Review of Smoking in Torbay

REVIEW OF SMOKING IN TORBAY Report to the Health Scrutiny Board 11th November 2005 Report OSB/18/05 to the Cabinet 13th December 2005 CONTENTS Foreword .......................................................................................................................1 1. 2. 3. 4. 5. 6. 7. Executive Summary ..........................................................................................3 Introduction .......................................................................................................5 Process................................................................................................................7 Key Findings .......................................................................................................9 Conclusions......................................................................................................21 Recommendations .........................................................................................23 Monitoring Arrangements..............................................................................25 Acknowledgements ..................................................................................................27 Appendix 1 (Implications of recommendations) ............................................................29 Appendix 2 (Project Plan) .............................................................................................31 Appendix 3 (List of key documents) ..............................................................................33 Appendix 4 (Response to government consultation) .....................................................35 Appendix 5 (Local and National Survey Results) ...........................................................41 Appendix 6 (Glossary of terms) ....................................................................................57 Further copies of this report can be obtained from: Vicky Booty – Democratic Services (Scrutiny) 01803 207014 vicky.booty@torbay.gov.uk Review of Smoking in Torbay Foreword Smoking and second-hand smoke is a major public health concern. During this review, the Panel has heard from various sections of the local community and studied a wide range of information, both national and international. There is no doubt that there is public concern particularly about second-hand smoke. The Panel’s main brief was to look at the impact of passive smoking on our workforce and young people. As we read and heard more, the Panel became convinced that together with our partners in the National Health Service, the Council should work to promote a smoke-free working environment. In the background, at the same time, was the Government’s proposed legislation. As our report was being written these proposals were published. The Panel was disappointed that it was not stronger, surely all workers should be protected. A lot of people have contributed to this report and I would like to thank them all: the local people who made their views known to us, our many colleagues in the National Health Service and Council Officers, particularly Claire Ammar (Assistant Director Risk Management) and our Scrutiny Officers Kate Spencer and Vicky Booty. Councillor Jean Cope Chairman of the Smoking in Torbay Review Panel Page 1 Review of Smoking in Torbay Page 2 Review of Smoking in Torbay 1. 1.1 Executive Summary The purpose of the review was to end health inequalities and increase the life expectancy of poorer and more vulnerable people in Torbay by promoting actions to cut the number of smokers and reduce the harm that smoking causes them and others. Utilising a variety of sources, the review considered the negative health impacts of smoking and undertook consultation in Torbay to ascertain the views of the Hospitality and Licensed Trade with regard to a ban on smoking in public places. Particular consideration was also given to the Council’s duty as an employer to protect workers from the harmful effects of smoke, in addition to existing health and safety legislation. The Panel recognises the contributions of the Office of Tobacco Control (Republic of Ireland) and the Smokefree Liverpool Group to the review. It is recommended to the Cabinet that: 1.2 1.3 1.4 The Council publicly announces its support for the development of smoke-free places in Torbay and assists in raising awareness of the Torbay Smoke Free Alliance and other relevant local schemes such as the Smoke Free Homes Initiative, which aims to promote a smoke-free living environment for families in Torbay. It is also recommended that a Councillor be nominated to act as a ‘Champion’ for the smoke-free agenda within Torbay, to drive these objectives. The Mayor, Council’s Chief Executive and the Director of Public Health send a joint letter to the Government, detailing the need for the publication (without further delay) of comprehensive national smokefree legislation and that the national legislative timetable be reviewed by the Council in February 2006. The Council and National Health Service policies on smoking be immediately reviewed and developed jointly to ensure that their employees and visitors are protected from the harmful effects of smoke and second-hand smoke, with assistance being given to those employees that wish to quit smoking. The policy should also be amended to reflect the Council’s commitment to the promotion of the National Clean Air Award. The Council effectively communicates its policy on smoking to stakeholders and in addition, that literature is produced inline with partner agencies, to respectfully request that individuals refrain from smoking in the presence of Council employees during off site visits. 1.5 1.6 1.7 Page 3 Review of Smoking in Torbay 1.8 The Council encourages the raising of awareness of the risks associated with smoking and second-hand smoke, in particular with young girls as this area was highlighted as at highest risk. The Council encourages local schools to develop smoke-free education and sign-posting to stop smoking services. The Council enables/trains a range of employees such as Youth Workers to develop the appropriate skills to advise about smoking issues. The Council’s Environmental Health and Consumer Protection Business Unit continue to strengthen enforcement of Health and Safety Legislation and jointly with Torbay Care Trust, raise awareness of the smoke-free agenda and the health benefits of smoke-free workplaces. Continuous support should also be provided for businesses, in achieving National Clean Air Award status. 1.9 1.10 1.11 Page 4 Review of Smoking in Torbay 2. 2.1 Introduction Smoking is the greatest single cause of preventable illness and premature death in the United Kingdom1. In the United Kingdom each year, more than 120,000 people die from smoking2 and approximately 260 of those live in Torbay. Across the United Kingdom, around 26%3 of adults smoke. In Torbay the figure is around 28%. Nationally, 9% of 1115 year olds are smokers4. Tobacco smoke is the only Class A carcinogen from which workers have no protection. It is estimated that at least 1,000 people die each year in this Country5 (including one bar worker per week6) as a result of exposure to other people’s smoke, second-hand tobacco smoke being the main source of indoor air pollution. There is scientific evidence which indicates that exposure to second-hand smoke both harms health and worsens existing health problems. The Government published a White Paper entitled Choosing Health: Making healthy choices easier that sets out a number of actions to tackle smoking. One of the proposals contained within the White Paper is that by the end of 2008 all enclosed public places and workplaces (including restaurants, pubs and bars that prepare and serve food) will be smoke-free. The Big Smoke Debate South West held during June and July 2004 was the biggest ever public health consultation. The results showed that a resounding majority of people (82.3%) were in favour of making enclosed public spaces smoke-free. The Torbay Smoke Free Alliance was launched in March 2004. The Alliance is a multi-agency group that includes representatives from Torbay Council, Torbay Care Trust, Devon Fire and Rescue Service and the Licensed Victuallers Association. The aim of the Alliance, as detailed in the Community Plan, is to work towards all enclosed public spaces becoming smoke-free. 2.2 2.3 2.4 2.5 Summary of Intelligence on Tobacco – Department of Health (2004) Ibid 3 Ibid 4 Ibid 5 The Human Cost of Tobacco – British Medical Association (date unknown) 6 One Hospitality Worker Dies Every Week From Passive Smoking – Royal College of Physicians (17 May 2004) 1 2 Page 5 Review of Smoking in Torbay 2.6 In light of the above, the Overview and Scrutiny Board agreed that a review of smoking in Torbay should be undertaken with the following scope: (i) (ii) (iii) (iv) To consider the health risks of smoking and second-hand smoke. To investigate the health risks to children and young people as a result of smoking and second-hand smoke. To consider the regulatory background and national priorities in relation to smoking and tobacco. To examine how public awareness of the health risks associated with smoking and second-hand smoke can be raised across Torbay. To consider the Council’s policy on smoking, in particular where Council employees enter smoky premises to undertake statutory functions. To assess the support for and appropriateness of introducing smoke-free public places within Torbay. (v) (vi) 2.7 The Members of the Review Panel were Councillors Brennan, Charlwood, Cope, Doggett, Faulkner (Mrs J), Hytche and Richards. Councillor Cope as Scrutiny Lead Member for Health and Social Care chaired the Review Panel. A copy of the Project Plan for the Review is included at Appendix 2 to this Report. 