15.4 Overview of key public areas and environments

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Implementing smokefree policies and legislation in some environments has proved more controversial and challenging than in others. This section outlines areas and environments that have faced unique hurdles in the smokefree debate.

15.4.1 Workplaces

Most Australian states and territories have adopted legislation banning smoking in workplaces (with a number of exceptions and variations as laid out in the state and territory summaries in Section 15.7) . A smokefree policy was adopted for all federal government workplaces in 1986.48 Workplace smoking bans were adopted primarily based on the occupational health and safety risk SHS exposure presents. Section 16 (1) of the Occupational Health and Safety Act 1991[1], imposes on all employers a duty to ensure, so far as is reasonably practical, that their workers are safe from injury and risks to their health while at work. In 2003, the National Occupational Health and Safety Commission (NOHSC) recommended that exposure to environmental tobacco smoke should be eliminated in all Australian workplaces. The Guidance Note on the Elimination of Environmental Tobacco Smoke in the Workplace (3019/2003) states: "The NOHSC has agreed that, given the health risks of environmental tobacco smoke, all Australian workplaces should be made completely smokefree as soon as possible, i.e. environmental tobacco smoke should be excluded".49 p1

15.4.2 Hospitality venues

Overseas examples of success in eliminating smoking in pubs and clubs, and the subsequent reductions in respiratory problems for staff, such as New Zealand, Norway, Ireland, California has influenced the debate in Australia.12, 22, 50–53 It has been found that eliminating smoking in pubs and clubs can reduce overall smoking prevalence and enhance standards of living for low-income earners and their children.54, 55

The tobacco industry has influenced the debate on smokefree areas, enlisted the aid of the hospitality sector, and its intervention is well documented, and described in other chapters.39, 43, 56 "The tobacco industry has effectively turned the hospitality industry into its de facto lobbying arm on clean indoor air. Public health advocates need to understand that, with rare exceptions, when they talk to organised restaurant associations they are effectively talking to the tobacco industry and must act accordingly."43 p94 

 15.4.2.1 Sleeping accommodation

All states and territories retain exemptions from smoking bans for private rooms in sleeping accommodation, including hotels and motels. Several international hotel chains have announced that they will no longer allow smoking even in private rooms and have elected to be entirely smokefree.57 In January 2006, Westin became the first hotel chain to ban smoking at all 77 locations in the United States, Canada and the Caribbean. Its smokefree policy has been since extended to include all hotels in Scotland, Australia and Fiji.[2] In October 2006, Marriott implemented a 100% smokefree policy in all 2300 hotels in the United States and Canada. This policy affects more than 400,000 guest rooms.[3] 

15.4.2.2 Cafes, restaurants

In the 1990s the restaurant trade supported a 'self regulation' approach to implementing smokefree areas in restaurants.58 A 1993 study examined whether nonsmoking policies had been implemented in accordance with the restaurateurs' perceived need for such policies. The research highlighted a large discrepancy between owner-perceived need and actual implementation: only one third of owners who thought they should provide smokefree areas actually provided such areas. The researchers concluded that, "self-regulation has not worked, as judged by the restaurant industry's own criterion of provision according to owners' perception of need."59 p1287

In 1994, the ACT became the first Australian government to ban smoking in restaurants. The successful60 and popular ban became, "a reference point to dispel industry scaremongering that the hospitality industry would face ruin because of smokers' reduced dining."61 p283 The ACT ban set a precedent that saw within six years of its introduction six out of eight states and territories move to ban smoking in restaurants.

A 2002 evaluation of South Australia's smokefree dining laws found that the legislation had "been adhered to by both the majority of restaurateurs and customers, and was inexpensive for restaurateurs to implement. Smokefree dining legislation can be implemented with confidence."62 p44

Smoking bans in cafes and restaurants came into force prior to bans in pubs and clubs. The reason for this discrepancy appears to be that politicians and the public were irritated by the effects of smoking in restaurants and around food, rather than for any public health reasons associated with differential effects. Restaurateurs were also more amenable to across-the-board smoking bans, and in some states such as Tasmania, would not support the position of the hotel industry association opposing smoking bans. 

15.4.2.3 Pubs and clubs

Licensed premises were among the last indoor environments and workplaces for smoking to be banned. (The reasons for this delay are detailed in Section 15.3.) Northern Territory is the only Australian jurisdiction that has yet to implement or announce an intention to implement a total ban in licensed premises; a partial ban is in place. Licensed premises are currently also the environment where people and particularly workers are the most likely to be exposed to SHS in Australia.63

The Australian Hotel Association (AHA) was the most vocal of opponents to banning smoking in licensed premises.42 A 2005 study examining the media themes (1996–2003) of bar smoking bans found that the AHA largely kept away from the health agenda and sought to reframe a ban as being economically devastating, impractical, and 'un-Australian'. The health effects of SHS were virtually uncontested in the media. The researchers concluded that, "either explicitly or by implication, the health perspective remained the core, unavoidable starting point of every media report about [SHS]."42 p683 

15.4.2.4 Casinos and poker machines

Most states have written exemptions into their smokefree legislation for highroller rooms in casinos. Tasmania, ACT and SA do not provide exemptions in their respective acts and all enclosed areas of casinos must be smokefree. WA allows smoking in high roller rooms provided the area meets ventilation requirements. In the case of NT, smoking is still permitted within all licensed premises, including casinos.

