15.6.1 Prevalence of exposure to secondhand smoke in domestic environments
Exposure of children to tobacco smoke in domestic environments, especially homes and cars, is a particular concern given the health risks of secondhand smoke (SHS) for children (see Chapter 4, Section 4.9) and the long hours that most children spend each day in these environments.
15.6.1.1 National data on smoking at home
Data from National Drug Strategy Household Surveys has found that only 3.7% of households with dependent children had at least one person who smoked inside the home in 2013, a decrease from 8% in 2007, and almost one-third in 1995. There has also been a declinein the proportion of households where someone smoked only outside the home (from 29% in 2010 to 26% in 2013).1 However exposure to SHS remains high, particularly for children in low socio-economic status (SES) households. In 2010, children in households in the most disadvantaged areas in Australia were four times more likely to be exposed to tobacco smoke in the home than those living in the most advantaged areas (12% compared with 3%). They were also more than twice as likely to have a regular smoker at home (who smokes outside) than households with children in the highest SES areas (39% compared with 17%).2
Nationally in 2012-13, 57% of Aboriginal and Torres Strait Islander children aged 0–14 years lived in a household with members who were daily smokers(down from 68% in 2004-05).3 The proportion of Aboriginal and Torres Strait Islander children aged 0–14 years living in a household where members usually smoked inside the house decreased from 21% in 2008 to 16% in 2012–13. However, Aboriginal and Torres Strait Islander children were still about five times more likely than non-indigenous children to live in a household with a daily smoker who smoked indoors at home (16% compared with 3%),3 consistent with higher rates of adult smoking.
15.6.1.2 State data on smoking at home
In New South Wales in 2014 approximately 93% of people aged 16 years and over lived in smokefree homes, a substantial increase since 1997 (70%). Adults in the fifth or most disadvantaged quintile were less likely to live in a smokefree home (89%), compared with the overall adult population or more advantaged groups. There was no significant difference between rural and urban areas.4
In South Australia in 2015, 9% of the population reported that they were exposed to passive smoke in their own home.5
The proportion of Victorian smokers who usually smoked outdoors increased steadily between 1998 and 2008 with a corresponding decline in those who smoked indoors.6
Table 15.6.1 Proportion of Victorian smokers who smoke inside or outside the home, 1998–2008
Year Number Always or usually outside (%) Sometimes
outside (%)
Always or
usually inside (%)
Don’t smoke at
all/ Don’t know/
Can’t say (%)
1998 (672) 53.1 19.8 25.0 2.1
1999 (732) 54.2 27.2 18.4 0.2
2000 (414) 48.5 30.9 20.6 0.0
2001 (654) 55.0 27.2 17.5 0.3
2002 (625) 63.9 17.4 17.6 1.0
2003 (871) 64.6 23.2 14.2 1.0
2004 (914) 65.5 20.6 11.8 2.1
2005 (888) 72.2 13.8 11.2 2.8
2006 (838) 65.6 17.2 12.1 5.2
2007 (830) 70.5 14.1 11.9 3.5
2008 (1256) 72.6 12.3 11.2 3.9
Note: Data are weighted by sex and age according to ABS 2006 Census data. Due to rounding, percentages may not total 100.
