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      Support for e-cigarette policies: a survey of smokers and ex-smokers in Great Britain

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          Abstract

          Introduction

          E-cigarette regulations are the topic of extensive debate. Approaches vary worldwide, and limited evidence is available on public support for specific policies or what influences support. The present study aimed to assess smokers' and ex-smokers' support for 3 e-cigarette policies: (1) equal or higher availability relative to cigarettes, (2) advertising, (3) use in smoke-free places, and to assess changes in support over time and associations with respondent characteristics.

          Methods

          Smokers and ex-smokers (n=1848) provided 3279 observations over 2 waves (2013 and 2014) of a longitudinal web-based survey in Great Britain. Multivariable logistic regressions fitted using generalised estimating equations assessed change in policy support over time, and associations between support and demographics (age, gender and income), smoking and e-cigarette use status, nicotine knowledge and perceived relative harm.

          Results

          Equal or higher relative availability was supported by 79% in 2013 and 76% in 2014; advertising by 66% and 56%, respectively; neither change was significant in adjusted analyses. Support for use in smoke-free places decreased significantly from 55% to 45%. Compared with ex-smokers, smokers were more likely to support advertising and use in smoke-free places. Respondents using e-cigarettes, those who perceived e-cigarettes as less harmful than cigarettes, and those with more accurate knowledge about nicotine were more likely to support all 3 policies.

          Conclusions

          Less restrictive e-cigarette policies were more likely to be supported by e-cigarette users, and respondents who perceived e-cigarettes to be less harmful than cigarettes, or knew that nicotine was not a main cause of harm to health.

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          Most cited references24

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          Association between smoke-free legislation and hospitalizations for cardiac, cerebrovascular, and respiratory diseases: a meta-analysis.

          S Glantz, E Tan (2012)
          Secondhand smoke causes cardiovascular and respiratory disease. Smoke-free legislation is associated with a lower risk of hospitalization and death from these diseases. Random-effects meta-analysis was conducted by law comprehensiveness to determine the relationship between smoke-free legislation and hospital admission or death from cardiac, cerebrovascular, and respiratory diseases. Studies were identified by using a systematic search for studies published before November 30, 2011 with the use of the Science Citation Index, Google Scholar, PubMed, and Embase and references in identified articles. Change in hospital admissions (or deaths) in the presence of a smoke-free law, duration of follow-up, and law comprehensiveness (workplaces only; workplaces and restaurants; or workplaces, restaurants, and bars) were recorded. Forty-five studies of 33 smoke-free laws with median follow-up of 24 months (range, 2-57 months) were included. Comprehensive smoke-free legislation was associated with significantly lower rates of hospital admissions (or deaths) for all 4 diagnostic groups: coronary events (relative risk, 0.848; 95% confidence interval 0.816-0.881), other heart disease (relative risk, 0.610; 95% confidence interval, 0.440-0.847), cerebrovascular accidents (relative risk, 0.840; 95% confidence interval, 0.753-0.936), and respiratory disease (relative risk, 0.760; 95% confidence interval, 0.682-0.846). The difference in risk following comprehensive smoke-free laws does not change with longer follow-up. More comprehensive laws were associated with larger changes in risk. Smoke-free legislation was associated with a lower risk of smoking-related cardiac, cerebrovascular, and respiratory diseases, with more comprehensive laws associated with greater changes in risk.
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            Legislative smoking bans for reducing secondhand smoke exposure, smoking prevalence and tobacco consumption.

