This study documents the changes in Korean smokers' attitudes towards smoking bans between 2005 and 2010 and explores the effects of anti-smoking advertising as a correlate of support for total smoking bans in public places. DESIGN Longitudinal cohort study of Korean adult smokers. SETTING The data were derived from three waves (2005, 2008 and 2010) of the International Tobacco Control (ITC) Korea Survey. PARTICIPANTS The ITC Korea Survey respondents were a probability-based, nationally representative sample of Korean smokers aged 19 and older. The current analysis includes 995 smokers who participated in Wave 1 (2005), 1737 smokers who participated in Wave 2 (2008) and 1560 smokers who participated in Wave 3 (2010). PRIMARY AND SECONDARY OUTCOME MEASURES Changes in respondents' awareness of secondhand smoke (SHS) harm, attitudes towards smoking bans and personal rules for smoking in private homes and/or vehicles were analysed. Correlates of support for smoking bans in public places were examined using generalised estimating equation regression models. RESULTS More than 80% of Korean smokers are aware of the harms of SHS. The proportion of smokers who support smoke-free restaurants or smoke-free bars increased twofold between 2005 and 2010. Smokers who were aware of the dangers of SHS were more likely to support a total smoking ban in workplaces. Noticing anti-smoking advertising or information was not significantly associated with support for a total smoking ban in public places. CONCLUSIONS Korean smokers became more supportive of smoking bans in public places between 2005 and 2008. These results show that smokers' attitudes towards smoking bans can change with the implementation of smoke-free policies, even in a country that has a high prevalence of smokers.
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Affiliation(s)
- Eunja Park
- Center for Food and Drug Policy Research, Korea Institute for Health and Social Affairs, Sejong, Korea (the Republic of)
| | - Sung-il Cho
- Department of Public Health Science, Seoul National University Graduate School of Public Health, Seoul, Korea (the Republic of)
| | - Hong Gwan Seo
- Center for Cancer Prevention and Detection, National Cancer Center, Goyangsi, Korea (the Republic of)
| | - Yeol Kim
- Center for Cancer Prevention and Detection, National Cancer Center, Goyangsi, Korea (the Republic of)
| | - Hyun-Suk Jung
- Total Healthcare Center, Kangbuk Samsung Hospital, Seoul, Korea (the Republic of)
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Kuang Hock L, Hui Li L, Chien Huey T, Yuvaneswary V, Sayan P, Muhd Yusoff MF, Kuang Kuay L, Miaw Yn L, Kee Chee C, Sumarni Mohd G. Support for smoke-free policy among Malaysian adults: findings from a population-based study. BMJ Open 2019; 9:e020304. [PMID: 30760510 PMCID: PMC6377523 DOI: 10.1136/bmjopen-2017-020304] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Public opinion and support can be powerful mandates for smoke-free policy. However, the scarcity of evidence on public opinion among Malaysians necessitates further investigation. Therefore, this study aimed to determine the level of support for smoke-free policy at various public domains and its associated factors among Malaysian adults. DESIGN Data were derived from the Global Adult Tobacco Survey, Malaysia (GATS-M). GATS-M is a nationwide study that employed a multistage, proportionate-to-size sampling strategy to select a representative sample of 5112 Malaysian adults aged 15 years and above. Multiple logistic regression was used to identify factors associated with support for smoke-free policy in selected public domains that is, workplaces, restaurants, bars, hotels, casinos, karaoke centres, public transport terminals and shopping centres. RESULTS The level of support for enactment of a smoke-free policy at selected public domains varied from 37.8% to 94.4%, with the highest support was for gazetted smoke-free domains, namely, shopping centres (94.4%, 95% CI: 93.2% to 95.3%) and public transport terminals (85.2%, 95% CI: 83.3% to 86.9%). Multiple logistic regression revealed that non-smokers were more likely to support smoke-free policy at all domains. In addition, respondents who worked in workplaces with total or partial smoking restrictions were more likely to support a smoke-free policy ((total restriction adjusted OR (AOR): 14.94 (6.44 to 34.64); partial restriction AOR: 2.96 (1.138 to 6.35); non-restriction was applied as a reference). CONCLUSION A majority of the Malaysian adult population supported the smoke-free policy, especially at gazetted smoke-free domains. Therefore, expansion of a total smoking ban to workplaces, restaurants, bars, hotels, casinos and karaoke centres is strongly recommended to reduce exposure to secondhand smoke and to denormalise smoking behaviour.
