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; see Chapter 15, Section 15.7). Smoking bans were adopted in most indoor workplaces throughout Australia many years before such legislation was introduced, primarily based on acceptance by employers that secondhand smoke (SHS) exposure presented an occupational health and safety risk to employees.1,2 Section 16 (1) of the Occupational Health and Safety Act 1991i 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' (p1).3
Implementing smokefree policies and legislation in some workplaces has proved more controversial and challenging than in others. A detailed description of the legislation applicable in each state and territory is set out in Chapter 15, Section 15.7. The material below provides an overview of the unique hurdles faced in gaining support for or implementing policies to protect against SHS in a number of venues and environments. Issues relevant to restriction of smoking in outdoor areas that do not constitute workplaces are covered in Section 15.5. Data about the acceptability of various sorts of policies is covered in Section 15.2. Evidence about the feasibility of, and compliance with, smoking bans is covered in Section 15.8. The final sections of this chapter describe evidence that such bans have been associated with changes in exposure to environmental tobacco smoke, smokers' behaviour (Section 15.9) and declines in illness and deaths from asthma and heart disease (Section 15.10).
Success in Canada, New Zealand, Norway, Ireland and California in eliminating smoking in pubs and clubs, and subsequently in reducing respiratory problems for staff, encouraged the push for smokefree hospitality venues in Australia.4–7
Smoking bans in cafés and restaurants came into force in Australia prior to bans in pubs and clubs in every state and territory. Public support for bans in dining areas was higher than support for bans in pubs and clubs at the time smokefree dining legislation was introduced, and the tobacco and hotel industries vigorously opposed bans in licensed premises. In the 1993 parliamentary debates for the introduction of smokefree dining legislation in the Australian Capital Territory (the first jurisdiction in Australia to introduce such legislation), the Minister for Health indicated that the proposed legislation did not apply to pubs and clubs due to the challenges for owners and managers in introducing smoking bans in these areas where smoking 'traditionally occurred'; the Minister stated the government preferred to transition to smoking bans in licensed premises over time (p4693).ii
Unlike the US, where more than 28 states and hundreds of local cities and counties have legislated to require a minimum proportion of smokefree rooms in hotels,8 in Australia, 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.9 In January 2006, Westin became the first hotel chain to ban smoking at all 77 locations in the US, Canada and the Caribbean. Its smokefree policy has been since extended to include all hotels in Scotland, Australia and Fiji.iii In October 2006, Marriott implemented a 100% smokefree policy in all 2300 hotels in the US and Canada. This policy affects more than 400,000 guest rooms.iv
In the 1990s the restaurant trade supported a 'self regulation' approach to implementing smokefree areas in restaurants.10 A 1993 study examined whether non-smoking 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' (p1287).11
In 1994, the Australian Capital Territory became the first Australian government to ban smoking in restaurants. The successful12 and popular ban became 'a reference point to dispel industry scare mongering that the hospitality industry would face ruin because of smokers' reduced dining' (p283).13 The Australian Capital Territory ban set a precedent: within six years of its introduction six out of eight states and territories moved to ban smoking in restaurants. By 2003 all states and territories had implemented smokefree indoor dining, with bans commencing in Queensland in 2002 and in the Northern Territory in 2003.
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. Smoke-free dining legislation can be implemented with confidence' (p44).14 Further evidence on the feasibility of, and compliance with, such legislation is described in Chapter 15, Section 15.8.