2.8 Page 6 Review of Smoking in Torbay 3. 3.1 Process The Panel gathered information for the review from a wide range of sources as detailed in the Project Plan. Verbal and written representations were provided by: • • • • • • • • • • • • • • • Director of Public Health (Torbay Care Trust) Assistant Director Environmental Health and Consumer Protection (Torbay Council) Health and Safety Manager (Torbay Council) Domiciliary Care Manager (Torbay Council) Sure Start, Paignton Torbay Healthy Schools Programme HM Revenue and Customs Devon and Cornwall Constabulary Office of Tobacco Control (Republic of Ireland) Smokefree Liverpool Action on Smoking and Health (ASH) Freedom Organisation for the Right to Enjoy Smoking and Tobacco (FOREST) Torbay Hospitality Association Torbay Licensed Victuallers Association English Riviera Association 3.2 The Panel also undertook a survey of members of the public who visited the Smoke Free Homes stand at Children’s Week in Paignton. Questionnaires were also available in each of the Connections offices, libraries and Tourist Information Centres around Torbay. Members of the public were also invited to submit written representations to the Panel for consideration. The Panel also considered extensive desk-based research from a variety of local, national and international sources including: • • • • • The British Medical Association (BMA) The Roy Castle Lung Cancer Foundation The National Health Service (NHS) Smoking-Related Behaviour and Attitudes (National Survey) – Office for National Statistics (ONS) 2004 New York: Smoke-free City – Jon Dawson Associates 2004 3.3 3.4 3.5 As part of the review process, smoking policies from other Local Authorities and Torbay Care Trust were considered. The Panel also produced a response to the Government Consultation on the Smoke-Free Elements of the Health Improvement and Protection Bill. A copy of which can be located at Appendix 4. Page 7 Review of Smoking in Torbay Page 8 Review of Smoking in Torbay 4. 4.1 Key Findings Reducing the number of people who smoke is one of the six key priorities of the Choosing Health White Paper. This is in recognition of the fact that smoking can lead to fatal disease and that people need support to give up smoking. It also takes account of the concerns about the impact of second-hand smoke and the numbers of children taking up smoking. The proposals within the White Paper set out different requirements for the various Government and statutory agencies. Health agencies will be required to provide more cessation (quitting) opportunities and Local Authorities will have responsibility for creating smoke-free environments and tackling the sale of tobacco to children under the age of 16. Nationally, the Government will ensure that people are aware of the health risks of smoking through publicity campaigns. There will be a further curb on tobacco advertising and the supply of Nicotine Replacement Therapy (NRT) will be addressed. Health Risks of Smoking and Second-Hand Smoke 4.2 4.3 4.4 Tobacco smoke contains approximately 4,000 different chemicals. Three of the main elements are nicotine, tar and carbon monoxide. Other chemicals include benzene, ethanol, ammonia, formaldehyde and hydrogen cyanide7. (For brief descriptions of the above named chemicals, please refer to the glossary at page 57). Table 1 shows the percentage of deaths that are attributable nationally to smoking. Cause of death Lung cancer and chronic lung disease Upper respiratory and oesophageal cancer Ischemic heart disease and cerebrovascular disease (in 35-54 year old age group) Stomach/duodenal ulcers and aortic aneurysms Percentage attributable to smoking 90% 70% 60% 60% 4.5 Table 1: Percentage of deaths attributable to smoking8 ‘Second Hand Smoke – What is it and what can you do about it?’ NHS and Roy Castle Lung Cancer Foundation 8 Health Development Agency ‘The Smoking Epidemic in England’ November 2004 7 Page 9 Review of Smoking in Torbay 4.6 Within Torbay, approximately five deaths per week (of people over the age of 35) are attributable to smoking (excluding second-hand smoke). Whilst this is slightly below the national average, they are premature deaths. Nationally nearly one third of all the deaths associated with smoking are from lung cancer. Within Torbay, the rate of lung cancer amongst the under-75s is comparable with the national average but is higher than the South West average. This rate has remained steady over the past seven years. The wards of Watcombe, Tormohun and Clifton with Maidenway have the highest rates of lung cancer amongst the under75s. The chart below shows the survival rates of lung cancer, compared with breast cancer and colon/rectal cancer, one year after diagnosis and five years after diagnosis. 4.7 Cancer Survival Rates 100 80 Percentage 60 40 20 0 Lung Cancer Breast Cancer Cancer Type Colon Cancer 1 Year After Diagnosis Five Years After Diagnosis Cancer Survival: England 1998-20039 4.8 Whilst smoking is often strongly associated with cancer of the lung, other cancers have also been linked with the smoking of tobacco including cancer of the mouth, oesophagus and bladder10. Smoking during pregnancy is linked to low birth weight. 25% of pregnant women in Torbay continue to smoke through their pregnancy with 304 babies within the Borough being born to mothers who smoked during pregnancy in 2004/2005. The Care Trust has targets to reduce the prevalence of smoking in manual workers and pregnant women. 4.9 Bernard Rachet and Michael Coleman – London School of Hygiene and Tropical Medicine Nicola Cooper and Mike Quinn – National Cancer intelligence Centre, Office for National Statistics www.statistics.gov.uk on 14 September 2005 10 Factsheet No: 4 – ASH, www.ash.org.uk on 20th October 2005 9 Page 10 Review of Smoking in Torbay As yet the data on prevalence in these groups is not robust but this will be addressed through the new General Practitioner contract. 4.10 Those people exposed to second-hand smoke are exposed to the same chemicals as smokers. This means that the risks to health of second-hand smoke include an increased risk of lung cancer and heart disease for adults. In a memorandum by FOREST (Freedom Organisation for the Right to Enjoy Smoking Tobacco) to the Panel dated September 2005, it was stated that ‘FOREST does not accept that passive smoking is a significant risk to the health of non-smokers’11. The memorandum made reference to various studies and suggested that consideration be given to enabling ‘the greatest possible choice to both the consumer and the workforce’12. The Panel considered the issues raised by FOREST, inline with the scope of the review. Health Risks to Children and Young People 4.13 Second-hand smoke leads to an increased risk of respiratory illness and middle ear infections for children. There is also thought to be a link between second-hand smoke and Sudden Infant Death Syndrome. Within Torbay, 28% of the population smoke with 34% of families having one or more parent who smokes. In Watcombe, Tormohun and Ellacombe 40-50% of families have one or more parent that smokes. Services for Children 4.15 Sure Start Paignton launched its Smoke Free Homes Project during Paignton Children’s Week in August 2005. The Project is one of the activities it offers inline with the requirement for all Children’s Centres to offer access to child and family