Base: Victorian adults from smoking households (n=1256)
Source: Abbott 20093
15.6.2 Factors affecting adoption of smokefree homes
15.6.2.1 Policies
Increasing prevalence of smokefree public places and workplaces has been associated in English-speaking countries with increasing numbers of smokefree homes.7-10 Although a 2010 Cochrane Collaboration review of the evidenceconcluded that there was little evidence of such a trend internationally,11 more recent studies suggest that smokefree laws and policies in some non-English-speaking countries have in fact been associated with an increase in smokefree homes.12-14 In particular, employment in a smokefree workplace has been linked to living in a smokefree home in low- and middle-income countries.15 Research has suggested there are likely to be complex social and cultural factors which may act as barriers to the adoption of smokefree homes in some contexts.16 Contrary to anecdotes promoted by the hospitality sector that smoking bans in pubs and clubs would lead to more children being exposed to smoking at home, an Irish study found that 1 in 5 smokers were smoking less at home since the introduction of the comprehensive smoking ban in that country in 2004.17 Similarly, research in the US and Canada has found that smokefree laws are associated with the voluntary adoption of smokefree rules in homes and cars, and do not result in any significant displacement of smoking into the home.9,18
15.6.2.2 Education campaigns
Education campaigns about smoking at home have become a regular part of tobacco control programs. Common themes include raising awareness of the health effects of SHS on children and encouraging parents to either quit or smoke outside for the health and safety of their children.19 These campaigns have been moderately helpful in increasing the number of people who make their homes smokefree.20-22 While there have been some successful interventions,23-25 evidence about the effectiveness of programs and efforts by health professionals to encourage parents of children admitted to medical facilities to adopt smokefree homes is somewhat equivocal.26
Some research has suggested that the provision of personalised feedback about secondhand smoke exposure in the home (such as measuring the level of indoor particulate matter in the home, and providing these measurements to parents together with information regarding health-based exposure guidelines) may assist in motivating parents to stop smoking in the home.27,28 The development of a nicotine-sensitive monitor which could be used for the purpose of providing such feedback is underway, but is not yet commercially available.29
Other research has demonstrated that a brief intervention in the form of a motivational video shown to parents and caregivers of children hospitalised for respiratory illnesses was effective in bringing about behaviour change to reduce exposure to secondhand and thirdhand smoke (including by increasing smoking cessation rates among parents/caregivers).30 An alternative approach is to encourage pre-teen and young teenage children to remove themselves temporarily from environments where adults are smoking.31
Researchers have also observed that education campaigns involving the use of new media may present a low-cost platform for educating families about the importance not smoking in the home.29 However, again, there are likely to be complex social and cultural factors which may affect the extent to which families engage with education campaigns.32,33
15.6.3 Benefits of smokefree homes
Higher prevalence of household smoking has been linked with a significantly higher level of asthma at a population level.34
Adoption of smokefree policies at home appears to promote anti-smoking attitudes among youths, and reduce progression to smoking experimentation among youths who live with non-smokers.35 The policies appear to reduce consumption of tobacco products36,37 and increase the success of quitting among adult smokers37-39 and reduce relapse.39 In its systematic review of all the relevant studies published on this topic to approximately 2007, the International Agency for Research on Cancer concluded that the evidence from such studies was strong with regard to youth smoking and sufficient for reductions in adult smoking.8,40
15.6.4 Cars
15.6.4.1 Rationale for restricting smoking in cars
Australians spend a considerable amount of time in their cars. In 1992, the latest year that data is available, Australians using cars did so for an average of 1 hour 27 minutes per day.41 People aged 35–54 spent the most time per day using cars: 1 hour 36 minutes per day on average. The longer time spent in cars by this age demographic is associated with their greater transport related commitments, such as work and family. At these ages, many people may have children who need to be driven to and from childcare, school, and social and sporting activities.41
The indoor environment of the family car has been a source of significant SHS exposure for the most vulnerable members of society: children.42-44 A 2001 study of infant cotinine levels—an indicator of SHS exposure—in the Hunter Region New South Wales found that almost half of infants in the study had cotinine in their urine.45 The researchers concluded that additional policy and education interventions were needed to protect infants from SHS, including a ban on smoking in cars when children are present. A 2006 New Zealand study measured the levels of fine particulates in a car while in the presence of a smoker.43 The researchers found that the air quality in the car with the window partially or wholly down was similar to that found in a typical smoky pub, whereas when smoking occurred with the window closed it was at least twice as bad as even the smokiest pub. A similar study undertaken in Vienna in 2016 demonstrated that when smoking occurs in the front seat of a car, fine particles can reach exorbitantly high levels in the back seat. Opening the front window next to the smoker did not reduce the level of exposure to fine particles in the rear seat.46 The same study demonstrated that one single cigarette smoked during a simulated 10 minute journey from home to school led to an alarming increase of fine particle mass and number of ultrafine particles in the rear seat.46
The low air change rates of motor vehicles—designed to shelter occupants from air pollutants entering from outside a vehicle—also work to concentrate pollution from any sources inside the passenger compartment. In a study of 100 air change rate measurements on four motor vehicles under moving and stationary conditions, researchers found that the 24-hour average personal exposure to particulate matter (PM) could exceed 35 mcg/m(-3) for just two cigarettes smoked inside the vehicle.47 Another study investigated the effects of smoking a single cigarette under moderate ventilation conditions (air conditioning or having the smoking driver hold the cigarette next to a half-open window).
