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By Tarun Sai Lomte May 12 2023 Reviewed by Lily Ramsey, LLM

In a recent study published in the eClinicalMedicine Journal, researchers assessed the levels of public support for smoke-free policies in indoor (semi)-private and outdoor areas.

Study:  Public support for smoke-free policies in outdoor areas and (semi-)private places: a systematic review and meta-analysis. Image Credit: LuckyBusiness/Shutterstock.com Background

Second-hand smoke exposure is a significant burden to global public health. Evidence suggests that legislation to protect people from smoke in workplaces and indoor public spaces can decrease the harmful effects of tobacco smoke. Several jurisdictions have extended smoke-free policies to include outdoor and private places.

Public support is critical for policymakers to implement such policies and maximize compliance. Prior studies have observed differences in support within populations and between smoke-free places.

Therefore, it is crucial to gain insights into the determinants and levels of public support for such policies to inform policymaking regarding their expansion covering outdoor and semi-private spaces. About the study

In the present study, researchers systematically reviewed the evidence on public support levels for smoke-free policies encompassing semi-private and outdoor places.

They searched Embase, Medline, Cochrane, PsycINFO, Web of Science, and the cumulative index to nursing and allied health literature (CINAHL) databases for studies published from January 2004 to January 2022, with no restrictions on language.

Studies were eligible if they assessed support for policies in indoor private or semi-private spaces, outdoor hospitality or non-hospitality places, and outdoor semi-private places, with policies already implemented, planned, or hypothetical.

Studies were excluded if the sample size was <400, only non-combustible tobacco products were covered, or support was reported for workplaces or indoor public places. Related StoriesResearchers map the immune system in the gut of kids with inflammatory bowel diseaseGun assault rates doubled for children in 4 major cities during the pandemic, new data showsExperts urge increased attention to the threat of climate change and pollution on children's health

Titles/abstracts and full texts were screened to identify eligible reports, and relevant data were extracted from included studies.

The risk of bias in included studies was assessed using the mixed methods appraisal tool. Logit transformations were applied if support was reported as proportions ranging from zero to one.

If reported as the average score on the Likert scale, it was transformed to the proportion support. A three-level meta-analysis accounted for between-study, within-study, and country-level clustering. Sub-group analyses were also performed by gender, age group, parental status, and smoking status. Findings

The authors identified more than 14,500 records from the databases. Duplicates and pre-2004 studies were removed, resulting in over 6,000 records for screening. Overall, 107 studies from 33 countries were included for analysis.

Sixty-seven studies investigated support for hypothetical scenarios, 36 investigated public support for implemented policies, and four assessed public support for policies likely to be introduced or extended.

Forty-two studies were considered to have a low risk of bias, and 65 were deemed as having a moderate or high risk of bias. Eight studies were excluded from the meta-analysis. The meta-analysis included data from almost 900,000 participants.

The highest public support levels for smoke-free places were for private indoor spaces (73%) and semi-private indoor places (70%). Public support for policies in outdoor non-hospitality and hospitality places was 69% and 50%, respectively.

For semi-private outdoor places, support was 67%. The lowest support was for outdoor private places (41%). Public support was the highest for making cars with children onboard smoke-free at 86%, followed by playgrounds and school grounds at 80% and 76%, respectively.

Parks, beaches, and outdoor hospitality or private places had the lowest public support. There was substantial heterogeneity within or between studies and between countries.

Support was significantly higher among ex- or non-smokers than among current smokers. Females were significantly more often in favor of policies than males.

People in low- and middle-income countries (LMICs) had similar levels of support for policies as those from high-income countries, except for higher support for outdoor non-hospitality policies in LMICs.

Twelve studies assessed public support for policies pre- and post-implementation. Six reported that support was significantly higher after implementation, whereas others did not find significant changes. Sensitivity analyses found no significant differences in support between studies with a low and high risk of bias, indicating that the evidence was robust. Conclusions

The authors observed that public support for smoke-free policies covering outdoor and semi-private spaces was particularly high for places where children are commonly present, such as playgrounds, school grounds, and cars with children.

