Association Between Secondhand Smoke Exposure Among Women and the Implementation of Tobacco Control Measures on Campus: A Cross-Sectional Study in 50 Universities Across China.

INTRODUCTION: Exposure to secondhand smoke (SHS) among women is prevalent in China which increases their risk of developing a wide range of diseases and can affect their susceptibility to adverse reproductive health effects. This study aims to examine the association between SHS exposure among women and the adoption and implementation of tobacco control measures on campus in China. AIMS AND METHODS: 7469 female college students who have never smoked were recruited from 50 universities across China using a multistage sampling technique. All participants reported their exposure to SHS and the tobacco advertising and promotion on campus. Participants from colleges with smoke-free policies reported the implementation of smoke-free policies on campus measured by: (1) no evidence of smoking and (2) the display of smoke-free signs in public places. Multivariate logistic regression models were applied using weighted survey data. RESULTS: SHS exposure among participants was 50.5% (95% CI = 44.2% to 56.9%). The adoption of a smoke-free policy was not associated with SHS exposure (OR: 1.01, 95% CI = .71, 1.42), however, the implementation of the policy was significantly negatively associated with SHS exposure (OR: 0.56, 95% CI = .47 to 0.67). In addition, tobacco advertising and promotion on campus were significantly positively associated with SHS exposure (OR: 2.33, 95% CI = 1.42, 3.82; OR: 1.52; 95% CI = 1.15, 2.02, respectively). CONCLUSIONS: Exposure to SHS is prevalent among female college students in China. Successful implementation of a smoke-free policy and banning tobacco advertising and promotion on campus could be effective measures to protect young women from the harms of SHS in China. IMPLICATIONS: Approximately half of female college students are exposed to SHS on campus in China. Failure to implement smoke-free policies and exposure to tobacco marketing on campus are associated with higher SHS exposure. To protect millions of young Chinese women from the health harms of SHS, universities need to enact and enforce smoke-free policies within campus boundaries and adopt comprehensive bans on tobacco advertising and promotion on campus.

Impact of Total Indoor Smoking Ban on Cardiovascular Disease Hospitalizations and Mortality: The Case of Chile.

INTRODUCTION: The harmful effects of first and secondhand smoking are well-established. Smoke-free laws aim at protecting nonsmokers. This study aimed to assess the impact of the 2013 total ban on indoor smoking in Chile on hospitalizations and deaths of major cardiovascular events. AIMS AND METHODS: The logarithm of the monthly hospitalization and death rates, standardized by age for every 100 000 inhabitants, were estimated for ischemic heart disease, acute myocardial infarction, strokes, and a composite outcome of ischemic heart diseases (which includes acute myocardial infarction) and strokes. In addition, interrupted time series with synthetic control groups were used to assess changes in levels and trends after the intervention. RESULTS: The total ban on indoor smoking caused significant reductions in death rates for the three diseases studied for age groups above 20 years old. In addition, there were substantial decreases in the post-intervention hospitalization rates for ischemic heart disease: for the 20-44 age group, the decrease was 8.7% compared to the pre-intervention period (p < .01). In comparison, such a reduction was 4% (p < .01) for the ≥65 age group. For acute myocardial infarction, the decrease was 11.5% (p < .01) for the 20-44 age group, while for stroke, it was a 1.2% (p < .01) decrease for the total population. It is estimated that the smoking ban averted 15.6% of the deaths compared with the synthetic control groups. CONCLUSIONS: The implementation of total smoke-free environments in Chile contributed to the reduction of mortality for main cardiovascular diseases. This study provides additional evidence of causality linking the policy to health outcomes. IMPLICATIONS: The total indoor smoking ban significantly affected age-standardized hospitalization and deaths. The number of deaths averted by this policy is estimated at approximately 4758 and 5256 for IHD and stroke, respectively, during the 2013-2017 period (15.6% fewer deaths than predicted by the synthetic control groups). The study contributes to the body of evidence that supports total indoor smoking bans.

Impact of cigarette price and tobacco control policies on youth smoking experimentation in Albania.