Researchers found that the average levels of PM(2.5) were reduced but still at significantly high levels (air conditioning = 844 mcg/m(3); holding cigarette next to a half-open window = 223 mcg/m(3)), demonstrating that tobacco smoke pollution in cars reaches unhealthy levels, even under realistic ventilation conditions.48 Other studies have demonstrated similarly high levels of exposure after the smoking of just a single cigarette.49,50
Research in 2007 among a Perth-based birth cohort of 14-year-old adolescents confirms the exceptional consequences of SHS exposure in the family vehicle. The study found that children exposed to SHS in the family vehicle were more likely to develop a persistent wheeze than those exposed to SHS in the home only.51 In addition, SHS exposure in cars is associated with an increased risk of smoking uptake in adolescence.52
Exposure to SHS may not be the only risk for children and others in cars where someone is smoking. Drivers who smoke also appear to be more prone to having a motor vehicle accident (see Chapter 3, Section 3.19.1).
A study published in 2008 showed an increase in symptoms of nicotine dependence in children who had never smoked but who were exposed to tobacco smoke in cars.53 If such findings were replicated they would raise further concerns about the dangers of early exposure.
Previously, private cars were regarded as the domain of the domestic environment, and therefore beyond the reach of regulation.54 Public acceptance of smokefree policies in the hospitality industry, concern about the health and rights of children as well as increasing regulation of the behaviour of motorists—including prohibition of the use of mobile phones—appear to have been some of the factors that have made the public and governments more amenable to the idea of prohibiting smoking where children are present in cars.7,55-60
In October 1995, a world-first study was published that measured support for regulation of smoking in cars carrying children.61 A total of 1461 New South Wales adult residents were asked, ‘Do you think it should be illegal to smoke in cars when travelling with children?’. A substantial majority of respondents agreed (72%), 27% disagreed and 1% were undecided. The majority of smokers (63%), also agreed with a ban.62
In November 1995, a working party on the effects of passive smoking of the National Health Advisory Committee released a draft report, The Health Effects of Passive Smoking. In addition to including an extensive review of the scientific evidence that exposure to SHS is harmful, the report also contained several policy recommendations to reduce exposure to SHS. The working party recommended that the ‘legal prohibition of smoking in private motor vehicles during periods when minors are passengers should be considered by State and Territory governments’ (p214).63
Results from a large-scale population health survey in New South Wales reveal that by 2008, the vast majority of adults (88.2%) reported that smoking was not allowed in their car, a significant increase over levels in 2003 (81.2%). A significantly lower proportion of people in the lowest socio-economic group (84.8%) and young adults aged 16–24 years (82.1%) reported smoking was not allowed in their car compared with the overall adult population.
15.6.4.2 Legislation banning smoking in cars
All Australian states and territories now have legislation in force which prohibits smoking in cars while children are present.
In June 2006, more than a decade after the issue of smoking in cars was first discussed in Australia, the Tasmanian Government released a discussion paper that included a proposal to ban smoking in cars carrying children in that state.64 In March 2007 a proposal to introduce legislation banning smoking in cars carrying children under 18 was announced.65 A Bill to amend s.67H(2) of the Public Health Act 1997 (Tas.) was passed and came into force on 19 December 2007, making Tasmania the first Australian jurisdiction to implement such a ban.
In February 2006, the South Australian Democrats proposed legislation to ban smoking in cars carrying children aged under 12,66 softening their previous position from a total smoking ban in cars. In August 2006 the South Australian Government announced plans to ban smoking in cars carrying children under the age of 16 with penalties of up to $200 applying. The Bill was passed in March 2007 and came into effect on 31 May 2007, World No Tobacco Day, making South Australia the first state in Australia to ban smoking in cars with children. The first reports of fines appeared in July 2007.67
In November 2006, the Parliamentary Secretary to the Commonwealth Minister for Health and Ageing issued a media release urging the states and territories to enact legislation banning smoking in cars.68 The possibility of national coordinated action for a ban was raised, but failed to be adopted at the December 2006 meeting of the Ministerial Council Drug Strategy.
