3.1. Analysis.

Comparison 3 Active smoking (narrative), Outcome 1 Active smoking rates.

Active smoking rates
Study	Country and Setting	Population	National Ban	Outcomes	B io chemical verification
Alonso‐Colmenero 2010	Spain	Hospital	Yes	N = 135 smokers in study. No significant difference reported at baseline. n = 53 smokers identified as smoking in hospital in study. 2005: 34.2% of the 53 smoked in hospital (95% CI 22.6 to 45.8). 2006: 45.1% of the 53 smoked in hospital after the policy (95% CI 31.9 to 58.3), P = 0.26.	Cotinine measure define smoker
Alonso‐Colmenero 2010
Etter 2008	Switzerland,Geneva, Psychiatric hospital	Staff	No	Pre‐ban n = 57 staff Post‐ban 2004: n = 54/55, 2005: n = 53/63, 2006: n = 57/62. Participation rates 84.1% to 100%. Current prevalence of smokers unchanged over time. 26.3% (baseline) and at final follow‐up. Significantly more staff perceived rules about smoking were too strict. This changed over time as the smoking ban increased, 7.0% at baseline to 59.6% (final follow‐up), P < 0.001. Rules on smoking not respected (staff and patients) 51.36% at baseline and 16.1% (partial ban 2005) and 32.6% ( total ban 2006), P < 0.001.	None
Etter 2008		Patients		73.5% of patients were daily smokers 2003, reduced to 65.8% in 2006. No significant change in mean number of cigarettes 2003 and post‐ban 2006. 24.1 vs 23.7, P = 0.81. Increased quit attempts reported 2.2% in 2005 to 18.4% in 2006, P = 0.01, OR 10.1, 95% CI 1.21 to 222.7 (wider interval).
Etter 2012	Switzerland, Prisons	Staff	No	Response rates among staff higher than prisoners. Ranged from 40% to 77% over time in the 3 prisons. Majority of staff surveyed were men. No follow‐up in Prison C for staff. In prison A, staff smoking reduced from 10% to 6% at follow‐up. In prison B, staff smoking increased from 26% to 38% at follow‐up.	None
Etter 2012		Prisoners		Response rate 17% to 44% over period. Prisoner smoking unchanged. At baseline prison A 75% smoked (n = 52/70) and 72% (n = 43/60) at follow‐up. Prison B 69% (19/27) smoked 2009 and 57% (17/30) in 2011. Prison C 58% (67/116) at baseline and 56% 40/66) 2011. No significant change detected in any of the prisoners in smoking status, quit attempts or relapse. Smoking behaviour prison A: more prisoners reported receiving medical help to quit smoking in 2011 (20%) than in 2009 (4%, P = 0.012). Prison A compared to Prison B, prisoners felt that staff should do more to help quit attempts, P = 0.015. In prison A, prisoners and staff reported less exposure to SHS in 2011 than in 2009: 31% of prisoners were exposed to smoke at workplaces in 2009 vs 8% in 2011 (P = 0.001); in common rooms: 43% vs 8%, (P < 0.001). No changes were observed in prisons B and C.	None
Filia 2015	Australia, Melbourne	Hospital	Yes	Before the totally smoke‐free policy, 69.6% smoked, with 67.7% smoking more when admitted to the psychiatry ward smoking average 18.1 cigs/day. (Alternatives to smoking identified included use of NRT, having a designated smoking area, keeping busy). After the totally smoke‐free policy, 57.7% smoked heavily before hospital (mean cigarettes/day = 24.9), with consumption reduced after admission to a totally smoke‐free psychiatric unit (mean cigarettes/day = 8.3). 5.8% of patients reported quitting since admission following the ban.	None
Filia 2015
Fitzpatrick 2012	Ireland, Dublin	Hospital Staff	Yes	Pre‐ban data: smoking prevalence rates in staff : 1998: 27.4%; 2001: 17.3%; 17.8% of staff reported smoking in 2006 (post‐1st ban and pre‐2nd phase) and this significantly reduced to 10.7% in 2010, P = 0.02. Significantly in female staff 17.6% vs 9.5%, P = 0.02 and in age group 30 ‐ 39 years. Positive attitude among staff (52.4% vs 83.3%, P < 0.001) to the campus‐wide ban increased significantly between 2006 and 2010; the greatest increase was seen in doctors. Campus ban resulted in a positive attitude amongst staff irrespective of smoking status. When perception of own role in implementation was examined, younger staff were less likely to agree they had a role, while ex‐smokers were more likely to agree they had a role in implementation. Nurses more likely to agree than all other occupational groups.	None
Fitzpatrick 2012		Patients		Pre ban data: smoking prevalence in patients: 1997/1998: 24.2%; 2002: 15.5%; 2004: 24.5%. No significant change in patients smoking at follow‐up in 2010 after total campus ban introduced in 2009: 22.7% vs 18.0% (2006), P = 0.22. Reducing trends noted for men and women, but not statistically significant. Positive attitude of patients (58.6% vs 84.2%, P < 0.001) to the campus‐wide ban increased significantly between 2006 and 2010. Univariate analysis of factors associated with agreement with campus ban significantly associated with being a non‐ or ex‐smoker (patients), but not current smokers, P = 0.286. Multivariate analysis identified being aged 60 years or older and being a current smoker as significant.	Patients with CO levels > 10 ppm were considered to be current smokers.
