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Nicotine & Tobacco Research Advance Access originally published online on May 19, 2009
Nicotine & Tobacco Research 2009 11(6):642-649; doi:10.1093/ntr/ntp063
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© The Author 2009. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oxfordjournals.org

Attitudes and beliefs about secondhand smoke and smoke-free policies in four countries: Findings from the International Tobacco Control Four Country Survey

Andrew Hyland, Cheryl Higbee, Ron Borland, Mark Travers, Gerard Hastings, Geoffrey T. Fong and K. Michael Cummings

Andrew Hyland, Ph.D., Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
Cheryl Higbee, M.P.H., Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
Ron Borland, Ph.D., VicHealth Centre for Tobacco Control, Cancer Council Victoria, Carlton, Victoria, Australia
Mark J. Travers, M.S., Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
Gerard Hastings, Ph.D., Department of Marketing, University of Stirling, Stirling, UK
Geoffrey T. Fong, Ph.D., Department of Psychology, University of Waterloo, Waterloo, ON, Canada
K. Michael Cummings, M.P.H., Ph.D., Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY

Corresponding Author: Andrew Hyland, Ph.D., Department of Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA. Telephone: 716-845-8391; Fax: 716-845-8487; E-mail: andrew.hyland{at}roswellpark.org


  Abstract

Introduction: This paper describes the varying levels of smoking policies in nationally representative samples of smokers in four countries and examines how these policies are associated with changes in attitudes and beliefs about secondhand smoke over time.

Methods: We report data on 5,788 respondents to Wave 1 of the International Tobacco Control Four Country Survey who were employed at the time of the survey. A cohort of these respondents was followed up with two additional survey waves approximately 12 months apart. Respondents’ attitudes and beliefs about secondhand smoke as well as self-reported policies in their workplace and in bars and restaurants in their community were assessed at all waves.

Results: The level of comprehensive smoke-free policies in workplaces, restaurants, and bars increased over the study period for all countries combined and was highest in Canada (30%) and lowest in the United Kingdom (0%) in 2004. In both cross-sectional and longitudinal analyses, stronger secondhand smoke policies were associated with more favorable attitudes and support for comprehensive regulations. The associations were the strongest for smokers who reported comprehensive policies in restaurants, bars, and their workplace for all three survey waves.

Discussion: Comprehensive smoke-free policies are increasing over time, and stronger policies and the public education opportunities surrounding their passage are associated with more favorable attitudes toward secondhand smoke regulations. The implication for policy makers is that, although the initial debate over smoke-free policies may be tumultuous, once people understand the rationale for implementing smoke-free policies and experience their benefits, public support increases even among smokers, and compliance with smoke-free regulations increases over time.

Received: January 31, 2008; Accepted: December 15, 2008
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