Relevant data from 89 cross-sectional surveys conducted between 1993 and 2014 show high support among both smokers and nonsmokers for smoke-free regulations in public spaces.
The “state-of-the-art review,” conducted by Dr. George Thomson and his colleagues, involved digital searches on Medline, Google Scholar, and Google. Selected studies included digitally available, English-language, population-based surveys of the general adult public in US and Canadian jurisdictions and included a minimum sample size of 500-plus participants. Searches yielded 59 relevant articles and reports, with 89 cross-sectional surveys.
Seventy-eight surveys were conducted in the United States, and 11 were conducted in Canada. Available survey data were from 26 US states, 3 US counties or groups of counties, and New York City, as well as 6 Canadian provinces. Nine surveys were conducted before 2000, 47 were conducted during 2000 to 2007, and 34 were conducted during 2008 to 2014. Ultimately, available data included only 52% of US states and 60% of Canadian provinces. All surveys appeared to be funded by government or health sector agencies.
Researchers identified 5 main data patterns: variation in public support by type of outdoor place, change in public support, different levels of support from smokers and nonsmokers, different levels of support by gender, and the effect of the survey design.
Highest support was indicated for smoke-free school grounds (57% to95%), playgrounds (89% to91%), and building entrances (45% to89%), while the lowest support was concentrated on smoke-free outdoor workplaces (12% to46%) and sidewalks (31% to49%).
The researchers generally found an increase in support for outdoor smoke-free regulations over time. For example, support for smoke-free school grounds in the United States increased from 67% to 78% during 2002 to 2008. Survey data also showed that overall, men were less supportive of smoke-free outdoor regulations than women in all instances where gender was reported. In addition, some ethnic groups, such as African Americans, were more supportive of smoke-free areas. Geographically, higher support was found in both California and Ontario.
In 39 surveys conducted in 20 jurisdictions from 1998 to 2013–2014, support for smoke-free school grounds and events ranged from 57% (United States in 2000) to 95% (New Mexico in 2003). In surveys asking only about smoke-free playgrounds and sports fields, support ranged from 89% (Ontario in 2011) to 91% (California in 2002, Saskatchewan in 2013, and Ontario in 2012).
All but 1 of 30 surveys conducted in 17 jurisdictions between 2001 and 2013 indicated 54% or higher support for smoke-free public entryway/entrance/doorway regulations. Support ranged from 45% (Onondaga County, New York in 2006) to 89% (Ontario in 2012).
While survey questions regarding parks were worded in a variety of ways, 20 surveys in 8 jurisdictions between 2000 and 2014 specified only parks and green spaces. Support for smoke-free policies in these types of spaces ranged from 25% to 39% in the United States (2000–2009), specifically 35% to 51% in Wyoming, Alabama, Nebraska, Virginia, and Iowa (2009–2014), and 48% to 53% in New York City (2010–2012), 55% in California (2008), and 61% in Manitoba, Canada (2013).
Researchers acknowledged a number of limitations within their meta-analysis, primarily their focus solely on adult attitudes.
“Smoke-free outdoor policies are a major intervention to improve population health by reducing exposure to tobacco smoke and smoking, and to reduce environmental contamination from tobacco-related litter,” the researchers wrote. “There is increasing evidence that the visibility or unacceptability of smoking at a community level is associated with higher cessation and lower smoking rates.”
- Thomson G, Wilson N, Collins D, et al. Attitudes to Smoke-Free Outdoor Regulations in the USA and Canada: A Review of 89 Surveys. Tob Control. 2015; doi:10.1136/tobaccocontrol-2015-052426