While smoking was once commonplace in the workplace, in shopping centres, on public transport, in restaurants and elsewhere, public health concerns about exposure to secondhand smoke have led to the introduction of ‘clean air’ acts and other smoking restrictions at the national, state/territory and local government levels.
Research shows comprehensive smoking bans not only reduce exposure to secondhand smoke, but also have the potential to reduce uptake among young people. Australian research has concluded that smokefree policies were directly related to the decline in smoking prevalence among young people between 1990 and 2015 (see Section 15.9.3.2).1
5.14.1 Influence of smoking restrictions in schools on smoking among young people
Primary and high school
One of the most inexpensive actions a school can take to reduce smoking can be to introduce a no-smoking policy followed by strict and consistent enforcement.2,3 Although research examining the effectiveness of school tobacco policies in reducing student smoking has been mixed4-9 the consistency with which schools enforce policy responses (regardless of the type of sanction imposed) appears to be the most important component of policy effectiveness:10 Student perceptions of policy and behaviours are influenced largely by school actions in response to policy violations rather than the mere existence of policies.7,11,12An analysis of smoking and policy at 55 schools demonstrated an association between policy strength, policy enforcement and the prevalence of smoking among pupils.13 When adolescents see others continuing to smoke in schools with smoking bans, research has shown this, along with weak implementation, may encourage others to disregard the ban and continue smoking.14 Moreover, teachers refraining from smoking on school grounds is also an important component of smokefree school policy, as they serve as role models to students.15,16 A 2018 study in Spain found that when teachers were observed by the students smoking on school premises on most or all days, students showed an increased odds of smoking.16 One study found that students were less likely to smoke if they attended a school with a focus on tobacco prevention, stronger policies prohibiting tobacco use, and fewer students smoking on the peripheries than in schools without these characteristics.4
What a school does beyond simply banning smoking is important. As discussed in Section 5.9, school-based smoking prevention efforts are most effective when comprehensive and multi-modal.17 Hence smoking bans in schools are ideally complemented by a range of other strategies within the school, and even more ideally, within the broader community. In Seoul many schools have designated their school commuting routes within a 50-meter radius as smokefree zones, in addition to the school campus.18 For further discussion on school-based interventions for smoking prevention see Section 5.9.
University
Like primary and secondary schools in both the public and independent (and Catholic) sectors), many Australian universities have also implemented smokefree campus policies. While these policies primarily aim to protect staff and students from secondhand smoke, and the campus environment from litter, these policies also affect broader community attitudes towards smoking, and these attitudes can be important in determining smoking behaviours (see Section 15.5.1.3). One US study measured a significant decrease in smoking prevalence among university students two years after adopting a smokefree policy, compared with a campus that allowed smoking. There were large decreases in perceived prevalence of smoking, and smoking was perceived as less socially acceptable. A significant decrease was also seen in the percentage of students from the smokefree campus reporting having two or more close friends who smoked, compared with no reported change among the control campus.19 A 2015 systematic review and meta-analysis of the acceptability and effectiveness of university smokefree policies found that the majority of both students and faculty supported the smokefree policies, and studies measuring student smoking prevalence showed a reduction in the prevalence of smoking post ban.20
Further reviews of the literature have confirmed the effectiveness of smokefree university policies in reducing tobacco use and exposure to secondhand smoke,21-24 although, a 2024 systematic review noted that these policies are challenged by an increase in vaping.25
5.14.2 Influence of smoking restrictions in other settings on smoking among young people
Smokefree policies are now widespread (see Section 15.7), and add to a greater perceived difficulty with finding a place to smoke, which leads to a lower likelihood of smoking and helps to reduce progression from experimental to established smoking.26-29 See Section 15.9. As well as physically reducing the places where smoking may occur, reducing opportunities to smoke and making it more difficult to smoke helps to challenge perceptions that smoking is normal behaviour30 and reduce the social acceptability of smoking.27 As discussed further in Section 5.19, young people are greatly influenced by their sense of what is normal and attractive.31 One Canadian study found that the more frequently young people observe smoking occurring in a range of settings, the more likely they are to have the view that smoking is both socially acceptable and normal.32 Hence bans on smoking in public places can help to reduce the ‘normalcy’ of seeing people smoking, thereby helping to reshape community norms and perceived social acceptability regarding smoking.32,33
The home and car
Increasing numbers of Australian households have chosen to ban smoking in their homes34 (see Section 4.5 and Section 15.6.3). Smokefree homes appear to be particularly important in influencing smoking behaviour among teenagers (see Section 5.7.5.1).35 Both Australian36 and international36-41 research suggest that home smoking bans are effective at inhibiting and/or delaying smoking initiation, experimentation and prevalence in young people. Partial bans, however, have not been found to be effective.42
Exposure to tobacco smoke in cars is associated with an increased risk of smoking uptake in adolescence,43 and an increase in symptoms of nicotine dependence in children who had never smoked but who were exposed to tobacco smoke in cars.44 Currently, all Australian states and territories have adopted legislation prohibiting smoking in cars with children. In all states and territories except WA, the ban extends to secondhand aerosol from vaping. For more on smoking in cars see, Section 15.6.6.
Hospitality venues
All Australian states and territories have now banned smoking indoors at hospitality venues. Bans on smoking in outdoor drinking and dining areas differ between jurisdictions (see Chapter 15, Section 15.7). A 2021 systematic review on the association between smokefree legislation in hospitality venues and smoking among young people found that such legislation is generally associated with a decrease in smoking among young people, and noted the particular importance of such legislation being comprehensive (i.e., without exemptions).45
Other public places
A 2019 European study exploring where adolescents smoke found some evidence to suggest bans on smoking in locations such as bars, school and the home may have displaced smoking to new more unregulated locations such as streets and parks. The authors suggest that comprehensive and expansive policies that include, for example, areas around school premises and around pubs/bars may be necessary to support smoking bans and avoid displacement of smoking.46 Many public outdoor locations around Australia such as children’s playgrounds, some parks, reserves, beaches, and sports and recreation venues are becoming smokefree. Research has shown in the past that restricting opportunities to smoke through bans in public places reduces smoking uptake among teenagers and sends a clear message to young people about the unacceptability of smoking. More extensive restrictions on smoking in public places has been shown to be associated with lower probability of smoking uptake35 See Section 15.5.
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References
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