RISKY BEHAVIOUR
Smoke-free outdoor areas: supporting local government to introduce tobacco control policies Andy J. Mark,1,2 Stafford C. Sanders,3 Julie Anne Mitchell,1 Holly Seale,2 Robyn L. Richmond2
M
ore than 10% of smoking-related deaths are due to secondhand smoke (SHS), with children and women more likely to die due to exposure.1 To date, most research, health promotion and advocacy efforts to reduce exposure to SHS have focused on indoor settings such as workplaces,2 pubs and clubs,3 and restaurants.4 This change in cultural and environmental practice in work and public spaces has had an effect in private spaces such as cars and homes.5 Australian surveys6 have measured the prevalence of people whose home is smoke-free, and have found an increase from 71.5% in 1997–19987 to 92.6% in 2010.8 In countries with legislation making indoor environments smoke-free, the decrease in exposure to SHS has coincided with a decrease in hospitalisation for associated chronic illnesses in both adults9 and children.10 International hospitalisation data suggests that with a decrease in exposure to SHS there is a corresponding decrease in risk of acute myocardial infarction.11,12 With the increase of indoor areas being covered by smoke-free legislation and the decrease in the prevalence of population smoking rates in high resource countries, there is growing interest in making specific outdoor areas smoke-free.13 While the health effects of outdoor exposure to SHS are not yet measurable compared to indoor exposure, research suggests that SHS levels in some outdoor environments can approach those found indoors, potentially posing a health risk.14,15 In addition, the US Surgeon
Abstract Objectives: To ascertain the proportion of councils with smoke-free outdoor areas (SFOA) policies in New South Wales (NSW), Australia and to explore the enablers and barriers to local governments introducing such policies. Methods: A structured survey of council staff at NSW councils was conducted by telephone in 2011. Participants were asked about the existence of any SFOA policy, and enablers and barriers of the policy. Results: The study was completed by 148 of 152 NSW councils. Eighty five (57%) councils had an SFOA policy, with playgrounds most likely to be covered by the policy. The most frequently cited enabler for the introduction of SFOA policy was direct advocacy letters, while the most commonly mentioned barrier was a lack of resources. Conclusion and implications: In the absence of state or federal legislation, local government or councils may respond to community expectations for smoke-free outdoor areas by introducing policy. Advocacy and support from non-government health organisations can increase the likelihood of this occurring and address barriers facing councils, with rural councils most likely to benefit from such support. Interest from councils can influence the adoption of state-wide smoke-free outdoor areas legislation. Key words: smoke-free outdoors, local government, tobacco control, advocacy
General warns that exposure to SHS can be life threatening and restriction of smoking in public places is needed.16 In New South Wales (NSW), Australia, population surveys demonstrate that the public strongly supports the introduction of smoke-free policy in a range of outdoor areas,17,18 with 94% of respondents supporting smoke-free children’s playgrounds, 86% smoke-free sports stadiums, 74% smoke-free beaches18 and 83% smoke-free outdoor dining and drinking.19 Internationally, smoke-free outdoor areas (SFOA) legislation and policy has been implemented in a number of jurisdictions
including California,20 New York,21,22 Canada,23 New Zealand24 and Japan.25 In Australia, tobacco control is typically the jurisdiction of state and federal governments. However, as early as 2004 a number of progressive councils in NSW, responding to public demands, introduced SFOA.26,27 SFOA policy addresses the health of community members and environmental issues, such as litter and community amenity.28 Initial advocacy directed to state governments in Australia met with mixed results, with Queensland the first state to introduce SFOA legislation in 2005/06.29 In NSW, the State Government initially
1. Cardiovascular Health, National Heart Foundation of Australia, New South Wales 2. School of Public Health and Community Medicine, University of New South Wales 3. Action on Smoking and Health Australia, New South Wales Correspondence to: Mr Andy J. Mark, National Heart Foundation of Australia (NSW Division) - Cardiovascular Health, Illawarra Office, Kiama, New South Wales 2533; e-mail: [email protected] Submitted: February 2014; Revision requested: April 2014; Accepted: May 2014 The authors have stated they have no conflict of interest. Aust NZ J Public Health. 2014; 38:518-23; doi: 10.1111/1753-6405.12265
518
Australian and New Zealand Journal of Public Health © 2014 Public Health Association of Australia
2014 vol. 38 no. 6
Risky Behaviour
Smoke-free outdoor areas
rejected calls from non-government health organisations (NGOs) for SFOA legislation. In 2006, the SFOA Working Party – a sub-group of the NSW Tobacco Control Network – was formed to encourage and support NSW councils to introduce SFOA policy. These areas included: within 10 metres of children’s playgrounds, sporting fields and facilities, outdoor dining areas, covered bus and taxi stands and crowded areas of beaches and reserves. The working party included members from NGOs and councils who led the development and introduction of local SFOA policy.
from the SFOA Working Party or health professionals; and two SFOA workshops.
Study design The SFOA Local Government survey was developed in 2007, and has been conducted yearly by the Heart Foundation.31 In 2011, approval was obtained from the University of New South Wales Medical and Community Human Research Ethics Advisory Panel for inclusion of the 2011 results into a thesis. This study is limited to reporting the findings from the 2011 survey.
