General discussion 393 12 also proven to be highly effective in reducing exposure to second-hand smoke and normalizing non-smoking behaviours, reducing the visibility of smoking and consequently the likelihood of smoking initiation. Indeed, protection against tobacco smoke is at the core of the ‘monitor tobacco use and prevention policies’ (MPOWER) recommendations, introduced by the World Health Organisation (WHO) to guide the implementation of the Framework Convention on Tobacco Control (FCTC). In Part 1 of this thesis, we explored various aspects related to the extension of smoke-free policies to areas beyond public indoor spaces and workplaces, such as outdoor public places and indoor private places. Our systematic review and meta-analysis, involving over 900,000 individuals from 33 countries, showed robust public support for smoke-free policies in these locations, particularly in locations where children are present (Chapter 3 and 4). This aligns with the findings of repeated cross-sectional analyses of public support within the Netherlands, as presented in Chapter 5. It appeared that over time support for (the implementation of) smoke-free policies increased for all locations, except for in private cars in the presence of children. For the latter situation, support was already consistently high (i.e. more than 90%), possibly indicating that a saturation point has been reached. Hence, we concluded that implementing smoke-free policies in cars with children is ‘low-hanging fruit’. Nevertheless, policymakers may perceive the implementation of smoke-free policies as challenging, with concerns often revolving around enforcement.3 Challenges can relate to where smoke-free zones start or end, who has to enforce smoke-free regulations, and what the legal basis for enforcements is. However, hard-to-enforce regulations have been implemented before, including in cars, such as banning the use of mobile phones and obligating seatbelt use. Despite the challenges in enforcing these regulations, these policies have been implemented nonetheless. Additionally, in each of the UK jurisdictions smokefree car rules were implemented despite that the police force did not plan to actively enforce the law due to planned financial cuts. In the first 7 months after the implementation of the smoke-free care rules only one fine was issued. Importantly however, despite the challenges in enforcement, a meta-analysis has shown that exposure to tobacco smoke in cars dropped by more than 30% following the regulation.4 In addition, a Scottish study showed that asthma rates among young children went down following the implementation.5 Rather than depending on external enforcement, outdoor smoke-free zones partly rely on the shift in social acceptability, where smoking is no longer perceived as
RkJQdWJsaXNoZXIy MTk4NDMw