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INTRODUCTION: In a prevalence and opinion survey on smoking, this work focused on a strategy favoring tobacco-free areas at hospital entrances. METHODS: Outreach to the public occupying outdoor spaces led to immediate collection of responses over the course of 13 actions carried out in November 2022, a tobacco-free month. RESULTS: Thirty-two percent of the persons interrogated were smokers, 38% among patients, 26% among professionals and 18% among nursing students. A majority expressed support for smoke-free building entrances, which were viewed by half of the smokers as an encouragement to quit or cut down on their consumption. However, a quarter of participants anticipated difficulties, particularly the "heaviest" smokers. In the psychiatry sector, 54% were smokers, and they were relatively unfavorable to the initiative. As for non-smokers, most voiced discomfort regarding the smell of tobacco, the infiltration of smoke in indoor spaces, passive smoking, a negative image of the hospital, and the detrimental ecological impact. CONCLUSIONS: The tobacco-free hospital entrance initiative is relevant and of benefit to hospitals. In order to succeed, it must involve all stakeholders, whether they are users or professionals, in a concerted attempt to optimize assistance to smokers wishing to quit, by applying an educational and synergistic approach at all levels.

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INTRODUCTION: Armenia's and Georgia's high rates of smoking and secondhand smoke and recent implementation of smoke-free laws provide a timely opportunity to examine factors that increase compliance, like social enforcement and support for governmental enforcement. METHODS: Using 2022 data from 1468 Armenian and Georgian adults (mean age=42.92 years, 48.6% male, 31.6% past-month smoking), multilevel linear regression examined tobacco-related media exposures, social exposures, and perceptions/attitudes in relation to: 1) likelihood of asking someone to extinguish cigarettes where a) prohibited and b) allowed; and 2) support of fines for smoke-free violations (1=not at all to 4=very). RESULTS: There was low average likelihood of asking someone to extinguish cigarettes where allowed (mean=1.01, SD=1.12) or prohibited (mean=1.57, SD=1.21) and 'little' agreement with fines for smoke-free violations (mean=2.13, SD=1.06). Having fewer friends who smoked, greater support for indoor smoke-free laws, and no past-month cigarette use were positively associated with all 3 outcomes. Greater exposure to media and community-based action supporting smoke-free policies, and witnessing more requests to stop smoking where prohibited, were associated with higher likelihood of asking someone to extinguish cigarettes where allowed or prohibited. Less exposure to news stories opposing smoke-free policies and cigarette ads and higher perceived harm of cigarettes were also related to higher likelihood of asking someone to stop smoking where prohibited. Higher perceived harm of cigarettes was also associated with greater agreement with fines for smoke-free violations. CONCLUSIONS: Comprehensive strategies targeting social norms, media exposure, and risk perceptions are needed to effectively facilitate strategies to enhance smoke-free law enforcement.

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Introduction: The issue of tobacco control remains a significant concern for public health worldwide. In recent years, remarkable progress has been made toward adopting smoke-free measures in indoor public places. Although China has yet to introduce a national regulation, specifically for smoke-free public places, more than a dozen cities have successively approved and implemented comprehensive smoke-free regulations. Different cities in China have diverse attitudes and behaviors toward smoke-free policies; however, the reasons for these policy differences and the influencing factors have not received sufficient attention and research. Methods: On the basis of the multiple streams framework, this study selects 36 key Chinese cities as research samples and uses a directed dyad-year event history analysis method to analyze the factors influencing the implementation of comprehensive smoke-free policies in cities. Results: Results show that the adoption of such policies is positively influenced by scientific evidence, focal events, media coverage, institutional foundations, economic comparisons, and the influence of health departments and of tobacco control groups. By contrast, policy adoption is negatively affected by the differences in administrative levels, central policy signals, and the influence of the tobacco industry. Discussion: This study contributes to understanding the internal logic behind local governments' adoption of comprehensive smoke-free policies, offering insights for further advocacy at the city and national levels in China and providing experiences that can promote the global tobacco control movement.