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Affiliation(s)
| | - Lim Hui Li
- Hospital Sultan Haji Ahmad Shah, Mentakab, Pahang, Malaysia
| | | | | | - Pan Sayan
- Institute of Public Health, Kuala Lumpur, Malaysia
| | | | | | - Ling Miaw Yn
- Institute of Public Health, Kuala Lumpur, Malaysia
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Rose SW, Emery SL, Ennett S, McNaughton Reyes HL, Scott JC, Ribisl KM. Public Support for Family Smoking Prevention and Tobacco Control Act Point-of-Sale Provisions: Results of a National Study. Am J Public Health 2015; 105:e60-7. [PMID: 26270303 DOI: 10.2105/ajph.2015.302751] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed public and smoker support for enacted and potential point-of-sale (POS) tobacco-control policies under the Family Smoking Prevention and Tobacco Control Act. METHODS We surveyed a US nationally representative sample of 17, 507 respondents (6595 smokers) in January through February 2013, and used linear regression to calculate weighted point estimates and identify factors associated with support for POS policies among adults and smokers. RESULTS Overall, nonsmokers were more supportive than were smokers. Regardless of smoking status, African Americans, Hispanics, women, and those of older ages were more supportive than White, male, and younger respondents, respectively. Policy support varied by provision. More than 80% of respondents supported minors' access restrictions and more than 45% supported graphic warnings. Support was lowest for plain packaging (23%), black-and-white advertising (26%), and a ban on menthol cigarettes (36%). CONCLUSIONS Public support for marketing and POS provisions is low relative to other areas of tobacco control. Tobacco-control advocates and the Food and Drug Administration should build on existing levels of public support to promote and maintain evidence-based, but controversial, policy changes in the retail environment.
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Affiliation(s)
- Shyanika W Rose
- At the time of the study, Shyanika W. Rose, Susan Ennett, and Kurt M. Ribisl were with the Department of Health Behavior, Gillings School of Global Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill. Heath Luz McNaughton Reyes was with the Department of Health Behavior, Gillings School of Global Public Health. Sherry L. Emery was with the Health Media Collaboratory, Institute for Health Research and Policy, University of Illinois at Chicago. John C. Scott was with the Department of Public Policy, University of North Carolina at Chapel Hill
| | - Sherry L Emery
- At the time of the study, Shyanika W. Rose, Susan Ennett, and Kurt M. Ribisl were with the Department of Health Behavior, Gillings School of Global Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill. Heath Luz McNaughton Reyes was with the Department of Health Behavior, Gillings School of Global Public Health. Sherry L. Emery was with the Health Media Collaboratory, Institute for Health Research and Policy, University of Illinois at Chicago. John C. Scott was with the Department of Public Policy, University of North Carolina at Chapel Hill
| | - Susan Ennett
- At the time of the study, Shyanika W. Rose, Susan Ennett, and Kurt M. Ribisl were with the Department of Health Behavior, Gillings School of Global Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill. Heath Luz McNaughton Reyes was with the Department of Health Behavior, Gillings School of Global Public Health. Sherry L. Emery was with the Health Media Collaboratory, Institute for Health Research and Policy, University of Illinois at Chicago. John C. Scott was with the Department of Public Policy, University of North Carolina at Chapel Hill
| | - Heath Luz McNaughton Reyes
- At the time of the study, Shyanika W. Rose, Susan Ennett, and Kurt M. Ribisl were with the Department of Health Behavior, Gillings School of Global Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill. Heath Luz McNaughton Reyes was with the Department of Health Behavior, Gillings School of Global Public Health. Sherry L. Emery was with the Health Media Collaboratory, Institute for Health Research and Policy, University of Illinois at Chicago. John C. Scott was with the Department of Public Policy, University of North Carolina at Chapel Hill
| | - John C Scott
- At the time of the study, Shyanika W. Rose, Susan Ennett, and Kurt M. Ribisl were with the Department of Health Behavior, Gillings School of Global Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill. Heath Luz McNaughton Reyes was with the Department of Health Behavior, Gillings School of Global Public Health. Sherry L. Emery was with the Health Media Collaboratory, Institute for Health Research and Policy, University of Illinois at Chicago. John C. Scott was with the Department of Public Policy, University of North Carolina at Chapel Hill
| | - Kurt M Ribisl
- At the time of the study, Shyanika W. Rose, Susan Ennett, and Kurt M. Ribisl were with the Department of Health Behavior, Gillings School of Global Public Health, and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill. Heath Luz McNaughton Reyes was with the Department of Health Behavior, Gillings School of Global Public Health. Sherry L. Emery was with the Health Media Collaboratory, Institute for Health Research and Policy, University of Illinois at Chicago. John C. Scott was with the Department of Public Policy, University of North Carolina at Chapel Hill
