Inequalities in Smoking and E-Cigarette Use in Young Adults With Mental Ill-Health, 20 years After Ireland's Smoking Ban.

Background: Ireland's Smoking Ban reduced health inequalities known to be associated with smoking but some groups may not have benefitted. Mental ill-health and smoking are known to be associated with health inequalities. Whether similar patterns exist for e-cigarette use is less clear, as few data exist. Objectives: To examine: (1) self-reported doctor-diagnosed mental ill-health in Irish 20-year-olds; (2) smoking, e-cigarette, and dual use in those with and without mental ill-health; and (3) protective and risk factors for smoking and e-cigarette use in these groups. Methods: We use cross-sectional data from 20 year-olds in Wave 4 of Growing Up in Ireland Child Cohort. They were asked to self-report mental ill-health which had been diagnosed by a clinician, and their smoking and e-cigarette use. All analyses were performed using SPSS v27. Results: 19.4% (n = 1008) of the total sample (n = 4729) reported a mental ill-health diagnosis. Comparing those with and without, those with mental ill-health had significantly higher prevalence of current smoking (47%, n = 419 vs 36%, n = 1361; OR 1.57, CI: 1.36, 1.82), e-cigarette use (17%, n = 152 vs 13%, n = 485; OR 1.40, CI:1.15, 1.70), and dual use (12%, n = 109 vs 9%, n = 328; OR 1.46, CI:1.16, 1.84). Risk factors for smoking and e-cigarette use were, earlier smoking initiation, peers or primary caregivers who smoked, being in paid employment, one-parent family background, and social media use. Being female was protective. Most risk factors were significantly higher in young adults with mental ill-health but, after adjusting for these variables, respondents with mental ill-health still have significantly higher adjusted higher odds of smoking (aOR 1.28, CI:1.05, 1.56). Conclusions: Inequalities in smoking and e-cigarette use in young adults with mental ill-health are evident 20 years after Ireland's National Smoking Ban. Despite extensive Tobacco Control interventions in the past 20 years, there is still need in Ireland for new targeted interventions to reduce health inequalities for left-behind young smokers with mental ill-health.

Decoding hotline's information with text-mining: A protocol for improving tobacco control in Shanghai.

Tobacco consumption in China remains the primary cause of preventable mortality, with Shanghai being particularly affected by issues related to secondhand smoke exposure. This study explores the role of the public service hotline 12345, a grassroots initiative in Shanghai, in capturing public sentiment and assessing the effectiveness of anti-smoking regulations. Our research aims to accurately and deeply understand the implementation and feedback of smoking control policies: by identifying high-frequency points and prominent issues in smoking control work based on the smoking control work order data received by the health hotline 12320. The results of this study will assist government enforcement agencies in improving smoking monitoring and clarify the direction for improving smoking control measures. Text-mining techniques were employed to analyze a dataset comprising 78011 call sheets, all related to tobacco control and collected from the hotline between 1 January 2015 and 31 December 2019. This methodological approach aims to uncover prevalent themes and sentiments in the public discourse on smoking and its regulation, as reflected in the hotline interactions. Our study identified hotspots and the issues of greatest concern to citizens. Additionally, it provided recommendations to enforcement agencies to enhance their capabilities, optimize the allocation of human resources for smoking control monitoring, reduce enforcement costs and support for anti-smoking campaigns, thereby contributing to more effective tobacco control policies in the region.

Impacts of Smoking Ban Policies on Billiard Hall Sales in South Korea Using Objective Sales Information of a Credit Card Company: Quasi-Experimental Study.

