This paper is divided into two parts. The first part explains the methodology of systematic literature searches and reviews, covering inclusion and exclusion criteria, documentation practices, primary versus secondary research, and the formulation of research hypotheses. The second part applies these principles to the topic of smoking in urban outdoor public spaces. It examines the epidemiology of secondhand smoke exposure, the health consequences for both smokers and non-smokers, relevant legislation in Canada and internationally, and the social determinants that shape smoking behavior in public. The paper concludes by identifying gaps in current research and calling for broader study of outdoor smoking and evolving public attitudes.
Probing, seriously investigating, and synthesizing the literature are vital skills for researchers. There is a massive amount of text and other material that is easily accessible, and it can be genuinely difficult to identify where to begin. It is therefore imperative that one is methodical — organized and precise — in one's approach while searching through available information. It is important to understand the search plan: what to include and what to exclude. For example, one might consider only studies that feature randomized controlled trials, or select only those studies published within the last five years because that is where changes in health policy have been most prominent. The databases searched and the keywords used should always be recorded.
In a systematic literature review, evidence from prior studies is located, examined, and synthesized using a rigorous and logical scientific approach. Once this process is complete, a systematic search becomes a systematic review. This involves reading all identified references thoroughly — while time may not permit reading every source in full, summaries can be read for most, with complete articles consulted for the most important ones. The process of what was included and what was excluded should be documented as part of the study.
The primary purpose of the systematic review is to produce a comprehensive and impartial assessment of the available evidence. Once the research has been located and assessed against acceptance and rejection criteria — such as requiring up-to-date journals and robust designs like randomized controlled trials (RCTs) — the results are typically organized into thematic topics. The topics that emerge from the research and all references within each topic must be documented. Part of the search process may also involve consultations with subject-matter experts. It is essential to document how sources were retrieved at every stage of the search process. After the initial search, a large number of articles may be returned, requiring further filtering — for instance, limiting results to English-language articles with strong research designs, or restricting the search to psychological rather than sociological databases (see Saks, 2007, under Systematic Review).
By following these steps, a researcher is conducting a methodical, systematic search. The example that follows illustrates this process in the context of a literature review focused on patient issues.
Incorporating the patient's perspective from the very first stage of the process is essential if the review is to have a meaningful effect on the definition of final parameters. One of the instruments used to achieve this precise focus on patient issues involves documenting findings prior to the initial meeting of a guideline development group. The scope of this type of search is not restricted to any particular study design; it is structured to take into account both quantitative and qualitative evidence. As part of a literature review, it is conducted in a similar fashion to other searches, drawing on the same range of databases and sources. It differs in that it also covers nursing and psychological literature, even where there is no specific connection to the medical literature used in subsequent searches. The results of this type of search are then filtered to identify publications relevant to the guideline topic. Using a standard checklist, the methodology of each paper is evaluated wherever feasible. The evaluation and search process may be classified into groups that direct attention to the primary concerns of the patients involved. These insights are then used by the guideline development group to help articulate the essential questions related to those patients.
Non-peer-reviewed sources are sometimes referred to as grey literature. Such materials may not have undergone peer review, but they can still be of high value and should be taken into account. This category includes reports and monographs typically published by government agencies, welfare and community organizations, and universities. Grey literature is commonly available online. Useful sources include the United States Centers for Disease Control and Prevention and comparable government health departments in other countries.
Note: The majority of references cited in academic work should come from peer-reviewed sources, including research and scientific journals and articles.
A research paper published under the name of its original author constitutes primary research. Such a paper includes the study's rationale and methodology, presents comprehensive results with their interpretations, and provides a detailed reference list at the end. It also supplies sufficient information for other researchers to replicate the study. Secondary research, by contrast, typically presents an assessment of a particular area. Examples include textbook chapters, newspaper and magazine articles, documentaries, and other compiled sources. An example of secondary research is the articles available on the Cochrane database.