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INTRODUCTION AND OBJECTIVE: Smoking-free policies protect non-smokers from the negative effects of smoking, but many young adults still use products containing nicotine. The aim of this article is to analyze the factors that influence young people's attitudes towards the ban on smoking in public places. MATERIAL AND METHODS: Data were obtained from a representative sample of young adults aged 13-15 from the Global Youth Tobacco Survey (GYTS) conducted in the Czech Republic, Lithuania, Romania, Slovakia and Slovenia. Logistic regression analysis was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: At least a quarter of the adolescents were exposed to cigarette smoking, about 40% have parents who smoke and over 50% declared that they have peers who smoke. A higher proportion of adolescents have knowledge about the harmful effects of second-hand smoking (62.6-71.9%), but at least one-fifth of young people are still exposed to the marketing of tobacco products. Compared with current smoking, those with never smoked were significantly associated with positive attitude toward to restricting smoking in all five analyzed countries, with an AOR= 4.74 (95% CI: 3.61-6.23), AOR=4.33 (95% CI: 2.32-8.07), AOR=2.85 (95% CI: 2.19-3.70) and AOR=2.45 (95% CI: 1.65-3.64), respectively. Gender, age, smoking, exposure to second-hand smoke, knowledge about the harmful effects of smoking, anti-smoking education, seeing people using tobacco and exposure to tobacco marketing, were significantly associated with the attitudes of young people towards restricting smoking in public places. CONCLUSIONS: The study provides useful information on factors that should be taken into account when planning anti-smoking strategies so that young people are able to resist the pressure to use tobacco products.

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INTRODUCTION: In Thailand, school smoke-free policies initially targeted cigarette smoking but now extend to include electronic cigarettes (e-cigarettes). Yet, the impact of this expansion on curbing e-cigarette use in schools is uncertain. This study seeks to explore how e-cigarette control policies and educational initiatives in Thai secondary schools influence students' legal knowledge, perception of harm, current e-cigarette use, and susceptibility to future use. METHODS: This cross-sectional survey was conducted in four regions of Thailand between May and August 2023, involving 6147 students selected through multistage sampling. Data collection utilized a self-reported online questionnaire in Thai, developed using Google Forms. For continuous outcomes, multiple linear regression models assessed relationships between school e-cigarette policy perceptions, covariates, knowledge of e-cigarette laws, and harm perception. Multiple logistic regression models analyzed the association between policy perceptions, covariates, and categorical outcomes: current e-cigarette use and susceptibility. RESULTS: Adjusting for covariates, a positive association was found between students' perceptions of e-cigarette policies and teachings and their knowledge of e-cigarette control laws (B=0.083, p<0.001) and harm perceptions (B=0.491, p<0.001). Additionally, these perceptions were protective against current e-cigarette use (AOR=0.970; 95% CI: 0.95-0.99, p=0.002) and susceptibility among non-users (AOR=0.962; 95% CI: 0.95-0.97; p<0.001). CONCLUSIONS: A heightened perception of e-cigarette policies and teachings in schools is associated with increased legal knowledge, heightened harm perception, and a lower likelihood of current or future e-cigarette use. This underscores the importance of enforcing the e-cigarette-free policy in schools to mitigate vaping susceptibility amid the ongoing youth e-cigarette epidemic.