Support was more than 50% or higher for all areas except private outdoor spaces. Ex- and non-smokers were more in support of policies than smokers.

The findings suggest high support for smoke-free spaces covering outdoor and semi-private areas from the surveyed populations. Policymakers should proceed with further steps in protecting the public, especially children, from the adverse effects of smoke exposure by expanding smoke-free policies. Journal reference:

Boderie, N.W., Sheikh, A., Lo, E., Sheikh, A., Burdorf, A., Van Lenthe, F.J., Mölenberg, F.J.M. & Been, J.V. (2023) Public support for smoke-free policies in outdoor areas and (semi-)private places: a systematic review and meta-analysis. eClinicalMedicine, p.101982. doi: 10.1016/j.eclinm.2023.101982. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(23)00159-1/fulltext

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Leafs’ Matthews in Germany for injury treatment

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Leafs' Matthews in Germany for injury treatment

TORONTO — Auston Matthews boarded a plane and crossed an ocean.

The Toronto Maple Leafs are hoping the trip provides some answers — and returns their best to the ice.

General manager Brad Treliving said following Tuesday’s practice his captain, out day-to-day since Nov. 5 because of an undisclosed upper-body injury, is in Germany to see a doctor the star center has worked with in the past.

“More as a general checkup,” Treliving said during an unscheduled availability with reporters. “But also to get some work done on this thing.”

Matthews has sat out six games and will be out a seventh Wednesday when Toronto hosts the Vegas Golden Knights.

Treliving, who added a team doctor accompanied the star forward to Europe, said with the Leafs playing only twice this week the organization decided to use the time to its advantage.

Treliving declined to provide further details on what’s ailing Matthews, who’s believed to have skated only twice since last playing Nov. 3.

“There’s been no setbacks,” Treliving said of the 2022 Hart Trophy winner. “Everything’s been, actually, going quite well. We’re just trying to use the days that we’ve got here with less games being played to just try to get this behind us.”

Toronto (11-6-2) was already down three forwards with Matthews, Max Pacioretty and Calle Jarnkrok sidelined before announcing earlier Tuesday center David Kampf (lower-body injury) is also now on the shelf. Fraser Minten was recalled from the minors to take his spot.

Reaves reaction

Leafs enforcer Ryan Reaves was suspended five games for Saturday’s illegal check to the head on Oilers defenseman Darnell Nurse.

“Never want to see anybody injured,” Treliving said. “It’s a hockey play that goes wrong.”

Reaves was in Toronto’s locker room Tuesday following practice and appeared willing to speak with reporters, but the team’s communications staff intervened and made it clear the 37-year-old forward wasn’t available to comment.

“We thought it was a little high,” Leafs center John Tavares said of a ban from the NHL’s Department of Player Safety that rules Reaves out until Dec. 4. “But we’ll stick behind him … we know how effective he’s been.”

Domi struggling

Leafs forward Max Domi has just six assists — and is on a career-worst 13-game point drought — despite playing an offensive role.

The 29-year-old, who was on the ice Tuesday, missed two recent practices for maintenance.

“He’s fighting through a lot right now … he’s banged up,” coach Craig Berube said. “I’m not overly concerned. We gotta keep working through it.”

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NHL ref Dunning back home after on-ice collision

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NHL ref Dunning back home after on-ice collision

PHILADELPHIA — The NHL referee who was stretchered out of a game following a violent collision with Colorado defenseman Josh Manson was back home Tuesday and expected to make a full recovery.

The league said that Mitch Dunning was home following a trip to the hospital for precautionary reasons after he was accidentally knocked down by Manson in the Avalanche-Flyers game.

Manson skated alone on the ice Monday night when he slammed into Dunning near the blue line early in the first period. Dunning went down in a heap and lay prone on the ice for several minutes. Dunning appeared to be moving his feet and moved his right hand when Manson went to talk to him.