When conducting a literature review — particularly when writing the introduction — the writer should ensure that the literature review builds toward the research question or hypotheses stated at the end of the introduction. Hypotheses can be defined as predictions that the author sets out to either confirm or refute, based on an established theory. For example: unemployed status is hypothesized to lower an individual's self-esteem compared to their self-esteem when employed (Winefield, Winefield, Tiggemann, and Goldney, 1993).
When planning a review, several considerations are important. First, the review should be relevant to the research problem and should inform readers with verified knowledge. The problem being studied should be situated within an existing theoretical framework, even if the research ultimately points toward a new theory. A review that merely reaffirms an existing theory without adding a new dimension is considered less productive for advancing scholarship. Second, the literature review should be logically coherent and consistent in its argumentation. There are many ways to organize and present material, and choosing the best approach can be difficult — the most important thing is to begin and to refine the structure over time. Third, the researcher should consider multiple perspectives and select the most relevant and useful angle. Finally, the review should not merely summarize existing work; it should offer deep analysis, articulating research methodologies, contextual assumptions, and the broader implications of the research (Kaufman et al., 2010).
The increasing number of restrictions on indoor smoking has contributed to a growing trend of smoking outside the home. This has created an emerging public health and social concern in urban environments. Outdoor smokers affect people in their immediate surroundings and expose them to secondhand smoke. According to research, approximately 53% of Canadian adults are exposed to secondhand smoke when entering a building (Health Canada, 2008).
In outdoor environments, smoking creates public health concerns because there is no established safe level of exposure (US Department of Health and Human Services, 2006). Outdoor smoking and the associated exposure have a considerable impact on bystanders, comparable in some respects to indoor smoking exposure (Repace, 2005; California Air Resources Board, 2005; Klepeis et al., 2007; Hall et al., 2009). A further report suggests that tobacco smoke near building entrances is a major concern, as its harmful effects may exceed those of other outdoor sources (Kaufman et al., 2009; Kennedy et al., 2009).
Secondhand smoke is considered a major contributing factor to increased rates of respiratory disease, lung and nasal cancer, and breathing difficulties. It can also cause the following medical concerns for both smokers and non-smokers:
Short-term smoke exposure can cause problems for individuals with sensitive cardiovascular systems (US Department of Health and Human Services, 2006; Barnoya and Glantz, 2005; Sargent et al., 2004; Pechacek and Babb, 2004) and may also lead to respiratory irritation, eye irritation, and asthma (US Department of Health and Human Services, 2006). A recent study found that even brief exposures of approximately 30 minutes can cause vascular damage and injury (Heiss et al., 2008). In addition, smoking near building entrances increases fire risk, contributes to toxic litter, and creates a negative impression of the building for visitors (Nagle et al., 1996; Parry et al., 2000; Alesci et al., 2003). These concerns have collectively contributed to an increase in jurisdictional measures implementing smoking restrictions in public places (Kaufman et al., 2010).
Across major Canadian provinces and cities, smoking prohibition legislation covers a wide range of public places and outdoor settings, including playgrounds, sports and leisure facilities, public parks, beaches, transit areas, and public events (Non-Smokers' Rights Association, 2009). In some cases, restrictions also extend to building entrances. By January 2010, nearly every Canadian province had introduced legislative measures to prohibit outdoor smoking near entrances, windows, and air intakes of buildings such as hospitals, workplaces, and public halls (Smoking and Health Action Foundation/Non-Smokers' Rights Association, 2010).
Ontario's Smoke-Free Ontario Act (SFOA), for example, restricts smoking within a nine-metre radius of the entrances to sensitive buildings such as healthcare centres, psychological rehabilitation centres, residential care homes, and private clinics. Approximately 25 municipalities in Ontario have expanded the scope of this legislation to cover areas two to ten metres from entrances, public buildings, operable windows, and all types of workplaces and public facilities — including Thunder Bay and Sioux Lookout (Smoking and Health Action Foundation/Non-Smokers' Rights Association, 2010). In the City of Woodstock, Ontario, businesses may define their own smoke-free zones by contacting local authorities and having restrictions enforced by bylaw, prohibiting smoking within nine metres of a building or public entrance (Non-Smokers' Rights Association, 2009; City of Woodstock, 2008; Kaufman et al., 2010).