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OBJECTIVE: This article looks at the evaluation of smoke-free (SF) and tobacco-free (TF) university campus policies that ban smoking (and often vaping) both indoors and outdoors. To assess the effectiveness of these policies, we performed a systematic literature review to answer the following questions: what is the effect of SF/TF policies on campus users' behaviors/norms/perceptions around smoking? Are the SF/TF policies an effective measure for reducing smoking among young adults? What methods and indicators can we use to assess the impact of SF/TF campus policies? What is the theoretical model underpinning the influence of SF/TF policies on the behavior of campus users? METHODS: Three databases (PubMed, Scopus, and Web of Science) were searched over the period from January 2005 to December 2022. The article selection process included 54 articles published in scientific journals that analyzed the post-implementation impact of SF/TF campus policies. The quality of these articles was analyzed using six ad hoc indicators based on the Critical Appraisal Skills Program checklist and Joanna Briggs Institute scoping tools. RESULTS: Most of the research on SF/TF campus policies has been conducted in the United States using quantitative methodologies. Most of these studies show that SF/TF policies reduce positive beliefs about smoking and its acceptability, influence smoking behavior (reducing smoking initiation and increasing the number of quits and quit attempts), and reduce exposure to passive smoking and pollution from cigarette butts. User acceptability of SF/TF policies is generally high. Limitations of SF/TF campus policies include difficulty for smokers to comply with them, persistence of passive smoking around campuses, and limited uptake of on-campus cessation support services provided to smokers. DISCUSSION: The various mediating and moderating variables identified in the literature have made it possible to propose a model of the potential influence of SF/TF policy on campus users, based on the theory of planned behavior. Based on this review, we provide health professionals and higher education institutions wishing to implement a SF/TF campus policy with a set of indicators that can serve to assess the impact of a SF/TF campus policy (attitudes, acceptability, beliefs, norms, exposure to passive smoking and pollution, changes in smoking behavior). CONCLUSION: Based on scientific evidence, the implementation of SF/TF campus policies in France is an important measure to help combat smoking in young adults.

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Smoking and exposure to secondhand smoke pose a significant risk to the health of populations. Although this evidence is not new, the commitment of countries to implement laws aimed at controlling consumption and eliminating exposure to secondhand smoke is uneven. Thus, in North America or in Europe, locations like California or Ireland, are pioneers in establishing policies aimed at protecting the population against smoking and secondhand smoke. Identifying measures that have worked would help control this important Public Health problem in other countries that are further behind in tobacco control policies. In Spain, there has been almost 15 years of little political action in legislation oriented to control the tobacco epidemic. If we want to achieve the tobacco endgame, new legislative measures must be implemented. In this paper, we have elucidated tobacco control policies that could be implemented and show how different countries have done so.

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Despite the success of the Framework Convention on Tobacco Control (FCTC), most jurisdictions in the world do not have policies that create 100% smoke-free environments in indoor workplaces, indoor public places, public transport, or other public places. We conducted a narrative review of articles that discuss smoke-free policies and describe the state of the current literature. A search of peer-reviewed and gray literature, published between 1 January 2004 and 30 April 2022, was conducted using PubMed and EMBASE databases. We classified articles based on the location of the policy discussed (WHO region, World Bank income classification) and the environment that was being made smoke-free. Insights related to policy development and implementation, as well as compliance and enforcement, were also identified. The search identified 4469 unique citations; 134 articles met the criteria for inclusion and underwent data extraction by two independent coders. The sample included articles published in or about jurisdictions in each WHO region, in high- and low- and mediumincome countries, and articles that discussed policies regulating smoke-free indoor workplaces, indoor public places, public transport, outdoor/quasi-outdoor environments, and other (unspecified) public places. Some important insights from the literature related to smoke-free policy implementation included tobacco industry interference, the important role of civil society, and the need for effective communication, education, and leadership. Enforcement officials' awareness and training, stakeholders' attitudes and beliefs, and understanding social norms were identified as relevant determinants of effective smoke-free policies. There continue to be challenges for implementing smoke-free policies in jurisdictions throughout the globe, in high- and low- and middle-income countries. The literature includes insights to support 100% smoke-free policies in each environment that must be made smoke-free as per the FCTC.