Gadomski 2010	USA, New York Hospital	Staff	Yes	Cohort of 489 hospital employees 2005 and 2007, 12% reported smoking in 2005 and 7.5% in 2007 (McNemar was significant P < 0.001). 2006 not reported. Including all hospital employees reporting any 1 year during their anniversary dates, the self‐reported smoking rates were 14.3% (n = 624) in March ‐ June 2005, 14.8% (n = 661) in March ‐ June 2006, and 9.4% (n = 1112) in March ‐ June 2007 (P < 0.0002).	None
Gadomski 2010		Patients (NRT use)		No change in % patients signing out against advice. 69.8% inpatients received brief intervention post‐ban. NRT orders tripled post‐ban. Inpatient orders increased 832 in 2 years pre‐ban to 2475 in 2 years post‐ban. The Chow test is highly significant for break point in June 2006, P = 0.008. 1 month prior to ban.
Gazdek 2013	Croatia, Kopriivnica‐ Krizevci county Hospital	Staff	Yes	Baseline smoking prevalence 34.3% reduced to 26.4% 2011. A reduction of 7.9%. Reduction in population 1994 to 2005 was 5.2%. Larger change in non‐health workers 39.2% to 26.4% (Change 12.8%). Number of cigarettes decreased per person from 15 to 12 per day. Percent of < 10 cigs consumed/day increased 33.7% to 57.4% in first 2 years of Act. Decrease greatest 2 ‐ 6 years after ban.	None
Gazdek 2013
Keizer 2009	Switzerland, Geneva Psychiatric hospital	Staff	No	No significant change in staff smoking prevalence 2001 and 2005. 2001 30.8% vs 29.9% 2005, P = 0.94. Daily consumption of cigarettes among staff: 13% of staff were heavy smokers (> 20 /day) compared to 53.5% of patients, P < 0.001.	None
Keizer 2009		Patients		No significant changes in current smoking among patients post‐ban (n = 86) 72.1% vs 65.2% (n = 62), P = 0.54. Daily consumption of cigs by patients was 29.47 (SD 16.79) and 17.83 (SD 13.26) for staff, P < 0.001. 13% of staff were heavy smokers (> 20/day) compared to 53.5% of patients, P < 0.001. 34.9% of patients and 52.2% of staff were moderate smokers. Patients displayed an increased desire to stop smoking post‐ban . Trends in patient smoking showed initial decrease in consumption but returned by day 10. Inconclusive as may be due to heavy‐smoker cohort. Increased smoking post‐ban (qualitative) identified boredom, waiting and mental state as reasons. Decreased smoking was explained by restrictions (smoking rooms), lack of cigarettes, tiredness, treatment, decrease in tension, less desire to smoke and respect for others.	None
Lechner 2012	USA, Oklahoma	University	No	Significant reduction in percentage of more frequent smokers over time Chi² = 8.53 (3, n = 4947), P = 0.036; especially between years 2009 and 2010, Chi² =7.06 (1, n = 2486), P = 0.009, and between 2007 and 2010: Chi² = 5.00 (1, n = 2454), P = 0.025. Proportion of smokers reduced but NS. Significant decreases in the proportion of more frequent smokers occurred in men, Chi² = 14.58 (3, n = 2290), P = 0.002, but not women. Significant decrease in the proportion of less frequent smokers across assessment points, Chi² = 20.87 (4, n = 4947), P < 0.001. Significant decrease occurred between years 2007 and 2010, Chi² = 15.38 (1, n = 2454), P < 0.001. Results indicated that exposure to smoke at an entrance to a campus building had significantly decreased over the 4‐year assessment period, F (3, 4908) = 126.38, P < 0.001, η2 = 0.071. Students reported significant increase in preference to socialise in smoke‐free environment F (34836) = 4.48, P = 0.004, η2 = 0.002. Noted in 2008 and 2010, but not in 2009. Significant agreement over time that campus be smoke‐free, P < 0.001.	None