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Jones MR, Barnoya J, Stranges S, Losonczy L, Navas-Acien A. Cardiovascular Events Following Smoke-Free Legislations: An Updated Systematic Review and Meta-Analysis. Curr Environ Health Rep 2014; 1:239-249. [PMID: 25328861 DOI: 10.1007/s40572-014-0020-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Legislations banning smoking in indoor public places and workplaces are being implemented worldwide to protect the population from secondhand smoke exposure. Several studies have reported reductions in hospitalizations for acute coronary events following the enactment of smoke-free laws. OBJECTIVE We set out to conduct a systematic review and meta-analysis of epidemiologic studies examining how legislations that ban smoking in indoor public places impact the risk of acute coronary events. METHODS We searched MEDLINE, EMBASE, and relevant bibliographies including previous systematic reviews for studies that evaluated changes in acute coronary events, following implementation of smoke-free legislations. Studies were identified through December 2013. We pooled relative risk (RR) estimates for acute coronary events comparing post- vs. pre-legislation using inverse-variance weighted random-effects models. RESULTS Thirty-one studies providing estimates for 47 locations were included. The legislations were implemented between 1991 and 2010. Following the enactment of smoke-free legislations, there was a 12 % reduction in hospitalizations for acute coronary events (pooled RR: 0.88, 95 % CI: 0.85-0.90). Reductions were 14 % in locations that implemented comprehensive legislations compared to an 8 % reduction in locations that only had partial restrictions. In locations with reductions in smoking prevalence post-legislation above the mean (2.1 % reduction) there was a 14 % reduction in events compared to 10 % in locations below the mean. The RRs for acute coronary events associated with enacting smoke-free legislation were 0.87 vs. 0.89 in locations with smoking prevalence pre-legislation above and below the mean (23.1 %), and 0.87 vs. 0.89 in studies from the Americas vs. other regions. CONCLUSION The implementation of smoke-free legislations was related to reductions in acute coronary event hospitalizations in most populations evaluated. Benefits are greater in locations with comprehensive legislations and with greater reduction in smoking prevalence post-legislation. These cardiovascular benefits reinforce the urgent need to enact and enforce smoke-free legislations that protect all citizens around the world from exposure to tobacco smoke in public places.
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Affiliation(s)
- Miranda R Jones
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Joaquin Barnoya
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis MO
| | - Saverio Stranges
- Division of Health Sciences, University of Warwick Medical School, Coventry, UK
| | - Lia Losonczy
- Highland Hospital of Alameda County, Oakland, CA
| | - Ana Navas-Acien
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
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Bakhturidze GD, Mittelmark MB, Aarø LE, Peikrishvili NT. Attitudes towards smoking restrictions and tobacco advertisement bans in Georgia. BMJ Open 2013; 3:e003461. [PMID: 24282242 PMCID: PMC3845040 DOI: 10.1136/bmjopen-2013-003461] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES This study aims to provide data on a public level of support for restricting smoking in public places and banning tobacco advertisements. DESIGN A nationally representative multistage sampling design, with sampling strata defined by region (sampling quotas proportional to size) and substrata defined by urban/rural and mountainous/lowland settlement, within which census enumeration districts were randomly sampled, within which households were randomly sampled, within which a randomly selected respondent was interviewed. SETTING The country of Georgia, population 4.7 million, located in the Caucasus region of Eurasia. PARTICIPANTS One household member aged between 13 and 70 was selected as interviewee. In households with more than one age-eligible person, selection was carried out at random. Of 1588 persons selected, 14 refused to participate and interviews were conducted with 915 women and 659 men. OUTCOME MEASURES Respondents were interviewed about their level of agreement with eight possible smoking restrictions/bans, used to calculate a single dichotomous (agree/do not agree) opinion indicator. The level of agreement with restrictions was analysed in bivariate and multivariate analyses by age, gender, education, income and tobacco use status. RESULTS Overall, 84.9% of respondents indicated support for smoking restrictions and tobacco advertisement bans. In all demographic segments, including tobacco users, the majority of respondents indicated agreement with restrictions, ranging from a low of 51% in the 13-25 age group to a high of 98% in the 56-70 age group. Logistic regression with all demographic variables entered showed that agreement with restrictions was higher with age, and was significantly higher among never smokers as compared to daily smokers. CONCLUSIONS Georgian public opinion is normatively supportive of more stringent tobacco-control measures in the form of smoking restrictions and tobacco advertisement bans.