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INTRODUCTION: The study aims to understand the facilitators and barriers associated with enforcing and complying with Türkiye's smoke-free policy from the perspective of hospitality venue owners and employees. METHODS: A qualitative open-ended survey was conducted in Istanbul and Ankara in 2021 with 58 respondents from 3 different districts in each city from four types of venues: restaurants, traditional coffee and waterpipe houses, and European-style cafés. The open-ended survey included questions to understand the knowledge, beliefs, and attitudes of respondents about Türkiye's smoke-free policy and their perceptions of the facilitators and/or barriers to smoke-free policy implementation and changes after COVID-19. The data were analyzed using an inductive approach to identify patterns and categorize the data into themes. RESULTS: The respondents expressed that the smoke-free policy aimed to protect employees and customers from secondhand smoke (SHS), respect human health, and improve air quality. Findings suggest that the positive attitude of venue owners and staff toward the smoke-free policy serves as a facilitator. However, fear of financial impact, customers' negative attitudes, difficulties in meeting physical requirements, and insufficient enforcement were found to be barriers to implementing the smoke-free policy. The effects of the COVID-19 pandemic were reported as an initial increase in compliance and awareness among customers and staff, but some respondents noted negative changes due to the emotional and financial effects of prolonged restrictions. These challenges have led to decreased attention on the smoke-free policy among venue owners, staff and customers. Respondents' suggested improvements were related to building infrastructure, such as the ventilation systems and educating the public on the harmful health effects of smoking. CONCLUSIONS: Despite the general understanding of the dangers of secondhand smoke and the smoke-free policy, this study highlights the challenges in implementing smoke-free policy measures and the continued need to raise awareness about the importance of a 100% smoke-free venue. A comprehensive approach to addressing the tobacco epidemic as a multifaceted public health issue is essential.

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BACKGROUND: Smoke-free policies (SFPs) have been effective in reducing smoking prevalence, but evidence remains limited for low- and middle-income countries. Due to decentralized governance in Indonesia, SFPs are adopted in different ways in different locations. This study aims to assess the impact of local smoke-free policies (SFPs) on current smoking among Indonesian adults. METHODS: Data from national health surveys conducted in 515 districts and 34 provinces in 2007, 2013, and 2018, involving 1,599,517 adults, were analyzed. A multilevel logistic regression analysis was performed, considering variables such as survey year, SFP adoption in 2007, SFP between 2007 and 2013, SFP between 2013 and 2018, socio-demographic factors, and district characteristics. RESULTS: Moderate (OR:0.94, 95%CI:0.91-0.97) and strong (OR:0.95, 95%CI:0.0.92-0.98) district-level SFPs between 2013 and 2018 were associated with decreased odds of current smoking, compared to no district-level SFP adoption. Similar results were observed for moderate (OR:0.91, 95%CI:0.86-0.96) and strong (OR:0.89, 95%CI:0.85-0.94) district-level SFPs between 2007 and 2013, compared to no district-level SFP. Compared to provinces without SFPs, individuals living in provinces with moderate SFPs between 2007 and 2013 had lower odds of current smoking (OR:0.67; 95% CI:0.63-0.71), while those in districts with moderate SFPs between 2013 and 2018 had higher odds (OR: 1.08, 95% CI: 1.05-1.11). CONCLUSIONS: Local SFPs demonstrated a potential in reducing smoking persistence in Indonesia, particularly at the district level. However, the impact of province-level SFPs differed. Tailored SFPs and district-province strategies, focusing on synchronizing the top-down SFP implementation in the Indonesia's decentralized systems, are critical for lowering smoking rates.

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[This corrects the article DOI: 10.18332/tid/174781.].

