5.14 Smokefree policies

Last updated:  April 2020

Suggested citation: Wood, L, Letcher, T, Winstanley, M & Hanley-Jones, S. 5.14 Smokefree policies. In Greenhalgh, EM, Scollo, MM and Winstanley, MH [editors]. Tobacco in Australia: Facts and issues. Melbourne: Cancer Council Victoria; 2020. Available from: https://www.tobaccoinaustralia.org.au/chapter-5-uptake/5-14-opportunity-to-smoke

 

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 (see Section 15.9). Smokefree policies are now widespread (see Section 15.7), and increasing numbers of Australian households have chosen to ban smoking in their homes1 (see Section 4.5 and Section 15.6.3). Smokefree homes appear to be particularly important in influencing smoking behaviour among teenagers (see Section 5.7.4).2

5.14.1 Influence of smoking restrictions in schools on youth smoking

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.3,4 Although research examining the effectiveness of school tobacco policies in reducing student smoking has been mixed5-10 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:11 Student perceptions of policy and behaviours are influenced largely by school actions in response to policy violations rather than the mere existence of policies.8,12,13An analysis of smoking and policy at 55 schools demonstrated an association between policy strength, policy enforcement and the prevalence of smoking among pupils.14 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.15 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.16,17 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.17

What a school does beyond simply banning smoking is important. As discussed in Section 5.20, school-based youth smoking prevention efforts are most effective when comprehensive and multi-modal.18 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. 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.19 For further discussion on school-based interventions for smoking prevention see Section 5.29.

Further to the adoption of smokefree policies in high schools, many Australian universities have also implemented smokefree campus policies. While these policies are primarily aimed to protect staff and students from secondhand smoke, and the campus environment from litter, these policies also add to broader community attitudes towards smoking (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.20

5.14.2 Influence of smoking restrictions in other settings on youth smoking

Smoking bans, both in the home and in public places, 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.21-24 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 behaviour25 and reduce the social acceptability of smoking.22 As discussed further in Section 5.24, young people are greatly influenced by their sense of what is normal and attractive.26 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.27 Hence bans on smoking in restaurants and other public places can help to reduce the ‘normalcy’ of seeing people smoking, thereby helping to reshape community norms and perceived social acceptability regarding smoking.27,28 Publicity supporting bans on smoking in cars in Australia was likely to have strengthened this view.29 Currently, all Australian states and territories have adopted legislation prohibiting smoking in cars with children. For more on smoking in cars see, Section 15.6.5.

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.30 As of 2020, 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 uptake31 See Section 15.5.

Relevant news and research

For recent news items and research on this topic, click  here. ( Last updated July 2020)

References 

1. Australian Institute of Health and Welfare. Australia’s health 2006. Australia's health series, no.10, cat. no. AUS 73.Canberra: AIHW, 2006. Available from: https://www.aihw.gov.au/reports/australias-health/australias-health-2006/contents/table-of-contents

2. Wakefield M, Chaloupka F, Kaufman N, Orleans C, Barker D, et al. Effect of restrictions on smoking at home, at school and in public places on teenage smoking: cross sectional study. British Medical Journal, 2000; 321:333-7. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27448

3. Penilla J, Gonzalez B, Barber P, and Santana Y. Smoking in young adolescents: an approach with multilevel discrete choice models. Journal of epidemiology and community health, 2002; 56:227-32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11854347

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5. Lovato C, Pullman A, Halpin P, Zeisser C, Nykiforuk C, et al. The influence of school policies on smoking prevalence among students in grades 5-9, Canada, 2004-2005. Preventing Chronic Disease, 2010; 7(6):A129. Available from: http://www.cdc.gov/pcd/issues/2010/nov/09_0199.htm

6. Overland S, Aaro L, and Lindbak R. Associations between schools' tobacco restrictions and adolescents' use of tobacco. Health Education Research, 2010; 25(5):748-56. Available from: https://www.ncbi.nlm.nih.gov/pubmed/20363827

7. Sabiston C, Lovato C, Ahmed R, Pullman A, Hadd V, et al. School smoking policy characteristics and individual perceptions of the school tobacco context: are they linked to students' smoking status? Journal of Youth and Adolescence, 2009; 38(10):1374–87. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2758151/?tool=pubmed