            Smoking bans have been implemented in a variety of settings, as well as being part of policy in many jurisdictions to protect the public and employees from the harmful effects of secondhand smoke (SHS). They also offer the potential to influence social norms and smoking behaviour of those populations they affect. To assess the extent to which legislation-based smoking bans or restrictions reduce exposure to SHS, help people who smoke to reduce tobacco consumption or lower smoking prevalence and affect the health of those in areas which have a ban or restriction in place. We searched the Cochrane Tobacco Addiction Group Specialised Register, MEDLINE, EMBASE, PsycINFO, CINAHL, Conference Paper Index, and reference lists and bibliographies of included studies. We also checked websites of various organisations. Date of most recent search; July 1st 2009. We considered studies that reported legislative smoking bans and restrictions affecting populations. The minimum standard was having a ban explicitly in the study and a minimum of six months follow-up for measures of smoking behaviour. We included randomized controlled trials, quasi-experimental studies (i.e. non-randomized controlled studies), controlled before and after studies, interrupted-time series as defined by the Cochrane Effective Practice and Organization of Care Group, and uncontrolled pre- and post-ban data. Characteristics and content of the interventions, participants, outcomes and methods of the included studies were extracted by one author and checked by a second. Because of heterogeneity in the design and content of the studies, we did not attempt a meta-analysis. We evaluated the studies using qualitative narrative synthesis. There were 50 studies included in this review. Thirty-one studies reported exposure to secondhand smoke (SHS) with 19 studies measuring it using biomarkers. There was consistent evidence that smoking bans reduced exposure to SHS in workplaces, restaurants, pubs and in public places. There was a greater reduction in exposure to SHS in hospitality workers compared to the general population. We failed to detect any difference in self-reported exposure to SHS in cars. There was no change in either the prevalence or duration of reported exposure to SHS in the home as a result of implementing legislative bans. Twenty-three studies reported measures of active smoking, often as a co-variable rather than an end-point in itself, with no consistent evidence of a reduction in smoking prevalence attributable to the ban. Total tobacco consumption was reduced in studies where prevalence declined. Twenty-five studies reported health indicators as an outcome. Self-reported respiratory and sensory symptoms were measured in 12 studies, with lung function measured in five of them. There was consistent evidence of a reduction in hospital admissions for cardiac events as well as an improvement in some health indicators after the ban. Introduction of a legislative smoking ban does lead to a reduction in exposure to passive smoking. Hospitality workers experienced a greater reduction in exposure to SHS after implementing the ban compared to the general population. There is limited evidence about the impact on active smoking but the trend is downwards. There is some evidence of an improvement in health outcomes. The strongest evidence is the reduction seen in admissions for acute coronary syndrome. There is an increase in support for and compliance with smoking bans after the legislation.
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              Perceived relative harm of electronic cigarettes over time and impact on subsequent use. A survey with 1-year and 2-year follow-ups

              Highlights • A cohort of smokers and ex-smokers was followed over a period of two years. • Perceived harm of electronic cigarettes relative to cigarettes increased over time. • Smoking cessation ande-cigarette use predicted subsequent perceived relative harm. • Perceived relative harm predicted subsequent use of e-cigarettes in non-users.
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                Author and article information

                Journal
                Tob Control
                Tob Control
                tobaccocontrol
                tc
                Tobacco Control
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                0964-4563
                1468-3318
                March 2017
                16 June 2016
                : 26
                : e1 , Conflicts and controversies in contemporary tobacco control
                : e7-e15
                Affiliations
                Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK and UK Centre for Tobacco and Alcohol Studies (UKCTAS) , London, UK
                Author notes
                [Correspondence to ] Dr Leonie S Brose, Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 4 Windsor Walk, London SE5 8BB, UK; leonie.brose@ 123456kcl.ac.uk
                Article
                tobaccocontrol-2016-052987
                10.1136/tobaccocontrol-2016-052987
                5739866
                27312824
                beaed4cb-5bc3-43f8-acdb-5206dd423b0b
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) license, which permits others to distribute, remix, adapt and build upon this work, for commercial use, provided the original work is properly cited. See: http://creativecommons.org/licenses/by/4.0/

                History
                : 18 May 2016
                : 12 February 2016
                : 24 May 2016
                Categories
                1506
                Research Paper
                Custom metadata
                unlocked

                Public health
                electronic nicotine delivery devices,public opinion,public policy,advertising and promotion

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