BACKGROUND: Smoking ban policies (SBPs) are potent health interventions and offer the potential to influence antismoking behavior. The Korean government completely prohibited smoking in indoor sports facilities, including billiard halls, since the government revised the National Health Promotion Act in December 2017. OBJECTIVE: This study aimed to examine the impact of the SBP on the economic outcomes of indoor sports facilities, particularly billiard halls. METHODS: This study used credit card sales data from the largest card company in South Korea. Data are from January 2017 to December 2018. Monthly sales data were examined across 23 administrative neighborhoods in Seoul, the capital city of South Korea. We conducted the interrupted time series model using the fixed effects model and the linear regression with panel-corrected standard errors (PCSE). RESULTS: The sales and transactions of billiard halls were not significantly changed after the introduction of the SBP in the full PCSE models. The R2 of the full PCSE model was 0.967 for sales and 0.981 for transactions. CONCLUSIONS: The introduction of the SBP did not result in substantial economic gains or losses in the sales of billiard halls. In addition to existing price-based policies, the enhanced SBP in public-use facilities, such as billiard halls, can have a positive synergistic effect on reducing smoking prevalence and preventing secondhand smoke. Health policy makers can actively expand the application of SBPs and make an effort to enhance social awareness regarding the necessity and benefits of public SBPs for both smokers and the owners of hospitality facilities.

Male Youth Tobacco Usage Pattern in Banned Smoking Area in Comparison With Non-banned Smoking Area: A Cross-Sectional Study.

OBJECTIVES: This study aimed to assess the impact of smoking bans in schools on smoking prevalence and behavior among Saudi male youth aged 13-15 years. METHODS: A cross-sectional comparative study was conducted involving students from two intermediate schools in Jeddah - one with a smoking ban and the other without. Data collection utilized the Global Youth Tobacco Survey questionnaire, and statistical analysis was performed using SPSS version 21.0. RESULTS: The study had a 93.9% response rate, with 659 students participating. Notably, a lower percentage of ever-smoking was observed in the banned area compared to the non-banned area (39.6% vs. 50.9%; p=0.002). Current smoking rates were also lower in the banned area (14.2% vs. 23.8%; p=0.014). Family and peer influences on smoking were reduced in the banned area, and more students discussed the harmful effects of smoking with family (72.8% vs. 59.8%; p=0.003). Students in the non-banned area found it easier to access cigarettes. A significantly higher percentage of students in the banned area were resolute in not smoking if offered a cigarette by their best friend (65.0% vs. 59.2%; p=0.006). Students in the non-banned area reported higher exposure to cigarette smoke at home and in other places compared to those in the banned area (15.8% vs. 10.8%; p=0.008), respectively. A higher percentage of smokers in the banned area expressed a desire to quit smoking, though the difference was not statistically significant. More anti-smoking media messages were reported in the banned area (35.6% vs. 33.6%; p=0.004). Fewer respondents in the banned area had items with cigarette brand logos (13.6% vs. 19.9%; p=0.03). CONCLUSION: The findings underscore the effectiveness of smoking bans in schools in reducing smoking prevalence among students. This suggests a broader societal shift in attitudes toward smoking, highlighting the need for comprehensive bans as part of public health strategies. However, there remains a need for targeted interventions to address the complexities of smoking behavior in both banned and non-banned areas.

A mixed-methods evaluation of the indoor and outdoor smoking ban in dining venues in Armenia: Early successes and challenges.

INTRODUCTION: Since March 2022, Armenia introduced a comprehensive smoking ban on all types of tobacco products in indoor and outdoor areas of hospitality venues. We aimed to rapidly appraise the implementation of the ban in the dining areas of the capital Yerevan and explore any differences in compliance and enforcement patterns between indoor and outdoor areas of the venues. METHODS: We used a mixed-methods approach through quantitative air quality monitoring, qualitative observations, and in-depth interviews (IDIs). We visited one venue in each remote district of the city and more venues from the central districts that have a much higher density of dining areas. Overall, we made 24 measurements of PM2.5 particles, 24 unobtrusive observations in the 19 visited venues, and 11 IDIs with six visitors and five workers. We used Stata13 for the analysis of numerical data and completed direct deductive content analysis of the textual data. RESULTS: Active tobacco use was observed in 12 out of 24 venues (50.0%) with more cases of smoking in outdoor areas (10 out of 12; 83.3%). No warning by workers or no reports to the police were observed. We detected elevated levels of PM2.5 particles in indoor and outdoor areas. The IDIs revealed predominantly negative attitudes towards the outdoor ban and the lack of awareness of and readiness to engage in the enforcement measures. The lack of enforcement by the owners and the respective bodies was mentioned as a contributor to continued violations of the ban. The change in the dynamic and the characteristics of the visitors, cleaner air, and less unpleasant work were mentioned as important positive aftermaths of the ban. CONCLUSIONS: The Government of Armenia should enhance the monitoring and enforcement activities and organize tailored awareness-raising campaigns to inform the general public and the hospitality industry of the health and social implications of the ban.

