Chapter 4 76 Introduction Exposure to second-hand smoke (SHS) poses a major burden to population health globally. Each year, 1.2 million deaths and 36.3 million disability-adjusted life years (DALYs) are attributed to SHS exposure.1 Compelling evidence indicates that comprehensive legislation to protect non-smokers from tobacco smoke exposure in all indoor public places and workplaces is a powerful tool to reduce the adverse effects of tobacco smoke, including among children.1-3 In an attempt to further improve population health, an increasing number of jurisdictions have expanded smoke-free policies to encompass outdoor places (e.g., public parks, pedestrian plazas and beaches),4 semi-private places (e.g., public housing units),5 and private places (e.g. cars).6 Emerging evidence shows that such “novel” policies can indeed be effective in further reducing the burden of SHS exposure in children.7, 8 Public support is important for policymakers to consider implementing novel smoke-free policies and to maximise compliance.9 The World Health Organization (WHO) stated in their 2009 report on the global tobacco epidemic that ‘involving civil society is central to achieving effective legislation’.10 Previous literature has shown large differences in public support between various smoke-free places and within populations. For example, in the USA and Canada playgrounds generally received a higher degree of support compared to sidewalks, and smokers are generally less in favour of smoke-free policies than non-smokers.11 To inform policy-making regarding extending smoke-free policies, it is thus important to derive insights into the levels and determinants of public support for smoke-free policies that cover outdoor areas and (semi-) private places. Therefore, the primary objective of this study was to systematically review evidence on the levels and determinants of public support for smoke-free policies covering outdoor places or (semi-) private places, henceforth referred to as ‘novel smoke-free policies’. To our knowledge this is the first comprehensive overview of support for novel smoke-free policies that is not limited to a specific smokefree place or geographic region. Our secondary objective was to identify which personal and country-level characteristics are associated with public support for these policies.
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