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OBJECTIVE: The effect of smoke-free spaces on the use of electronic cigarettes has not been empirically demonstrated. The objective of this systematic review was to evaluate the influence of smoke-free and vape policies on the use of electronic cigarettes in young adults and adults. METHODS: A systematic review was carried out according to PRISMA criteria in the Web of Science, PubMed and SCOPUS databases. Keywords used were: Electronic Nicotine Delivery Systems, Smoke-Free Policy, Young Adult and Adult. We included studies that analyzed the use of electronic cigarettes in smoke-free spaces in adults aged fifteen years and older. The search was conducted from January 2010 to March 2022. Risk of bias was analyzed with the Mixed Methods Assessment Tool. RESULTS: The search identified 861 records. A total of 840 records were excluded because they did not meet the inclusion criteria. The final sample included ten studies on smoke-free spaces, six studies on vape-free spaces and five studies on smoke-free spaces and vape-free spaces. The main risk of bias in the studies was the sampling and measurements used. Most studies associate the use of electronic cigarettes and smoke-free spaces. CONCLUSIONS: Studies suggest that the use of electronic cigarettes and smoke-free spaces and vape are associated. Studies with higher quality of evidence and simultaneous implementation of smoke-free and vape-free spaces are required.

OBJETIVO: El efecto de los espacios libres de humo en el uso de cigarros electrónicos no ha sido demostrado empíricamente. El objetivo de esta revisión sistemática fue evaluar la influencia de las políticas de espacios libres de humo y vapeo en el uso de cigarros electrónicos en adultos jóvenes y adultos. METODOS: Se realizó una revisión sistemática según los criterios PRISMA en las bases de datos Web of Science, PubMed y SCOPUS. Las palabras clave utilizadas fueron: Electronic Nicotine Delivery Systems, Smoke-Free Policy, Young Adult y Adult. Se incluyeron estudios que analizaron el uso de cigarros electrónicos en los espacios libres de humo en adultos de quince años o más. La búsqueda se realizó entre enero de 2010 a marzo de 2022. El riesgo de sesgo se analizó con la Herramienta de Evaluación de Métodos Mixtos. RESULTADOS: La búsqueda identificó 861 registros. Se excluyeron 840 registros por no cubrir los criterios de inclusión. La muestra final incluyó diez estudios sobre espacios libres de humo, seis estudios sobre espacios libres de vapeo y cinco estudios sobre espacios libres de humo/vapeo. El principal riesgo de sesgo en los estudios fue el muestro y las mediciones utilizadas. La mayoría de los estudios asocian el uso de cigarro electrónico y los espacios libres de humo. CONCLUSIONES: Los estudios sugieren que el uso de cigarros electrónicos y los espacios libres de humo y vapeo están asociados. Se requieren estudios con mayor calidad de la evidencia y la aplicación simultanea de los espacios libres de humo/vapeo.

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OBJECTIVE: This commentary emphasizes the importance of implementing outdoor smoke-free policies at sports clubs, particularly highlighting their limited adoption across Europe. The primary aim was to assess the progress made in the Netherlands, explore the strategies employed, and outline future challenges. METHODS: Our methodology involved an examination of national regulations and the voluntary adoption of smoke-free policies at sports clubs throughout Europe. We also assessed the adoption and implementation of these policies using recent evidence, leading to the identification of impending challenges in their implementation across Europe. RESULTS: While only a few European countries currently have national legislation prohibiting outdoor smoking at sports clubs, voluntary initiatives promoting such policies have emerged in various nations. Experiences from the Netherlands have demonstrated the feasibility of implementing outdoor smoke-free policies at sports clubs. To expand these policies across Europe, five key challenges need to be addressed: 1) encouraging smoke-free policies at sports clubs that are less inclined to adopt them, 2) ensuring consistent compliance and enforcement of outdoor smoke-free policies, 3) preventing smoking just outside the sports club, 4) garnering support from various stakeholders to ensure widespread adoption of smoke-free sports clubs, and 5) establishing monitoring and evaluation mechanisms for policy implementation. CONCLUSION: The Dutch experiences serve as a testimony to the feasibility of outdoor smoke-free policies at sports clubs. By addressing the remaining challenges, we can create healthier sports environments for children and take substantial steps towards realizing a smoke-free Europe.

