Diffusion of smoke-free policies at outdoor sports clubs in the Netherlands

Abstract Background Although outdoor smoke-free policies (SFPs) at sports clubs represent an important new area of tobacco control, the majority of sports clubs are not smoke-free. This study aims to assess diffusion patterns of outdoor SFPs at sports clubs in the Netherlands, which may inform national strategies aimed at making all outdoor sports clubs smoke-free. Methods Using a retrospective, registry-based design, an inventory was made of football, field hockey, tennis, and korfball clubs that became smoke-free between 2016-2020. We determined the type of sports, number of members, and proportion of youth members. The degree of urbanization and density of smoke-free sports clubs were measured at the municipality level. The association between sports clubs’ characteristics, degree of urbanization, and SFP adoption was analysed using multilevel regression analysis. Horizontal diffusion was tested by analysing the association between the density and annual incidence of smoke-free sports clubs. Results Since 2016, the number of sports clubs with an outdoor SFP increased from 0.3% to 26.4%. Field hockey [OR compared to football 6.00 95% CI 4.46-8.07] and korfball clubs [OR 6.65 95% CI 4.98-8.87] and clubs with many (youth) members [OR 8.75 95% CI 6.20-2.35] were more likely to be smoke-free. SFPs spread from the most urbanized to less urbanized municipalities, which could mostly be attributed to sports clubs’ characteristics. A higher density of smoke-free sports clubs within municipalities was associated with an increased incidence of new SFPs in the following year. Conclusions Outdoor SFPs at sports clubs in the Netherlands diffused across horizontal and hierarchical lines. National strategies for smoke-free sports should monitor clubs that are more likely to stay behind, such as football and tennis clubs, smaller clubs, and clubs in less urbanized areas.

In 2021, the European Union's (EU) 'Europe's Beating Cancer Plan' set the goal to achieve a tobacco-free generation in Europe by 2040, which means that less than 5% of people will use tobacco. The EU proposed policies to address internationally relevant issues such as tobacco taxation, cross-border purchases, packaging, flavours, and online advertising. However, many tobacco control policies need to be adopted and implemented at the national or local level. It is therefore important to exchange research findings and insights on national tobacco control policies. In this workshop we present results mainly from the Netherlands. With a 21% smoking prevalence and scores 53 out of 100 points on the Tobacco Control Scale, it may therefore be considered an average European country in terms of its tobacco control. However, the Netherlands has progressed its tobacco control policies in recent years, in part due to the 2018 National Prevention Agreement. This Agreement included the same goal as the European tobacco-free generation goal. Achieving a tobaccofree generation requires the prevention of smoking initiation among young people, but also smoking cessation among those who already smoke. This is especially important among lower socioeconomic groups, as the smoking prevalence in these groups is higher both in adults and adolescents. Therefore, smoking and tobacco products need to be less visible and available in the environment, and easily accessible smoking cessation support needs to be provided. With this workshop, we cluster very recent evidence on the EU's tobacco-free generation goal. We will present evidence on four policy strategies for the smoke-free generation, in which their potential impact and challenges in implementation will be discussed. These presentations will be followed by a plenary discussion on the implications and the relevance of the four strategies taking into account differences between international settings. The presentations will focus on four policy areas: Policies to reduce smoke-exposure in and around sport clubs Policies to reduce availability of tobacco products in the retail environment Policies to reduce smoke-exposure in hospitality venues and homes Policies to increase access to smoking cessation The objectives of the workshop are: 1. Present evidence of four tobacco control policies strategies 2. Discussion of the international relevance and implications of the results Key messages: We present on multiple settings that can be further capitalised on to achieve a non-smoking norm, including sports clubs, retail outlets, hospitality venues, and the home environment.
The majority of European countries currently does not have strong tobacco control policies in the presented settings, and the potential of such policies throughout Europe will be discussed.

Background:
Although outdoor smoke-free policies (SFPs) at sports clubs represent an important new area of tobacco control, the majority of sports clubs are not smoke-free. This study aims to assess diffusion patterns of outdoor SFPs at sports clubs in the Netherlands, which may inform national strategies aimed at making all outdoor sports clubs smoke-free.

