Smokefree Policies to Reduce Tobacco Use
A Systematic Review
David P. Hopkins, MD, MPH, Sima Razi, MPH, Kimberly D. Leeks, PhD, MPH,
Geetika Priya Kalra, MPA, Sajal K. Chattopadhyay, PhD, Robin E. Soler, PhD, the Task Force
on Community Preventive Services
Abstract: 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 a median 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. The median 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 Prev Med 2010;38(2S):S275–S289) Published by Elsevier Inc. on behalf of American Journal of Preventive Medicine
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