BACKGROUND: Smoking ban at public areas leads to clustering of smoking behavior, particularly at smoking hotspots where ashtrays are available. However, the real-world impact of exposure to smoking hotspots on smoking behaviors in daily tobacco users remains unclear.
METHODS: A one-week ecological momentary assessment (EMA) was conducted among daily tobacco users (n=449) in Hong Kong. Participants completed five fixed-interval signal-contingent EMAs daily, reporting smoking behaviors including number of cigarettes consumed, craving, and purchases within past 3-hour in each EMA. Exposure to smoking hotspot was documented in the final EMA daily at evening. Daily aggregates of cigarettes smoked, craving, and tobacco purchases were calculated. Two-part models including multilevel logistic and gamma regressions, analyzed within-person and between-person effects within the same day.
RESULTS: Participants (66.6% male, mean age 36.8 (SD 10.7)) completed 12091 EMAs (76.9% completion rate). Participants reported tobacco use in 81.8%, tobacco craving in 36.3%, and tobacco products purchase in 7.9% of all EMAs. Exposure to smoking hotspot was reported in 14.6% of the evening EMAs. At between-person level, exposure to smoking hotspot was associated with higher probability of reporting tobacco craving (adjusted odds ratio [AOR]=4.82, 95%CI 1.47-15.80), and purchases (AOR=4.02, 95%CI1.80-8.98), as well as more tobacco consumption (adjusted exp(B)=1.27, 95%CI 1.05-1.55)[m2] at the same day. At within-person level, exposure to smoking hotspot was associated with higher probability of reporting tobacco craving (AOR=1.58, 95% CI 1.05-2.38) and purchases (AOR=2.30, 95%CI 1.56-3.40) at the same day.
CONCLUSIONS: Smokefree policy inevitably produces smoking clusters at public areas. Exposure to such smoking hotspots potentially normalizes smoking behavior and leads to more tobacco craving and consumption in daily tobacco users. Guidance in encountering such environmental cue of smoking should be included in craving management.