Smokers contribute more to gambling revenues than non-smokers and according to a gambling industry report, "smoking is a powerful re-enforcement for the trance-inducing rituals associated with gambling".64 p231 Public health advocates have reframed this argument as reduced time on poker machines being beneficial to the overall health of smoker who may also have a gambling problem. In NSW, licensed premises that provide poker machines have moved the machines to outdoor areas to enable smokers to play the machines while smoking.65

15.4.3 Institutions 

15.4.3.1 Hospitals and health facilities

While smoking within hospitals and health facilities is no longer permissible in any Australian jurisdiction, the debate about smoking on the grounds and outdoor areas of hospitals and health facilities is ongoing. Several district hospitals across states have enacted smoking bans on all hospital grounds.66, 67 Staff, visitors and patients must leave the grounds before lighting up. Patients are provided with nicotine replacement therapy to assist with the management of withdrawal and addiction. In 2006, Queensland implemented a policy banning smoking on all state hospital grounds. However, Northern Territory stated that "it [had] no plans to follow suit".68 p1 From 1 January 2008, smoking has not been permitted on all Department of Health premises and grounds throughout Western Australia. State-wide policy applies to all staff, patients, visitors, contractors and other persons who enter Department of Health buildings, grounds or vehicles. 

15.4.3.2 Mental health facilities

Smoking rates are high among mental health consumers. While smoking rates in the general population have fallen to under 20% about 40% of people with mental illness continue to smoke.69 Mental health treatment systems can also act to reinforce smoking and discourage cessation.70 A NSW project trialled the implementation of the Department of Health Smokefree Workplace Policy and concluded that a smokefree policy is entirely feasible for mental health units. The biggest barriers encountered were "staff resistance, habit and the leaden hand of administrative procedure".71 p1 In WA, a smokefree policy is in place at the State Forensic Mental Health Service, based at the Frankland Centre on the campus of Graylands Hospital. In July 2007, the Frankland Centre was the first mental health facility in the state to apply a total smoking ban. The premises and grounds of all other health services in WA, including all mental health facilities, have been smokefree since 1 January 2008.72 

15.4.3.3 Prisons

Many Australian prisons and other corrective services facilities still permit indoor smoking, sometimes with restrictions, but this is not consistent across the country. It may be that corrective services staff believe that prisoners would be more recalcitrant if smoking were not permitted, or it may be that tobacco control advocates have found it difficult to galvanise public opinion to support efforts to protect marginalised or stigmatised groups. Chapman has noted that these groups often are not counted in smoking statistics, "some subpopulations with high smoking rates are never included in estimates of national smoking. These include prisoners, the homeless, illegal immigrants, people in mental health institutions, people who do not speak the language of the country in which surveys are being conducted and poor people living in remote areas with no telephone."73 p145

In a NSW study of prison smoking, it was found that, "in most correctional facilities in Australia, there is the additional issue of indifference in social concern, and reluctance by correctional authorities to allocate resources and address tobacco use in prisons, an issue that is sometimes perceived as capable of disrupting the peace in correctional environments, through protests and riots by inmates."74 p85

The NSW Department of Corrective Services reported in 2007 that, "there have been a small number of workers' compensation claims that have attempted to link environmental tobacco smoke (ETS) exposure to illness. One of these claims related to alleged sensitivity developed by an ex-smoker and cancer sufferer to passive ETS."75 p1

In Queensland, prison smoking is not permitted in air-conditioned buildings, food preparation areas and dining rooms, visiting areas, vehicles, four metres from entrances and outdoor eating areas. Smoking is permitted in exercise areas, non air-conditioned cells and rooms and multi-occupant rooms where everyone smokes.76

In the Northern Territory juvenile facilities are smokefree. In adult prisons there are designated smoking and no-smoking areas, including accommodation. Prisoners can request no-smoking accommodation. Prisoners can request a medical referral for smoking-related issues, and NRT is supplied to prisoners on medical advice at cost. Cigarettes can be bought by inmates from the prison canteen at cost. On 21 December 2005 a WA newspaper report stated that a man was granted bail on the previous day, after arguing that the smoke in prison was causing him life-threatening asthma attacks.77

Canada's prisons are totally smokefree, including outdoor areas, under a policy that was phased in over May and June 2008. Maximum-security prisons became smokefree on 5 May 2008, followed by medium security prisons on 20 May 2008 and minimum security on 2 June 2008.78, 79 

15.4.3.4 Immigration Detention Centres—DIC[4]

The operational procedures of the Detention Services Provider outline the measures that are in place regarding smoking in immigration detention. All staff, visitors and detainees are advised that Commonwealth law specifically prohibits smoking in an "enclosed area of Commonwealth property" and states that smoking is forbidden in enclosed areas within immigration detention. Smoking is permitted in outside courtyards and exercise areas, covered areas such as walkways and other external areas as specified in signage.