health services (which incorporates smoking cessation/intervention). The aims of the Project are: • • • 4.16 To raise awareness of the impact of second-hand smoke To encourage people living within the area to have smoking restrictions within their homes To create a home environment that leads to cessation of smoking by parents 4.11 4.12 4.14 There are three levels within the Project and individuals will be encouraged to sign up to one of three goals (and to move from one goal to the next over time): 11 12 Smoking in Public Places – Memorandum by FOREST to Torbay Council (September 2005). Ibid Page 11 Review of Smoking in Torbay Bronze Silver Gold 4.17 Not smoking in front of their children within the home Smoking restricted to one room within the home Totally smoke-free home Families who register for the Project will receive a welcome pack and recognition certificates are issues when they achieve each level. Families who achieve Gold will be entered into a free prize draw. Healthy Schools Programme 4.18 In response to the publication of various government documents including the Green Paper, Every Child Matters and the White Paper Choosing Health, the new National Healthy Schools Status (NHSS) was launched in September 2005 to focus on four key themes: • • • • personal, social and health education including sex and relationship education and drug education (including alcohol, tobacco and volatile substance abuse) healthy eating physical activity and emotional health and well-being (including bullying) 4.19 Prior to the implementation of the NHSS, many schools throughout the United Kingdom (including Torbay) had already introduced Healthy Schools Awards. The local Torbay award was accredited to the national programme in 2000. To attain the Healthy Schools Award, schools were required to complete an appropriate audit, produce an action plan and evidence progress against that plan. The now implemented Healthy Schools Programme requires schools to produce evidence based on the four key themes listed above, which are directly linked to Every Child Matters. Every Child Matters outlines the Government's aim for every child, whatever their background or circumstances, to have the support they need to: • • • • • Be healthy Stay safe Enjoy and achieve Make a positive contribution Achieve economic well-being 4.20 4.21 4.22 4.23 The Healthy Schools Programme covers a multitude of issues, which are primarily delivered through the Personal Health Social and Citizenship Education (PHSCE) curriculum. Page 12 Review of Smoking in Torbay The issue of smoking is addressed within the drugs education programme (a ‘drug’ being defined as any substance which changes the way the body works). Young people are taught about alcohol, tobacco and other substances in order to increase their personal knowledge, provide them with skills and develop their attitudes. 4.24 Drugs education in Torbay is delivered by teachers and school nurses. To ensure that teachers and school nurses are provided with the necessary skills to educate about often sensitive issues, a national certification programme for PHSCE has been implemented. In 2004, five teachers in Torbay received certificates for the training programme and eight teachers are working towards this achievement in 2005. Also this year, three nurses are working towards the award for Community Nurses in PHSCE. In Torbay a network of PHSCE teachers exists to share best practice and receive group training and information from a variety of sources, one of which is the Healthy Schools Co-ordinator. The Healthy Schools Programme is not an inspection process but a positive auditing and development (or quality assurance) programme, to which schools and partners (including parents) are receptive. The programme impacts upon the work of Torbay Drug Action Team (DAT) and assists schools in preparation for Office for Standards in Education (Ofsted) inspections. Public Awareness of the Risks of Smoking and Second-Hand Smoke 4.27 Government plays a major role in raising public awareness of the risks of smoking and second-hand smoke through national publicity campaigns, placing restrictions on the advertising of tobacco and placing health warnings on tobacco products. In his Annual Report for 2004, the Chief Medical Officer states that “taxation has been one of the most effective health policy measures for reducing tobacco consumption” – another role of the Government in addressing the health risks of smoking. National initiatives are used to signpost those smokers who want help to stop, to local services. Local National Health Service services helped 2500 people to quit in the last four years (this equates to 2% of the population). These smoking cessation services are provided by the specialist Stop Smoking Service and through General Practitioners Practices, pharmacies, health visitors, school nurses and Sure Start. Challenging targets have been set for the current year as part of the drive to meet the Public Service Agreement target of reducing the prevalence of smokers in Torbay to 21% by 2010. 4.25 4.26 4.28 Page 13 Review of Smoking in Torbay Stop Smoking Services in Torbay 4.29 In 2003, Torbay Council and the Care Trust jointly funded a post to coordinate a Smoke Free Alliance. The Co-ordinator is responsible for all activities in Torbay relating to the Smoke Free Agenda13. The Smoke Free Alliance, established in March 2004, has a diverse membership, including Members of the Council and Council Officers, a number of statutory, voluntary and business organisations and members of the public. The Torbay Alliance has an ultimate aim for all enclosed public places in Torbay to be smoke-free14. The Smoke Free Alliance has been responsible for a number of awareness raising activities including promotion of the Big Smoke Debate South West, the development and distribution of workplace smoke-free policy development packs and the provision of support to businesses, employees and the public. The Smoke Free Alliance also works with the Devon Alliance and the South West Tobacco Partnership Committee. The National Health Service also provides specialist stop smoking services or ‘Quit Groups’ in Torbay. The service is provided to groups of individuals based on demand, however it is recognised that 10-12 people create the optimal number for a supportive environment. In addition to group activity, one-to-one support is also available. Group activities are scheduled throughout a 9-week period and cover the following themes: • • • • 4.34 Information and preparation Quitting Relapse prevention Follow up 4.30 4.31 4.32 4.33 Access to Quit Groups can be via direct contact by an individual or referral from a health professional. Regulatory Background in relation to Tobacco 4.35 The Panel received a presentation from the Assistant Director (Environmental Health and Consumer Protection) on the regulatory issues surrounding smoking and tobacco. The Council’s responsibilities with regard to Trading Standards and tobacco are to act in accordance with the following legislation: 4.36 13 14 Report 43/2005 – Tobacco Control in Torbay and the Impact on the Health of the Population – 8th March 2005 Torbay Smoke Free Alliance Work Plan (Draft) 2004 Page 14 Review of Smoking in Torbay • • • • 4.37 Health and Safety at Work Act 1974 Workplace (Health, Safety and Welfare) Regulations Food Safety Legislation Children and Young Persons (Protection from Tobacco) Act 1991 In an effort to protect young people in Torbay from tobacco, the Council test purchase from shops in the area. Regular checks are undertaken to establish whether premises are selling tobacco products to under age children. The Panel raised concern with regard to the difficulty experienced by employees when bringing cases against licensed premises. Cases of ill health due to passive smoking are difficult to prove, as it must be established when and where the smoke (that subsequently caused damage) was inhaled. Council Officers are currently restricted in tackling the entry of cheap tobacco into Torbay as only counterfeit products fall under the remit of Trading Standards. Evidence from Her Majesty’s (HM) Revenue and Customs stated that tobacco smuggling undermines the Government’s health objectives (based on the policy of high taxation on tobacco projects playing an important role on in reducing the overall consumption of tobacco) and involves widespread criminality. In March 2000, a new strategy was launched which saw almost 1000 additional frontline and investigative staff deployed, investment in a national network of x-ray scanners, the introduction of “UK Duty Paid” markings on legitimate packets of cigarettes and the setting of challenging targets for HM Revenue and Customs to slow, stabilise and reverse the growth in tobacco smuggling within three years. Working within this strategy, HM Revenue and Customs have succeeded in halting the growth in cigarette smuggling and holding the market share of smuggled cigarettes at 15 % in 2003/04. The market in illicit cigarettes has been reduced by nearly 30% on its peak and the target is to reduce the illicit market share to 13% by 2007/08. By working with tobacco manufacturers, HM Revenue and Customs has successfully restricted the availability of genuine tobacco products to smugglers. As a result of this success, smugglers have now turned to counterfeit supplies of cigarettes. Whilst there is no clinical evidence to show that counterfeit cigarettes are worse for smokers’ health than genuine ones, laboratory tests have shown that counterfeit cigarettes have increased yields of tar and nicotine over genuine brands. 