Research paper
 
CC-BY-NC 4.0
 
 

Relation between individual factors and support for smoking bans in bars in Greece: A cross-sectional study of the 2013 Global Adult Tobacco Survey (GATS)

Anna Tzortzi 1, 2,  
 
1
George D. Behrakis Research Laboratory, Hellenic Cancer Society, Athens, Greece
2
Institute of Public Health, The American College of Greece,Athens, Greece
3
Biomedical Research Foundation, Academy of Athens,Athens, Greece
Tob. Prev. Cessation 2017;3(June):118
Publish date: 2017-06-16
KEYWORDS:
TOPICS:
 
ABSTRACT:
Introduction:
Smoking rates among the general population and among youth are decreasing in Greece. Low compliance with smoke-free legislation in indoor places in Greece renders non-smokers exposed to secondhand smoke, especially when frequenting bars. The aim of the current study was to identify the factors related to support for smoking bans in bars in Greece.

Methods:
A cross-sectional secondary data analysis was conducted on the 2013 Greek Global Adult Tobacco Survey. Multivariate regression was used to analyze individual factors and their relation to support for the smoking ban in bars. The total sample was nationally representative of the Greek population and included 3961 residents over the age of 15 with 2061 supporting a ban in bars.

Results:
Overall, 50.5% (95% CI: 46.5-54.4) of Greeks supported the smoking ban in bars. Among them, 1,832 (74.9%, 95% CI=70.1-79.1) were non-smokers and 229 (13.7%, 95% CI=10.6-17.5) were smokers. Age over 65 years was significantly related to increased support for the smoking ban in bars compared to those aged 15-24 years (p<0.05). Belief that secondhand smoke causes lung cancer was significantly related (p<0.001) to having increased support for the ban. Increased knowledge of smoking-related harm was significantly related to increased support for the ban in bars (p<0.001). Male non-smokers were significantly less likely to support the ban in bars than females (p<0.05).

Conclusions:
Increasing knowledge and awareness of smoking-related harm will enhance smoking ban support and compliance, improving tobacco prevention and cessation, especially among the youth and young adults.



CORRESPONDING AUTHOR:
Stephanie Irene Teloniatis   
George D. Behrakis RESEARCH LAB -Hellenic Cancer Society, Dorileou 8, 11521 Athens, Greece
 