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BACKGROUND: Smoke-free housing policies in multiunit housing are increasingly widespread interventions to reduce smoking and secondhand smoke exposure. Little research has identified factors that impede compliance with smoke-free housing policies in low-income multiunit housing and test corresponding solutions. METHODS: We are using an experimental design to test two compliance support interventions: (A) a "compliance through reduction (via relocation and reduction in personal smoking) and cessation" intervention targets households with smokers and involves support to shift smoking practices to areas beyond the apartment or building setting, reduce personal smoking, and deliver in-residence smoking cessation support services via trained peer educators and (B) a "compliance through resident endorsement" intervention involving voluntary adoption of smoke-free living environments through personal pledges, visible door markers, and/or via social media. We will compare randomly sampled participants in buildings that receive A or B or A plus B to the NYCHA standard approach. DISCUSSION: This RCT addresses key gaps in knowledge and capitalizes on key scientific opportunities by (1) leveraging the federal mandate to ban smoking in a public housing system of more than sufficient size to conduct an adequately powered RCT; (2) expanding our understanding of smoke-free policy compliance beyond policy implementation by testing two novel treatments: (a) in-residence smoking cessation and (b) resident endorsement, while (3) addressing population and location-specific tobacco-related disparities. At the conclusion of the study, this RCT will have leveraged a monumental policy shift affecting nearly half a million NYC public housing residents, many of whom disproportionately experience chronic illness and are more likely to smoke and be exposed to secondhand smoke than other city residents. This first-ever RCT will test the effects of much-needed compliance strategies on resident smoking behavior and secondhand smoke exposure in multiunit housing. TRIAL REGISTRATION: Clinical Trials Registered, NCT05016505. Registered on August 23, 2021.

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Background: Smoke-free policies are essential to protect people against tobacco smoke exposure. To successfully implement smoke-free policies that go beyond enclosed public places and workplaces, public support is important. We undertook a comprehensive systematic review of levels and determinants of public support for indoor (semi-)private and outdoor smoke-free policies. Methods: In this systematic review and meta-analysis, six electronic databases were searched for studies (published between 1 January 2004 and 19 January 2022) reporting support for (semi-)private and outdoor smoke-free policies in representative samples of at least 400 respondents aged 16 years and above. Two reviewers independently extracted data and assessed risk of bias of individual reports using the Mixed Methods Appraisal Tool. The primary outcome was proportion support for smoke-free policies, grouped according to location covered. Three-level meta-analyses, subgroup analyses and meta-regression were performed. Findings: 14,749 records were screened, of which 107 were included; 42 had low risk of bias and 65 were at moderate risk. 99 studies were included in the meta-analyses, reporting 326 measures of support from 896,016 individuals across 33 different countries. Support was pooled for indoor private areas (e.g., private cars, homes: 73%, 95% confidence interval (CI): 66-79), indoor semi-private areas (e.g., multi-unit housing: 70%, 95% CI: 48-86), outdoor hospitality areas (e.g., café and restaurant terraces: 50%, 95% CI: 43-56), outdoor non-hospitality areas (e.g., school grounds, playgrounds, parks, beaches: 69%, 95% CI: 64-73), outdoor semi-private areas (e.g., shared gardens: 67%, 95% CI: 53-79) and outdoor private areas (e.g., private balconies: 41%, 95% CI: 18-69). Subcategories showed highest support for smoke-free cars with children (86%, 95% CI: 81-89), playgrounds (80%, 95% CI: 74-86) and school grounds (76%, 95% CI: 69-83). Non-smokers and ex-smokers were more in favour of smoke-free policies compared to smokers. Support generally increased over time, and following implementation of each smoke-free policy. Interpretation: Our findings suggested that public support for novel smoke-free policies is high, especially in places frequented by children. Governments should be reassured about public support for implementation of novel smoke-free policies. Funding: Dutch Heart Foundation, Lung Foundation Netherlands, Dutch Cancer Society, Dutch Diabetes Research Foundation and Netherlands Thrombosis Foundation.