BACKGROUND: Albania has one of the highest smoking prevalence in Europe especially among the youth. There is a lack of evidence in Albania, as well as in most of Eastern Europe and middle-income countries, regarding the effect of price on smoking experimentation. OBJECTIVE: The study aims to assess the effect of price and tobacco control policies on youth smoking experimentation in Albania. METHODS: We used microdata from the Global Youth Tobacco Survey in Albania for 2004, 2009, 2015 and 2020. We constructed a pseudo-longitudinal dataset and estimated a split-population model to assess the hazard of smoking experimentation. RESULTS: Price is a significant predictor of smoking experimentation among teenagers in Albania for both males and females (p<0.001). Being male increases the odds for smoking experimentation by more than 50% as compared with females (p<0.001), whereas females appear to be more price sensitive. Peer and parent smoking are also important determinants for smoking experimentation. Introducing penalties for smokers and legal entities violating smoke-free policies implemented in 2014 is also associated with a lower hazard of smoking experimentation. CONCLUSION: Price is a significant predictor of smoking experimentation among teenagers in Albania for both males and females. A combination of increasing taxes and strengthening the rule of law to control tobacco use in public spaces, in addition to public awareness campaigns targeting both youth and smoking parents, could help to significantly reduce the probability of smoking experimentation.

The crossroads of work and home: linkages between smoke-free policies at work and household environments.

BACKGROUND: Tobacco use causes over eight million global deaths annually, with seven million directly attributed to tobacco use and 1.2 million to second hand smoke (SHS). Smoke-free environments are crucial to counter SHS. Although India banned smoking in public places in 2008, SHS exposure remains high. Studies have noted that limiting smoking in workplaces, restaurants, etc., helps to reduce overall smoking and reduce SHS exposure. Under this background, the study explores the linkages between smoke-free workplaces and living in smoke-free homes in India. METHODS: The two rounds of the GATS India (2009-10 and 2016-17) have been used for the study. The study focuses on male tobacco smokers working indoors or outdoors or both indoors and outdoors. The sample for the study was 2,969 for GATS 1 and 2,801 for GATS 2. Dependent variables include living in a smoke-free home, while the independent variables were adherence to a smoke-free office policy and socio-demographic variables. The two rounds of the GATS data were pooled for analysis. Statistical analysis involves bivariate and multivariate analysis. RESULTS: Findings reveal that 41% of respondents worked in smoke-free workplaces in GATS 2. Nationally, smoke-free homes increased from 35% in 2009-2010 to 44% in 2016-17. Individuals with smoke-free workplaces were more likely to have smoke-free homes. The Southern region consistently exhibited the highest proportion of smoke-free homes. Urban areas and higher education correlated with increased smoke-free homes. Logistic regression analysis confirmed that workplace smoke-free status is a significant predictor of smoke-free homes. In GATS 2, respondents aged 30 years and above were less likely to have smoke-free homes, while education and Southern region residence positively influenced smoke-free homes. CONCLUSIONS: The correlation between smoke-free workplaces and smoke-free homes is linked to stringent workplace no-smoking policies, potentially deterring individuals from smoking at home. Opportunities exist for the expansion and stringent implementation of the smoke-free policies among Indian working adults, leveraging the workplace as a key setting for evidence-based tobacco control. The study highlights positive trends in India's smoke-free homes, crediting workplace policies. Effective policies, education, and regional strategies can advance smoke-free homes, stressing the pivotal role of workplace policies and advocating broader implementation.

Impact of secondhand smoke on air quality in partially enclosed outdoor hospitality venues: a review.