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Affiliation(s)
- George D Bakhturidze
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
- Tobacco Control Research, Framework Convention on Tobacco Control Implementation and Monitoring Center in Georgia, Tbilisi, Georgia
| | - Maurice B Mittelmark
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Leif E Aarø
- Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
- Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Nana T Peikrishvili
- Tobacco Control Research, Framework Convention on Tobacco Control Implementation and Monitoring Center in Georgia, Tbilisi, Georgia
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Schoretsaniti S, Filippidis FT, Vardavas CI, Tzavara C, Dimitrakaki C, Behrakis P, Connolly GN, Tountas Y. Prevalence and determinants of SHS exposure in public and private areas after the 2010 smoke-free legislation in Greece. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2013; 24:401-411. [PMID: 24044769 DOI: 10.1080/09603123.2013.835033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The objective of the present survey was to assess the extent and socio-economic determinants of population exposure to secondhand smoke (SHS) in Greece in 2011. The national household survey Hellas Health IV was conducted in October 2011. SHS exposure was based on self-reported exposure within home, workplace and public places. Thirty-three per cent of the respondents reported living in a smoke-free home. Smokers (p < 0.001) and single individuals (p < 0.017) were less likely to prohibit smoking at home. SHS exposure at work, in restaurants and in bars/clubs/cafes was frequently mentioned by 41.6, 84.2 and 90.5%, respectively. SHS exposure in a bar/club/cafe was noted more among single individuals (p = 0.004) and those aged 18-34 years (p = 0.007). Inhabitants of rural areas were more likely to report someone smoking indoors in all the above venues. Public health education and effective enforcement of the nationwide smoke-free legislation are imperative.
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Affiliation(s)
- Sotiria Schoretsaniti
- a Department of Hygiene, Epidemiology and Medical Statistics , National and Kapodistrian University of Athens , Athens , Greece
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Reshuffling and relocating: the gendered and income-related differential effects of restricting smoking locations. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2012; 2012:907832. [PMID: 22619688 PMCID: PMC3348646 DOI: 10.1155/2012/907832] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Accepted: 02/10/2012] [Indexed: 11/18/2022]
Abstract
This study investigates secondhand smoke (SHS) exposure and management in the context of smoking location restrictions, for nonsmokers, former, and current smokers. A purposive sample of 47 low income and non-low-income men and women of varied smoking statuses was recruited to participate in a telephone interview or a focus group. Amidst general approval of increased restrictions there were gendered patterns of SHS exposure and management, and effects of SHS policies that reflect power, control, and social roles that need to be considered as policies are developed, implemented and monitored. The experience of smoking restrictions and the management of SHS is influenced by the social context (relationship with a partner, family member, or stranger), the space of exposure (public or private, worksite), the social location of individuals involved (gender, income), and differential tolerance to SHS. This confluence of factors creates differing unintended and unexpected consequences to the social and physical situations of male and female smokers, nonsmokers, and former smokers. These factors deserve further study, in the interests of informing the development of future interventions and policies restricting SHS.