Evidence from a Smoking Management Service in a University Teaching Hospital in Dublin, Ireland monitored by repeat surveys, 1997-2022.

St Vincent's University Hospital (SVUH) has a comprehensive smoking management programme and since 1997 has conducted periodic surveys of inpatients, outpatients, staff and visitors to establish prevalence of smoking and associated attitudes towards the hospital's smoke-free campus policy pioneered in 2009. We report trends and describe also the online community stop smoking course (SSC) developed more recently in response to COVID-19. A questionnaire examining attitudes and smoking status was administered by census surveys of inpatients, quota or random sub-sample surveys of staff, and quota surveys with outpatients and visitors in the time period of 1997-2018. Chi square test for trend was used. Smoking rates declined in all groups but significantly so in outpatients (19.5% vs. 10%; p < 0.01), visitors (27.4% vs. 9.5%; p < 0.0001) and staff (30.0% vs. 10.8%; p < 0.0001). Use of E-Cigarettes was low in all cohorts. Rates of smoking were borderline higher in inpatients eligible by income for state-funded General Medical Services (33.2% vs 26.8%, p = 0.099). Support for and awareness of the ban increased over time. Demographic and quit data was compared between participants of in-person or online SSC. The online courses were successful with a maintenance of quit rates (End of Course: 54.7% vs. 55.0%, 1 Month: 50.4% vs. 54.0%, 3 Month: 19.8% vs. 22.5%). While the hospital community's smoking prevalence has decreased over time and attitudes to the smoking ban have been increasingly positive, the campus is not without difficulties in keeping it smoke-free. We continue to advocate for hospital staff support in enacting this flagship initiative.

Long-Term Follow-up Study of Hospitalizations for Acute Coronary Syndrome in Kobe-City and Other Districts Under the Hyogo Smoking Ban Legislation　- A Nationwide Database Study.

BACKGROUND: Hyogo Prefecture has managed smoking ban legislation with partial restrictions in public places (Hyogo-L) since 2013. Previous studies have reported a significant decrease in admissions for acute coronary syndrome (ACS) in Kobe-city, but not in other districts of Hyogo Prefecture in the 2 years after Hyogo-L. The aim of the present study was to define the long-term effect of Hyogo-L.Methods and Results: The JROAD-DPC dataset was used to collect information on the number of hospitalizations for ACS in Hyogo Prefecture, and in Osaka-city without smoking ban legislation, from April 2013 to March 2020. Poisson regression analysis was performed to calculate incident rate ratios (IRRs) and 95% confidence intervals (CIs). ACS records of 3,101 in Kobe-city, 11,375 in areas of Hyogo Prefecture other than Kobe-city and 11,079 in Osaka-city were collected for admissions. The incidence of ACS reduced significantly over time in Kobe-city [IRR (95% CI); 0.96 (0.94-0.97)], but did not reduce in the others. The decrease in Kobe-city was observed in ACS patients without smoking, hypertension, and hyperlipidemia, but not in those with such risk factors. CONCLUSIONS: The long-term ACS reduction or non-reduction under Hyogo-L was determined at the initial period and the same scenario continued, supporting the importance of legislation and compliance with the smoking ban. The lowering effect was remarkable in ACS patients without risk factors such as non-smoking.

Trends in smoking-related diseases by socioeconomic position following a national smoking ban in 2007: a nationwide study in the Danish population.