BACKGROUND: Smoking is a leading cause of premature mortality and morbidity globally. The pollutants generated from smoke are not only harmful to smokers, but also to those exposed to secondhand smoke. As a result of increasingly restrictive indoor smoke-free policies in many countries, there is a tendency for tobacco smoking to move outdoors into partially enclosed settings in hospitality venues. The aim of this systematic review was to evaluate the impact of secondhand smoke on air quality in outdoor hospitality venues. METHODS: Two electronic databases PubMed and Scopus were searched from 1 January 2010 to 30 June 2022 for studies of air quality impacts from tobacco smoking in outdoor hospitality venues. A total of 625 studies were screened and 13 studies were included in this review. RESULTS: The majority (9 studies) of reviewed studies monitored PM2.5 concentration as an indicator of secondhand smoke. PM2.5 was reported from 10.9 µg/m3 to 91.0 µg/m3 in outdoor smoking areas, compared to 4.0 µg/m3 to 20.4 µg/m3 in outdoor control sites unaffected by smoking. Secondhand smoke can also drift into adjacent outdoor areas or infiltrate into indoor environments thus affecting air quality in spaces where smoking is not permitted. CONCLUSIONS: The reviewed studies indicated that air quality within outdoor hospitality venues where smoking is permitted is unlikely to meet current World Health Organization (WHO) ambient air quality guidelines for PM2.5. Customers and staff in outdoor hospitality venues with active smoking, and in adjacent outdoor and indoor non-smoking areas, are potentially exposed to secondhand smoke at levels exceeding WHO guidelines. Stronger smoking control policies are recommended for outdoor hospitality venues to protect the health of customers and staff from harmful secondhand smoke exposure. PROSPERO REGISTRATION: CRD42022342417.

The contribution of Dutch municipalities to stimulate smoke-free outdoor sports clubs: a qualitative study.

Local governments may play a key role in making outdoor sports clubs smoke free. This study aims to assess the activities, motives, challenges and strategies of Dutch municipalities regarding stimulating outdoor sports clubs to become smoke free. Semi-structured interviews were conducted with 19 policy officers of different municipalities in the Netherlands. The included municipalities varied in terms of region, population size and degree of urbanization. Data were analyzed using content analysis. Municipalities stimulated sports clubs to become smoke free by providing information and support and, to a lesser extent, by using financial incentives. Motives of municipalities varied from facilitating a healthy living environment for youth, responding to denormalization of smoking and aligning with goals formulated in national prevention policy. Policy officers faced several challenges, including limited capacity and funds, a reluctance to interfere with sports clubs and little support within the municipal organization. These challenges were addressed by employing various strategies such as embedding smoke-free sports in a broader preventive policy, setting a good example by creating outdoor smoke-free areas around municipal buildings, and collaborating with stakeholders in the municipality to join forces in realizing smoke-free sports clubs. Municipalities demonstrated evident motivation to contribute to a smoke-free sports environment. Currently, most municipalities fulfil an informative and supportive role, while some municipalities still explore their role and position in relation to supporting sports clubs to become smoke free. Other municipalities have established, according to them, effective strategies.

Examining the creation of synergy in community coalitions for smoke-free environments in Armenia and Georgia.

Community coalitions depend on their members to synergistically pool diverse resources, including knowledge and expertise, community connections and varied perspectives, to identify and implement strategies and make progress toward community health improvement. Several coalition theories suggest synergy is the key mechanism driving coalition effectiveness. The Community Coalition Action Theory (CCAT) asserts that synergy depends on how well coalitions engage their members and leverage their resources, which is influenced by coalition processes, member participation and satisfaction and benefits outweighing costs. The current study used mixed methods, including coalition member surveys (n = 83) and semi-structured interviews with leaders and members (n = 42), to examine the process of creating collaborative synergy in 14 community coalitions for smoke-free environments in Armenia and Georgia. Members, typically seven per coalition representing education, public health, health care and municipal administration sectors, spent an average of 16 hr/month on coalition-related work. Common benefits included making the community a better place to live and learning more about tobacco control. The greatest cost was attending meetings or events at inconvenient times. Members contributed various resources, including their connections and influence, skills and expertise and access to population groups and settings. Strong coalition processes, greater benefits and fewer costs of participation and satisfaction were correlated with leveraging of member resources, which in turn, was highly correlated with collaborative synergy. Consistent with CCAT, effective coalition processes created a positive climate where membership benefits outweighed costs, and members contributed their resources in a way that created collaborative synergy.

Global trends in deaths and disability-adjusted life years of diabetes attributable to second-hand smoke and the association with smoke-free policies.

