International outdoor smokefree area policies

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2 International outdoor smokefree area policies September 23, 2015 Smokefree Outdoor Areas Forum, Auckland George Thomson, University of Otago, Wellington, NZ

3 Overview International trends for smokefree area policies International evidence for: the rationale the effects How enforceable policies work overseas New South Wales Health advert

4 1: International outdoor smokefree area trends Enforceable Initially locally driven Wider range of areas Larger areas covering more people Changes in rationale Changes in attitudes

5 Wider range of outdoor areas 100% outdoor dining: Most Australian states by US cities (eg, Los Angeles) 100% outdoor bars: Hawaii, Ontario, + 7 states/provinces, cities, eg, Vancouver Transport areas: New York State, Wisconsin, Iowa, Quebec + Entrances: Queensland, Oregon, 6 Canadian provinces

6 Larger areas with greater populations Pedestrian streets City blocks Beaches Small cities

7 The importance of streets Streets have more people than playgrounds (up to 44,000/hr v under 1000/hr) The number of children can be up to 3000/hr in streets v under 300/hr in playgrounds Lambton Quay, Wellington versus average for 6 NZ playgrounds 7

8 Smokefree footpaths Since 2006: 26 Californian cities with some smokefree sidewalks (usually commercial areas) Includes 7 with over 100,000 population: El Cajon, Burbank, Concord, Fremont, Hayward, Berkeley, Santa Rosa

9 Smokefree downtown areas Increasing size of smokefree areas Smokefree downtown Concord, California

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11 Changes in the rationale From SHS protection to changing norms: to help smokers, quitters, children Litter reduction Fire prevention Injury and poison protection butt consumption a frequent concern for poison control centres, parents and pet owners Novotny et al. Int J Environ Res Public Health 2009

12 Increasing public approval: Victoria

13 New Zealand: bar manager attitudes: Approval of smokefree bars 44% 60% Patrons will respond positively to being asked to go outside 37% 82% Milne et al 2006

14 2: Evidence around smokefree area policy effects Smoking cues increase relapses: Successful quitters avoid smoking cues Peuker, Bizarro 2014 Californian smokers: Perception of smokefree parks/dining associated with increased quit attempts (multiple regression: gender, age, income, ethnicity, education +) Zablocki et al 2014

15 Evidence of smokefree dining/bar effects Those not exposed to smoking on Ontario bar/ restaurant outdoor areas: were more likely to have tried to quit over twice as likely to not relapse Chaiton et al. Tob Control 2014

16 NZ neighbourhood norm effects Moving to a NZ neighbourhood with a lower smoking prevalence decreased the chance of relapsing (Controlled for income, labour force status, household tenure, family status, smokers in household, neighbourhood deprivation) Moving by a one decile decrease in the neighbourhood smoking prevalence was associated with a 4% decreased odds of being a smoker Ivory et al. AJE 2015

17 3: Enforceable policies working overseas New York smokefree parks May 2011 Observation: prevalence of smoking in parks: 3.3 % in October % in October 2011 Johns et al. Am J Community Psychol 2012 Enforcement: $50 tickets by Parks Dept, 2011: July: 14 August: 18 September: 4 October: 5

18 Santa Cruz, California: Observed smoking in Pacific Ave Smokers/hr 2008: : Smokefree policy introduction 2010: 11 Santa Cruz County Health Services Agency Tobacco Control Project. June 2010

19 37 Ontario municipalities with outdoor bylaws 95% used signs 40% used pamphlets and/or posters None used additional enforcement staff Most actively enforced by-law with city enforcement officers, & parks, recreation staff 57% had warned smokers 16% had issued tickets, none contested Kennedy et al Tob Induc Dis, 2014

20 Perth smokefree mall implementation January June 2014: mall smoking cut by 2/3 June 2014: Performance artists highlighting policy with smoke alarms and danger tape June-July: In 5 weeks,rangers cautioned about 400 smokers: 5 infringement notices

21 Summary: Smokefree outdoor policies Widespread, increasing in scope Increasingly to help quitting rather than just protect from SHS Increasing evidence of effectiveness, feasibility