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Mons U, Nagelhout GE, Guignard R, McNeill A, van den Putte B, Willemsen MC, Brenner H, Pötschke-Langer M, Breitling LP. Comprehensive smoke-free policies attract more support from smokers in Europe than partial policies. Eur J Public Health 2012; 22 Suppl 1:10-6. [PMID: 22294779 PMCID: PMC3269297 DOI: 10.1093/eurpub/ckr202] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Support for smoke-free policies increases over time and particularly after implementation of the policy. In this study we examined whether the comprehensiveness of such policies moderates the effect on support among smokers. METHODS We analysed two waves (pre- and post-smoke-free legislation) of the International Tobacco Control (ITC) surveys in France, Germany, and the Netherlands, and two pre-legislation waves of the ITC surveys in UK as control. Of 6,903 baseline smokers, 4,945 (71.6%) could be followed up and were included in the analyses. Generalised Estimating Equations (GEE) were used to compare changes in support from pre- to post-legislation to the secular trend in the control country. Multiple logistic regression models were employed to identify predictors of individual change in support. FINDINGS In France, the comprehensive smoking ban was associated with sharp increases in support for a total smoking ban in drinking establishments and restaurants that were above secular trends. In Germany and the Netherlands, where smoke-free policies and compliance are especially deficient in drinking establishments, only support for a total smoking ban in restaurants increased above the secular trend. Notable prospective predictors of becoming supportive of smoking bans in these countries were higher awareness of cigarette smoke being dangerous to others and weekly visiting of restaurants. CONCLUSIONS Our findings suggest that smoke-free policies have the potential to improve support once the policy is in place. This effect seems to be most pronounced with comprehensive smoking bans, which thus might be the most valid option for policy-makers despite their potential for creating controversy and resistance in the beginning.
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Affiliation(s)
- Ute Mons
- Unit Cancer Prevention and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center, DKFZ, Heidelberg, Germany.
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Perceived justice and popular support for public health laws: A case study around comprehensive smoke-free legislation in Mexico City. Soc Sci Med 2010; 70:787-93. [DOI: 10.1016/j.socscimed.2009.10.064] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2009] [Revised: 10/22/2009] [Accepted: 10/28/2009] [Indexed: 11/18/2022]
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Yong HH, Foong K, Borland R, Omar M, Hamann S, Sirirassamee B, Fong GT, Fotuhi O, Hyland A. Support for and reported compliance among smokers with smoke-free policies in air-conditioned hospitality venues in Malaysia and Thailand: findings from the International Tobacco Control Southeast Asia Survey. Asia Pac J Public Health 2010; 22:98-109. [PMID: 20032039 DOI: 10.1177/1010539509351303] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined support for and reported compliance with smoke-free policy in air-conditioned restaurants and other similar places among adult smokers in Malaysia and Thailand. Baseline data (early 2005) from the International Tobacco Control Southeast Asia Survey (ITC-SEA), conducted face-to-face in Malaysia and Thailand (n = 4005), were used. Among those attending venues, reported total smoking bans in indoor air-conditioned places such as restaurants, coffee shops, and karaoke lounges were 40% and 57% in Malaysia and Thailand, respectively. Support for a total ban in air-conditioned venues was high and similar for both countries (82% Malaysian and 90% Thai smokers who believed there was a total ban), but self-reported compliance with bans in such venues was significantly higher in Thailand than in Malaysia (95% vs 51%, P < .001). As expected, reporting a ban in air-conditioned venues was associated with a greater support for a ban in such venues in both countries.
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Affiliation(s)
- Hua-Hie Yong
- VicHealth Centre for Tobacco Control, The Cancer Council Victoria, 1 Rathdowne Street, Carlton, Victoria, Australia.