OBJECTIVES: The diabetic burden attributable to second-hand smoke (SHS) is a global public health challenge. We sought to explore the diabetic burden attributable to SHS by age, sex, and socioeconomic status during 1990-2019 and to evaluate the health benefit of smoke-free policies on this burden. STUDY DESIGN: Cross-sectional study. METHODS: The diabetic burden attributable to SHS was extracted from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 dataset. Country-level smoke-free policies were obtained from the World Health Organization Global Health Observatory. The deaths or disability-adjusted life years (DALYs) were quantified, and the average annual percentage changes were calculated. Hierarchical linear mixed models were applied to evaluate the health effects. RESULTS: From 1990 to 2019, the absolute number of global deaths and DALYs of diabetes attributable to SHS has doubled, and the age-standardised rate has significantly increased. The disease burden was higher in females than in males and increased with increasing age. The SHS-related diabetic burden varied across regions and countries. Age-standardised death or DALY rates first increased and then decreased with increased Socio-demographic Index (SDI), peaking in the 0.60-0.70 range. In low to low-middle, and middle to high-middle SDI countries, SHS-related diabetic deaths and DALYs were significantly lower in countries with more than 3 smoke-free public places than in countries with 0-2 smoke-free public places. CONCLUSIONS: More attention should be paid to females and the elderly, who bear a heavy SHS-related diabetic burden. Banning smoking in public places was associated with reduced burden of SHS-attributable diabetes, especially in low to middle social development countries.

[Tabacco harm reduction: the need for a paradigm shift in German tobacco control policy]. / Tabak Harm Reduction: Die Notwendigkeit eines Paradigmenwechsels in der deutschen Tabakkontrollpolitik.

The consumption of tobacco continues to be the greatest preventable health risk in Germany. Every year, more than 127,000 people die prematurely as a result of using tobacco - one in five new cases of cancer is a consequence of smoking. Germany's current tobacco control policy, consisting of advertising bans, the promotion of smoke-free environments, and an abstinence-only paradigm, are only able to initiate slow change. Other countries have shown how the number of smokers can be reduced and deaths prevented by integrating harm reduction as a complementary measure and providing a much more active support for people who want to quit. This article first presents the current situation and current measures in Germany. Then recommendations for changes to the current tobacco control policy in Germany are derived from a look at the United Kingdom, which is considered a pioneer throughout Europe with its tobacco control policy, as well as a summary of the current state of research.

Compliance with smoke-free legislation and smoking behaviour: an observational field study in Karachi, Pakistan.

Objective: To observe compliance with smoke-free law at different public places in an urban setting. METHODS: The cross-sectional study was conducted from January to June 2022 after approval from the ethics review board of Jinnah Sindh Medical University, Karachi, at public places, including public and private offices, health institutions, education institutions, malls, markets and eateries, in 5 districts of Karachi. Boundary, entrance, waiting areas/corridors, toilet areas and eating areas were assessed using a checklist for smoke-free law compliance. Places were considered compliant if no smoking activity, cigarette butt litter or ashtrays was found. Data was analysed using SPSS 21. RESULTS: Out of 400 places observed, there were 80(20%) in each of the 5 districts. Overall, 36(44%) of the venues showed indoor compliance and 10(12%) showed outdoor compliance. Presence of cigarette butts was observed at 350(87.5%) outdoor places around the boundary of the premises. Only 38(9.5%) of the places had no smoking boards outdoors and at the entrance, with 16(4%) being clearly visible. Also, 27(43%) of educational institutions had a cigarette shop within 50 metres of the boundary. Conclusion: The city was found to have poor implementation of smoke-free laws, especially for outdoor areas, exposing the public to constant second-hand smoke.

[Effects of a smoke-free policy on healthcare staff attitudes and aggression in psychiatry]. / Effecten van een rookvrijbeleid op attitudes zorgpersoneel en agressie in de psychiatrie.

