5.2 Measures to assess the effectiveness of smoke-free policies

Article 8 of the FCTC, calls for greater protection from exposure to tobacco smoke (Figure 5.4). In the 1980s, some countries began to implement subnational smoke-free policies. By 2004, Ireland, Norway, and New Zealand were the first countries to implement comprehensive smoke-free worksite policies that also included restaurants and bars. Motivated in part by the FCTC mandate to expand smokefree policies, other countries have followed suit, but the vast majority of nations have not made progress in this area. Understanding if these policies are effective in achieving their goal of reducing exposure to secondhand smoke and improving health outcomes, is important not only for policymakers in places that pass smoke-free policies, but also to help inform policymaking in other jurisdictions. The main goal of smoke-free policies is to reduce secondhand smoke exposure and thus to improve health outcomes. There are several measures that should be considered when assessing the effectiveness of smoke-free policies, and factors that might influence how the policy may contribute to reductions in secondhand smoke exposure, as well as more distal outcomes related to secondhand smoke beliefs, attitudes, and practices. Furthermore, there are also potential incidental effects of smoke-free regulations, such as possible business losses/gains, and increased cessation activity among smokers. There is value to assessing constructs around smoke-free initiatives, both before, during, and after their introduction as policy. Before they are introduced in a jurisdiction, the main variables of interest are an inventory of the level of existing smoke-free policies, as well as the belief about the health harms, and attitudes to restrictions in various locations. During the early implementation period of smokefree policies, variables of interest are those associated with compliance with the policy and how this relates to secondhand smoke (SHS) exposure. During post-policy introduction, these variables remain of interest, but there are others including how health and economic indicators may have or have not changed. Understanding each of these areas is useful for evaluation purposes and helps to guide subsequent policymaking. Figure 5.5 presents the logic model guiding the constructs discussed in detail in this section. First we need to understand the nature of the policies. What areas are covered and are there exemptions or possible loopholes? Within a jurisdiction, there may be local policies (from local government), or business-specific policies that need to be considered. The next step is to consider the impact of these policies on markers of exposure to SHS, which is the