The game at the Wells Fargo Center was delayed for several minutes while trainers and medical staff tended to Dunning.

The game continued with one referee and two linespersons. Colorado beat Philadelphia 3-2.

Dunning is a former professional hockey defenseman who played parts of three seasons in the OHL. He later shifted into officiating and was promoted to full-time NHL status in 2022.

The NHL did not say when Dunning would return to work.

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2 years after record season, B’s fire Montgomery

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2 years after record season, B's fire Montgomery

The Boston Bruins have fired coach Jim Montgomery after stumbling to a losing record in their first 20 games, the team announced Tuesday.

Associate coach Joe Sacco was elevated to interim head coach. The Bruins are off to an 8-9-3 start (.475 points percentage) and outside of a playoff seed in the Eastern Conference.

General manager Don Sweeney called the move “a difficult decision.”

“Jim Montgomery is a very good NHL coach and an even better person. He has made a positive impact throughout the Bruins organization, and I am both grateful and appreciative of the opportunity to work with him and learn from him,” Sweeney said in a statement.

Sacco was previously coach of the Colorado Avalanche from 2009 to 2013 and has been a part of the Boston coaching staff since 2014. The 55-year-old had a 13-year NHL playing career with five teams from 1990 to 2003.

“Our team’s inconsistency and performance in the first 20 games of the 2024-25 season has been concerning and below how the Bruins want to reward our fans. I believe Joe Sacco has the coaching experience to bring the players and the team back to focusing on the consistent effort the NHL requires to have success,” Sweeney said. “We will continue to work to make the necessary adjustments to meet the standard and performance our supportive fans expect.”

Montgomery, 55, had a 120-41-23 record (.715 points percentage) in three seasons with the Bruins, making the playoffs twice. Both trips to the postseason ended at the hands of the Florida Panthers. Boston was stunned in a seven-game, first-round upset in 2023 after having the most successful regular season in NHL history (135 points), and again earlier this year when it lost to Florida in the second round after eliminating the Maple Leafs in seven games.

Montgomery won the Jack Adams Award as NHL coach of the year in 2022-23. He previously coached the Dallas Stars for two seasons (2018-20), amassing a record of 60-43-10.

As Montgomery chronicled in his 2023 NHL Awards speech, his success in Boston came after he turned his personal life around. “Three and a half years ago, the Dallas Stars terminated my contract because of my struggles with alcohol,” he said. “And I had to change my actions and behaviors.”

Despite Sweeney saying the sides were discussing an extension during training camp, Montgomery didn’t have a contract beyond the 2024-25 season.

The Bruins have been one of the NHL’s most notable disappointments this season. They’re 31st in team offense (2.40 goals per game) and 28th in defense (3.45 goals against per game).

Previously dependable aspects of the team have malfunctioned, in particular the goaltending. The team traded former Vezina winner Linus Ullmark to the Ottawa Senators for goalie Joonas Korpisalo. The Ullmark deal broke up the best goalie tandem in the NHL with 26-year-old Jeremy Swayman, who missed training camp during a bitter negotiation before signing an eight-year contract that will pay him $66 million.

Swayman has a 5-7-2 record with an .884 save percentage and a 3.47 goals-against average. After the Bruins lost to the Columbus Blue Jackets 5-1 on Monday, Montgomery said missing training camp wasn’t advantageous.

“I don’t think missing training camp helps anyone,” Montgomery said. “That’s why you have training camps.”

Montgomery has been seen having animated discussions with captain Brad Marchand on the Boston bench multiple times this season. He also benched leading goal scorer David Pastrnak in a game earlier this month.

Montgomery’s firing is the first coaching change of the 2024-25 season. Sacco is the fourth head coach under Sweeney since the GM took over in 2015.

“I’m supportive of Don’s decision to address our current play and performance,” team president Cam Neely said in a statement. “Joe Sacco has a wealth of experience and knowledge of our roster and can help lead our team in the right direction. He has a strong understanding of our standards and expectations, and I trust he will do all he can to accomplish our organization’s goals this season.”

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