Background The prevalence of smoking among patients with psychiatric disorders is 3-4 times higher than the general population. However, smoking is still permitted in many psychiatric clinics. The National Prevention Agreement (2018) mandates that all psychiatric wards be smoke-free by 2025. The UMC Utrecht clinics have been smoke-free since November 2020. Aim To examine healthcare workers’ attitudes before and after implementing the smoke-free policy. Method In an observational study with quantitative data analysis, data were collected in one center from healthcare workers in psychiatry departments with surveys. We collected demographic information, smoking status, attitudes towards the smoke-free policy, and its impact on patients and care. Incidents of aggression were prospectively recorded and reported in the MAP (aggression incidents in patient care). Results Out of 172 healthcare workers invited to participate, 30% (n = 52) completed the pre-implementation survey, and 20% (n = 34) completed the post-implementation survey. Prior to implementation, 62% (n = 32/52) of healthcare workers had a positive attitude towards the smoke-free policy, which increased to 77% (n = 26/34) post-implementation. Expectations of increased aggression incidents were reported by 62% (n = 32/52) during the pre-implementation phase. The number of aggression incidents was 46 in the one-year period before implementation (November 2019 – February 2020) and 45 incidents after implementation (November 2020 – February 2021). Conclusion This study supports the implementation of a smoke-free policy in psychiatric clinics due to the lack of a significant increase in aggression incidents. Healthcare workers perceived this outcome and observed quicker granting of ‘green’ freedoms.

ATTITUDES AND BEHAVIORS RELATED TO REDUCING SECONDHAND SMOKE EXPOSURE AMONG MEDICAL UNIVERSITY STUDENTS IN THE COUNTRY OF GEORGIA.

Public smoke-free policy support can contribute to effective policy adoption, implementation, and impact. Furthermore, individuals may engage in behaviors to reduce secondhand smoke exposure (SHSe). This study examined factors associated with smoke-free policy support and behaviors to reduce SHSe. MATERIAL AND METHODS: We analyzed cross-sectional survey data among 261 students (Mage=22.26, SD=2.76; 55.6% female) at a large medical university in Tbilisi, Georgia. Multivariable regression analyses assessed sociodemographics, tobacco use, past-week SHSe, perceived risk of SHSe, and perceived smoke-free policy effectiveness in relation to smoke-free policy support; SHSe avoidance; and having asked others to put out cigarettes. RESULTS: Overall, 38.3% reported current smoking, 62.8% lived with someone who used tobacco, and the average number of days of SHSe was 4.07 (SD=2.17). Most commons SHSe sources were open (58.2%) and closed public places (24.1%). The majority supported the smoking ban in closed (94.6%) and open public places (59.8%); 71.6% believed it should include other places. Average ratings were relatively high for perceived risk (M=3.38, 1=no-4=serious) but lower for perceived smoke-free policy effectiveness (M=2.51, 1=not-4=quite) and avoidance of SHSe (M=3.32, 1=never-5=always); 58.6% had asked someone to put out cigarettes. Greater smoke-free policy support, avoidance of SHSe, and having asked someone to put out cigarettes (respectively) were associated with nonsmoking status and greater perceived SHSe risk (p's<.01). CONCLUSIONS: Despite general support for smoke-free policy and engagement in SHSe reduction behaviors in Georgia, additional efforts to reduce SHSe are needed (e.g., media campaigns to raise SHSe risk awareness, engaging nonsmoking adults in enforcement).

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.

Assessing the choice of smoke-free policies for multiunit housing and its associated determinants in Bangladesh: a cross-sectional study.

OBJECTIVES: This study aimed to assess the desire for smoke-free housing, determine the choice of smoke-free policies for multiunit housing (MUH), and identify the factors associated with policy choice among MUH residents in Bangladesh. DESIGN: We conducted a cross-sectional study from April to November 2019 using a semi-structured survey questionnaire. SETTING: This study was conducted in seven divisional cities of Bangladesh: Dhaka, Chattogram, Rajshahi, Khulna, Sylhet, Barishal, and Rangpur. PARTICIPANTS: A total of 616 adult individuals living in MUH for at least 2 years participated in the study. PRIMARY OUTCOME MEASURE: Multinomial logistic regression was used to identify the determinants of the choice of smoke-free policies for MUH. RESULTS: Overall, 94.8% of the respondents wanted smoke-free housing. Among those who wanted smoke-free housing, 44.9% preferred a smoke-free building policy, 28.3% preferred a smoke-free common area policy, 20.2% favoured a smoke-free unit policy, and 6.7% did not know what policy they should choose. Three factors were found to be significantly associated with the choice of a smoke-free building policy: staying at home for more than 12 hours (adjusted OR (aOR): 2.6; 95% CI 1.035 to 6.493), being a non-smoker (aOR: 3.2; 95% CI 1.317 to 7.582), and having at least one family member who smoked (aOR: 3.0; 95% CI 1.058 to 8.422). Results also showed that residents having at least one child under 15 in the family (aOR: 0.3; 95% CI 0.152 to 0.778) were less likely to choose a smoke-free common area policy and that women (aOR: 3.7; 95% CI 1.024 to 13.188) were more likely to choose a smoke-free unit policy. CONCLUSIONS: MUH residents in urban Bangladesh highly demanded smoke-free housing. Most residents favoured a smoke-free building policy for MUH. Those who stayed at home for a longer time, were non-smokers, and had smoking family members were more likely to choose this policy.

