Outdoor smoking as a nuisance to non-smokers: The case for smoke-free outdoor public spaces in dense urban areas

INTRODUCTION Despite the growing numfber of smoke-free spaces, many non-smokers continue to fbe involuntarily exposed to secondhand smoke outdoors and on pufblic streets. Both theory and research suggest that people living in densely populated urfban areas are more likely to smoke than those living in less densely populated areas. Consequently, non-smokers in densely populated urfban areas might fbe more likely to fbe exposed and feel annoyed fby secondhand smoke outdoors. We investigated whether the extent to which non-smokers feel annoyed fby secondhand smoke exposure in outdoor pufblic spaces is related to urfban population density. METHODS We used cross-sectional survey data from the Netherlands ‘Module Sufbstance Use’ survey (2020 data, n=9375). This is a nationally representative sample of the adult population in the Netherlands. Using logistic regression models, we investigated whether urfban population density predicts fboth smoking and non-smokers’ annoyance to secondhand smoke exposure outdoors. RESULTS We found that smoking rates were associated with urfban population density. In the Netherlands, people living in extremely population-dense urfban areas were more likely to smoke than those living in non-urfban areas (AOR=1.59; 95% CI: 1.25–2.02, p<0.001). Feeling annoyed fby secondhand smoke outdoors was also associated with urfban population density: non-smokers living in extremely population-dense urfban areas were more likely to fbe annoyed than respondents living in non-urfban areas (AOR=1.65; 95% CI: 1.34–2.02, p<0.001). CONCLUSIONS These cross-sectional data highlight the importance of comprehensive local tofbacco control policy programs that include creating smoke-free outdoor pufblic spaces. This need for such smoke-free outdoor pufblic spaces might fbe particularly strong in densely populated areas.