Jurisdictions with smoking bans in outdoor dining areas include the Australian Capital Territory, the Northern Territory, Queensland, Tasmania and Western Australia. The South Australian Government announced in March 2011 that it plans to phase in smokefree al fresco dining by 2016.15 Tasmania was the first state to implement a smoking ban in al fresco dining areas with a ban applying to 50% of outdoor dining areas commencing in 2005. In March 2011 the Tasmanian Government announced that it intends to introduce legislation to make outdoor dining areas 100% smokefree.16 Queensland was the first state to implement a smoking ban that covered 100% of al fresco dining areas, with effect from July 2006. The hospitality industry has continued to oppose smokefree al fresco dining legislation.17,18 Following ongoing calls for smokefree dining from tobacco control advocates, the New South Wales and Victorian governments have both indicated that they are willing to consider enacting bans.19–21
In the absence of, or prior to, the enactment of state legislation, a growing number of local governments across Australia have implemented smoking bans in al fresco dining areas under their control. These include Fremantle, the Vincent and Joondalup councils in Western Australia, and a number of councils in New South Wales. As of 31 July 2010, 22 New South Wales councils had adopted or voted to adopt smokefree al fresco dining policies. This includes regional councils (such as Bega Valley, Newcastle and Wagga Wagga) and metropolitan councils (including Leichhardt, Mosman, Newcastle, Parramatta, Pittwater, Ryde, Willoughby and Waverley).22
Licensed premises were among the last indoor environments and workplaces for smoking to be banned. (The reasons for this delay are detailed in Chapter 15, Section 15.3.) Licensed premises were also the environment where people and particularly workers were the most likely to be exposed to SHS in Australia.23 The first state or territory to ban smoking in pubs and clubs was the Australian Capital Territory in 1998. The Northern Territory was the last jurisdiction to act, bringing in a ban on smoking in enclosed areas of licensed premises from 2 January 2010.
The Australian Hotels Association was the most vocal opponent of banning smoking in licensed premises.24 A 2005 study examining the media themes (1996–2003) of bar smoking bans found that the Australian Hotels Association 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 ETS' (p683).24
Several states and territories have written exemptions into their smokefree legislation for high-roller rooms in casinos. However Tasmania, the Australian Capital Territory and South Australia do not provide exemptions in their respective acts and all enclosed areas of casinos must be smokefree. Casinos in New Zealand are also smokefree. Western Australia allows smoking in high-roller rooms provided the area meets ventilation requirements.
Smokers contribute more to gambling revenues than non-smokers and, according to a gambling industry report, 'smoking is a powerful reinforcement for the trance-inducing rituals associated with gambling' (p231).25 Smokefree policies in Victorian gambling venues were found to lead to an abrupt, long-term decrease in electronic gaming machine losses, suggesting that policies have an impact on slowing gambling losses.26 Public health advocates have reframed this argument as reduced time on poker machines being beneficial to smokers who may also have a gambling problem.26
In New South Wales, licensed premises that provide poker machines have moved the machines to outdoor areas to enable smokers to play the machines while smoking.27,28 Outdoor gambling areas have also been set up in the Australian Capital Territory, South Australia, Tasmania and Western Australia. In March 2011 the South Australian Government's Office of the Liquor and Gambling Commission directed Adelaide Casino to shut down poker machines that the casino had moved to an outdoor courtyard to allow smokers to continue gambling outside.29
The Commonwealth Department of Health adopted a smokefree workplace policy with effect from 1 December 1986. A smokefree policy in enclosed areas was adopted in November 1986, providing for all Commonwealth government departments to become smokefree by March 1988.30
Australia's Parliament House was declared smokefree by the then Presiding Officers, Senator the Hon. Kerry Sibraa and the Hon. Leo McLeay MP in May 1991.
Enclosed areas of the New South Wales parliamentary precincts became smokefree in January 1994; this was the last public service department and the last parliament in Australia to ban smoking in enclosed areas.
By the mid-1990s, all state and Commonwealth government offices were smokefree.
While smoking within enclosed areas of hospitals and health facilities is no longer permissible in any Australian jurisdiction, the debate continues about smoking on the grounds and in outdoor areas of hospitals and health facilities.
The World Health Organization has recommended that all health care premises and their immediate surrounds be smokefree, and that healthcare staff be provided with assistance to quit smoking where appropriate.31
Some Australian states and territories, such as South Australia and Western Australia, have adopted total smoking bans within the grounds of public health facilities. In other states and territories, smoking is permitted in designated outdoor areas of public hospitals and health facilities.
A totally smokefree policy for Western Australia Department of Health premises and grounds came into effect in 2008, and a similar policy for South Australia Health facilities commenced in May 2010. Both policies apply to staff, patients and visitors, and apply throughout the hospital or health service grounds including car parks. Persons wishing to smoke must leave the grounds to do so.
