Assessment of the smoke-free outdoor regulation in the WHO European Region.
OBJECTIVE
The aim of this study is to assess the level of protection of secondhand smoke in outdoor locations among countries belonging to the WHO European Region.


METHODS
This cross-sectional study measures the level of protection provided by laws in outdoor locations. A protocol to evaluate the outdoor smoke-free legislation was developed according to the recommendations provided by the WHO Guidelines for implementing smoke-free outdoor places. For each law 6 main sectors and 28 outdoor locations were evaluated.


RESULTS
68 laws from 48 countries were reviewed, totally assessing 1758 locations. Overall 3.1% of the locations specified 100% smoke-free outdoor regulation without exceptions, 2.5% permitted smoking in designated outdoor areas, 37.5% allowed smoking everywhere, and 56.9% did not provide information about how to deal with smoking in outdoor places. In the Education sector 17.8% of the laws specified smoke-free outdoor regulation, mainly in the primary and secondary schools. Three pioneering laws from recreational locations and two from general health facilities specified 100% outdoor smoke-free regulation.


CONCLUSIONS
Outdoor smoke-free policies among countries belonging to the WHO European Region are limited and mainly have been passed in the primary and secondary schools, which protect minors from the hazards of secondhand smoke in educational settings.
Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Gran Via de L'Hospitalet 199-201, 08908 L'Hospitalet de Llobregat Barcelona, Spain; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, United States; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona, Spain; Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain. Electronic address: cmartinez@iconcologia.net.
Cristina
C
Martínez
Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, United States.
Joseph
J
Guydish
Tobacco Control Programme, City and Hackney Public Health Service, London Borough of Hackney, UK.
Gillian
G
Robinson
Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Gran Via de L'Hospitalet 199-201, 08908 L'Hospitalet de Llobregat Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona, Spain; Medicine and Health Sciences School, Universitat Internacional de Catalunya, Barcelona, Spain.
Jose María
JM
Martínez-Sánchez
Tobacco Control Unit, Cancer Control and Prevention Programme, Institut Català d'Oncologia-ICO, Gran Via de L'Hospitalet 199-201, 08908 L'Hospitalet de Llobregat Barcelona, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge - IDIBELL, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Campus of Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain; Biostatistics Unit, Department of Basic Science, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain.
Esteve
E
Fernández
D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D004781:Environmental Exposure / Q000331:legislation & jurisprudence* / Q000517:prevention & control; D005060:Europe; D006801:Humans; D012907:Smoking / Q000331:legislation & jurisprudence*; D000074606:Smoking Prevention; D014028:Tobacco Smoke Pollution / Q000331:legislation & jurisprudence* / Q000517:prevention & control; D014944:World Health Organization
D014028:Tobacco Smoke Pollution
Europe; Law; Legislation; Outdoor; Smoke-free