REFERENCES:
1. Rachiotis G, Barbouni A, Katsioulis A, Antoniadou E, Kostikas K, Merakou K, et al. Prevalence and determinants of current and secondhand smoking in Greece: results from the Global Adult Tobacco Survey (GATS) study. BMJ Open. 2017 Jan 19;7:e013150. doi:10.1136/bmjopen-2016-013150.
2. Öberg M, Jaakkola MS, Prüss-Üstün A, Schweizer C, Woodward A. Second-hand smoke. Assessing the burden of disease at national and local levels. WHO Environ Burd Dis Ser. 2010;18.
3. Kobayashi Y, Takeuchi T, Hosoi T, Loeppky JA. Effects of habitual smoking on cardiorespiratory responses to sub-maximal exercise. J Physiol Anthropol Appl Human Sci. 2004; 23: 163–9. doi:10.2114/jpa.23.163
4. Action on Smoking and Health. ASH research report: The health effects of exposure to secondhand smoke. 2014. Available at: http://ash.org.uk/files/documents/ASH_597.pdf (accessed 8 November 2016).
5. World Health Organization, World Heart Federation. ITC Project: Cardiovascular harms from tobacco use and secondhand smoke: Global gaps in awareness and implications for action. Waterloo, Ontario, Canada and Geneva, Switzerland; 2012.
6. Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. In: Frazer K, editor. Cochrane Database of Systematic Reviews. Chichester, UK: John Wiley & Sons, Ltd; 2016.
7. Institute of Medicine (US) Committee on Secondhand Smoke Exposure and Acute Coronary Events. Secondhand Smoke Exposure and Cardiovascular Effects: Making Sense of the Evidence. Washington (DC): National Academies Press (US); 2010. Available at: https://www.ncbi.nlm.nih.gov/books/NBK219565/. doi: 10.17226/12649.
8. Öberg M, Woodward A, Jaakkola MS, Peruga A, Prüss-Ustün A. Global estimate of the burden of disease from second-hand smoke II WHO Library Cataloguing-in-Publication Data. WHO Press; 2011.
9. Hoffman SJ, Tan C. Overview of systematic reviews on the health-related effects of government tobacco control policies. BMC Public Health. BMC Public Health; 2015; 15:744. doi: 10.1186/s12889-015-2041-6.
10. World Health Organization. Assessing the national capacity to implement effective tobacco control policies: WHO Operational Manual on planning, conduct and follow-up of joint national capacity assessments. Geneva; 2013.1–56.
11. World Health Organization. Fact sheet on smoke free legislation; 2016. Available at: http://www.euro.who.int/en/health-topics/disease-prevention/tobacco/world-no-tobacco-day/2011-who-framework-convention-on-tobacco-control/fact-sheet-on-smoke-free-legislation (accessed 10 May 2016).
12. Schoretsaniti S, Filippidis FT, Vardavas CI. Prevalence and determinants of SHS exposure in public and private areas after the 2010 smoke-free legislation in Greece. 2014; 24:401–11. doi: 10.1080/09603123.2013.835033.
13. Fong GT, Hyland A, Borland R, Hammond D, Hastings G, McNeill A, et al. Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/UK Survey. Tob Control. BMJ Publishing Group Ltd; 2006; 15:iii51-8. doi:10.1136/tc.2005.013649.
14. Gallus S, Zuccaro P, Colombo P, Apolone G, Pacifici R, Garattini S, et al. Effects of new smoking regulations in Italy. Ann Oncol. 2005;17:346–7. doi:10.1093/annonc/mdj070.
15. Harvard School of Public Health. The Greek Tobacco Epidemic. 2011. Available at: http://www.who.int/fctc/reporting/party_reports/greece_annex1_the_greek_tobacco_epidemic_2011.pdf (accessed 25 March 2016).
16. Hellenic Statistical Authority. PRESS RELEASE: HEALTH DETERMINANTS, 2014. Piraeus; 2016.
17. World Health Organization. Report on the Global Tobacco Epidemic, 2015 Greece WHO Framework Convention on Tobacco Control (WHO FCTC) status Summary of MPOWER measures. 2015. Available at: http://www.who.int/tobacco/surveillance/policy/country_profile/grc.pdf (accessed 25 March 2016).
18. Global Adult Tobacco Survey. Country Report, Greece 2013. 2013. Available at: http://www.who.int/tobacco/surveillance/survey/gats/grc_country_report.pdf?ua=1 (accessed 13 April 2016).
19. Fabian LEA, Bernat DH, Lenk KM, Shi Q, Forster JL. Smoke-free laws in bars and restaurants: does support among teens and young adults change after a statewide smoke-free law? Public Health Rep. Association of Schools of Public Health; 2011; 126:669–76. doi:10.1177/003335491112600509.
20. Nagelhout GE, Mons U, Allwright S, Guignard R, Beck F, Fong GT, et al. Prevalence and predictors of smoking in “smoke-free” bars. Findings from the International Tobacco Control (ITC) Europe Surveys. Soc Sci Med. 2011; 72:1643–51. doi:10.1016/j.socscimed.2011.03.018.
21. Yong H-H, Foong K, Borland R, Omar M, Hamann S, Sirirassamee B, et al. Support for and Reported Compliance Among Smokers With Smoke-Free Policies in Air-Conditioned Hospitality Venues in Malaysia and Thailand: Findings From the International Tobacco Control Southeast Asia Survey. Asia-Pacific J Public Heal. 2010; 22:98–109. doi:10.1177/1010539509351303.
22. Borland R, Yong H-H, Siahpush M, Hyland A, Campbell S, Hastings G, et al. Support for and reported compliance with smoke-free restaurants and bars by smokers in four countries: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control. 2006; 15:34–41. doi:10.1136/tc.2004.008748.
23. Hood NE, Ferketich AK, Klein EG, Wewers ME, Pirie P. Individual, social, and environmental factors associated with support for smoke-free housing policies among subsidized multiunit housing tenants. Nicotine Tob Res. 2013; 15:1075–83. doi:10.1093/ntr/nts246.
24. Macy J, Chassin L, Presson C. The association between implicit and explicit attitudes toward smoking and support for tobacco control measures. Nicotine Tob Res. 2013; 15:291–6. doi:10.1093/ntr/nts117.
25. Center for Disease Control and Prevention. Global tobacco control: About GTSS. Available at: http://www.cdc.gov/tobacco/global/gtss/index.htm (accessed 26 May 2016).
26. GATS Global Adult Tobacco Survey: Fact Sheet Greece 2013. 2013. Available at: http://www.who.int/tobacco/surveillance/survey/gats/grc.pdf (accessed 4 April 2016).
27. Hellenic Statistical Authority (ELSTAT). Greece in figures: January- March 2016. Athens; 2016. Available at: http://www.statistics.gr/documents/20181/1515741/GreeceInFigures_2016Q1_EN.pdf/53b7a687-807e-4dd5-b8ff-b5ce6c9dc992 (accessed 27 May 2016).
28. Center for Disease Control and Prevention. The Social-Ecological Model: A framework for prevention. 2015. Available at: http://www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html (accessed 20 March 2016).
29. Ferketich AK, Lugo A, La Vecchia C, Fernandez E, Boffetta P, Clancy L, et al. Relation between national-level tobacco control policies and individual-level voluntary home smoking bans in Europe. Tob Control. 2014; tobaccocontrol-2014-051819. doi:10.1136/tobaccocontrol-2014-051819.
30. Li Q, Hyland a, O’Connor R, Zhao G, Du L, Li X, et al. Support for smoke-free policies among smokers and non-smokers in six cities in China: ITC China Survey. Tob Control. 2010; 19 Supp2:i40-6. doi:10.1136/tc.2009.029850.
31. Nagelhout GE, Zhuang Y-L, Gamst A, Zhu S-H. Do smokers support smoke-free laws to help themselves quit smoking? Findings from a longitudinal study. Tob Control. 2015 May; 24:233–7. doi:10.1136/tobaccocontrol-2013-051255.
32. Lazuras L, Eiser JR, Rodafinos A. Predicting smokers’ non-compliance with smoking restrictions in public places. Tob Control. 2009; 18:127–31. doi:10.1136/tc.2008.025841.
33. Gallus S, Lugo A, Vecchia C La, Boffetta P, Chaloupka FJ, Colombo P, et al. PPACTE, WP2: EUROPEAN SURVEY ON SMOKING Final Report. Dublin. 2012. Available at: http://www.tri.ie/uploads/3/1/3/6/31366051/european_survey_on_economic_aspects_of_smoking_wp2_ppacte.pdf (accessed April 20 2017).
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