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Hyland A, Higbee C, Borland R, Travers M, Hastings G, Fong GT, Cummings KM. Attitudes and beliefs about secondhand smoke and smoke-free policies in four countries: findings from the International Tobacco Control Four Country Survey. Nicotine Tob Res 2009; 11:642-9. [PMID: 19454550 PMCID: PMC2688606 DOI: 10.1093/ntr/ntp063] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 12/15/2008] [Indexed: 11/14/2022]
Abstract
INTRODUCTION This paper describes the varying levels of smoking policies in nationally representative samples of smokers in four countries and examines how these policies are associated with changes in attitudes and beliefs about secondhand smoke over time. METHODS We report data on 5,788 respondents to Wave 1 of the International Tobacco Control Four Country Survey who were employed at the time of the survey. A cohort of these respondents was followed up with two additional survey waves approximately 12 months apart. Respondents' attitudes and beliefs about secondhand smoke as well as self-reported policies in their workplace and in bars and restaurants in their community were assessed at all waves. RESULTS The level of comprehensive smoke-free policies in workplaces, restaurants, and bars increased over the study period for all countries combined and was highest in Canada (30%) and lowest in the United Kingdom (0%) in 2004. In both cross-sectional and longitudinal analyses, stronger secondhand smoke policies were associated with more favorable attitudes and support for comprehensive regulations. The associations were the strongest for smokers who reported comprehensive policies in restaurants, bars, and their workplace for all three survey waves. DISCUSSION Comprehensive smoke-free policies are increasing over time, and stronger policies and the public education opportunities surrounding their passage are associated with more favorable attitudes toward secondhand smoke regulations. The implication for policy makers is that, although the initial debate over smoke-free policies may be tumultuous, once people understand the rationale for implementing smoke-free policies and experience their benefits, public support increases even among smokers, and compliance with smoke-free regulations increases over time.
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Affiliation(s)
- Andrew Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
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Chen YH, Yeh CY, Chen RY, Chien LC, Yu PT, Chao KY, Han BC. Moving toward people's needs for smoke-free restaurants: before and after a national promotion program in Taiwan, 2003-2005. Nicotine Tob Res 2009; 11:503-13. [PMID: 19357316 DOI: 10.1093/ntr/ntp037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION In Taiwan, the Smoke-Free Restaurant Program (SFRP) was implemented from 2003 to 2005 as an initial phase before the introduction of restrictive legislation promoting smoke-free restaurants (SFRs). No studies have evaluated trends in public opinion before and after a national health promotion campaign for the introduction of SFRs on a voluntary basis. The present study investigated whether public opinion with respect to eliminating environmental tobacco smoke (ETS) in restaurants changed after implementation of the SFRP. METHODS Data were obtained from four large-scale, nationally representative surveys conducted in 2003-2005 before and after implementation of the SFRP. Weighted analyses were performed to obtain nationally representative results. RESULTS After a series of SFRP campaigns, reported exposure to ETS in restaurants by survey participants decreased by approximately 14%. Approximately 20% more people had heard of SFRs, and approximately 25% more had chosen to dine in a smoke-free restaurant. We found consistently high community support for SFRs (ca. 95%), and approximately 80% supported smoke-free restaurant legislation, although both rates dropped slightly in 2005. People aged 60 years or more, nonsmokers, and those who had greater knowledge of ETS hazards were more likely to support smoke-free restaurant legislation. DISCUSSION The SFRP was effective at promoting SFRs on a voluntary basis. Strong community endorsement has major implications for legislators who are considering the nature and extent of further smoke-free restaurant legislation in Taiwan and other countries.
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Affiliation(s)
- Yi-Hua Chen
- School of Public Health, Taipei Medical University, Taipei, Taiwan
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13
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News on tobacco and public attitudes toward smokefree air policies in the United States. Health Policy 2008; 86:42-52. [DOI: 10.1016/j.healthpol.2007.09.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2007] [Revised: 09/25/2007] [Accepted: 09/26/2007] [Indexed: 11/18/2022]
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The effects on smokers of Boston's smoke-free bar ordinance: a longitudinal analysis of changes in compliance, patronage, policy support, and smoking at home. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2007; 13:630-6. [PMID: 17984718 DOI: 10.1097/01.phh.0000296140.94670.d4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We prospectively examined effects of the implementation of a smoking ban in bars on Boston, Massachusetts, smokers. METHODS A representative sample of Massachusetts smokers was interviewed before and after the smoking ban was implemented in Boston. Participants were adult smokers living in Boston (n = 83) and in 203 other Massachusetts cities and towns that did not adopt smoking bans in bars prior to July 2004 (n = 903). The outcome measures were changes in reports of smoking in bars, frequency of bar patronage, support for smoke-free bars, smoking at home, and exposure to secondhand smoke at home based on town of residence. RESULTS Compared to changes over the same time period among smokers in towns where smoking in bars was permitted, smokers in Boston were significantly less likely to observe smoking and less likely to decrease their bar patronage after the smoking ban was implemented. Changes in support for smoke-free bars, smoking patterns at home, and exposure to secondhand smoke at home did not differ between the groups. CONCLUSION Expectations about noncompliance, declines in patronage, and displacement of smoking to the home as a consequence of extending smoking restrictions to bars are not supported by the data.