4.38 4.39 4.40 4.41 4.42 Page 15 Review of Smoking in Torbay Additional research has also identified that counterfeit cigarettes in the United Kingdom contain, on average, three times the levels of arsenic, five times the levels of Cadmium and nearly six times the Lead found in genuine brands. 4.43 The Crime Reduction Sergeant from Safer Communities Torbay / Devon and Cornwall Constabulary provided written information for the Panel. He reported that the Police have a moral duty to seize any cigarette papers or tobacco from a person who is under the age of 16. However, the Police have no powers of stop and search for people under 16. The detection and prosecution of offences for the supply of cigarettes to young people is generally enforced by Trading Standards. However, should a particular retailer pose a significant problem within the community, Local Neighbourhood Teams would work in partnership with Trading Standards to address the matter. The Police raised the issue of theft connected with the transportation and storage (both in warehouses and in retail premises, including vending machines) of large volumes of tobacco products. Council Policy on Smoking at Work 4.46 There is currently no over-arching controlling legislation, which focuses explicitly upon the practice of smoking as opposed to the promotion and purchase of tobacco. Proposed legislation in this country and existing legislation in other jurisdictions is targeted upon the obligation of the employer to protect employees and the right of the employee to work in a safe working environment. Second-hand smoke is recognised as a workplace hazard by the Health & Safety Commission. To be lawful, smoking policy must be concerned with where and when people smoke, not whether. As recent case law in both the Employment Tribunals and the European Court of Human Rights indicate, the employer’s obligation is to frame policy which can be wholly justified in scope as being for the legitimate purpose of protecting the safety of non-smokers. Pretty v UK (European Court of Human Rights 2002) establishes that there is a right to personal autonomy under Article 8(2) European Convention of Human Rights which includes a right to chose detriment to quality of life. This right is limited only by consideration of the health and safety of others. As an employer the Council is required under the Health & Safety at Work Act 1974 Section 2 to ensure “as far as reasonably practicable” the health and safety at work of all employees. The Health & Safety Commission states that public authorities as employers should exemplify best practice. Whilst no employer’s liability claim for personal 4.44 4.45 4.47 4.48 Page 16 Review of Smoking in Torbay injuries consequent upon a smoky working environment has yet succeeded, this is a developing area of law where liability is likely in future. 4.49 Torbay Council’s current policy on smoking at work promotes and supports a smoke-free work environment. The policy recognises the Council’s duty, as an employer, to protect its employees, elected Members, visitors, contractors and volunteers from the harmful effects of second-hand smoke, or environmental tobacco smoke. The policy also provides information and support to those employees that wish to stop smoking, via the Occupational Health Service or local organisations. The Panel agreed that the Council’s policy should be reviewed and developed with that of the National Health Service. It was also agreed that the policy should be further amended to clearly reflect duty of care, enforcement, disciplinary issues and staff working at or visiting premises not owned by the Council. Consultation on the Health Improvement and Protection Bill 4.51 Inline with the Council’s review of smoking in Torbay, a response was submitted to the Department of Health with regard to the national consultation on the smoke-free elements of the Health Improvement and Protection Bill. Comments were sought for seven key areas, namely: • • • • • • • 4.53 The definition of ‘enclosed’ public place / workplace The definition of ‘prepare and serve food’ Exemptions in general Placing of signage The offences, penalties and defences Enforcement; and Timetable 4.50 4.52 Whilst consideration and response was given to the areas listed above, the Panel made specific reference to practical implications of the smoke-free legislation and exemptions. A copy of the consultation response is included at Appendix 4 to this Report. Smoke-Free Public Places 4.54 4.55 In order to ascertain the impacts of smoke-free legislation, the Panel considered evidence provided by the Office of Tobacco Control in the Republic of Ireland, and the Smokefree Liverpool Group. Whilst smokefree legislation was introduced in the Republic of Ireland in March 2004 Page 17 Review of Smoking in Torbay (and Northern Ireland in October 2005), efforts are currently being made in Liverpool to introduce a local ban, prior to the implementation of national legislation. 4.56 In the Republic of Ireland, smoke-free legislation was introduced within the Public Health (Tobacco) Acts 2002 and 2004. The aim of the legislation was to ‘protect the health of workers and the public from exposure to second-hand smoke (or environmental tobacco smoke)’15. An extensive campaign of research and publicity both prior to and post implementation of the legislation has resulted in high compliance within the hospitality sector and notable public support. Whilst full studies of how the smoke-free legislation has impacted upon the Irish economy are yet to be published, a decline in bar sales has been noted since 200116. However it is recognised that the market is subject to fluctuation and a decline in sales may be attributable to factors such as high prices and changes in lifestyles. Smokefree Liverpool (established in 2003) is a partnership of voluntary and statutory organisations, which aim to make Liverpool a smoke-free city, prior to the implementation of national legislation. The Smokefree Liverpool group has utilised a vast amount of research, existing and commissioned, to progress the smoke-free agenda within the wider context of health issues and tobacco control. The use of extensive research has enabled the sharing of best practice (with areas such as New York and the Republic of Ireland), whilst also providing credibility to the campaign. Whilst Smokefree Liverpool has endeavoured to introduce a local Bill prior to national legislation, much work has been done to set the foundations for a smoke-free city. Work has included: • • • • • • • • 4.62 Supporting workplaces to go smoke-free Ensuring that schools are smoke-free areas Assistance in developing smoke-free policies Community initiatives, such as organised smoke-free nights in pubs and clubs Research and community consultation Smoking cessation Supporting national training Awareness raising and education 4.57 4.58 4.59 4.60 4.61 Based on the information supplied by the Office of Tobacco Control (Republic of Ireland) and Smokefree Liverpool, it was recognised that 15 16 Smoke-Free Workplaces in Ireland – A One Year Review (Office of Tobacco Control, Ireland March 2004) Smoke-Free Workplaces in Ireland – A One Year Review (Office of Tobacco Control, Ireland March 2004) Page 18 Review of Smoking in Torbay protecting the wellbeing of workers was a common theme. Neither Ireland nor Liverpool has communicated that people should not smoke, they have however advocated the need for responsible smoking and the duty to protect employees from second-hand smoke. 