Initial leadership concerns and availability of tobacco cessation services moderate changes in employee-reported concerns about tobacco-free workplace policy implementation over time.

Tobacco-free workplace policies (TFWPs) are underused evidence-based interventions that reduce the elevated use of tobacco among substance use treatment center (SUTC) employees and patients. SUTC employees' anticipated concerns about stakeholder pushback are barriers to TFWP adoption. Examination of discrepancies between anticipated and actualized employee-reported TFWP concerns arising from coworkers, patients, and community members in the context of leadership concerns and tobacco cessation care availability for employees may inform strategies to increase TFWP uptake. This study analyzed changes in employee-reported TFWP concerns from before to after a comprehensive tobacco-free workplace intervention that included TFWP implementation, using Chi-square/Fisher's exact tests. Preimplementation leadership policy concerns and tobacco cessation care availability were examined as moderators in generalized linear mixed models. Overall, 452 employees and 13 leaders provided data from 13 SUTCs collectively serving >82 000 patients annually. Results revealed significant decreases over time in employee-reported concerns about TFWP resistance from coworkers. Moderation analyses indicated that employee-anticipated concerns from coworkers and patients, respectively, were less likely to be actualized in SUTCs where leadership endorsed preimplementation TFWP concerns, whereas employee-reported patient concerns rose over time in SUTCs where leadership had no initial implementation concerns. Additionally, employee-anticipated concerns from coworkers were overestimated in SUTCs that did not offer tobacco cessation care to employees. Results supporting the nonactualization of anticipated employee concerns following TFWP implementation can be used to engage other SUTCs for TFWP adoption. Furthermore, moderation effects may suggest that center characteristics translate to greater attention to rollout, ultimately enhancing TFWP stakeholder acceptance.

Substance use treatment center (SUTC) employees and patients use tobacco at elevated rates and suffer disproportionately from tobacco-related diseases. The implementation of a tobacco-free workplace policy (TFWP) can reduce tobacco use disparities in this setting. However, employee concerns about TFWPs are often a deterrent to their adoption. This study assessed how employee-reported concerns changed over time and whether these changes differed based on center characteristics like center leadership concerns about the TFWP and availability of tobacco cessation services for employees. Overall, the most common employee-reported concerns were those arising from patients, followed by coworkers and community members throughout policy implementation. Results demonstrated that anticipated concerns from coworkers decreased over time in all SUTCs. Furthermore, TFWP concerns from coworkers and patients were overestimated by employees at centers wherein leadership had concerns about TFWP implementation, whereas patient concerns were underestimated at centers where leadership had no preimplementation concerns. Finally, employee-anticipated concerns from coworkers were overestimated in SUTCs without tobacco cessation care for employees. Findings suggest that employees may overestimate concerns/complaints from various stakeholders based on organizational factors. This information may be used to engage additional SUTCs in TFWP implementation by alleviating employee concerns about policy adoption.

Compliance to the Tobacco-Free Educational Institution(ToFEI) guidelines at Madhyamik Vidhyalayas of Pimpri-Chinchwad, Pune, Maharashtra-A cross sectional study.