In New South Wales smoking in cars when children are present was banned under the Public Health (Tobacco) Act 2008 (NSW) from July 2009.
In 2009 the Tobacco Products Control Amendment Act 2009 was introduced into Western Australia’s State Parliament by Dr Janet Woollard as a Private Member’s Bill. The new law was passed and smoking in cars when children under the age of 17 years are present was banned in Western Australia from 22 September 2009.
In 2009, the Australian Capital Territory Government expressed concern about the issue of smoking in cars, and released a discussion paper in 2009.69 On 20 October 2011, the Smoking in Cars with Children (Prohibition) Act 2011 (ACT) was passed. The Act came into force on 1 May 2012, and prohibits smoking in cars when a person under the age of 16 is present.
Similar bans were introduced in both Queensland and Victoria on 1 January 2010.70,71
The Northern Territory was the last Australian jurisdiction to introduce a ban on smoking in cars when children are present. The relevant legislative provision came into operation on 1 December 2014, and applies where children under the age of 16 are present.72
15.6.4.3 Restrictions on smoking in cars in countries outside Australia
Canada is another country that has been at the forefront of efforts to protect children from exposure to tobacco in cars, with all provinces and territories now having legislation in place to address this issue. At least seven US states—Arkansas, California, Louisiana, Maine, Oregon, Utah and Vermont—have banned smoking in cars when children are present, along with the US territories of Puerto Rico and Guam. Many more have drafted legislation or are considering it.73 Similar restrictions apply in France, Ireland, the UK, Mauritius, Bahrain, Cyprus, South Africa and the United Arab Emirates, with many other countries now moving towards bans.
Table 15.6.2 Summary of legislation concerning smoking in cars with minors—as at March 2011
Jurisdiction Applicable age Date law in force Date law adopted
Canadian provinces/territories
Nova Scotia 19 1 April 2008 13 Dec. 2007
Yukon Territory 18 15 May 2008 22 Apr. 2008
British Columbia 16 date to be set 29 May 2008
Ontario 16 21 Jan. 2009 18 June 2008
Manitoba 16 15 July 2010
Prince Edward Island 18 15 Sept. 2009
New Brunswick 16 1 Jan. 2010
Saskatchewan 16 1 Oct. 2010
Newfoundland 16 31 May 2011 13 Dec. 2010
Labrador 16 7 Jan. 2014 7 Jan. 2014
Alberta 18 14 Nov. 2014 27 Nov. 2013
Quebec 16 26 May 2016 26 Nov. 2015
Canadian municipalities
Wolfville, Nova Scotia 19 1 June 2008 19 Nov. 2007
Surrey, British Columbia 19 31 July 2008 14 July 2008
Okotoks, Alberta 16 1 Sept. 2008 15 July 2008
Whiterock, British Columbia 16 1 Nov. 2008
Richmond, British Columbia 19 30 Nov. 2008
Okotoks, Alberta 16 1 Sept. 2008
Athabasca, Alberta 18 March 2011
Leduc, Alberta 18 2 July 2011
Alberta, Alberta 18 2 July 2011
Medicine Hat, Alberta 16 1 Sept. 2011
US states
Arkansas 14 30 March 2011 amended prior law
California 18 1 Jan. 2008 10 Oct. 2007
Louisiana 13 15 Aug. 2006 5 July 2006
Maine 16 1 Sept. 2008 10 Apr. 2008
Puerto Rico (US Commonwealth in Caribbean) 13 2 Mar. 2007 2 Mar. 2006
Many states also ban smoking in cars when foster children are present.74
US municipalities
Bangor, Maine 18 18 Jan. 2007 8 Jan. 2007
Keyport, New Jersey 18 26 Apr. 2007 24 Apr. 2007
Rockland County, N.Y. 18 21 June 2007 15 June 2007
West Long Branch Borough, NJ 18 9 June 2007 6 June 2007
Loma Linda, California 18 24 July 2008
Monroe County, Indiana 14 8 April 2009
Rohnert Park, California 18 28 May 2009
Martinez, California 18 5 June 2009
Hawaii County, Hawaii 18 8 Aug. 2010
Kingman, Arizona 18 18 June 2015
Tempe, Arizona 18 20 June 2015
Australian states and territories
South Australia 16 31 May 2007 5 Apr. 2007
Tasmania 18
1 Jan. 2008 19 Dec. 2008
New South Wales 16
1 July 2009 20 Nov. 2008
Victoria 18
Jan. 1 2010 18 Aug. 2009
Western Australia 17
23 Sept. 2010 22 Sept. 2009
Queensland 16
1 Jan. 2010 29 Oct. 2009
Australian Capital Territory
16 1 May 2012 20 Oct. 2011
Northern Territory
16 1 Dec, 2014 13 Nov. 2014
Countries
Bahrain (private cars with accompanying children)
13 April 2009
Cyprus 16 since 2004
South Africa
12 21 Aug. 2009 23 Feb. 2008
Mauritius (while carrying passengers)
1 March 2009
United Arab Emirates
12 21 Jan 2014
France
16 October 2011
Ireland
18 25 Dec. 2014
United Kingdom 18 1 Oct 2016
Source: Global Advisors on Smokefree Policy73
15.6.5 Multi-unit dwellings