4.63 In order to assess local support for introducing smoke-free public places in Torbay, a local survey was produced by the Service Manager, Democratic Services (Scrutiny) and the Council’s Consultation and Research Team. The consultation period occurred between August 2005 and September 2005 and 173 respondents completed the questionnaire. The results of the survey were presented to the Panel by the Team Leader, Torbay Council’s Consultation and Research Team, who commented on the findings. It was explained that due to the small number of respondents to the survey, detailed comparative analysis with national research could not be produced to identify trends. However it was noted, with regard to opinions given, that when asked about smoking in public places, 87% (144 respondents) agreed strongly that smoking should be restricted in places where there are likely to be children under the age of 16. With regard to smoking in restaurants, 85% (143 respondents) would like to see smoking restrictions. The local survey also sought opinions about what restrictions (if any) should be imposed in pubs. Of 170 responses, 65% (111) agreed that smoking should not be allowed anywhere in pubs, compared with a national figure of 31%. A copy of the document illustrating the results of the local survey and a national survey entitled Smoking-related Behaviour and Attitudes 200417 is included at Appendix 5 to this Report. The Council presently has no statutory authority to ban or otherwise take direct action regarding smoking in enclosed premises owned by others or in open spaces. The Licensing Act 2003 does not allow authorities to indirectly control smoking, as the danger to public safety must be “immediate” for the purposes of the Act. For similar reasons Environmental Health Officers are only empowered to promote awareness and to promote public health. Since no primary legislation yet exists, the Council cannot use the bylaw-creating process to restrict smoking within Torbay at large. However the local legislation procedure under the Local Government Act 1972 Section 239 enables deposit of a Local Bill with Parliament. A resolution to promote a Bill requires a majority of the whole number of 4.64 4.65 4.66 4.67 4.68 4.69 17 Deborah Lader and Eileen Goddard, Office for National Statistics (2004) Page 19 Review of Smoking in Torbay the Council Members, not just those present and voting. The meeting and the proposal must be advertised in the local press 30 clear days in advance. A further meeting must be called as close to 14 days after the deposit of the Bill in Parliament as possible. If a majority of the whole number of Members does not confirm their approval of promoting the Bill, it must be withdrawn. 4.70 The Panel was informed of the risks associated with pursuing local legislation, in that its passage may be obstructed if it conflicts with Central Government’s agenda or approach to the issue. Equally if the Bill wholly reflects imminent national legislation it may be viewed as redundant. Page 20 Review of Smoking in Torbay 5. 5.1 Conclusions Whilst the Panel recognised an individual’s right to smoke, it was agreed that smoking and second-hand smoke cause significant health risks to all members of the community. The Panel welcomed the proposal for the introduction of national smoke-free legislation by Central Government but was concerned about a possible delay in the publication of such legislation. The Panel supported a limited number of exemptions to the proposed smoke-free legislation (as illustrated in the response at Appendix 4) but favoured a total ban on smoking in all licensed premises in Torbay. The Panel recognised the need to develop the Council’s policy on smoking, to ensure that employees are appropriately protected against the harmful effects of second-hand smoke. The Panel also agreed that the Council’s involvement in the National Clean Air Award should be promoted through the policy. The Panel was impressed with information received from the Republic of Ireland and Smokefree Liverpool with regard to implementing smoke-free legislation. It was recognised that public support for the smoke-free agenda in Ireland and Liverpool had been maintained due to: • • • • • Credible and extensive research Continuous communication Education Awareness raising of the risks to employees of second-hand smoke Respecting the individual’s right to smoke, whilst offering support to quit 5.2 5.3 5.4 5.5 5.6 5.7 The Panel was concerned that a rise in smoking prevalence has been recorded in young girls. The Panel were impressed with the work of the Torbay Smoke Free Alliance and agreed that the profile of the group should be raised. Page 21 Review of Smoking in Torbay Page 22 Review of Smoking in Torbay 6. Recommendations It is recommended to the Cabinet that: 6.1 The Council publicly announces its support for the development of smoke-free places in Torbay and assists in raising awareness of the Torbay Smoke Free Alliance and other relevant local schemes such as the Smoke Free Homes Initiative, which aims to promote a smoke-free living environment for families in Torbay. It is also recommended that a Councillor be nominated to act as a ‘Champion’ for the smoke-free agenda within Torbay, to drive these objectives. The Mayor, Council’s Chief Executive and the Director of Public Health send a joint letter to the Government, detailing the need for the publication (without further delay) of comprehensive national smokefree legislation and that the national legislative timetable be reviewed by the Council in February 2006. The Council and National Health Service policies on smoking be immediately reviewed and developed jointly to ensure that their employees and visitors are protected from the harmful effects of smoke and second-hand smoke, with assistance being given to those employees that wish to quit smoking. The policy should also be amended to reflect the Council’s commitment to the promotion of the National Clean Air Award. The Council effectively communicates its policy on smoking to stakeholders and in addition, that literature is produced inline with partner agencies, to respectfully request that individuals refrain from smoking in the presence of Council employees during off site visits. The Council encourages the raising of awareness of the risks associated with smoking and second-hand smoke, in particular with young girls as this area was highlighted as at highest risk. The Council encourages local schools to develop smoke-free education and sign-posting to stop smoking services. The Council enables/trains a range of employees such as Youth Workers to develop the appropriate skills to advise about smoking issues. The Council’s Environmental Health and Consumer Protection Business Unit continue to strengthen enforcement of Health and Safety Legislation and jointly with Torbay Care Trust, raise awareness of the smoke-free agenda and the health benefits of smoke-free workplaces. 6.2 6.3 6.4 6.5 6.6 6.7 6.8 Page 23 Review of Smoking in Torbay Continuous support should also be provided for businesses, in achieving National Clean Air Award status. Page 24 Review of Smoking in Torbay 7. 7.1 Monitoring Arrangements That the Panel should reconvene in February 2006 to monitor the progress that is being made in implementing their recommendations. Page 25 Review of Smoking in Torbay Page 26 Review of Smoking in Torbay Acknowledgements The Members of the Review Panel would like to thank all of the people and organisations that contributed towards the work of this review particularly: Claire Ammar Gill Brown Geoff Chamings Simon Clark Andrea Crossfield Kevin Devine Cecilia Farren Fran Hughes Lynne Kilner David McCaffery Eleanor McGillie Tim Morris Fiona Tolley Lyn Ware Assistant Director Risk Management - Torbay Council Healthy Schools Co-ordinator - Torbay Council Team Leader, Consultation & Research - Torbay Council Director - FOREST Smokefree Liverpool Co-ordinator - Liverpool Council Tobacco Control Unit, Department of Health & Children - Republic of Ireland Action on Smoking and Health (ASH) Assistant Director Consumer Protection and Environmental Health - Torbay Council Smoking and Lifestyles Lead - Torbay Care Trust Safer Communities Torbay – Devon and Cornwall Constabulary Senior Reporter - Herald Express Enforcement & Compliance Operations - HM Revenue & Customs Director of Public Health - Torbay Care Trust Clean Air Project Officer - Torbay Council English Riviera Association Flagship Public House Sure Start, Paignton Torbay Licensed Victuallers Association Page 27 Review of Smoking in Torbay Torbay Care Trust Torbay