4.19 Public attitudes to secondhand smoke

The most recent data published on public attitudes to secondhand smoke are presented in this section, and are largely taken from surveys between 2004 and 2010. It should be noted that public awareness of the damage to health caused by secondhand smoke is likely to have continued to increase with the progressive introduction of further legislation for smokefree workplaces and public places in most Australian states and territories, and the launch of television campaigns to raise awareness of the dangers of exposure to secondhand smoke for children.ⁱ The following information may therefore under-represent the current state of public attitudes and perceptions about the extent of the health effects of secondhand smoke.

In response to strong evidence showing that secondhand smoke is harmful to health, restrictions on smoking in public places, the workplace, and in private domains such as the home and in motor vehicles generally receive widespread support from the public. The prevalence of exposure to secondhand smoke among children and non-smoking adults has decreased substantially over time (see Section 4.3), both due to strong smokefree legislation (see Chapter 15) and increasing awareness of its harms leading to changes in attitudes and behaviours.

4.19.1 General perception that secondhand smoke is harmful to health

The majority of people, regardless of their smoking status, believe that living or working with a person who smokes could affect the health of others, although people who do not smoke are more likely to have this perception. The proportion of Australians believing that exposure to secondhand smoke causes health harms has increased over time. In 1985, a Victorian study showed that 80% of people who do not smoke and 57% of people who currently smoke agreed that the health of people who do not smoke could be damaged by secondhand smoke.¹ In 2004, the National Drug Strategy Household Survey reported that about 90% of people who do not smoke and 70% of people who did smoke thought that living, working or socialising with people who smoke could cause health problems (Table 4.19.1). Exposure to secondhand smoke in the home was considered to be slightly more likely to affect a person who does not smoke’s health than working or socialising with people who smoke.²

In 2006, the International Tobacco Control Four Country Survey asked Australians who smoked how often they thought about the harm their smoking might be doing to other people. Thirty-nine per cent of respondents thought about it often or very often, 22% thought about it sometimes and 40% rarely or never thought about it.³

4.19.2 Knowledge of specific health effects

A range of state-based surveys have confirmed that although there is a high general awareness that secondhand smoke is harmful, knowledge about specific health outcomes is less consistent.^4-6

Table 4.19.2 presents the findings of a survey undertaken in Victoria in 2007.⁴ This study found that people who did not smoke were more likely than people who smoke to believe that exposure to secondhand smoke caused a range of health problems. The highest awareness was for secondhand smoke as a cause of lung cancer, followed by other respiratory problems and heart disease. There was lower awareness about the effects of secondhand smoke on children and babies.⁴

The International Tobacco Control (ITC) Four Country Survey (2008) asked Australians who smoked and those who had quit smoking whether they believed ‘smoking caused lung cancer in non-smokers from secondhand smoke’ and ‘smoking caused asthma in children from secondhand smoke’. Agreement among people who smoked and people who had quit smoking respectively was 72% and 80% for lung cancer, and 76% and 84% for asthma in children.⁷

4.19.3 Changes in smoking behaviour due to beliefs about secondhand smoke

The National Drug Strategy Household Survey (2022-23) found that among people who smoke who had modified their smoking behaviour (for example by attempting to quit, by cutting back or by switching to lower tar or nicotine brands), 16% had been motivated by the concern that their smoking was affecting the health of those around them (Table 4.19.3).⁸ This was a 6% decrease from 2007, when 22% of people who smoked modified their smoking behaviour due to concern that their smoking was affecting the health of those around them.

The 2021 NSW Smoking & Health Survey asked people who smoke that were considering quitting in the next six months about their reasons. Health, fitness, and cost remained the most common reasons, while ‘The effect of my smoking on my family's health’ was less frequently given as a reason for thinking about quitting at 7% for 2019 and 2% for 2021.⁹ See Figure 4.19.1 below.

4.19.4 Avoidance of cigarette smoke

Up until 2019, the National Drug Strategy Household Survey asked Australians whether they avoid places where they may be exposed to other people’s cigarette smoke. Consistently in each of the survey years, more than four in five people who did not smoke (i.e., had never smoked or had quit) reported always or sometimes avoiding exposure to secondhand smoke, compared with about one in three people who currently smoked—see Figure 4.19.2.¹⁰

Earlier Victorian research that asked people how they would respond if someone nearby lit a cigarette similarly found that most respondents who did not smoke (71%) and many who did smoke (23%) would move away. However, only a minority reported that they would ask the person to stop smoking.¹¹