‘Neighbour smoke’ is a relatively new concept in tobacco control.74 Several published studies now have documented significant transfer of SHS between dwellings in multi-unit apartment complexes.75,76 Research conducted in Australia and overseas suggests that people living in multi-unit housing are more likely to be exposed to second-hand smoke than those living in separate housing.77-79 Children in apartments have been found to have higher mean cotinine levels than children in detached houses.78
Air sealing and modifications to ventilation can reduce, but not completely eliminate, smoke drift from apartments where residents smoke indoors.80 Studies measuring air-nicotine concentrations and particulate matter have shown that air pollution increases in homes and common areas located adjacent to areas where smoking occurs.75,81,82 This is because smoke can easily spread via gaps in door and window jambs, mechanical ventilation and air conditioning systems, elevator shafts, hallways, stairwells, cracks in walls, balconies and courtyards.82
While smoking is banned in enclosed common or shared areas of multi-unit housing in several Australian states and territories, private living areas are generally exempt from these bans. However, it may be possible for owners corporations to agree to adopt their own by-laws or rules banning smoking in both common areas and private living areas. In 2011 the owners of a block of apartments in Ashfield, Sydney agreed to a by-law banning smoking anywhere within the building and on balconies, making the building the first multi-unit dwelling in Australia to become 100% smokefree. Furthermore, in the case of Solerno v Proprietors of Strata Plan No 42724, the Supreme Court of New South Wales confirmed the validity of a by-law adopted by an owners corporation which banned smoking on common property and within any private living area.
Where an owners corporation does not adopt its own set of rules or by-laws, the ‘model rules’ or ‘model by-laws’ set out in the relevant state/territory regulations will apply. In most jurisdictions, the model rules or by-laws include a general provision prohibiting residents or visitors from causing a ‘nuisance’ or ‘hazard’ to other residents. Although such provisions do not specifically refer to smoking, it may be possible for residents to rely upon these general provisions to prevent others from smoking on common property or even in private living spaces.
For example, in 2006 the New South Wales Consumer, Trader and Tenancy Tribunal upheld a case brought by occupants of an apartment against their smoking neighbours, requiring them to stop smoking in their adjacent apartment because of smoke drift.83 The occupants relied on a general by-law which prohibited residents from causing a nuisance to other occupants. This case could precipitate other such actions and give license to rental managers to advise tenants that smoking is banned in rental apartments. However, a number of similar cases brought before Tribunals in Queensland have been dismissed.
New South Wales is currently the only Australian jurisdiction with model by-laws which specifically address the issue of smoking in multi-unit housing. The model by-laws are contained in the Strata Schemes Management Regulation 2016 (NSW), and include a ‘tier’ of by-laws regarding smoking from which an owners corporation can choose. Where an owners corporation has not made a selection between the tiers, the ‘default’ tier will apply. The ‘default’ by-law prohibits smoking on common property, but not in private living areas. However, under the default by-law an owner or occupier has an obligation to ensure that smoke from a private living areas does not penetrate common property or any other private space. The Queensland Government is undertaking a review of Queensland’s property laws, and is considering (among other matters) the issue of smoke infiltration. The regulation of smoking in private lots and on common property was one of the issues raised during stakeholder meetings.84 The consultation sought feedback on a proposal to empower owners corporations to prohibit smoking on balconies, or where a structure is within four metres of another structure on an adjacent lot, as well as any other ideas regarding how smoking could be dealt with by owners corporations. The Options Paper for the review noted: “The law has increasingly recognised a need to protect non-smokers from the harmful effects of second hand smoke in public areas and workplaces. There is little reason not to extend this protection to people in a community title scheme. Residential bodies corporate are one of the only places of concentrated occupation to which no power is given to restrict (or prohibit) smoking except on common property.”84 As of January 2017, the report on the consultation was yet to be released.