8. Evans-Whipp TJ, Bond L, Ukoumunne OC, Toumbourou JW, and Catalano RF. The impact of school tobacco policies on student smoking in Washington State, United States and Victoria, Australia. International Journal of Environmental Research and Public Health, 2010; 7(3):698–710. Available from: http://www.mdpi.com/1660-4601/7/3/698/pdf

9. Wiium N, Burgess S, and Moore L. Brief report: multilevel analysis of school smoking policy and pupil smoking behaviour in Wales. Journal of Adolescence, 2010; 34(2):385-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20307905

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12. Lipperman-Kreda S, Paschall M, and Grube J. Perceived enforcement of school tobacco policy and adolescents' cigarette smoking. Preventive Medicine, 2009; 48(6):562–6. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748128/

13. US Department of Health and Human Services. Preventing tobacco use among youth and young adults: A report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2012. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/2012/.

14. Moore L, Roberts C, and Tudor-Smith C. School smoking policies and smoking prevalence among adolescents: multilevel analysis of cross-sectional data from Wales. Tobacco Control, 2001; 10(2):117-23. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/10/2/117

15. Rozema AD, Hiemstra M, Mathijssen JJP, Jansen MWJ, and van Oers H. Impact of an Outdoor Smoking Ban at Secondary Schools on Cigarettes, E-Cigarettes and Water Pipe Use among Adolescents: An 18-Month Follow-Up. International Journal of Environmental Research and Public Health, 2018; 15(2). Available from: https://www.ncbi.nlm.nih.gov/pubmed/29370137

16. Rozema AD, Mathijssen JJP, Jansen MWJ, and van Oers JAM. Sustainability of outdoor school ground smoking bans at secondary schools: a mixed-method study. European Journal of Public Health, 2017. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29016786

17. Escario JJ and Wilkinson AV. Visibility of smoking among school-teachers in Spain and associations with student smoking: a cross-sectional study. BMJ Open, 2018; 8(1):e018736. Available from: https://www.ncbi.nlm.nih.gov/pubmed/29306888

18. Lynagh M, Perkins J, and Schofield M. An evidence-based approach to health promoting schools. Journal of School Health, 2002; 72:300-2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12357912

19. Lovato C, Zeisser C, Campbell H, Watts A, Halpin P, et al. Adolescent smoking effect of school and community characteristics. American Journal of Preventive Medicine, 2010; 39(6):507–14. Available from: http://www.ajpm-online.net/article/S0749-3797%2810%2900510-6/fulltext

20. Seo D, Macy J, Torabi M, and Middlestadt S. The effect of a smoke-free campus policy on college students' smoking behaviors and attitudes. Preventive Medicine, 2011; 53(4):347–52. Available from: https://www.ncbi.nlm.nih.gov/pubmed/21851836

21. Bernat DH, Erickson DJ, Widome R, Perry CL, and Forster JL. Adolescent smoking trajectories: results from a population-based cohort study. Journal of Adolescent Health, 2008; 43(4):334–40. Available from: http://www.jahonline.org/article/PIIS1054139X08001572/fulltext

22. Song A and Glantz S. Pushing secondhand smoke and the tobacco industry outside the social norm to reduce adolescent smoking. Journal of Adolescent Health, 2008; 43(4):315–17. Available from: http://www.jahonline.org/article/S1054-139X(08)00235-8/fulltext

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25. Alesci N, Forster J, and Blaine T. Smoking visibility, perceived acceptability, and frequency in various locations among youths and adults. Preventive Medicine, 2003; 36(3):272-81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12634018

26. Hastings G and Angus K. Forever cool: the influence of smoking imagery on young people. London: British Medical Association, Board of Science, 2008. Available from: https://www.stir.ac.uk/media/stirling/services/faculties/management/documents/Angus---Forever-Cool-the-influence-of-smoking-imagery.pdf

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28. Eureka Strategic Research, Youth tobacco prevention research project. Undertaken for the Australian Government Department of Health and Ageing. Canberra: Department of Health and Ageing; 2005. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-pub-tobacco-literature-cnt.htm.

29. Freeman B, Chapman S, and Storey P. Banning smoking in cars carrying children: an analytical history of a public health advocacy campaign. Australian and New Zealand Journal of Public Health, 2008; 32(1):60-5. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.2008.00167.x/full

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31. Wakefield M, Chaloupka F, Kaufman N, Orleans C, Barker D, et al. Effect of restrictions on smoking at home, at school and in public places on teenage smoking: cross sectional study. British Medical Journal, 2000; 321:333–7. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27448