Lechner 2012
Martínez 2014	Spain	Hospital	Yes	Smoking prevalence decreased from 33.1% (95% CI 29.3 to 36.9) to 30.5% (95% CI 26.3 to 34.7) and in 2012 22.2% (95% CI 16.7 to 27.6), P < 0.005. Prevalence decreased in all hospital groups. Decreased amongst women 35.1% Baseline to 33.0% (1st ban), 23.1% (2nd ban), P = 0.009, and in aged > 35 years 31.9% baseline, 23.3% (1st ban), 16.3% (2nd ban), P = 0.0001. Smoking decreased in men, but not statistically significant. Smoking reduced in all staff groups, not statistically significant. Smoking patterns: occasional smokers increased 2‐fold. 12.1% to 24.5% (2nd ban), P = 0.012. No clear trend in number of cigs or time to first cig reported. First cig after awakening ≤ 30 mins 3.6% at baseline and 39.1% (2nd law), P < 0.001. Readiness to quit 60.3% baseline, 28.2% (1st ban), 11.5% (2nd ban), P < 0.001. Significant reduction in concern about tobacco use, readiness to fix date to quit and, consulted professional to quit and refrain from smoking in working hrs post‐bans. Attitude to ban: agreed with policy P < 0.001, and parents should set example. Support for the tobacco control policies increased from 59% at baseline to 80.5% following the passage of the 2nd bill.	None
Martínez 2014
Ripley‐Moffitt 2010	USA, North Carolina Hospital	Staff	No	Total sample was 5534, with 2024 respondents to initial survey, of which 307 were current smokers or had quit in preceding 6 months. Follow up n = 210 smokers agreed to be interviewed at 6 months and 1 year post‐ban. n = 166 responded at 6 months. Of 179 participants in study who were smokers, 45% reported quit attempt in previous 6 months. At 6 months, of the 133 participants currently smoking, 53% reported quit attempt. At 1 yr, 39 participants reported not smoking (18.5%). Of the 117 participants who were current smokers at 12 months, 48% reported attempts to quit during preceding 6 months.	None
Ripley‐Moffitt 2010
Santina 2011	Spain, Barcelona	Hospital	Yes	The number of workers smoking decreased from 35.2% to 27.4%, P < 0.05. This reduction was seen across all hospital workers, less in nursing staff. People only smoked in smoking areas, P < 0.0001. Policy supported by smokers and nonsmokers. 8.2% received help to quit pre‐ban, 19.7% post‐ban, P = 0.02.	None
Santina 2011
Seo 2011	USA, Indiana University	Students	No	Prevalence and tobacco consumption fell in Indiana (pre‐ban: 16.5%; post‐ban: 12.8%) and increased at Purdue (control) during the same time period. In addition, perceptions of peer tobacco use and smoking norms improved at Indiana University. Peer tobacco use: significant decrease in percentage of Indiana students who perceived 26% of students or more were smoking, P < 0.001. Control: significant increase in perceived smoking, P ≤ 0.001. Percentage of friends smoking decreased in Indiana, P < 0.001. Longitudinal panel comparisons samples: n = 170 for Indiana and n = 128 for Purdue. Significant declines in number of cigs smoked in Indiana post‐policy, ‐5.0, P < 0.05, compared to Purdue. Indiana students had significant increases in agreement that smoking regulation is good, P < 0.05; should be banned on all university property, P < 0.05, compared to Purdue for both fixed‐effect and random‐effects modelling.	None
Seo 2011