A Systematic Review

In 2001, a systematic review for the Guide to Community Preventive Services identifıed strong evidence of effectiveness of smoking bans and restrictions in reducing exposure to environmental (secondhand) tobacco smoke. As follow-up to that earlier review, the focus here was on the evidence on effectiveness of smokefree policies in reducing tobacco use. Smokefree policies implemented by worksites or communities prohibit smoking in workplaces and designated public areas. The conceptual approach was modifıed for this review; an updated search for evidence was conducted; and the available evidence was evaluated. Published articles that met quality criteria and evaluated changes in tobacco-use prevalence or cessation were included in the review. A total of 57 studies were identifıed in the period 1976 through June 2005 that met criteria to be candidates for review; of these, 37 met study design and quality of execution criteria to qualify for fınal assessment. Twenty-one studies measured absolute differences in tobacco-use prevalence with amedian effect of 3.4 percentage points (interquartile interval: 6.3 to 1.4 percentage points). Eleven studies measured differences in tobacco-use cessation among tobacco users exposed to a smokefree policy compared with tobacco users not exposed to a smokefree policy. Themedian absolute change was an increase in cessation of 6.4 percentage points (interquartile interval: 1.3 to 7.9 percentage points). The qualifying studies provided suffıcient evidence that smokefree policies reduce tobacco use among workers when implemented in worksites or by communities. Finally, a systematic economic review identifıed four studies that, overall, demonstrated economic benefıts from a smokefree workplace policy. Additional research is needed to more fully evaluate the total economic effects of these policies. (Am J PrevMed 2010;38(2S):S275–S289) Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine