Relation between local restaurant smoking regulations and attitudes towards the prevalence and social acceptability of smoking: a study of youths and adults who eat out predominantly at restaurants in their town

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Abstract
Objective: To examine the relation between strength of local restaurant smoking regulations and smoking related social norms among youths and adults. Design: We used generalised estimating equations logistic regression analysis to examine the relation between regulation strength and youths’ and adults’ perceptions of adult smoking prevalence and the social acceptability of smoking in their town, while controlling for baseline anti-smoking sentiment in the town. Setting: Each of the 351 Massachusetts towns were classified as having strong (complete smoking ban), medium (restriction of smoking to enclosed, separately ventilated areas), or weak (all others) restaurant smoking regulations. Subjects: 1147 Massachusetts youths ages 12–17 years and 2116 adults who reported that they often or always eat out in their own town, drawn from a random digit dial survey. Main outcome measures: Perceived adult smoking prevalence and perceived social acceptability of smoking in restaurants, in bars, or in general. Results: Compared to youths from towns with weak regulations, youths from towns with strong regulations were more likely to perceive lower adult smoking prevalence (odds ratio (OR) 1.71; 95% confidence interval (CI) 1.02 to 2.84) and social unacceptability of adult smoking (OR 2.00, 95% CI 1.29 to 3.08) in their town. Adults from towns with strong regulations were not more likely to perceive lower adult smoking prevalence, but had more than twice the odds of perceiving that smoking was unacceptable in restaurants (OR 2.19, 95% CI 1.58 to 3.02) or bars (OR 2.51, 95% CI 1.90 to 3.31). Conclusions: Strong local restaurant smoking regulations are associated with favourable smoking related social norms among youths and adults.