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Abstract
OBJECTIVE Community members are occasionally polled about tobacco control policies, but are rarely given opportunities to elaborate on their views. We examined laypeople's conversations to understand how 11 regulatory options were supported or opposed in interactions. DESIGN Qualitative design; purposive quota sampling; data collection via focus groups. SETTING Three locations in Sydney, Australia. PARTICIPANTS 63 smokers and 75 non-smokers, men and women, from three age groups (18-24, 35-44, 55-64 years), recruited primarily via telephone. MEASUREMENTS Semi-structured question route; data managed in NVivo; responses compared between groups. RESULTS Laypeople rejected some regulatory proposals and certain arguments about taxation and the cost of cessation treatments. Protecting children and hypothecating tobacco excise for health education and care were highly acceptable. Plain packaging, banning retail displays and youth smoking prevention received qualified support. Bans on political donations from tobacco corporations were popular in principle but considered logistically fraught. Smokers asked for better cessation assistance and were curious about cigarette ingredients. Justice was an important evaluative principle. Support was often conditional and unresolved arguments frequent. We present both sides of these conflicts and the ways in which policies were legitimised or de-legitimised in conversation. CONCLUSIONS Simple measures of agreement used in polls may obscure the complexity of community responses to tobacco policy. Support was frequently present but contested; some arguments that seem self-evident to advocates were not so to participants. The detailed understanding of laypeople's responses provided through qualitative methods may help frame proposals and arguments to meet concerns about justice, effectiveness and feasibility.
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Affiliation(s)
- Stacy M Carter
- Centre for Values, Ethics and the Law in Medicine, Central Clinical School, Faculty of Medicine, The University of Sydney, NSW, Australia 2006.
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Friis RH, Safer AM. Analysis of responses of Long Beach, California residents to the Smoke-free Bars Law. Public Health 2005; 119:1116-21. [PMID: 16214188 DOI: 10.1016/j.puhe.2005.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Revised: 04/11/2005] [Accepted: 05/23/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVES We investigated survey responses to the Smoke-free Bars Law by residents of Long Beach, California (population 460,000), a city that reflects the state's diverse population. The research specifically aimed to determine: (1) residents' approval for the 1998 California Smoke-free Bars Law when it was implemented; and (2) changes in approval between baseline and 2-year follow-up. Data were also assessed for the demographic characteristics of the respondents and whether the respondents were self-acknowledged smokers or non-smokers. STUDY DESIGN A random telephone survey was conducted in 1998 and 2000 in Long Beach to determine the degree of community support for the 1998 state law that prohibited smoking in all workplaces including alcohol-serving establishments. The numbers analysed were 784 in 1998 and 1237 in 2000. METHODS Statistical analyses used in this research included univariate frequency distributions and logistic regression for 1998 and 2000. RESULTS The major findings were as follows. Overall community approval for the 1998 state law increased from 65.2% in 1998 to 72.6% in 2000. Over this period, the rate of approval by smokers increased from 20.6% to 37.1%, and the rate of approval by non-smokers increased from 74.5% to 80.3%. CONCLUSIONS The general public in a large city in California strongly approve of the prohibition of smoking in all indoor public places. This strong endorsement has major public health implications.
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Affiliation(s)
- R H Friis
- Department of Health Science, California State University, Long Beach, USA
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Koh HK, Judge CM, Robbins H, Celebucki CC, Walker DK, Connolly GN. The first decade of the Massachusetts Tobacco Control Program. Public Health Rep 2005; 120:482-95. [PMID: 16224981 PMCID: PMC1497757 DOI: 10.1177/003335490512000503] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This article provides a comprehensive overview of the first decade of the Massachusetts Tobacco Control Program (MTCP). Born after Massachusetts passed a 1992 ballot initiative raising cigarette excise taxes to fund the program, MTCP greatly reduced statewide cigarette consumption before being reduced to a skeletal state by funding cuts. The article describes the program's components and goals, details outcomes, presents a summary of policy accomplishments, and reviews the present status of MTCP in the current climate of national and state fiscal crises. The first decade of the MTCP offers many lessons learned for the future of tobacco control.