The 1999 New South Wales Health Smoke Free Workplace Policy provided for all of its facilities to work towards becoming totally smokefree over a number of years. Under the final phase of policy implementation, smoking would be banned throughout health facility buildings, vehicles and property. In January 2005, New South Wales Health issued a mandatory policy directive that health facilities should continue to work towards becoming totally smokefree in accordance with the 1999 policy, after meeting criteria relating to public awareness, staff consultation and provision of smoking cessation support for staff.
Smoking was banned in all Queensland state hospital grounds, other than in outdoor nominated smoking places, in 2006. A similar policy has applied to the Northern Territory Department of Health and Families premises since 2009, with hospitals being permitted to identify up to two designated outdoor smoking areas. The smokefree policy for the Australian Capital Territory Health facilities also provides for smoking in designated outdoor smoking areas.
Generally, Australian legislation banning smoking in enclosed workplaces provides exemptions for workplaces that are also individuals' homes or dwelling places, such as prisons, mental health institutions and nursing homes.
Smoking prevalence is high among people with a mental illness. While smoking rates in the general population have fallen to under 20%,32 smokers are almost twice as likely as non-smokers to report suffering high rates of psychological distress in the previous year.32 Rates of smoking are higher still among those who live with serious mental illness (see Chapter 9, Section 9.6.4). Many policies and practices within mental health treatment services in the past have acted to reinforce smoking behaviour and discourage cessation attempts.33 While staff have been concerned about the feasibility of introducing smokefree policies, two major reviews of the effects of smokefree policies in psychiatric institutions found that patients generally adapted more quickly than staff, staff concerns about difficult or aggressive reactions from patients were generally unfounded, and total bans were more successful than partial bans (p69).34
Consistent with smokefree policies adopted within other sectors of health care services, mental health care services should also be reinforcing smokefree messages, supporting smokers to quit and managing nicotine dependence during hospital admissions.
In more recent years, South Australia, Western Australia and New South Wales have acted to ensure that policies and practices in mental health facilities are not reinforcing smoking behaviour, as has occurred in previous decades. These policies require smokefree mental health services and include a focus on staff training, supporting smokers to quit and the appropriate management of nicotine dependence and withdrawal symptoms during hospital admissions and outpatient programs.
In 2009, the New South Wales Department of Health developed guidelines to facilitate the adoption of its Smoke Free Workplace Policy in mental health facilities.35 This followed a trial, which concluded that a smokefree policy was entirely feasible for mental health units. The biggest barriers encountered were 'staff resistance, habit and the leaden hand of administrative procedure' (p1).36
West Australian Department of Health premises, including mental health facilities, became smokefree from 1 January 2008. The state's Council of Official Visitors called for a review of the policy in its 2010 annual report, following reports of mental health patients poking electricity sockets with paper clips to obtain a spark to light a cigarette.37 The Mental Health Minister responded that no hospitals would be exempt from the smokefree policy.
The South Australian Department of Health introduced a totally smokefree policy for mental health institutions from November 2010, six months after the smoking ban commenced in other public health facilities.
In Victoria, Melbourne Health voluntarily adopted a totally smokefree policy for its mental health facilities in the city's north and west in April 2009.
