Chapter 12 402 but now widely implemented and accepted in many countries,25 possibilities for smoke-free homes lay ahead. Another important step for future research is to remain investing in comparative analysis across countries. Such comparisons are pivotal for insights from successful tobacco control initiatives and their implementation process. Given that over 80% of global smokers reside in low- and middle-income countries, including a wider array of countries is important.26 Without effective enforcement, the number of smokers in these countries is expected to rise. Low and middleincome countries have historically been underrepresented in research, and rectifying this imbalance is essential to raising awareness and advancing future research. Environment Smoking cessation interventions at the workplace or policies such as smokefree homes more and more target the social and or physical environment. Many models, such as the determinants of health model by Dahlgren and Whitehead or the health field concept by Lalonde, show the importance of the social and physical environment for health.27,28 The link between the social and physical environment and smoking has been researched extensively, showing associations between area deprivation and smoking prevalence.29–31 Neighbourhood effects can generally be seen as geographical, environmental, institutional, or socialinteractive pathways influencing smoking behaviour.32 Examples can be tobacco retail density, social norms or peer pressure, or crime rates.33,34 The major challenge in this type of research is to disentangle whether people who smoke self-select into socioeconomically deprived neighbourhoods or whether neighbourhood factors cause smoking. A novel two-step method developed by van Ham et al. provided a strategy to potentially disentangle these effects, which we applied in a study on mental health.35 We found indications that contact with neighbours positively impacts mental health, while distance to green space, neighbourhood income, and perceived safety did not affect mental health.36 Application of this method to smoking in future studies, may lead to more insights about the causal role of the physical and social environment on smoking. Ideally this would provide potential entry points for smoking cessation interventions. Such research investigating relevant factors outside the behaviour of interest fits within the wider trend of system thinking, i.e. “a way of making sense of
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