INTRODUCTION: Revised guidelines for Tobacco-Free Educational Institutes (ToEFI) were laid down in 2019 and they provide for tobacco free environment leading to a healthy life, implementation of legal provisions, and recognition about various approaches available for tobacco cessation. OBJECTIVE: To assess Madhyamik Vidyalays (MVs) for their compliance to the guidelines for ToFEI at the baseline using self-evaluation score card as part of operational research. MATERIAL AND METHOD: A cross sectional study was carried out during March 2021 among 19 MVs of Pimpri-Chinchwad block in Pune District, Maharashtra using census sampling. Trained data collectors scored for all 9 ToFEI criteria including the mandatory one's and their weightage points were calculated. RESULTS AND DISCUSSION: Eight {42%(0.21-0.64)} MVs had displays on tobacco-free area and awareness on the harms of tobacco displayed inside the premises and another three (16%(0.04-0.37)} had only the display of ToFEI signage at their boundary wall. No MV met with 4 or more criteria out of the total 9 criteria. The highest weightage of 29-30 out of 100 was achieved by only 2 {11%(0.01-0.30)} MVs and 5 {26%(0.10-0.49)} MVs achieved 0 points. No significance was given to tobacco free school probably because of untrained teachers and unawareness of the guidelines. CONCLUSION: This study demonstrates that minimal importance has been given to the revised ToEFI guidelines in making MVs tobacco-free. Hence, none of the them could attain the tobacco-free status.

Non-compliance with smoke-free law in public places: a systematic review and meta-analysis of global studies.

Introduction: Non-compliance with smoke-free law is one of the determinants of untimely mortality and morbidity globally. Various studies have been conducted on non-compliance with smoke-free law in public places in different parts of the world; however, the findings are inconclusive and significantly dispersed. Moreover, there is a lack of internationally representative data, which hinders the evaluation of ongoing international activities towards smoke-free law. Therefore, this meta-analysis aimed to assess the pooled prevalence of non-compliance with smoke-free law in public places. Methods: International electronic databases, such as PubMed/MEDLINE, Science Direct, Cochrane Library, CINAHL, African Journals Online, HINARI, Semantic Scholar, google and Google Scholar were used to retrieve the relevant articles. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols (PRISMA) guidelines. The Higgs I2 statistics were used to determine the heterogeneity of the reviewed articles. The random-effects model with a 95% confidence interval was carried out to estimate the pooled prevalence of non-compliance. Results: A total of 23 articles with 25,573,329 study participants were included in this meta-analysis. The overall pooled prevalence of non-compliance with smoke-free law was 48.02% (95% CI: 33.87-62.17). Extreme heterogeneity was observed among the included studies (I2 = 100%; p < 0.000). The highest non-compliance with smoke-free law was noted in hotels (59.4%; 95% CI: 10.5-108.3) followed by homes (56.8%; 95% CI: 33.2-80.4), with statistically significant heterogeneity. Conclusion: As the prevalence of non-compliance with smoke-free law is high in public places, it calls for urgent intervention. High non-compliance was found in food and drinking establishments and healthcare facilities. In light of these findings, follow-up of tobacco-free legislation and creating awareness that focused on active smokers particularly in food and drinking establishments is recommended.

Identifying factors influencing local governments' adoption of comprehensive smoke-free policies: an event history analysis based on panel data from 36 key cities in China (2013-2021).

Introduction: The issue of tobacco control remains a significant concern for public health worldwide. In recent years, remarkable progress has been made toward adopting smoke-free measures in indoor public places. Although China has yet to introduce a national regulation, specifically for smoke-free public places, more than a dozen cities have successively approved and implemented comprehensive smoke-free regulations. Different cities in China have diverse attitudes and behaviors toward smoke-free policies; however, the reasons for these policy differences and the influencing factors have not received sufficient attention and research. Methods: On the basis of the multiple streams framework, this study selects 36 key Chinese cities as research samples and uses a directed dyad-year event history analysis method to analyze the factors influencing the implementation of comprehensive smoke-free policies in cities. Results: Results show that the adoption of such policies is positively influenced by scientific evidence, focal events, media coverage, institutional foundations, economic comparisons, and the influence of health departments and of tobacco control groups. By contrast, policy adoption is negatively affected by the differences in administrative levels, central policy signals, and the influence of the tobacco industry. Discussion: This study contributes to understanding the internal logic behind local governments' adoption of comprehensive smoke-free policies, offering insights for further advocacy at the city and national levels in China and providing experiences that can promote the global tobacco control movement.