Public support for smoke-free private indoor and public outdoor areas in the Netherlands: a trend analysis from 2018-2022 221 5 is no longer perceived as normal. Finally, an important argument supporting implementation of smoke-free policies in these places is that reductions in SHS exposure and health benefits have been demonstrated, despite existing challenges in enforcement.4, 12, 24, 25 Future research is needed to better understand the determinants of public support for smoke-free policies in relation to the local political and cultural context. Also, more work is needed to see how public support may inform future policy-making. Additional studies identifying the impact of novel smoke-free policies on tobacco smoke exposure, smoking behaviour, and health outcomes are also needed. This is one of few studies assessing temporal trends in support for novel smokefree policies in a large, nationally representative sample. As these data go up to 2022, it is possible that COVID-19 mitigation measures influenced support. While initially support for the Dutch government was high in this period, this later on changed to much more distrust. Whether this dissatisfaction trickled down to support for smoke-free policies cannot be tested within our data, but could be suggested for future research. Limitations This study comes with several limitations. The results should be interpreted in the Dutch context and therefore might not be generalizable to other countries. Despite our attempts to control for confounding residual confounding might be present. Furthermore, survey studies are at risk of bias. By using survey weights and representative sampling we tried to minimise this risk. There are some limitations regarding measuring support. Within the study period there were slight changes in wording of the questions assessing support, from negatively framed (support for a smoking ban) to positively framed (support for a smokefree area). However, no significant differences were found according to whether questions were asked as negative or positive within the same questionnaire. Furthermore, there is no validated scale to measure support and reliability is challenging to check. One might argue that support is hypothetical and does not reflect support for actual implemented policies. However, previous literature has shown that support often increases following implementation.26 In our data support following implementation of smoke-free areas surrounding elementary schools remained high following implementation in 2020.27, 28
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