Public support for smoke-free private indoor and public outdoor areas in the Netherlands: a trend analysis from 2018-2022 213 5 Introduction In order to reduce exposure to second-hand smoke, the World Health Organization’s (WHO) Framework Convention on Tobacco Control (FCTC) urges countries to implement comprehensive smoke-free legislation in indoor workplaces, public transport and indoor public places.1 A broad evidence base has identified clear health benefits of smoke-free policies across age ranges and settings.2-4 Governments are now increasingly implementing smoke-free policies in outdoor public places or places that go beyond these recommendations. Examples are policies to regulate smoking at beaches, and in parks, playgrounds and private cars,5-8 henceforth referred to as ‘novel smoke-free policies’.4, 9 Emerging studies indicate that such policies can successfully reduce second-hand smoke exposure, denormalise smoking10, 11 and are associated with health benefits.4, 12-14 A country quickly moving up the European Tobacco Control Scale, from place 14 to 4 out of 37 between 2019 and 2021, is the Netherlands.15 A smoke-free generation ambition was integrated into the National Prevention Agreement (NPA), a national plan involving the government and societal stakeholders to address tobacco use, problematic alcohol use, and obesity.16 However, besides regulating smoking in outdoor areas of schools no formal smoke-free policies were included in the NPA, only shared ambitions with no legal basis. Besides outdoor areas of schools and day care centres, the NPA contained no other novel smoke-free policies. A timeline of key measures taken is provided table 1.17 For policymakers to consider implementing such novel smoke-free policies, a comprehensive overview of trends in public support can be helpful. Previous literature has shown that data on public support can be used as a persuasive tool to increase the likelihood of policy implementation.18-20 In the Netherlands, annual surveys on public support for a range of different tobacco control measures have been conducted since 2009, showing that the Smoke-free Generation concept is well known in the Dutch society and appeals to the majority of adults (73%).21 However, little is known on how support for novel smoke-free policies changed in this context. Therefore, this study investigates national-level trends in public support for novel smoke-free policies in the Netherlands from 2018-2022.
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