Summary 412 An important element in implementing such policies, is a social norm change where smoking is no longer perceived as normal in certain places. One way to reach this is by addressing people who smoke in a smoke-free zone. A previous study in the Rotterdam inner city smoke-free zone showed that only very few people who smoked in the area are in fact addressed. It appears that many people perceive barriers in addressing people who smoke in smoke-free areas due to fear of negative responses. However, insights in actual responses by people who smoked to being addressed were lacking. In an observational field study we observed responses of persons to being addressed when smoking in a newly implemented smoke-free zone surrounding the Erasmus MC and two educational institutions in Rotterdam (Chapter 6). In the first month after implementing the zone, Erasmus MC representatives performed rounds to address smokers who were smoking inside the zone. Four people observed addressors for two weeks then they also addressed the smokers. In all, 331 smokers were observed of whom 73% were addressed directly. Most verbal reactions were positive (46%) or neutral (18%). Employees were more likely to respond guiltily, whereas patients more often responded angrily than the others. After being addressed, the majority of smokers either extinguished their cigarette (41%) or left to continue smoking outside the smoke-free zone (34%). Overall, most smokers showed a positive or neutral response when being addressed about smoking inside the smoke-free zone and the majority adapted their behaviour to comply with the policy. These findings may help decrease barriers for those in doubt about addressing smokers that fail to comply with a smoke-free policy. Another way forward to implement novel smoke-free policies is by learning form others. In a multidisciplinary team of public health experts, medical doctors, lawyers and social media experts we investigated the implementation of smokefree policies for private cars and playgrounds in Chapter 7. We describe the legal frameworks that enabled implementation, the health impact and level of public support for these novel smoke-free policies, and the experiences of stakeholders involved in the implementation of smoke-free cars and playgrounds in other countries. Smoke-free policies are justified on grounds of public health and the rights of the child. Smoke-free car policies are associated with substantial reductions in children’s tobacco smoke exposure in cars by over 30%. A Scottish study demonstrated that hospital admissions of children with asthma also decreased following implementation. Child health benefits of smoke-free playgrounds have not been formally evaluated. Public support for expanding
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