title: Ashtrays and signage as determinants of a smoke-free legislation's success.
abstract: BACKGROUND
  Successful smoke-free legislation is dependent on political will, enforcement and societal support. We report the success and pitfalls of a non-enforced nationwide smoke-free legislation in Greece, as well as ways in which compliance and enforcement-related factors, including ashtrays and signage, may impact indoor secondhand smoke (SHS) concentrations.
  
  
  METHODS
  A follow-up study of venues (n=150, at baseline, n=75 at 2-year follow-up) in Greece assessed indoor particulate matter with a diameter less than 2.5 micrometers (PM 2.5 ) concentrations attributable to SHS smoke every six months for two years (n=455 venue/measurements).
  
  
  RESULTS
  Following the implementation of the 2010 smoke-free legislation, mean PM2.5 concentrations attributable to SHS fell from 175.3 µg/m(3) pre-ban to 84.52 µg/m(3) immediately post-ban, increasing over subsequent waves (103.8 µg/m(3) and 158.2 µg/m(3) respectively). Controlling for potential influential factors such as ventilation, time of day, day of week, city and venue type, all post-ban measurements were still lower than during the pre-ban period (Wave 2 beta: -118.7, Wave 3 beta: -87.6, and Wave 4 beta: -69.9). Outdoor or indoor signage banning smoking was not found to affect SHS concentrations (beta: -10.9, p=0.667 and beta: -18.1, p=0.464 respectively). However, ashtray or ashtray equivalents were strong determinants of the existence of indoor SHS (beta: +67 µg/m(3), p=0.017).
  
  
  CONCLUSIONS
  While the public may be supportive of smoke-free legislation, adherence may decline rapidly if enforcement is limited or nonexistent. Moreover, enforcement agencies should also focus on the comprehensive removal of ashtray equivalents that could act as cues for smoking within a venue.
authors.affiliation: Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America ; Smoking and Lung Cancer Research Center, Hellenic Cancer Society, Athens, Greece ; Clinic of Social and Family Medicine, Department of Social Medicine, University of Crete, Heraklion, Greece.
authors.forename: Constantine I
authors.initials: CI
authors.lastname: Vardavas
authors.forename: Israel
authors.initials: I
authors.lastname: Agaku
authors.forename: Evridiki
authors.initials: E
authors.lastname: Patelarou
authors.forename: Nektarios
authors.initials: N
authors.lastname: Anagnostopoulos
authors.forename: Chrysanthi
authors.initials: C
authors.lastname: Nakou
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Dramba
authors.forename: Gianna
authors.initials: G
authors.lastname: Giourgouli
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Argyropoulou
authors.forename: Antonis
authors.initials: A
authors.lastname: Antoniadis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Gourgoulianis
authors.forename: Despoina
authors.initials: D
authors.lastname: Ourda
authors.forename: Lambros
authors.initials: L
authors.lastname: Lazuras
authors.forename: Monique
authors.initials: M
authors.lastname: Bertic
authors.forename: Christos
authors.initials: C
authors.lastname: Lionis
authors.forename: Gregory
authors.initials: G
authors.lastname: Connolly
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Behrakis
mesh_terms: D016902:Air Pollution, Indoor / Q000032:analysis; D004784:Environmental Monitoring; D006115:Greece; D006801:Humans; D012907:Smoking / Q000331:legislation & jurisprudence*; D000074606:Smoking Prevention
references.citation: Eur J Public Health. 2013 Oct;23(5):772-6
references.pmid: 23115328
references.citation: Health Psychol. 1996 Nov;15(6):455-61
references.pmid: 8973926
references.citation: Addict Behav. 2011 Dec;36(12):1253-60
references.pmid: 21903332
references.citation: Am J Public Health. 1997 Jun;87(6):1035-7
references.pmid: 9224192
references.citation: J Environ Monit. 2006 Mar;8(3):362-8
references.pmid: 16528420
references.citation: Eur J Public Health. 2011 Feb;21(1):15-20
references.pmid: 20110272
references.citation: Tob Control. 2007 Oct;16(5):312-7
references.pmid: 17897989
references.citation: BMC Public Health. 2007 Oct 23;7:302
references.pmid: 17956612
references.citation: Nicotine Tob Res. 2009 Jun;11(6):642-9
references.pmid: 19454550
references.citation: Tob Control. 2008 Jun;17(3):159-65
references.pmid: 18303089
references.citation: Tob Control. 2012 Sep;21(5):511-3
references.pmid: 22016506
references.citation: Tob Control. 1997 Winter;6(4):326-31
references.pmid: 9583631
references.citation: Lancet. 2011 Jan 8;377(9760):139-46
references.pmid: 21112082
references.citation: J Aerosol Med Pulm Drug Deliv. 2012 Dec;25(6):349-54
references.pmid: 22393905
references.citation: Tob Control. 2006 Jun;15 Suppl 3:iii34-41
references.pmid: 16754945
references.citation: Tob Control. 2009 Apr;18(2):79-80
references.pmid: 19326496
references.citation: Psychol Addict Behav. 2011 Dec;25(4):733-7
references.pmid: 21553947
references.citation: J Public Health Policy. 2011 Feb;32(1):46-59
references.pmid: 21150943
references.citation: N Engl J Med. 2010 Sep 16;363(12):1139-45
references.pmid: 20843248
references.citation: Tob Control. 2007 Apr;16(2):127-32
references.pmid: 17400951
references.citation: Pediatrics. 2004 Oct;114(4):1028-34
references.pmid: 15466101
references.citation: J Occup Environ Med. 2004 Sep;46(9):887-905
references.pmid: 15354053