BACKGROUND: National comprehensive smoke-free legislation has been found to decrease the incidence of several smoking-related diseases. In 2007, Denmark introduced a national smoking ban, which banned smoking indoor in workplaces and public places, although only partial restrictions were applied in certain settings. We examined the impact of the smoking ban on smoking-related diseases and whether this differed across socioeconomic groups. METHODS: Interrupted time series analyses of nationwide register data were performed using Poisson regression models to examine the differential impact of the smoking ban on monthly incidence rates of acute myocardial infarction, chronic obstructive pulmonary disease, and smoking-related cancers from 2002 to 2015. Immediate changes in incidence rates after the smoking ban and long-term changes in disease trends were estimated by comparing data from the pre- and post-ban period. Models were stratified by socioeconomic position. RESULTS: Overall, we found neither immediate changes in rates of acute myocardial infarction, chronic obstructive pulmonary disease, and smoking-related cancers following the smoking ban nor long-term post-ban changes in disease trends as compared to before the ban. Results did not differ across socioeconomic groups. A pronounced socioeconomic gradient in incidence rates was observed for all outcomes both before and after the smoking ban. CONCLUSION: The national smoking ban was not associated with a lower incidence of smoking-related diseases in the post-ban period compared to pre-ban levels and no differences between socioeconomic groups were observed. Future tobacco control in Denmark should consider which measures most effectively target the low socioeconomic groups to decrease the current strong socioeconomic inequality in health.

Promoting Smoke-Free Environments: The Impact of Thirdhand Smoke Awareness on Smoking Bans at Home.

OBJECTIVE: A creating smoke-free home is a way to protect a vulnerable group from being exposed to secondhand smoke in the home, such as children, infants, and non-smokers. Studies reported an intervention for promoting a smoke-free home by using secondhand smoke messages and smoking cessation messages. However, the thirdhand smoke (THS) message has rarely been found. Therefore, this study aimed to explore the prevalence and correlations of smoking bans in homes. METHODS: Secondary data from a community-based cross-sectional design survey was used for this study. Smoking ban status was defined as a smoking ban or no smoking ban. We used multiple logistic regression to test the association between factors and smoking ban status. An adjusted odd ratio and 95% confidence interval were reported. RESULTS: Of the 882 participants included in this analysis, 38.66% (95%CI: 35.43, 41.97) had a smoking ban at home. A multiple logistic regression analysis showed that participants who believe that secondhand or THS harms children had a greater correlation with developing a smoking ban in the home compared with those who did not believe (odd ratio: 3.94, 95% confidence interval: 2.35, 6.60 and odd ratio:4.22, 95% confidence interval:2.6, 6.86, respectively). CONCLUSION: This study found that the belief that thirdhand smoke and secondhand smoke exposure harm children. The smoke-free home message's relevance to the harms of thirdhand smoke exposure should be adapted to be promoted, especially in homes.

Smoking Bans and Circulatory System Disease Mortality Reduction in Macao (China): Using GRA Models.

This study evaluates the association between smoking rates and mortality from circulatory system diseases (CSD) after implementing a series of smoking bans in Macao (China). (1) Background: Macao phased in strict total smoking bans since 2012. During the past decade, smoking rates among Macao women have dropped by half. CSD mortalities in Macao also show a declining trend. (2) Method: Grey relational analysis (GRA) models were adopted to rank the importance of some key factors, such as income per capita, physician density, and smoking rates. Additionally, regressions were performed with the bootstrapping method. (3) Results: Overall, smoking rate was ranked as the most important factor affecting CSD mortality among the Macao population. It consistently remains the primary factor among Macao's female population. Each year, on average 5 CSD-caused deaths were avoided among every 100,000 women, equivalent to about 11.45% of the mean annual CSD mortality. (4) Conclusions: After the implementation of smoking bans in Macao, the decrease in smoking rate among women plays a primary role in the reduction in CSD mortality. To avoid excess CSD mortality due to smoking, Macao needs to continue to promote smoking cessation among the male population.

Smoke-free homes in Poland during the COVID-19 pandemic - a nationwide cross-sectional survey.

