Evidence supporting the expansion of smoke-free (indoor, outdoor, public and private) environments: a literature review
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Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization, Athens, Greece
Tobacco Control Unit and WHO Collaborating Center for Tobacco Control, Catalan Institute of Oncology, L’Hospital et de Llobregat, Spain
Bellvitge Biomedical Research Institute (IDIBELL), L’Hospital et de Llobregat, Spain
Center for Biomedical Research in Respiratory Diseases (CIBERES), Madrid, Spain
School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
Publication date: 2023-10-08
Corresponding author
Sotiria Schoretsaniti   

Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization, Athens, Greece
Tob. Prev. Cessation 2023;9(Supplement 2):A72
Even though there has been great progress in the implementation of Article 8 of WHO FCTC to protect citizens from secondhand smoke (SHS) and aerosols (SHA) from tobacco/nicotine products, still most of the world population remains exposed.

To assess and create the framework for the expansion of Smoke- and Aerosol-Free Exposure legislation in Europe, within the workpackage 8 of the JATC2.

Material and Methods:
Review published papers in peer-reviewed journals. The search was conducted in PubMed and Science Direct databases (2010 to 2022).

After screening, 83 papers were included. These papers indicate a high SHS-SHA exposure at public and private, indoor and outdoor settings and at indoor locations adjacent to outdoor smoking areas. Social inequalities in SHS-SHA exposure clearly exists across the EU, between and within countries. Indoors SHS-SHA exposure in hospitality venues dramatically decreased after the implementation of national smoke-free legislation while smoking outdoors at cafes/pubs/bars increased indicating allocation of smoking to outdoor spaces. High SHS levels at some outdoor smoking areas and at adjacent smoke-free indoor areas were also registered. There is compelling evidence of SHS exposure at university and hospital campuses, school outdoor entrances, children’s playgrounds, parks and beaches, and that SHS from outdoors settings of building entrances drifts to adjacent places indoors. SHS-SHA exposure remains a public health problem in major airports across Europe specifically related to the presence of smoking rooms. Furthermore, ban on smoking in public places, prompted more homes to become smoke-free, though exposure to SHS and SHA at home is high for non-smokers cohabiting with smokers. Almost 2/3 of smokers across Europe have a voluntary smoking ban for cars in the presence of children.

Implementing comprehensive smoke-free legislation, including private vehicles, and ensuring its strict enforcement should be the way forward for EU MS and beyond. Expanding interventions to prompt smoke-free homes is also needed.

The authors have no conflicts of interest to disclose.
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