The Australian Capital Territory recognises smoke-drift in multi-unit developments as part of its work on restricting places of tobacco use under its plan ‘Future directions for tobacco reduction in the ACT 2013–2016’.85 The plan has March 2015 noted for project commencement in this area.
In Victoria, the issue of smoke infiltration in multi-unit housing is being considered as part of a review undertaken by Consumer Affairs Victoria regarding the state’s consumer property laws. In an Options Paper released in November 2016, Consumer Affairs Victoria sought feedback regarding a proposal to amend Victoria’s existing model rules to include a specific rule addressing smoking in multi-unit housing (among other things).86,87 As of January 2017, the final suite of reforms proposed by Consumer Affairs was yet to be released.
15.6.5.1 International trends and developments regarding multi-unit housing
While there appears to be a lack of Australian survey data measuring community support for smoke-free requirements in multi-unit housing, international research has shown high levels of interest by owners, occupiers and managers in adopting smoke-free policies.88 A Canadian survey found that 46% of apartment dwellers had experienced smoke from a neighbour seeping into their apartment and 64% would prefer to live in an entirely smokefree complex.89 In a survey published in 2010, the majority of apartment owners in New York expressed interest in introducing smokefree policies.90
Studies also suggest that landlords have tended to over-estimate the negative commercial impact of proposed smoke-free policies.91,92 Following implementation, the actual impact of smoke-free policies on vacancy and turnover has been shown to be negligible, neutral or positive.93,94 A study of landlords who had implemented smokefree policies in apartment buildings in Douglas County Nebraska found that anticipated adverse consequences generally did not occur.93
Internationally, there are growing calls for smoke-free multi-unit housing policies to protect the health of occupants.95,96 In particular, smoke-free laws and policies affecting multi-unit housing are becoming more prevalent in the US. Since 2009, the US Department of Housing and Urban Development has been strongly encouraging public housing authorities to adopt smoke-free policies. On 30 November 2016 the Department issued a final rule requiring Public Housing Authorities to adopt and implement a smokefree policy for all of their public housing properties.97 As of November 2015, more than 600 housing authorities in 44 states had implemented policies making at least one of their buildings smoke-free.98
Laws addressing smoking in multi-unit housing are also becoming more prevalent among US state and local governments. For example, state law in Utah recognises that tobacco smoke that drifts into a residential unit may be considered a ‘nuisance’.99 Furthermore, a number of Californian local governments have enacted local laws prohibiting smoking in both private and common areas of multi-unit residences.
15.6.5.2 Benefits of smoke-free policies in multi-unit housing
Research undertaken in the US indicates that smokefree policies in multi-unit housing reduce resident exposure to secondhand smoke, decrease daily cigarette consumption amongst smoking residents, encourage smoking cessation and increase quit attempts.100
In addition, cost analyses indicate that there are considerable economic benefits associated with implementing smoke-free policies in multi-unit residences, and that these benefits outweigh any implementation costs.76,101 One US study estimated that prohibiting smoking in all US subsidised housing would result in cost savings of approximately $521 million per year.102 The estimated savings were calculated based on reduced health care costs, reduced renovation costs, and reduced incidence or risk of smoking related fires.
15.6.6 Domiciliary services
Community nurses and other health and welfare workers may be repeatedly exposed to SHS while dealing with clients living in their own home or in community supported accommodation outside institutions.103 This is an occupational health and safety issue for these workers, and some institutions in the UK and Australia insist as a matter of policy that clients do not smoke in their presence. The Aged and Community Services Association of New South Wales and the Australian Capital Territory for instance advises agencies that all clients should be advised not to smoke in the presence of workers.104
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