Hospitality Association Torbay Smoke Free Alliance The Roy Castle Lung Cancer Foundation Page 28 Review of Smoking in Torbay Appendix 1 Implications of the Recommendations Legal With regard to the Council as a landlord, where non-employees occupy premises they do so under a lease or licence, which cannot be retrospectively varied without consent. As a matter of private contract law a restriction on user could be imposed on tenants. This could be imposed in relation to all new lettings but on existing tenants only with their agreement. Compliance with any local or national statutory restriction would automatically be incorporated into all Council leases. Further legal implications are outlined at paragraphs 4.46, 4.47, 4.48 (page 16) and 4.68, 4.69 and 4.70 (pages 19 – 20). Financial implications cannot be fully assessed until further work on the implementation of the recommendations has been undertaken. The recommendation as indicated at 6.17 would have training implications for employees. Implications for the Human Resources Business Unit also include: • • • the continued promotion of stop smoking support for employees within Torbay Council work with Torbay Care Trust Stop Smoking Service to raise awareness with employees the promotion of health initiatives to employees, such as Stop Smoking Day, Men’s Health Week and Health and Safety Week Financial Human Resources Property Attention is drawn to Council owned café restaurants and other leased premises where a smoking ban may have an effect on business. No implications recorded at this time. Change Management Plan The recommendations contained within this Report are in accordance with the Council’s Budget and Policy Framework. The recommendations contained within this Report would be a Key Decision (Reference X34/2005). Page 29 Review of Smoking in Torbay Page 30 Review of Smoking in Torbay Appendix 2 Review of Smoking in Torbay Project Plan Objective of the Review To end health inequalities and increase the life expectancy of poorer and more vulnerable people in Torbay by promoting actions to cut the number of smokers and reduce the harm that smoking causes them and others. Scope of the Review 1. 2. 3. 4. 5. To consider the health risks of smoking and second-hand smoke. To investigate the health risks to children and young people as a result of smoking and second hand smoke. To consider the regulatory background and national priorities in relation to smoking and tobacco. To examine how public awareness of the health risks associated with smoking and second-hand smoke can be raised across Torbay. To consider the Council’s policy on smoking, in particular where Council employees enter smoky premises to undertake statutory functions. To assess the support/appropriateness of providing smoke-free public places within Torbay. 6. Rationale Smoking is the single greatest cause of preventable illness and premature death in the United Kingdom (UK). In the UK each year, more than 120,000 people die each year from smoking. Of these around 8,300 live in the South West and approximately 216 live in Torbay. Across the UK, around 26% of adults smoke whilst the figure in Torbay is around 28%. Tobacco smoke is the only Class A carcinogen from which workers have not protection. It is estimated that at least 1,000 people die each year in this Country (including one bar worker per week) as a result of exposure to other people’s smoke. Secondhand tobacco smoke (SHS) is the main source of indoor air pollution. There is convincing scientific evidence that exposure to SHS both harms health and worsens existing health problems. Page 31 Review of Smoking in Torbay The Government recently published a White Paper entitled Choosing Health that sets out a number of actions to tackle smoking. The delivery plan for this White Paper is expected in Spring 2005. However, a number of nationwide initiatives have been introduced following the publication of another White Paper, Smoking Kills, in 1998. The Big Smoke Debate South West that was held during June and July 2004 was the biggest ever public health consultation. The results showed that a resounding majority of people were in favour of making enclosed public spaces smoke free. The Torbay Smoke Free Alliance was launched in March 2004. The Alliance is a multi-agency group that includes representatives from Torbay Council, Torbay Primary Care Trust, Devon Fire and Rescue and the Licensed Victuallers Association. The aim of the Alliance, as detailed in the Community Plan, is to work towards all enclosed public places becoming smoke free. Review Panel Councillors Brennan, Charlwood, Cope, Doggett, Faulkner (Mrs J), Hytche and Richards Page 32 Review of Smoking in Torbay Appendix 3 List of Key Documents Every Child Matters Towards a Smoke Free Agenda for Liverpool Choosing Health New York: Smoke-Free City Summary of Intelligence on Tobacco The Human Cost of Tobacco One Hospitality Worker Dies Every Week From Passive Smoking Second-hand Smoke: Review of Evidence Since 1998 Smoking Related Behaviour and Attitudes Smoke-Free Workplaces in Ireland – A One Year Review Department for Education and Skills Jon Dawson Department of Health Jon Dawson Associates Department of Health British Medical Association Royal College of Physicians Department of Health Office for National Statistics Office of Tobacco Control 2003 2003 2004 2004 2004 2004 2004 2004 2004 2004 2004 2004 Survey of Second-Hand Tobacco Smoke Sophia Christakopoulou in Liverpool Workplaces and Jon Dawson The Big Smoke Debate South West Department of Health and Government Office South West Health Development Agency British Medical Association FOREST The Smoking Epidemic Behind the Smokescreen Memorandum to Torbay Council 2004 2005 2005 Page 33 Review of Smoking in Torbay Page 34 Review of Smoking in Torbay Appendix 4 Consultation on the Smoke-Free Elements of the Health Improvement and Protection Bill 1. Proposed definition of ‘smoke’ or ‘smoking’ Whilst the proposed definition outlines that ‘smoke’ pertains to tobacco or any substance or mixture which includes it, concern is raised with regard to practical enforcement. It is noted that not all lit products used for smoking contain tobacco and therefore evidential proof (at a cost to the Authority) would be required through any enforcement procedure. The Authority recommend that the proposed definition of ‘smoke’ be amended to reflect any item that can be smoked. 2. Proposed definition of ‘enclosed’ The Authority expresses the view that the proposed definition does contain ‘loopholes’ that could be exploited by individuals and businesses. Whilst the Authority agree in principal with the details of the proposed definition, it is recommended that the definition be amended to provide further clarification, specifically in relation to buildings, communal areas (building entrances and exits) and areas which impact upon groups of people. It is suggested that the Government look closely at the definition used in Ireland and the definition being developed by Liverpool. 3. Other public places and workplaces that might fall outside the definition of ‘enclosed’, which might be smoke-free An exhaustive list of places outside the perimeters of ‘enclosed’ cannot be created until a detailed definition of the term ‘enclosed’ is established. When reviewing areas such as sports arenas / stadiums and other outdoor areas, care should be given to issues such as congregating groups of people, ventilation and actual risk of harm. The Authority recommend that in the interests of public confidence, there should be corporacy of approach to non-smoking in public areas, on a national level. A consistent and clearly defined approach to smoke-free public places will also enable efficient and successful enforcement for local Authorities and partner agencies. Page 35 Review of Smoking in Torbay 4. Exceptions – All licensed premises (receive a longer lead-in time) The Authority recommend that a fixed limited extension be available to all licensed premises. 