OBJECTIVES: Secondhand smoke exposure causes serious health problems. Banning smoking in public venues decreases exposure to secondhand smoke. However, the implementation of smoke-free rules in a private setting (including homes) is largely voluntary. This study aimed to assess the prevalence and characteristics of voluntary smoke-free home rules in Poland during the COVID-19 pandemic as well as to identify factors associated with the voluntary implementation of smoking bans at home. MATERIAL AND METHODS: This cross-sectional survey was conducted in March 2022 with a nationally representative sample of 1090 individuals aged ≥18 years in Poland. Data were collected using a computerassisted web interviewing (CAWI) technique. The research tool was an original questionnaire developed for the purpose of this study. RESULTS: Nationally, 60.6% of individuals had total ban on smoking in home (100% smoke-free home rules), 34.0% had implemented a partial smokefree home rule and 5.4% had not implemented any smoke-free home rules. Over three-quarters of non-smokers (76.8%) and only one-fifth of smokers (20.7%) had adopted a full smoke-free home rule. In multivariate logistic regression analysis, males (OR = 1.65, 95% CI: 1.22-2.22, p < 0.01), non-smokers (OR = 13.78, 95% CI: 9.80-19.38, p < 0.001), respondents who had higher education (OR = 1.57, 95% CI: 1.15-2.14, p < 0.01) as well as those who lived alone (OR = 2.44, 95% CI: 1.52-3.90, p < 0.001) had higher odds of having a 100% smoke-free home rule. CONCLUSIONS: This study demonstrated the negative impact of the COVID-19 pandemic on the implementation of smoke-free home rules in Poland. Less than two-thirds of the Polish population has adopted a total smoke-free home rule, with significant gaps between smokers and nonsmokers. Information on current voluntary smoke-free rules will be useful for further implementation of the smoke-free law in Poland. Int J Occup Med Environ Health. 2023;36(1):84-95.

Environmental tobacco smoke at home and in public places prior to smoking ban enforcement: Assessment by hair analysis in a population of young adult students.

Despite inititatives to reduce tobacco consumption, smoking remains a primary cause of death for both smokers and nonsmokers exposed to environmental tobacco smoke (ETS). The characteristics of some specific groups can make them more exposed to ETS or limit the benefit of prevention measures. This study investigated determinants of ETS in a population of young adult students, considered at higher risk of exposure due to their specific lifestyle. This cross-sectional study involved 90 students aged 20 ± 1.7 years, from the University of Luxembourg, prior to the smoking ban enforcement in public places in the country. Participants reported their tobacco consumption and exposure to ETS at home and/or in public places, and provided a hair sample analyzed for nicotine and cotinine. Nicotine and cotinine were significantly higher in smokers than in nonsmokers' hair in general (median: 2.6 vs. 0.9 ng/mg and 87.1 vs. 22.5 pg/mg respectively). However, nonsmokers exposed to ETS at home and in public places had comparable concentrations to smokers (nic = 2.2 ng/mg; cot = 56.2 pg/mg), whereas unexposed nonsmokers presented significantly lower values (nic = 0.4 ng/mg, cot = 8.5 pg/mg). Nonsmokers exposed to ETS only at home presented higher values than nonsmokers only exposed in public places (nic: 1.3 vs. 0.8 ng/mg, cot: 70.4 vs. 15.0 pg/mg). The study shows the widespread exposure to ETS in this population, the importance of exposure assessment, and the relevance of hair analysis for this purpose. Results suggest that ETS can lead to equivalent exposure to active smoking and that exposure at home can highly contribute to ETS, which is not solved by smoking ban in public places.

Nurses' Perspectives on Smoking Policies, Safety and Cessation Support in Psychiatric Wards: A Cross-Sectional Survey.

A high prevalence of smoking and low rates of smoking cessation interventions can be observed in psychiatric wards. A questionnaire-based, cross-sectional study was performed in five hospitals among 107 psychiatric ward nurses. The aim was to investigate nurses' views on patients' smoking practices and their influence on the safety of both the patients and medical personnel. In addition, we asked about the availability of smoking cessation support. Most of the respondents noticed the negative impacts of smoking on patients and medical personnel. Nearly a third of our respondents (29.0%) recalled smoking-related accidents in their facilities. In 45.2% of these accidents, a patient set someone else on fire. Around one fifth of nurses had rather permissive attitudes towards tobacco use in hospital wards. Significant associations were identified between respondents' smoking status and their opinions on amending smoking policies and on unsupervised smoking. Regarding professional help available to smoking patients, 88.8% of participants reported that interventions to address smoking were available in their wards. Psychiatric hospitalisation can be an opportunity to offer tobacco treatment to patients with mental health conditions. To make use of this opportunity, smoke-free policies need to be put in place and hospital personnel, particularly nurses, should be trained and equipped with the knowledge and skills needed to assist in the smoking care of psychiatric ward patients.

