Chapter 4 92 study this led to the reported outcome including neutral and positive answers, potentially overestimating support, any bias resulting from this will be very limited. Negative or positive framing of a question might also influence the response.132 These aspects may have contributed to the substantial heterogeneity observed across studies, in addition to existing cultural and contextual differences. Finally, the minimum sample size requirement of 400 participants might have caused an underrepresentation of locations with smaller populations, such as subsidised housing or inpatient facilities. For a complete overview of excluded full reports see Appendix XI. Previous studies have shown strong increases in support for novel smokefree policies over time,11 which was not confirmed in our study. Since support was generally high, it is possible that support already reached a plateau, after which little change is observed. Policy makers might be concerned that actual implementation can backfire support. Our review indicates that this concern is not backed by previous literature, with 6 out of 12 studies that assessed support before and after implementation showing an increase in support.31, 45, 59, 76, 122, 127 Among the remaining studies support was often already high, indicating a plateau in support.52, 70, 76, 114 An additional worry could be that support is theoretical and might change when it regards actual implementation. However, our study showed no differences in support between implemented policies and hypothetical scenarios. For outdoor non-hospitality places, the group with most estimates, no significant differences were found, indicating support is equally high for hypothetical questions as for implemented policies. Another consideration for policy makers could be that a high level of support may not necessarily ensure adequate compliance with smoke-free policies, especially in places where enforcement is challenging. Additional research is needed to investigate optimal approaches to enforcement, including self-enforcement in places where formal regulation is lacking. Public support is an essential element facilitating policy implementation. We identified highest levels of support for places where children are frequently exposed to tobacco smoke. For example, support for smoke-free cars when driving with children was much higher (86%) compared to a generic policy making cars smoke-free (57%). Similarly, support for smoke-free playgrounds (80%) was higher compared to support for smoke-free parks and beaches (53%). On average, support was highest for indoor private places; this was primarily driven by the high level of support for smoke-free cars carrying children. Apart from
RkJQdWJsaXNoZXIy MTk4NDMw