Methods:
Using a retrospective, registry-based design, an inventory was made of football, field hockey, tennis, and korfball clubs that became smoke-free between 2016-2020. We determined the type of sports, number of members, and proportion of youth members. The degree of urbanization and density of smokefree sports clubs were measured at the municipality level. The association between sports clubs' characteristics, degree of urbanization, and SFP adoption was analysed using multilevel regression analysis. Horizontal diffusion was tested by analysing the association between the density and annual incidence of smoke-free sports clubs. were more likely to be smoke-free. SFPs spread from the most urbanized to less urbanized municipalities, which could mostly be attributed to sports clubs' characteristics. A higher density of smoke-free sports clubs within municipalities was associated with an increased incidence of new SFPs in the following year.

Conclusions:
Outdoor SFPs at sports clubs in the Netherlands diffused across horizontal and hierarchical lines. National strategies for smoke-free sports should monitor clubs that are more likely to stay behind, such as football and tennis clubs, smaller clubs, and clubs in less urbanized areas.

Background:
After implementation of a tobacco vending machine ban in 2022 and a supermarket sales ban in 2024, the Dutch government intends to further phase out tobacco sales after 2030 by prohibiting sales in petrol stations and small outlets. This study aims to understand 1) the impact of these policies on tobacco outlet availability, and 2) differences in tobacco outlet availability by area socioeconomic status (SES) in the Netherlands.

Methods:
Between September 2019 and June 2020, all potential tobacco retailers in four Dutch cities (Amsterdam, Eindhoven, Haarlem, and Zwolle) were visited and mapped using Global Positioning System (GPS). Expected reductions in tobacco outlet availability were calculated per policy measure. Tobacco outlet density was calculated using ESRI ArcMap version 10.4.1. The association between neighbourhood SES and tobacco outlet availability was estimated with linear and logistic regression model.

Conclusions:
The availability of tobacco outlets varies within and between cities depending on the distribution of the built environment. Future tobacco control policies targeting the retail environment should focus on limiting the overall number tobacco outlets and especially small outlets, which may benefit low SES neighbourhoods in mid-sized cities most.
Abstract citation ID: ckac129.755 Impact of smoke-free policies in hospitality venues and the home environment on smoking behaviour and exposure to second-hand smoke: results of two systematic reviews

Background:
Smoke-free policies (SFPs) have proven to be effective in protecting people from exposure to second-hand smoke (SHS) and lowering smoking rates. Our aims were to assess the impact of SFPs in hospitality venues (e.g. bars) on smoking behaviour of young people and to assess the impact of SFPs in the home environment on smoking behaviour and exposure to SHS.

Methods:
Two reviews were conducted. The first was conducted in June 2020. We searched PubMed, Embase, and Scopus for studies that assessed the association between any form of SFPs in hospitality venues and a measure of smoking behaviour among young people (aged 10-24 years). The second review will be conducted in June 2022. Searches will be conducted in PubMed, Embase, Web of Science, PsycINFO and CENTRAL. We will search for studies that assess the association between any form of SFPs in the home environment (e.g. multi-unit housing) and a measure of smoking behaviour (e.g. initiation) or SHS exposure.

Results:
Nine studies (publication years 2005-2016) were included in the first review, of which the majority used a quasiexperimental design. Four studies evaluated SFPs in hospitality venues specifically. Two studies reported that strict, but not weaker, SFPs decrease progression to established smoking. Two other studies provided mixed results. Five studies also included other workplaces, of which three studies found significant decreases in current smoking, smoking frequency, and/or smoking quantity. The results of the second review will be presented in detail during the workshop, however an exploration suggests that SFPs in the home environment may prevent smoking and SHS exposure.

Conclusions:
Most studies of the first review found that SFPs in hospitality venues are associated with a decrease in smoking behaviour among young people. Their results indicate the need for strict smoke-free legislation without exemptions. The conclusions of the second review will be presented during the workshop.