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Background: The household is considered as a private area that is untouched tobacco control policies in developing countries, especially in Indonesia, which has not ratified the Framework Convention on Tobacco Control (FCTC) treaty. Objectives: This study aims to identify smoking behavior and expenditure on cigarettes in the household, which are part of the initiation of a policy including a smoke-free home, so it assumes that the home is a public domain in Tegal Regency, Central Java Province, Indonesia. Methods: This research is an observational study with a quantitative descriptive design. A total of 225 subjects in the seven regions designated as smoke-free areas were all selected as samples in this study and were willing to be the subject of research. Results: The results found that 76.1% of smokers smoked with their nuclear family (wife/children/husband) present. Smoking behavior with the nuclear family inside the home (39.13%) and outside the home (36.96%) was more common than not smoking with the nuclear family. Expenditure for cigarettes per month was one-third of household revenue (IDR 607,521.74) based on the regency minimum wage (UMR) set by the local government. Conclusions: The study concludes that smokers who smoke with family still lack knowledge on smoking's impact on health and household economics. The smoke-free regulation that is initiated should include households as a parameter.

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OBJECTIVES: Secondhand smoke exposure causes serious health problems. Banning smoking in public venues decreases exposure to secondhand smoke. However, the implementation of smoke-free rules in a private setting (including homes) is largely voluntary. This study aimed to assess the prevalence and characteristics of voluntary smoke-free home rules in Poland during the COVID-19 pandemic as well as to identify factors associated with the voluntary implementation of smoking bans at home. MATERIAL AND METHODS: This cross-sectional survey was conducted in March 2022 with a nationally representative sample of 1090 individuals aged ≥18 years in Poland. Data were collected using a computerassisted web interviewing (CAWI) technique. The research tool was an original questionnaire developed for the purpose of this study. RESULTS: Nationally, 60.6% of individuals had total ban on smoking in home (100% smoke-free home rules), 34.0% had implemented a partial smokefree home rule and 5.4% had not implemented any smoke-free home rules. Over three-quarters of non-smokers (76.8%) and only one-fifth of smokers (20.7%) had adopted a full smoke-free home rule. In multivariate logistic regression analysis, males (OR = 1.65, 95% CI: 1.22-2.22, p < 0.01), non-smokers (OR = 13.78, 95% CI: 9.80-19.38, p < 0.001), respondents who had higher education (OR = 1.57, 95% CI: 1.15-2.14, p < 0.01) as well as those who lived alone (OR = 2.44, 95% CI: 1.52-3.90, p < 0.001) had higher odds of having a 100% smoke-free home rule. CONCLUSIONS: This study demonstrated the negative impact of the COVID-19 pandemic on the implementation of smoke-free home rules in Poland. Less than two-thirds of the Polish population has adopted a total smoke-free home rule, with significant gaps between smokers and nonsmokers. Information on current voluntary smoke-free rules will be useful for further implementation of the smoke-free law in Poland. Int J Occup Med Environ Health. 2023;36(1):84-95.

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Social network research has evidenced the role of peer effects in the adoption of behaviours. Little is known, however, about whether policies affect how behaviours are shared in a network. To contribute to this literature, we apply the concept of diffusion centrality to school tobacco policies and adolescent smoking. Diffusion centrality is a measure of centrality which refers to a person's ability to diffuse a given property-in our case, smoking-related behaviours. We hypothesized that stronger school tobacco policies are associated with less diffusion centrality of smoking on school premises and of smoking in general. A whole network study was carried out in 2013 and 2016 among adolescents (n = 18,805) in 38 schools located in six European cities. Overall, diffusion centrality of smoking in general and of smoking on school premises significantly decreased over time. Diffusion centrality of smoking significantly decreased both in schools where the policy strengthened or softened over time, but for diffusion of smoking on school premises, this decrease was only significant in schools where it strengthened. Finally, stronger school tobacco policies were associated with lower diffusion centrality of smoking on school premises and of smoking in general, though to a lesser extent. With such policies, smoking may, therefore, become less prevalent, less popular, and less clustered, thereby lowering the risk of it spreading within networks in, and even outside the school.

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