5. Exceptions – All licensed premises that do not prepare and serve food – definition of ‘prepare and serve food’ The Authority, on the advice of Health Service partners, make reference to public health concerns and inequality issues in terms of exceptions of licensed smoke-free premises. Whilst the consultation document indicates that smoking should be permitted within ‘drinking-only’ licensed premises, the Authority question this issue. For this exception to be justified, the Authority would welcome clarification of links between the sale and consumption of food and the dangers of secondhand smoke inhalation. Potential loopholes were identified via the definition of ‘food’ and issues surrounding food preparation, storage and packaging. Should the exception be agreed in legislation, a flexible list of pre-packaged food items (prepared off the premises) should be made available for enforcement use. 6. Exceptions – Residential premises The Authority recognises that an individual’s dwelling or clearly private space should be exempt from the smoke-free legislation. The Authority support 11 of the 12 areas listed within the residential premises proposed exceptions, however make the following comments: Adult Hospices, Long-Stay Adult Residential Care Homes and Psychiatric Hospitals / Units The Authority recognise conflict surrounding an individual’s right to smoke in their place of residence, and an employers duty to protect staff from secondhand smoke. Therefore the Authority recommend that a designated single room or area be allocated as a smoking environment. This room or area should be adequately ventilated in order to reduce risk of harm to employees. Issues of sensitivity and operational running of units should be taken into consideration. Prisons or Other Places of Detention The Authority consider prisons establishments and detention centres to be spaces of an ‘enclosed’ nature, thereby increasing the risk of harm through second-hand smoke to non-smoking prisoners, staff and visitors. Page 36 Review of Smoking in Torbay It is recommended that establishments of this nature are not exempt under smoke-free legislation. Reference is made to the requirement for exemptions under the smoke-free legislation to conform to the Health and Safety at Work Act 1974, particularly in relation to the responsibilities of employers to provide a reasonable duty of care for all employees. 7. Exceptions – Membership clubs The views of the Authority for the proposed exception do not form a consensus. It is noted that if the term ‘private members club’ pertains to strict private membership, members may be free to choose the smoking status of the club. However opinion is also expressed that many clubs are open to visitors and external workers, therefore private clubs should not be exempt under the smoke-free legislation. Questions are also raised with regard to the long-term health of staff in private and non-private licensed establishments. It is recognised that whilst staff choose to work in an environment which may expose them to secondhand smoke, a margin of responsibility for the duty of their long-term care, should fall to the employers remit. 8. Exceptions – Practical implications The Authority agrees that the introduction of smoke-free legislation would present practical difficulties, specifically in terms of amendment to policy, monitoring, operational activity, administrative functions and enforcement. 9. Signage No issues are raised with regard to the provision of signage illustrating smokefree areas. 10. Offence and penalties The Authority is satisfied with the proposed definition of offences, however note that no reference is made to children or young people. Should children and young people be excluded from smoke-free legislation, impacts will be seen in enforcement and credibility in the form of public confidence. Views from the Authority’s Environmental Health Department reflect the need to increase the proposed penalty fees. The impacts of the proposed fines are identified as follows: a) A fine of £200.00 would make it uneconomical to pursue a prosecution. Page 37 Review of Smoking in Torbay b) Should an organisation be liable as opposed to an individual, a £200 fine would not be a credible penalty or deterrent. c) The proposed fine does not correspond or reflect penalties imposed in the Republic of Ireland. d) Other health and safety offences incur significantly higher penalties in the margin of £20,000. 11. Defences The Authority agrees with the definitions proposed. 12. Enforcement In its current form, enforcement of the proposed legislation is resource intensive and would create significant difficulties. Additional resources should be made available to all local Authorities to ensure that the proposed legislation is enforced consistently across the country. It is recommended that Environmental Health Units undertake responsibility for enforcement. 13. Smoking at the bar Scientific evidence cannot be produced to justify a minimum smoke-free distance from a bar. Should smoking occur anywhere within an ‘enclosed’ bar area the Authority states that second-hand smoke would create health risks to those present. Should the definition be amended to reflect ‘circulation of air’ and ‘ventilation’, this should be scientifically evidence based. The Authority deems the definition as not applicable, instead favouring a noexception approach to all licensed premises. 14. Timetable The Authority recognises the importance of appropriately timed implementation of legislation. Implementation over the Christmas and New Year period would be met with negativity from businesses and the public. Implementing new legislation in the middle of the financial year would have a major impact on the resources of the Authority and it is therefore recommended that implementation occur at the commencement of the financial year. Page 38 Review of Smoking in Torbay 15. Unintended consequences for binge-drinking The Authority deems a link between binge-drinking and smoke-free legislation as inappropriate and therefore potential risks as minimal. 16. General Points Should all licensed premises be smoke-free, issues of variances in communities would be not applicable. Further information For further information on this response please contact: Vicky Booty Overview and Scrutiny Officer Democratic Services Torbay Council Town Hall Castle Circus Torquay TQ1 3DS Telephone: 01803 207014 E-mail: vicky.booty@torbay.gov.uk Page 39 Review of Smoking in Torbay Page 40 Review of Smoking in Torbay Appendix 5 ATTITUDES TO SMOKING NATIONAL AND LOCAL INFORMATION Page 41 Review of Smoking in Torbay Index The national picture The survey The respondents Giving up Previous attempts to stop smoking Reasons to stop Advice Health issues and smoking Second-hand smoke Attitudes to smoking Smoking at work Smoking in public places The local picture Torbay survey Of those that smoked Of those that had never smoked All respondents Comments from respondents Local and national responses Advice Smoking restrictions Smoking at work Risks to health Further information 55 55 56 56 56 52 52 53 53 55 43 43 44 45 46 46 47 48 49 49 50 Page 42 Review of Smoking in Torbay Smoking-related Behaviour and Attitudes – National Survey The national picture The report Smoking-related Behaviour and Attitudes, 200418 illustrates the results of a survey conducted in October and November 2004 on smoking behaviour and attitudes. The survey was the ninth in a series conducted by the Department of Health as part of the Office for National Statistics Omnibus Survey. The Omnibus Survey is used to monitor changes in attitude towards smoking in general and in terms of smoking in public places. Key topics examined in the Survey are: • • • • • • Smoking behaviour and habits Views about giving up smoking Attempts to stop smoking Awareness of health issues relating to smoking Attitudes related to smoking Smokers response to their attitudes The survey Interviews are conducted with approximately 1,800 adult individuals (aged 16 and over) each month and contain a variety of topics. The Survey uses postcode address files as its sampling frame and a new sample of 100 postal sectors is selected each month. The respondents At the time of the survey 23% of men and women smoked cigarettes, 47% of men and 52% of women had never or only occasionally smoked cigarettes. The prevalence of cigarette smoking by socio-economic classes (2001 Socioeconomic classification) showed that people in non-manual occupations were less likely to smoke than those in manual occupations. Smoking-Related Behaviour and Attitudes – Deborah Lader and Eileen Goddard, Office for National Statistics (2004) 18 Page 43 Review of Smoking in Torbay Of those surveyed, 32% of men and 21% of women smoked 20 cigarettes or more per day. 32% of men and 35% of women smoked fewer than 10 cigarettes per day. As an indicator of dependence, smokers were asked how soon after waking they smoke their first cigarette of the day. 11% of smokers had their first cigarette within 5 minutes of waking up. Giving Up 73% of smokers wanted to stop smoking. 28% of smokers ‘very much’ wanted to stop smoking and 24% wanted to stop ‘quite a lot’. 