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Affiliation(s)
- Howard K Koh
- Division of Public Health Practice, Harvard School of Public Health, Boston, MA 02115, USA.
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18
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McMillen RC, Winickoff JP, Klein JD, Weitzman M. US adult attitudes and practices regarding smoking restrictions and child exposure to environmental tobacco smoke: changes in the social climate from 2000-2001. Pediatrics 2003; 112:e55-60. [PMID: 12837906 DOI: 10.1542/peds.112.1.e55] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE A substantial proportion of homes and automobiles serve as settings for environmental tobacco smoke (ETS) exposure, and many public settings that children frequent are still not smoke-free. Tobacco control efforts are attempting to increase smoking bans. The objective of this study was to describe the knowledge, attitudes, and practices of smokers and nonsmokers regarding smoking bans and child ETS exposure in multiple public and private settings and to report changes from 2000-2001. METHODS Cross-sectional data from the annual Social Climate Survey of Tobacco Control were analyzed for changes in knowledge, attitudes, and practices regarding tobacco. These data were collected via automated, random-digit-dialing telephone surveys that were conducted in the summers of 2000 and 2001. The samples were weighted by race and gender to be representative of the US population. RESULTS Response rates for eligible adults actually contacted were 1501 (75%) of 1876 in 2000 and 3002 (84%) of 3566 in 2001. The majority of adults, both smokers and nonsmokers, support smoking bans in a wide variety of places. The percentage of all respondents reporting the presence of smoking bans in several public and private places increased from 2000-2001: the household (69%-74%), in the presence of children (84%-88%), convenience stores (68%-74%), fast-food restaurants (52%-58%), and non-fast-food restaurants (25%-28%). Support for smoking bans also increased in shopping malls (71%-75%), fast-food restaurants (77%-80%), and indoor sporting events (78%-80%). There were no significant changes in support for smoking bans in convenience stores, restaurants, or outdoor parks. Adults' knowledge of the harm caused by tobacco was unchanged, with the vast majority of adults recognizing the dangers of exposure to ETS from parental smoking (95%) and exposure to ETS in cars (77%). CONCLUSIONS Small improvements in adult attitudes and practices regarding children's ETS exposure occurred from 2000-2001. However, a significant number of adults in the United States still report ignorance of the harmful effects of child ETS exposure, and there was no improvement in reported knowledge in this 1-year period. In contrast, a growing majority of smokers and nonsmokers favor restrictions on smoking in public settings, suggesting that states and communities have public support for broad public smoking restriction policies. There are significant roles that pediatricians can play in preventing children's ETS exposure, through both patient and family education and by moving smoking restriction policies forward on their community's agenda.
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Affiliation(s)
- Robert C McMillen
- Social Science Research Center, Mississippi State University, Starkville, Mississippi 39762, USA.
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Siegel M. The effectiveness of state-level tobacco control interventions: a review of program implementation and behavioral outcomes. Annu Rev Public Health 2002; 23:45-71. [PMID: 11910054 DOI: 10.1146/annurev.publhealth.23.092601.095916] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In 2001, nearly one billion dollars will be spent on statewide tobacco control programs, including those in California, Massachusetts, Arizona, and Oregon, funded by cigarette tax revenues, and the program in Florida, funded by the state's settlement with the tobacco industry. With such large expenditures, it is imperative to find out whether these programs are working. This paper reviews the effectiveness of the statewide tobacco control programs in California, Massachusetts, Arizona, Oregon, and Florida. It focuses on two aspects of process evaluation--the funding and implementation of the programs and the tobacco industry's response, and four elements of outcome evaluation--the programs' effects on cigarette consumption, adult and youth smoking prevalence, and protection of the public from secondhand smoke. The paper formulates general lessons learned from these existing programs and generates recommendations to improve and inform the development and implementation of these and future programs.
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Affiliation(s)
- Michael Siegel
- Social and Behavioral Sciences Department, Boston University School of Public Health, Boston, Massachusetts 02118, USA.
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