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Attitudes to smoke-free outdoor regulations in the USA and Canada: a review of 89 surveys
  1. George Thomson1,
  2. Nick Wilson1,
  3. Damian Collins2,
  4. Richard Edwards1
  1. 1Department of Public Health, University of Otago, Wellington, New Zealand
  2. 2Department of Earth and Atmospheric Sciences, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Dr George Thomson, Department of Public Health, University of Otago, Mein St, Wellington 6002, New Zealand; george.thomson{at}


Objective To review the published survey data on public support for smoke-free outdoor regulations in the USA and Canada (two countries at the forefront of such policies).

Data sources and study selection We searched for English language articles and reports using Medline, Google Scholar and Google for the period to December 2014. We retained population-based surveys of the adult general population in jurisdictions in the USA and Canada, with a minimum survey sample of 500.

Data extraction The analysis focused on assessing levels and trends in public support for different types of places and also explored how support varied between population groups.

Results Relevant data were found from 89 cross-sectional surveys between 1993 and 2014. Support for smoke-free regulations in outdoor places tended to be highest for smoke-free school grounds (range: 57–95%) playgrounds (89–91%), and building entrances (45–89%) and lowest for smoke-free outdoor workplaces (12–46%) and sidewalks (31–49%). Support was lower among smokers, though for some types of places there was majority smoker support (eg, school grounds with at least 77% support in US state surveys after 2004). Trend data involving the same questions and the same surveyed populations suggested increased general public and smoker support for smoke-free regulations over time (eg, from 67% to 78% during 2002–2008 for smoke-free school grounds in the USA). Higher support was typically seen from women and some ethnic groups (eg, African-Americans).

Conclusions Outdoor smoke-free regulations can achieve majority public support, including from smokers.

  • Public opinion
  • Public policy
  • Prevention
  • Secondhand smoke
  • Socioeconomic status

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