High smoking prevalence rates are reported among prisoners.38 The threat of SHS exposure in prisons where smoking is permitted in enclosed spaces is high.39,40 Incarceration can also lead to non-smokers taking up smoking and smokers increasing their cigarette consumption.41 The New South Wales 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' (p1).42
Many Australian prisons and other corrective services facilities still permit smoking indoors, 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' (p145).43
In a New South Wales 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' (p85).44
The West Australian Department of Corrective Services introduced a trial smoking ban in enclosed areas of Greenough regional prison in 2008. Prisoners were provided with nicotine patches, lozenges and support programs to help them quit or reduce smoking. The department subsequently issued a policy banning smoking in enclosed areas of prisons across Western Australia, with effect from 30 June 2009. Under the policy, prisoners are only permitted to smoke in designated outdoor areas and may not smoke inside cells or units.45
In 1997, a total smoking ban was introduced in Queensland's Woodford prison. However the policy was abandoned after 120 inmates rioted following the policy's implementation. This is the only instance of an attempted total smoking ban in an Australian prison to date. In Queensland prisons, smoking is not permitted in prison cells, air-conditioned buildings, food preparation areas or dining rooms, play or residential areas in mothers and babies units, vehicles, within 4 m of building entrances or in outdoor eating or drinking places. Smoking is permitted in nominated smoking places.46
Canada's Commissioner of Correctional Service issued a directive that federal prisons must be totally smokefree from April 2008, including outdoor areas.47 Prisoners successfully challenged the legality of the policy in the Canadian Federal Court in October 2009. However the Federal Court's decision was overturned and the smokefree policy was reinstated in 2010. The Federal Court of Appeal ruled that the Commissioner of the Correctional Service had authority to issue the smokefree directive in accordance with laws governing penitentiaries.48
In England and Wales, indoor areas of prisons, except for cells occupied only by smokers aged 18 and over, have been required to be smokefree since 2007.49 Indoor areas of facilities holding persons under 18 years of age must be entirely smokefree. The Prison Service has stated that it intends to work towards 100% smokefree prisons in the future, and that prisoners will be provided with assistance in smoking cessation as far as possible.49 The Isle of Man became the UK's first completely smokefree prison in 2008.
In June 2010 the New Zealand Government announced that smoking would be prohibited in prisons from July 2011, in order to reduce health risks associated with SHS exposure and risk of injury caused by cigarette lighters.
In the US the Federal Bureau of Prisons made all facilities under its control 100% smokefree in July 2004.50 Correctional facility inmates, employees and visitors must all observe the policy. The American Jail Association, the American Correctional Association, and the National Commission on Correctional Health have all adopted smokefree resolutions that promote smokefree policies in jails and prisons. According to the American non-smokers rights group, in the US as at 1 April 2011, correctional facilities are 100% smokefree indoors and outdoors on all grounds in Arkansas, Florida (effective 9/2011), Georgia, Iowa, Louisiana, Maine, Michigan, Minnesota, Nebraska, Nevada, North Carolina, Puerto Rico, Ohio, Rhode Island, North Carolina, Virginia and Wyoming. Facilities are smokefree in California (employee housing exempt), Colorado, Delaware, Hawaii, Illinois, Kentucky (except Eddyville State Penitentiary), Massachusetts, Montana, New Hampshire, New York, Oklahoma, Texas, Utah, Vermont and Washington.50
The operational procedures of the detention services provider (Serco) outline the measures that are in place regarding smoking in Australian immigration detention centres. 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 centres. Smoking is permitted in outside courtyards and exercise areas, covered areas such as walkways, and other external areas as specified by signage.
Exemptions from legislative bans on smoking in enclosed workplaces exist for residential care facilities in most Australian states and territories, in recognition of these being the personal living spaces of residents. Under the Smoke-free Environment Act 2000 (NSW), common areas of nursing homes such as living rooms, hallways and foyers are considered to be enclosed public places, but smoking is permitted inside single rooms that are considered to be the occupant's home. Under the Tobacco Act 1987 (Vic.), the ban on smoking in an enclosed workplace does not apply to a personal sleeping or living area of a residential care facility.
Many nursing homes have implemented restrictions on smoking in recognition of the health risks of SHS and risk of fire, such as requiring residents to be supervised or to wear a smoke retardant apron while smoking. Cigarette-related fires are thought to have caused a number of accidental deaths in nursing homes.51–53 After a death in South Australia, the Commonwealth Department of Health and Ageing distributed a recommendation of the South Australian Deputy State Coroner to all aged care providers, to the effect that the practice of allowing residents disabled by dementia and/or with reduced manual dexterity to smoke unsupervised was intrinsically unsafe, and that such residents may require close supervision by either family members or staff.54
ii See Mr Berry, Hansard of the Australian Capital Territory Legislative Assembly, 16 December 1993 p4691 http://www.hansard.act.gov.au/hansard/1993/pdfs/19931216.pdf and 16 December 1993 p4693 http://www.hansard.act.gov.au/hansard/1993/pdfs/19931216.pdf
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