Impact of smoking bans and other smoking cessation interventions in prisons, mental health and substance use treatment settings: A systematic review of the evidence.

ISSUES: We conducted a systematic review to examine whether smoking bans alone are effective in achieving smoking cessation in people released from prison, and patients discharged from mental health or substance use settings. APPROACH: We searched health, criminology and social science databases. Detailed search strings were used to combine terms related to smoking bans and cessation interventions in prison, mental health and substance use treatment settings. We used backward and forward snowballing and manual hand searching to find additional studies. Studies were included if they: were published between 1 January 2000 and 25 February 2022; included a complete smoking ban; measured people released from prison and/or mental health and/or substance use patients smoking post-release/discharge from a smoke-free facility; and reported smoking cessation intervention and/or smoking ban outcomes. Methodological quality was assessed using the Effective Public Health Practice Project's Quality Assessment Tool for Quantitative Studies and reviewed by two authors. KEY FINDINGS: People released from prison, mental health and substance use in-patients who experience a smoking ban while incarcerated or in in-patient settings often relapse to smoking shortly after release or discharge. We found that although smoking bans alone do not promote cessation, multi-component interventions in combination with smoking bans can significantly increase cessation rates post-release/discharge provided they support participants during this time. CONCLUSIONS: There is limited evidence to suggest tobacco bans alone in prison, mental health and substance use treatment settings are effective in achieving long-term smoking cessation. This review suggests that combining smoking bans and cessation interventions including pre- and post-release/discharge support can be effective in achieving smoking cessation.

Guest Support for Outdoor Smoke-Free Policies within a Homeless Shelter.

Roughly 70-80% of adults experiencing homelessness smoke cigarettes. Smoke-free living/workplace policies are an empirically-supported tobacco control intervention. However, homeless shelters may be reluctant to implement smoke-free policies due to fears of it discouraging current/potential shelter guests from taking refuge there. The current study was meant to characterize guest support for on-property smoke-free policies within a homeless shelter with an extant indoor tobacco use ban amongst never smokers, former smokers, and current smokers to provide data on this point. Participants comprised a convenience sample of adult guests of a homeless shelter in Texas (N = 394, 28.2% women; 10.2% former; and 75.9% current smokers). Participant sociodemographics, smoking status, behavioral health diagnoses, and support for two versions of an on-property outdoor courtyard smoke-free policy (one partial, one complete) were assessed. Data were collected in two waves in a repeated cross-sectional design. Overall, 64.0% of participants supported a partial, and 32.0% a full smoking ban. Logistic regressions, controlling for wave of data collection, age, sex, and any additional significant predictors from a semi-adjusted model, examined associations between participant characteristics and policy support. Older participants (OR = 1.024, CI0.95 = 1.005-1.044), non-veterans (OR = 2.523, CI0.95 = 1.156-5.506), former smokers (OR = 2.730, CI0.95 = 1.191-6.258), and those without severe mental illness (OR = 1.731, CI0.95 = 1.061-2.824) had significantly greater odds of supporting a partial smoking ban. Relative to current smokers, never smokers (OR = 3.902, CI0.95 = 2.133-7.137) and former smokers (OR = 8.257, CI0.95 = 3.951-17.258) had significantly greater odds of supporting a complete smoking ban. The implementation of smoke-free living/workplace policies in homeless shelters may enjoy more support from guests-specifically, non-smokers-than anticipated by shelter administrators. Aside from reducing ambient smoke exposure for never and former smokers, these policies can help to reduce ubiquitous smoking cues for those who may want to quit, are undergoing a quit attempt, or are trying to maintain abstinence. Interventionists might partner with shelter guests, particularly smokers, to inform the roll-out of such policies for maximal acceptance and adoption.

