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Background : To evaluate changes in smoke free rules in the foster care system after the implementation of the Romanian national clean air law. Methods : A repeated cross-sectional, self-administered questionnaire among foster care employees ( n = 599) was conducted in 58 foster care homes during 2014 ( n = 295) and 51 homes during 2016 ( n = 304). We estimated the absolute difference in the proportion of employees who stated that smoke free rules existed before and after national clean air legislation. Results : There was an absolute increase in 4 of 5 smoke free measures after the law: bans on non-cigarette tobacco products ( n = 169 to 206, +10.6%), non-smoking on premises for adults ( n = 142 to 202, +18.3%), and for children ( n = 201 to 239, +10.3%), and no smoking in cars to transport children ( n = 194 to 227, +9%). There was a significant increase in the perception of outdoor bans that prohibit employees from smoking on foster care home premises (AOR 2.24, 95% CI 1.14⁻4.38). The increase in the perception of indoor smoking bans did not change. Conclusion : The national law may have had a spillover influence by strengthening smoke free rules in unregulated spaces. Nonetheless, foster care home rules could be further enhanced, particularly in cars that transport children.

Home- and Car-Based Rules in Foster Care Settings to Reduce Exposure to Secondhand Smoke: Before and after Romanian National Clean Air Legislation