Councils were categorised as urban or rural according to the Australian Classification of Local Government.32 The Pearson chi-square test was used to assess statistical association in univariate analyses and a p-value of
Smoke-free outdoor areas: supporting local government to introduce tobacco control policies Andy J. Mark,1,2 Stafford C. Sanders,3 Julie Anne Mitchell,1 Holly Seale,2 Robyn L. Richmond2
M
ore than 10% of smoking-related deaths are due to secondhand smoke (SHS), with children and women more likely to die due to exposure.1 To date, most research, health promotion and advocacy efforts to reduce exposure to SHS have focused on indoor settings such as workplaces,2 pubs and clubs,3 and restaurants.4 This change in cultural and environmental practice in work and public spaces has had an effect in private spaces such as cars and homes.5 Australian surveys6 have measured the prevalence of people whose home is smoke-free, and have found an increase from 71.5% in 1997–19987 to 92.6% in 2010.8 In countries with legislation making indoor environments smoke-free, the decrease in exposure to SHS has coincided with a decrease in hospitalisation for associated chronic illnesses in both adults9 and children.10 International hospitalisation data suggests that with a decrease in exposure to SHS there is a corresponding decrease in risk of acute myocardial infarction.11,12 With the increase of indoor areas being covered by smoke-free legislation and the decrease in the prevalence of population smoking rates in high resource countries, there is growing interest in making specific outdoor areas smoke-free.13 While the health effects of outdoor exposure to SHS are not yet measurable compared to indoor exposure, research suggests that SHS levels in some outdoor environments can approach those found indoors, potentially posing a health risk.14,15 In addition, the US Surgeon
Abstract Objectives: To ascertain the proportion of councils with smoke-free outdoor areas (SFOA) policies in New South Wales (NSW), Australia and to explore the enablers and barriers to local governments introducing such policies. Methods: A structured survey of council staff at NSW councils was conducted by telephone in 2011. Participants were asked about the existence of any SFOA policy, and enablers and barriers of the policy. Results: The study was completed by 148 of 152 NSW councils. Eighty five (57%) councils had an SFOA policy, with playgrounds most likely to be covered by the policy. The most frequently cited enabler for the introduction of SFOA policy was direct advocacy letters, while the most commonly mentioned barrier was a lack of resources. Conclusion and implications: In the absence of state or federal legislation, local government or councils may respond to community expectations for smoke-free outdoor areas by introducing policy. Advocacy and support from non-government health organisations can increase the likelihood of this occurring and address barriers facing councils, with rural councils most likely to benefit from such support. Interest from councils can influence the adoption of state-wide smoke-free outdoor areas legislation. Key words: smoke-free outdoors, local government, tobacco control, advocacy
General warns that exposure to SHS can be life threatening and restriction of smoking in public places is needed.16 In New South Wales (NSW), Australia, population surveys demonstrate that the public strongly supports the introduction of smoke-free policy in a range of outdoor areas,17,18 with 94% of respondents supporting smoke-free children’s playgrounds, 86% smoke-free sports stadiums, 74% smoke-free beaches18 and 83% smoke-free outdoor dining and drinking.19 Internationally, smoke-free outdoor areas (SFOA) legislation and policy has been implemented in a number of jurisdictions
including California,20 New York,21,22 Canada,23 New Zealand24 and Japan.25 In Australia, tobacco control is typically the jurisdiction of state and federal governments. However, as early as 2004 a number of progressive councils in NSW, responding to public demands, introduced SFOA.26,27 SFOA policy addresses the health of community members and environmental issues, such as litter and community amenity.28 Initial advocacy directed to state governments in Australia met with mixed results, with Queensland the first state to introduce SFOA legislation in 2005/06.29 In NSW, the State Government initially
1. Cardiovascular Health, National Heart Foundation of Australia, New South Wales 2. School of Public Health and Community Medicine, University of New South Wales 3. Action on Smoking and Health Australia, New South Wales Correspondence to: Mr Andy J. Mark, National Heart Foundation of Australia (NSW Division) - Cardiovascular Health, Illawarra Office, Kiama, New South Wales 2533; e-mail: [email protected] Submitted: February 2014; Revision requested: April 2014; Accepted: May 2014 The authors have stated they have no conflict of interest. Aust NZ J Public Health. 2014; 38:518-23; doi: 10.1111/1753-6405.12265
518
Australian and New Zealand Journal of Public Health © 2014 Public Health Association of Australia
2014 vol. 38 no. 6
Risky Behaviour
Smoke-free outdoor areas
rejected calls from non-government health organisations (NGOs) for SFOA legislation. In 2006, the SFOA Working Party – a sub-group of the NSW Tobacco Control Network – was formed to encourage and support NSW councils to introduce SFOA policy. These areas included: within 10 metres of children’s playgrounds, sporting fields and facilities, outdoor dining areas, covered bus and taxi stands and crowded areas of beaches and reserves. The working party included members from NGOs and councils who led the development and introduction of local SFOA policy.
from the SFOA Working Party or health professionals; and two SFOA workshops.
Study design The SFOA Local Government survey was developed in 2007, and has been conducted yearly by the Heart Foundation.31 In 2011, approval was obtained from the University of New South Wales Medical and Community Human Research Ethics Advisory Panel for inclusion of the 2011 results into a thesis. This study is limited to reporting the findings from the 2011 survey.
Councils were categorised as urban or rural according to the Australian Classification of Local Government.32 The Pearson chi-square test was used to assess statistical association in univariate analyses and a p-value of