Children's exposure to second-hand smoke 10 years on from smoke-free legislation in England: Cotinine data from the Health Survey for England 1998-2018.

BACKGROUND: We aimed to investigate trends in children's exposure to second-hand tobacco smoke in England from 1998 to 2018. METHODS: We used twenty-one years of data from the Health Survey for England, a yearly repeated cross-sectional population study. A total of 49,460 children participated between 1998 and 2018, of whom 17,463 were biochemically confirmed non-smokers aged 4-15. We examined changes in (i) the proportion of children living in reported smoke-free homes and (ii) second-hand smoke uptake, measured quantitatively using saliva cotinine concentration. FINDINGS: The percentage of children living in a home reported to be smoke-free increased from 63.0% (95% CI 60.5%-65.2%) in 1998 to 93.3% (91.8%-94.6%) in 2018. This increase was most pronounced among children with a smoker parent, rising from 17.1% (14.7%-19.8%) to 75.9% (70.8%-80.4%). Segmented regression showed that the rate of adoption of smoke-free homes accelerated leading up to the 2007 ban on smoking in public places, growing most rapidly in the four years after its entry into law. Between 1998 and 2018, there was a ten-fold decline in geometric mean cotinine among non-smoking children, from 0.50 ng/ml (0.46-0.56) to 0.05 ng/ml (0.04-0.06). A total of 65.0% (61.2%-68.6%) of children had undetectable cotinine in 2018, up from 14.3% (12.7%-16.0%) in 1998. Children living in rented accommodation were more exposed than those from owner-occupied households, but they experienced similar relative declines across years. INTERPRETATION: Cotinine data show that children's exposure to second-hand smoke has fallen by some 90% since 1998, with an apparent acceleration in adoption of smoke-free homes since the 2007 ban on smoking in public places. A norm has emerged that sees smoking in the home as inappropriate, almost universally where parents are non-smokers, but also increasingly among smoking parents. FUNDING: Public Health England, now the Office for Health Improvement and Disparities, and Cancer Research UK.

Non-smokers' and smokers' support for smoke-free legislation in 14 indoor and outdoor settings across 12 European countries.

BACKGROUND: European countries differ considerably in the scope and the extent of their policies to protect people from the harms of secondhand smoke exposure. Public opinion may have a substantial influence on several stages of policy development, implementation, and compliance. For this reason, we aimed to evaluate the population level of support for smoke-free policies and its correlates. METHODS: We used data from the TackSHS Survey (2017-2018), a cross-sectional study with representative samples of the general population aged ≥15 years from 12 European countries. We described the proportion of non-smokers' and smokers' support for the implementation of smoke-free legislation in 14 indoor and outdoor settings and the country-level characteristics associated with it. RESULTS: In the total sample (n = 11,902), support for smoke-free legislation were the lowest for restaurants/bar patios (non-smokers = 53.0%; smokers = 29.2%) and the highest for workplaces (non-smokers = 78.5%; smokers = 66.5%). In the country-level analysis, the highest support among non-smokers was for workplaces in Bulgaria (93.1%) and the lowest for restaurants/bars patios in Greece (39.4%). Among smokers, the corresponding estimates were for children's playgrounds in Latvia (88.9%) and for cars in Portugal (21%). For most settings, support for smoke-free legislation was directly related with the countries' prevalence of secondhand smoke presence and reported smoking in each setting. DISCUSSION: Our results show that the majority of European adults (including a large proportion of smokers) are supportive of implementing smoke-free legislation in indoor settings and extending it to selected outdoor settings. Such expressive support can be seen as an opportunity to advance legislation and protect the European population from secondhand smoke exposure.

The Role of Ethnicity and Nativity in the Correspondence between Subjective and Objective Measures of In-Home Smoking.

