Introduction
On 2 September 2019, Rotterdam’s first inner-city outdoor smoke-free zone encompassing the Erasmus MC, a large university hospital in the Netherlands, the Erasmiaans high school, the Rotterdam University of Applied Sciences and the public road in between, was implemented. We aimed to assess spatiotemporal patterning of smoking before and after implementation of this outdoor smoke-free zone.
Methods
We performed a before-after observational field study. We systematically observed the number of smokers, and their locations and characteristics over 37 days before and after implementation of the smoke-free zone.
Results
Before implementation of the smoke-free zone, 4,098 people smoked in the area every weekday during working hours. After implementation, the daily number of smokers was 2,241, a 45% reduction (p=0.007). There was an increase of 432 smokers per day near and just outside the borders of the zone. At baseline, 31% of the smokers were categorised as employee, 22% as student and 3% as patient. Following implementation of the smoke-free zone, the largest decreases in smokers were observed among employees (–67%, p-value 0.004) and patients (–70%, p-value 0.049). Before and after implementation, 21 and 20 smokers were visibly addressed and asked to smoke elsewhere.
Conclusions
Implementation of an inner-city smoke-free zone was associated with a substantial decline in the number of smokers in the zone, and an overall reduction of smoking in the larger area. Further research should focus on optimising implementation of and compliance with outdoor smoke-free zones.