Reducing Secondhand Smoke Exposure

Research Gaps

What are Research Gaps?

Prior to and during the literature review and data analysis, the review team and the Community Preventive Services Task Force attempt to address the key questions of what interventions work, for whom, under what conditions, and at what cost. Lack of sufficient information often leaves one or more of these questions unanswered. The Community Guide refers to these as "research gaps." Research gaps can be pulled together in the form of a basic set of questions to inform a research agenda for those in the field.

Identified Research Gaps

Effectiveness

The effectiveness of smoking bans and restrictions in reducing exposure to ETS in the workplace is established. Research issues, which have been identified by others overlap with questions generated as a result of this review.

• What are the relative effects of smoking bans and restrictions on tobacco use behaviors? What is the full range of effects on tobacco use behaviors that occurs in response to smoking bans and to smoking restrictions? In addition to reducing exposure to ETS, what are the effects on tobacco use cessation and tobacco use prevalence?
• What are the extended effects (beyond 1 to 2 years after implementation) of smoking bans and restrictions on the tobacco use behaviors of workers? Do these effects increase over time?
• What is the full range of effects that occurs in communities in response to different types of local ordinances?
• How does the effectiveness of smoking policies vary by the specific requirements of the legislation and vigorousness of enforcement?
• How is the effect of workplace smoking policies affected by the size and composition of the workforce?
• What is the full range of health benefits that results from reducing or eliminating exposure to ETS in workers and customers currently exposed to ETS on a regular basis (e.g., in restaurants, bars, and casinos)?
• How do cultural characteristics of businesses and workers contribute to increased or decreased effectiveness of smoking bans and restrictions? The effectiveness of community education interventions in reducing exposure to ETS in the home has not been established. Basic research questions proposed by others overlap the questions generated from this review.
• How effective are educational methods in reducing exposure to ETS in the home?
• What are the relative contributions to reducing home ETS exposures of (1) adherence to policies that ban or restrict smoking in the home and (2) smoking cessation?
• Do policies in the home that ban or restrict smoking reduce exposure to ETS? In adults? In children? Are households with children more likely to adopt policies that ban or restrict smoking in the home?
• Are home smoking bans more effective than smoking restrictions?
• What information or message is effective in prompting and maintaining practices in the home?
• What channels are effective for dissemination of information to reduce home ETS?

Applicability

Workplace smoking bans and restrictions should be applicable in most workplace settings and populations. However, possible differences in the effectiveness of each intervention for specific subgroups of the population could not be determined. Several questions regarding applicability of these interventions in settings and populations other than those studied remain.

• Are smoking bans effective in high schools in reducing exposure to ETS and/or tobacco use?
• Are smoking bans and restrictions effective in universities in reducing exposure to ETS and/or tobacco use?
• Are smoking bans effective in child-care settings in reducing exposure to ETS?
• Do meaningful differences exist in effectiveness of smoking bans and restrictions relative to the level or scale of implementation (private, local, state, national)?

Other Positive or Negative Effects

Smoking bans and restrictions may have important effects on such tobacco use behaviors as consumption, cessation attempts, and cessation. Assessing the full range of effects of smoking bans and restrictions is important and was addressed in the section on Effectiveness. In addition, research on the following issues would be useful:

• How effective are workplace smoking bans and restrictions in reducing relapses?
• Do smoking bans and restrictions divert tobacco consumption from cigarettes to smokeless tobacco?
• To what extent, if any, do workplace smoking bans and restrictions increase consumption and ETS exposures in the home?
• What effects do workplace smoking bans and restrictions have on productivity?

Economic Evaluations

The available economic information consisted of a single evaluation. Considerable research is, therefore, warranted regarding the following questions:

• What are the costs of these interventions?
• What is the cost-effectiveness, net cost, or net benefit of smoking bans and restrictions when the cost-effectiveness analysis includes cost of illness averted?

Barriers

Research issues important to communities and local governments identified in this evaluation include the following:

• What aspects of efforts to prevent or to overturn state pre-emption laws are effective?
• What aspects of efforts to pass local smoking bans are effective in addressing local concerns and industry-organized opposition? What arguments for smoking bans are most persuasive to voters? To local legislative bodies?
• Published reports of community and state efforts to pass smoking bans in California are informative, and continued investigation is warranted to identify and to disseminate information to counter the evolving strategies of the tobacco industry.