At the global level, several governments have not only deliberated on outdoor smoking legislation but have enacted it. The Tasmanian government, for instance, has passed legislation banning smoking within three metres of any public place or building (Smoking and Health Action Foundation/Non-Smokers' Rights Association, 2010). The European Union has also considered anti-smoking measures, with England potentially leading the way toward stricter laws (BBC News, 2002). In Tokyo, Japan, the government has banned smoking not only on streets but also in heavily crowded areas (BBC News, 2002). In California, smoking has been banned in alleyways, public recreational areas, and within twenty feet of building exits and entrances (City of Calabasas, 2006).
Thomson et al. (2009) found that as public awareness has grown, support for banning smoking in public places has become widespread. Accompanying this rising support has been a declining tolerance for smokers. The rejection of smoking in public places can result in the social isolation of smokers, which has been shown to lead either to quitting or to a gradual reduction in smoking consumption (Stuber et al., 2008). Similarly, social norms and customs that reduce the social acceptability of smoking have contributed to a weakening of smoking culture more broadly (Alamar and Glantz, 2006).
"Distinguishing source types and forming hypotheses"
City of Calabasas, 2006. Ordinance No. 2006-217. An ordinance of the city of Calabasas regulating secondhand smoke and amending the Calabasas municipal code.
California Air Resources Board, California Environmental Protection Agency, 2005. Technical report: proposed identification of environmental tobacco smoke as a toxic air contaminant. California Environmental Protection Agency, Sacramento, CA.
City of Woodstock, 2008. The Corporation of the City of Woodstock Municipal Code. Chapter 835, Smoke-free workplaces and public places bylaw.
DiFranza, J.R., Lew, R.A., 1996. Morbidity and mortality in children associated with the use of tobacco products by other people. Pediatrics 97, 560–568.
Hall, J.C., Bernert, J.T., Hall, D.B., St. Helen, G., Kudon, L.H., Naeher, L.P., 2009. Assessment of exposure to secondhand smoke at outdoor bars and family restaurants in Athens, Georgia, using salivary cotinine. Journal of Occupational and Environmental Hygiene 6, 698–704.
Health Canada, 2008. Canadian Tobacco Use Monitoring Survey (CTUMS) 2007. Health Canada, Ottawa.
Heiss, C., Amabile, N., Lee, A.C., et al., 2008. Brief secondhand smoke exposure depresses endothelial progenitor cells activity and endothelial function. Journal of the American College of Cardiology 51, 1760–1771.
Johnson, K.C., 2005. Accumulating evidence on passive and active smoking and breast cancer risk. International Journal of Cancer 117, 619–628.
"Canadian and international smoking legislation and social norms"
Stuber, J., Galea, S., Link, B.G., 2008. Smoking and the emergence of a stigmatized social status. Social Science and Medicine 67, 420–430.
Thomson, G., Wilson, N., Edwards, R., 2009. At the frontier of tobacco control: a brief review of public attitudes towards smoke-free outdoor places. Nicotine and Tobacco Research 11, 584–590.
US Department of Health and Human Services, 2006. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General. Centers for Disease Control and Prevention, Office on Smoking and Health, Atlanta, GA.
US Environmental Protection Agency, 1992. Technical Report EPA/600/6-90/006F: Respiratory Health Effects of Passive Smoking: Lung Cancer and Other Disorders. Office of Research and Development, Washington, DC.
You’re 75% through this paper. Sign up to read the remaining 2 sections.
Sign Up Now — Instant Access Already a member? Log inAlways verify citation format against your institution’s current style guide requirements.