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Article | Attitudes to smoke-free outdoor regulations in the USA and Canada: a review of 89 surveys

This collaborative study between the University of Otago, New Zealand and University of Alberta, Canada, provides new and some unexpected insights for health promotion in North America.

University of Otago, Wellington researcher Dr George Thomson said the study showed that there was substantial and growing public support for outdoor smokefree areas in the USA and Canada.

The media release for this study can be read here.

The article was published in the leading international journal for smokefree research, Tobacco Control.



To review the published survey data on public support for smoke-free outdoor regulations in the USA and Canada (two countries at the forefront of such policies).

Data sources and study selection

We searched for English language articles and reports using Medline, Google Scholar and Google for the period to December 2014. We retained population-based surveys of the adult general population in jurisdictions in the USA and Canada, with a minimum survey sample of 500.

Data extraction

The analysis focused on assessing levels and trends in public support for different types of places and also explored how support varied between population groups.


Relevant data were found from 89 crosssectional surveys between 1993 and 2014. Support for smoke-free regulations in outdoor places tended to be highest for smoke-free school grounds (range: 57–95%) playgrounds (89–91%), and building entrances (45–89%) and lowest for smoke-free outdoor workplaces (12–46%) and sidewalks (31–49%). Support was lower among smokers, though for some types of places there was majority smoker support (eg, school grounds with at least 77% support in US state surveys after 2004). Trend data involving the same questions and the same surveyed populations suggested increased general public and smoker support for smoke-free
regulations over time (eg, from 67% to 78% during 2002–2008 for smoke-free school grounds in the USA). Higher support was typically seen from women and some ethnic groups (eg, African-Americans).


Outdoor smoke-free regulations can achieve majority public support, including from smokers.


Thomson, G., Wilson, N., Collins, D., Edwards, R. (2015) Attitudes to smokefree outdoor regulations in the USA and Canada: A review of 89 surveys. Tobacco Control Online September 15. doi:10.1136/tobaccocontrol-2015-052426

For more information please contact:
George Thomson
University of Otago, Wellington

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