Studies are needed to understand the association between self-reported home smoking bans and objective measures of in-home smoking according to smokers' ethnicity/nativity. Data came from a trial that used air particle monitors to reduce children's secondhand smoke exposure in smokers' households (N = 251). Linear regressions modeled (a) full home smoking bans by ethnicity/nativity, and (b) objectively measured in-home smoking events, predicted by main and interaction effects of self-reported home smoking bans and ethnicity/nativity. Among smokers reporting < a full ban, US-born and Foreign-born Latinos had fewer in-home smoking events than US-born Whites (p < 0.001). Participants who reported a full smoking ban had a similar frequency of smoking events regardless of ethnicity/nativity. Results indicate that self-reported home smoking bans can be used as a proxy for in-home smoking. Establishing smoking bans in the households of US-born White smokers has the largest impact on potential exposure compared to other ethnicity/nativity groups.

Support and attitudes of Qatar mental health professionals to a proposed mental health inpatient smoking ban: Results of a cross-sectional survey.

WHAT IS KNOWN ON THE SUBJECT?: Smoking is more common among people with serious mental illness, and it contributes to a reduced life expectancy. Several Western countries have successfully introduced smoke-free policies in inpatient mental health units. There is virtually no information about attitudes to smoking bans in mental health units from countries in the Middle East and North Africa region. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We surveyed mental health professionals working in Qatar's main mental health service to determine support for and attitudes towards a proposed total smoking ban in psychiatric wards. Most staff who completed the survey supported an inpatient smoking ban. However, further analysis, both quantitative and qualitative, showed markedly ambivalent attitudes, that is staff simultaneously held attitudes that supported and opposed a smoking ban. Professionals who did not support a ban were more likely to have not received smoking cessation training in the last 5 years, to be a psychiatrist rather than a nurse or allied mental health professional, to be current smokers and to be a Middle Eastern and North African national. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further staff training is necessary to achieve more consistent attitudes that support a total smoking ban and increase the likelihood of successful implementation. The attitudes in this study showed similarities and differences to those reported for mental health professionals in Western countries. This highlights that local research is necessary to help shape training and successfully implement smoke-free policies. ABSTRACT: Introduction Despite the fact that patients with serious mental illness (SMI) have high rates of smoking and an increased standardized mortality, there is virtually no information about attitudes to smoking bans in mental health units from countries in the Middle East and North Africa region. Aim To assess support for, and attitudes towards, a proposed total smoking ban in psychiatric wards among mental health clinicians in Qatar. Method Cross-sectional survey of mental health professionals working in Qatar's primary mental health service. Results The response rate was 68% (353/520). Support for a ban was assessed with a single-item question; 73% of respondents supported a ban with opposition significantly (p < .05) associated with being a current smoker, a Middle Eastern and North African (MENA) national, a psychiatrist versus a mental health nurse or allied health professional and not receiving smoking cessation training in the last 5 years. A 21-item questionnaire assessed attitudes to a total smoking ban. It showed marked ambivalence with multiple linear regression identifying MENA nationality, male gender and current smoking status as independent variables influencing attitudes. The most strongly held attitude supporting a ban was concern about passive smoking and against a ban was concern it may increase patient agitation. Qualitative data confirmed ambivalent views. Discussion The results show similarities and differences to research from other countries suggesting that cultural factors influence some attitudes to smoke-free policies. Implications for Practice Staff support and smoking cessation education are necessary to achieve more consistent staff attitudes to support smoke-free policies.

Evaluation of a smoke- and tobacco-free campus policy: The issue of displacement.

Objective This study evaluates the effectiveness of a smoke- and tobacco-free campus policy by examining the volume, density, and location of discarded cigarette butts before and after the implementation of the policy. Participants: Student, staff, and faculty volunteers collected and recorded the location of discarded cigarette butts in April 2017 and October 2018. Methods: The Smoke and Tobacco Free Environment policy was effective September 1, 2017. A campus-wide collection of cigarette butts was conducted 5 months before, and 13 months after it came into effect. Results: The number of cigarette butts on campus decreased after policy implementation, especially in areas with formal enforcement. There was evidence of displacement of smoking behavior from the campus center to its periphery where parking lots and staff buildings are located. Conclusions: Formal enforcement is key to increasing the efficacy of the policy. Interventions should be directed to the locations where smoking behavior is concentrated.