4.19.5 Public attitudes to thirdhand smoke

Thirdhand smoke refers to residual tobacco smoke constituents that remain on surfaces such as carpets, furniture, walls, blankets, and toys, and in dust, or are present on smokers themselves (clothes, hair, and hands) after tobacco has been smoked. These substances are then re-emitted as gases or react with other compounds in the environment to create other substances.^12-14

A 2023 systematic review analysing papers focusing on knowledge, beliefs, and behaviours regarding third-hand smoke found the percentages of parents who believed that third-hand smoke was harmful ranged from 42.4% to 91%.¹⁵ The study also found that parental awareness of the health effects of third-hand smoke was not always associated with the adoption of a home- and car-smoking ban or healthy behaviours.¹⁵

A 2023 meta-analysis attempting to determine the prevalence of people’s knowledge that third-hand smoke may be harmful to health similarly found large variations between samples (high heterogeneity).  Overall, the prevalence of people reporting that third-hand smoke was harmful to health was 80.1%.¹⁶ See Section 4.3 for information on the health effects of thirdhand smoke.

^{i Such as the Smokefree Home and Car Campaign, launched in Western Australia in May 2007; see https://www.makesmokinghistory.org.au/quit-stories/our-campaigns/past-campaigns for details.}

Related reading 

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References

1. Hill D. Public opinion in victoria about the dangers of passive smoking. Medical Journal of Australia, 1986; 144:615–6.

2. Australian Institute of Health and Welfare. Australia’s health 2006. Australia's Health, no. 10, AIHW cat. no. AUS 73.Canberra: AIHW, 2006. Available from:  http://www.aihw.gov.au/publications/aus/ah06/ah06-c00.pdf

3. Savvas S. International tobacco control four country data, 2006, Carolyn Ford of the Cancer Council Victoria, Editor 2011, The Cancer Council Victoria: Melbourne, Vic.

4. McCarthy M, Germain D, Brennan E, and Durkin S. Perceptions about the health effects of smoking and passive smoking among Victorian adults, 2003–2007. CBRC Research Paper Series no. 37.Melbourne, Australia: Centre for Behavioural Research in Cancer, The Cancer Council Victoria, 2009. Available from:  http://www.cancervic.org.au/perceptions_smoking_cbrc_09.html

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8. Australian Institute of Health and Welfare. National Drug Strategy Household Survey, 2022-2023. ADA Dataverse, 2024. Available from: https://doi.org/10.26193/U6LY7H.

9. Cancer Institute NSW. NSW Smoking & Health Survey 2021. Cancer Institute NSW, Sydney 2022. Available from: https://www.cancer.nsw.gov.au/about-cancer/document-library/nsw-smoking-health-survey-2021.

10. Australian Institute of Health and Welfare. Data tables: National Drug Strategy Household Survey 2019 - 2. Tobacco smoking chapter, Supplementary data tables. Canberra: AIHW, 2020. Available from: https://www.aihw.gov.au/reports/illicit-use-of-drugs/national-drug-strategy-household-survey-2019/data.

11. Germain D. Exposure to and perceptions of the dangers and illnesses of passive smoking among Victorians: 2004 CBRC research paper series no.17 Melbourne, Australia: Centre for Behavioural Research in Cancer, Cancer Council Victoria, 2004.

12. Matt GE, Quintana PJ, Destaillats H, Gundel LA, Sleiman M, et al. Thirdhand tobacco smoke: emerging evidence and arguments for a multidisciplinary research agenda. Environmental Health Perspectives, 2011; 119(9):1218–26. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21628107

13. Winickoff J, Friebely J, Tanski S, Sherrod C, Matt G, et al. Beliefs about the health effects of 'thirdhand' smoke and home smoking bans. Pediatrics, 2009; 123(1):e74–9. Available from: http://pediatrics.aappublications.org/cgi/content/full/123/1/e74

14. Northrup TF, Jacob P, 3rd, Benowitz NL, Hoh E, Quintana PJ, et al. Thirdhand Smoke: State of the Science and a Call for Policy Expansion. Public Health Rep, 2016; 131(2):233-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26957657

15. Vanzi V, Marti F, and Cattaruzza MS. Thirdhand Smoke Knowledge, Beliefs and Behaviors among Parents and Families: A Systematic Review. Healthcare (Basel), 2023; 11(17). Available from: https://www.ncbi.nlm.nih.gov/pubmed/37685437

https://mdpi-res.com/d_attachment/healthcare/healthcare-11-02403/article_deploy/healthcare-11-02403.pdf?version=1693115113

16. Yildirim-Ozturk EN, Uyar M, and Ozturk M. Determining the prevalence of people's knowledge that third-hand smoke is harmful to health: A meta-analysis study. Public Health Nurs, 2024. Available from: https://www.ncbi.nlm.nih.gov/pubmed/38591176