Chapter 1 12 Future tobacco control To build on these past successes and make further progress in tobacco control, additional steps are needed. Preventing youth from initiating smoking and raising them in a tobacco-free environment is the most effective way to do so. This approach, known as creating ‘a smoke-free generation’, has been adopted by many countries as part of their tobacco endgame strategies. In order to reach a smoke-free generation, tobacco control needs to step up its game, building on the successes of previous measures. An example of such a strategy is to expand smoke-free zones from indoor public places and workplaces to novel areas, such as outdoor public places and indoor private places. Another pathway could be to explore novel ways to further promote quit rates. Ideally, a range of measures focused on protection, prevention and cessation support are implemented simultaneously. Smoke-free zones In terms of smoking cessation, smoke-free zones diminish the visibility of smoking, assisting recent quitters in maintaining abstinence, normalizing smokefree environments, and deterring youth from adopting smoking behaviour.11,12 In a recent survey in the Netherlands 25% of smokers stated that smoke-free places such as terraces, entrances to health care facilities or parks would help them smoke less. Furthermore, smoke-free zones have proved to be effective in protecting non-smokers against second-hand smoke exposure. Smokefree policies consistently reduce exposure to second-hand smoke and do not increase exposure in other places such as homes. Also important, reductions in second-hand smoke are sustainable and do not reverse over time.15,16 Moreover, smoke-free policies have had a substantial effect on child health via reductions in preterm birth rates, hospital attendance for asthma and hospitalisation due to respiratory tract infections. In line with the MPOWER guidelines, smoke-free zones are recommended for indoor public places and workplaces, but expanding these policies to outdoor public and indoor private spaces can further improve public (child) health. Implementing smoke-free policies in such novel settings requires public support, which not only is crucial for convincing policy makers, but also fosters a social norm change required for ensuring compliance with the policy. If public support for a smoke-free zone is high, smoking in that area may no longer be socially accepted. A seemingly effective way to increase support for smoke-free zones is the smoke-free generation framework, in which tobacco
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