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Effect of smoking regulations in local restaurants on smokers’ anti-smoking attitudes and quitting behaviours

¹ Social and Behavioral Sciences Department, Boston University School of Public Health, Boston, Massachusetts, USA
² Biostatistics Department, Boston University School of Public Health, Boston, Massachusetts, USA
³ Center for Survey Research, University of Massachusetts Boston, Boston, Massachusetts, USA
⁴ General Medicine Division and Tobacco Research and Treatment Center, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA

Correspondence to:
Dr A Albers
Social and Behavioral Sciences Department, Boston University School of Public Health, 715 Albany Street, TW2, Boston, MA 02118, USA; aalbers{at}bu.edu

Objective: To examine the effect of smoking regulations in local restaurants on anti-smoking attitudes and quitting behaviours among adult smokers.

Design: Hierarchical linear modelling (HLM) was used to assess the relationship between baseline strength of town-level restaurant smoking regulation and follow-up (1) perceptions of the social acceptability of smoking and (2) quitting behaviours.

Setting: Each of the 351 Massachusetts towns was classified as having strong (complete smoking ban) or weak (all other and no smoking restrictions) restaurant smoking regulations.

Subjects: 1712 adult smokers of Massachusetts aged 18 years at baseline who were interviewed via random-digit-dial telephone survey in 2001–2 and followed up 2 years later.

Main outcome measures: Perceived social acceptability of smoking in restaurants and bars, and making a quit attempt and quitting smoking.

Results: Among adult smokers who had made a quit attempt at baseline, living in a town with a strong regulation was associated with a threefold increase in the odds of making a quit attempt at follow-up (OR = 3.12; 95% CI 1.51 to 6.44). Regulation was found to have no effect on cessation at follow-up. A notable, although marginal, effect of regulation was observed for perceiving smoking in bars as socially unacceptable only among smokers who reported at baseline that smoking in bars was socially unacceptable.

Conclusions: Although local restaurant smoking regulations did not increase smoking cessation rates, they did increase the likelihood of making a quit attempt among smokers who had previously tried to quit, and seem to reinforce anti-social smoking norms among smokers who already viewed smoking in bars as socially unacceptable.

Abbreviations: HLM, hierarchical linear modelling