Impact of national smoke-free legislation on home smoking bans: findings from the International Tobacco Control Policy Evaluation Project Europe Surveys
- Ute Mons1,2,
- Gera E Nagelhout3,4,
- Shane Allwright5,
- Romain Guignard6,
- Bas van den Putte7,
- Marc C Willemsen3,4,
- Geoffrey T Fong8,9,
- Hermann Brenner2,
- Martina Pötschke-Langer1,
- Lutz P Breitling2
- 1Unit Cancer Prevention and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
- 2Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg, Germany
- 3Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, the Netherlands
- 4STIVORO for a smoke-free future, The Hague, the Netherlands
- 5Department of Public Health and Primary Care, Trinity College, Dublin, Ireland
- 6French Institute for Health Promotion and Health Education (INPES), Saint-Denis, France
- 7Amsterdam School of Communication Research, University of Amsterdam, Amsterdam, the Netherlands
- 8Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- 9Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Correspondence to Ute Mons, German Cancer Research Center, Unit Cancer Prevention and WHO Collaborating Centre for Tobacco Control, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany;
Contributors UM planned the paper, carried out the statistical analyses, interpreted the data and drafted the manuscript. She is the guarantor of the paper. LPB substantially contributed to the conception of the paper, to the interpretation of the data and to drafting the paper. GEN, SA and BvdP substantially contributed to the conception of the paper and to the interpretation of the data. RG, MCW, GTF, HB and MP-L advised on the design of the study and substantially contributed to the interpretation of the data. In addition, all coauthors revised drafts critically for important intellectual content, and all authors reviewed and approved the final manuscript.
- Received 6 July 2011
- Accepted 20 December 2011
- Published Online First 13 February 2012
Objectives To measure changes in prevalence and predictors of home smoking bans (HSBs) among smokers in four European countries after the implementation of national smoke-free legislation.
Design Two waves of the International Tobacco Control Policy Evaluation Project Europe Surveys, which is a prospective panel study. Pre- and post-legislation data were used from Ireland, France, Germany and the Netherlands. Two pre-legislation waves from the UK were used as control.
Participants 4634 respondents from the intervention countries and 1080 from the control country completed both baseline and follow-up and were included in the present analyses.
Methods Multiple logistic regression models to identify predictors of having or of adopting a total HSB, and Generalised Estimating Equation models to compare patterns of change after implementation of smoke-free legislation to a control country without such legislation.
Results Most smokers had at least partial smoking restrictions in their home, but the proportions varied significantly between countries. After implementation of national smoke-free legislation, the proportion of smokers with a total HSB increased significantly in all four countries. Among continuing smokers, the number of cigarettes smoked per day either remained stable or decreased significantly. Multiple logistic regression models indicated that having a young child in the household and supporting smoking bans in bars were important correlates of having a pre-legislation HSB. Prospective predictors of imposing a HSB between survey waves were planning to quit smoking, supporting a total smoking ban in bars and the birth of a child. Generalised Estimating Equation models indicated that the change in total HSB in the intervention countries was greater than that in the control country.
Conclusions The findings suggest that smoke-free legislation does not lead to more smoking in smokers' homes. On the contrary, our findings demonstrate that smoke-free legislation may stimulate smokers to establish total smoking bans in their homes.
- Impact of smoke-free legislation
- home smoking restrictions
- second-hand smoke
- prospective study
- public policy
- socioeconomic status
- surveillance and monitoring
- smoking-caused disease
- environmental tobacco smoke
- public opinion
- packaging and labelling
- social psychology
- research methods
- psychosocial theories
Funding ITC Ireland: US National Cancer Institute (R01 CA90955), Glaxo Smith Kline, Flight Attendants' Medical Research Institute, Pfizer (Ireland) and Cancer Research UK. ITC France: French Institute for Health Promotion and Health Education (INPES), French National Cancer Institute (INCa), French Monitoring Centre for Drugs and Drug Addiction (OFDT). ITC Netherlands: The Netherlands Organisation for Health Research and Development (ZonMw). ITC Germany: German Ministry of Health, German Cancer Research Center, Dieter-Mennekes-Umweltstiftung. ITC UK: US National Cancer Institute (RO1 CA100362 and P50 CA111236), Canadian Institutes of Health Research (57897), Cancer Research UK (C312/A6465). Survey development, management and data management, ITC Project, University of Waterloo: US National Cancer Institute (P50 CA111236; P01 CA138389); Canadian Institutes of Health Research (57897; 79551); Ontario Institute of Cancer Research. UM was financially supported by Klaus Tschira Foundation gGmbH. GTF was supported by a Senior Investigator Award from the Ontario Institute for Cancer Research and a Prevention Scientist Award from the Canadian Cancer Society Research Institute.
Competing interests None.
Ethics approval The study was approved by Research Ethics Board of the University of Waterloo, Ontario, Canada.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Technical reports, questionnaires and National Reports are available on www.itcproject.org.