Secondhand smoke in outdoor settings: smokers' consumption, non-smokers' perceptions, and attitudes towards smoke-free legislation in Spain

BMJ Open. 2015 Apr 8;5(4):e007554. doi: 10.1136/bmjopen-2014-007554.


Objective: To describe where smokers smoke outdoors, where non-smokers are exposed outdoors to secondhand smoke (SHS), and attitudes towards smoke-free outdoor areas after the implementation of national smoke-free legislation.

Design: This cross-sectional study was conducted between June 2011 and March 2012 (n=1307 participants).

Setting: Barcelona, Spain.

Participants: Representative, random sample of the adult (≥16 years) population.

Primary and secondary outcomes: Proportion of smoking and prevalence of exposure to SHS in the various settings according to type of enclosure. Percentages of support for outdoor smoke-free policies according to smoking status.

Results: Smokers reported smoking outdoors most in bars and restaurants (54.8%), followed by outdoor places at work (46.8%). According to non-smokers, outdoor SHS exposure was highest at home (42.5%) and in bars and restaurants (33.5%). Among non-smoking adult students, 90% claimed exposure to SHS on university campuses. There was great support for banning smoking in the majority of outdoor areas, which was stronger among non-smokers than smokers. Over 70% of participants supported smoke-free playgrounds, school and high school courtyards, and the grounds of healthcare centres.

Conclusions: Extending smoking bans to selected outdoor settings should be considered in further tobacco control interventions to protect non-smokers from SHS exposure and to establish a positive model for youth. The majority of public support for some outdoor smoke-free areas suggests that it is feasible to extend smoking bans to additional outdoor settings.


Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Attitude to Health*
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Middle Aged
  • Public Opinion*
  • Self Report
  • Smoke-Free Policy / legislation & jurisprudence*
  • Smoking / epidemiology
  • Smoking / legislation & jurisprudence
  • Smoking / psychology*
  • Spain
  • Tobacco Smoke Pollution* / legislation & jurisprudence
  • Tobacco Smoke Pollution* / prevention & control
  • Tobacco Smoke Pollution* / statistics & numerical data
  • Young Adult


  • Tobacco Smoke Pollution