43% of smokers aged 65 and over wanted to stop smoking, compared with 74% of smokers aged 16-64. Smokers with children under the age of 16 years present in the household were more likely to want to stop smoking than those without children. Smokers who were most likely to want to give up smoking were: • • younger aware of the effect of second-hand smoke on chest infections among children Those people surveyed who wanted to stop smoking were asked for their reasons for this decision. The results are as follows: For health reasons For better ‘general health’ Reduction of risk in getting a smoking related illness Existing health problems 88% 68% 27% 15% After health reasons, the next most common reason for wanting to stop was financial. Could not afford to smoke / consider smoking a waste of money Due to family pressure Impacts upon children 26% 18% 16% In 2004, 75% of smokers wanted to give up smoking (this result was similar to previous years). Generally, smokers who intended to give up in the next year were: • Younger Page 44 Review of Smoking in Torbay • • Aware of the effect of second-hand smoking on chest infections and cot death among children Smokers of packet cigarettes The survey indicates that there are two dimensions to stopping smoking: 1. Wanting to stop 2. Intending to stop 94% of smokers who wanted to give up, intended to give up smoking. 22% of smokers who said they did not want to stop smoking, said that they intended to stop at some point. As in the 2002 and 2003 surveys, smokers with no children in the household were more likely than those with children, to neither want or intend to stop smoking. Previous attempts to stop smoking 74% of current smokers had attempted to stop smoking at some point. Smokers with children in the household were more likely to have tried to stop smoking. Heavy and moderate smokers were the most likely to have tried to give up. Smokers who had tried to stop smoking in the past year were asked how many attempts they had made. 17% had made three or more attempts in the past year. Heavy smokers were more likely to have made only one attempt to stop. A third of smokers that had previously tried to stop smoking, had successfully stopped for six months or more. 10% of smokers had lasted for more than two years. 19% had stopped for one week and 67% had stopped for less than six months. 96% of those aged 16-24 had lasted less than a year, compared with 81% of those aged 45-64. Of those that had stopped smoking in the past year, and then started again, the following reasons were cited: Found life too stressful Missed the habit Listed more than one reason Like smoking Friends smoke 34% 16% 16% 15% 14% Page 45 Review of Smoking in Torbay Couldn’t cope with cravings 9% 31% of smokers who wanted to stop smoking but had not tried, or had not succeeded for more than one day, gave the following reasons: Found life too stressful Liked smoking Listed more than on reason 26% 23% 18% Reasons to stop All smokers were asked if anyone had been trying to persuade them to stop smoking in the last year. 53% said that someone had been trying to get them to stop (usually a partner, child or parent). Those who used to smoke regularly but no longer did were asked how long ago they stopped smoking. 77% had stopped smoking for five years or more and men tended to have stopped for longer than women. 68% of ex-smokers gave at least one health reason for giving up smoking. 18% could not afford to smoke or considered smoking a waste of money. Advice Those who had successfully given up smoking in the past year were no more likely to have sought help and advice. Successful quitters were more likely to have used Nicotine Replacement Therapy (NRT) or prescribed drugs. 44% of all smokers had sought help or advice for stopping smoking by the following means: Read leaflets Asked a doctor or health professional Rung a helpline Referred to a stop smoking group Prescribed NRT Purchased non-prescription NRT 35% 15% 5% 7% 9% 11% Respondents were asked whether they had been given advice on smoking by members of the medical profession in the five years prior to the survey. 44% of all current smokers said that they had been given advice in the following form: General Practitioner (GP) Someone else at the GP surgery Consultant or doctor (hospital) Pharmacist 37% 19% 11% 6% Page 46 Review of Smoking in Torbay Other medical personnel 4% 80% of the advice provided was in the form of discussion about smoking. 20% of smokers had been given literature only. 59% said they had found the advice helpful. 35% of people who had stopped smoking in the past five years said they had received advice in that time. Exregular smokers who had been given advice (in the five years prior to the survey) were more likely to say that the advice was helpful (82%). Health issues and smoking Respondents were asked which of a list of possible causes they thought was responsible for premature deaths (deaths before the age of 65). Answers to this type of question should be viewed with caution because the concept of premature death is a difficult one, which is likely to mean different things to different people. Respondents stated that the most common cause of premature death was smoking. Perceptions of causes of premature deaths are as follows: Smoking Road accidents Alcohol misuse Illegal drugs 54% (compared with 48% in 2003) 30% 6% 5% The answers received from respondents are a measure of perception and not fact. In the United Kingdom fewer than 3,000 people (under the age of 69) die in road accidents each year, compared with an estimate of 33,000 from smoking19. Current smokers were less likely than those who had never smoked, to say that smoking causes the most premature deaths. Men were more likely than women to say that smoking causes the most deaths under the age of 65. The youngest and oldest respondents were least likely to think that smoking was the main cause of premature death. Second-hand smoke 19 Mortality from smoking in developed countries - Peto R, Lopez A, Boreham J, Thun M and Heath CJ (2004) Page 47 Review of Smoking in Torbay Respondents were asked whether or not they thought that living with a smoker increased the risk of a child getting a range of medical conditions known, perceived to be caused or made worse by second-hand smoke. Conditions included: • • • • • Asthma Ear infections Cot death Chest infections Other infections Respondents were also asked a similar set of questions with regard to secondhand smoke increasing the risk of a non-smoking adult getting: • • • • • Asthma Lung cancer Heart disease Bronchitis Coughs and Colds Diabetes was included in questions pertaining to children and adults (the risk of which is not medically proven to be increased by active or second-hand smoke). One respondent in five said that they thought the risk of becoming diabetic would be increased by second-hand smoking. Respondents appeared to have a greater awareness of the effect of second-hand smoking on a child’s risk of getting chest infections and asthma. Respondents appeared to be the least aware of the effect of second-hand smoke on a child’s risk of ear infections. Ex-smokers and those who had never smoked were either more aware of the risks of second-hand smoking or more prepared to acknowledge them. Of people who had never smoked, 90% said that second-hand smoking increased a child’s risk of asthma. 64% said it increased their risk of cot death. Women were more aware than men of the link between second-hand smoking and cot death. People who were living in a household containing children were more likely to think that second-hand smoke increased the risk of cot death or ear infections. Page 48 Review of Smoking in Torbay 80% thought that a non-smoking adult’s risk of lung cancer, bronchitis and asthma would be increased by second-hand smoke. 76% said that secondhand smoke would increase the risk of heart disease. Those in the younger age groups (under 45) and those who had never smoked were more likely to know about the effect of second-hand smoking on adults and children. As with questions seeking information about causes of death, the answers provided with regard to illness should be viewed as perception, rather than knowledge. Attitudes to smoking Non-smokers were asked if they would mind if other people smoked near them. 60% of non-smokers said they would mind. This was higher than the percentage illustrated in previous years. The main reasons for this were: • • • The smell of cigarette smoke The smell of smoke left on clothing The health effects of second-hand smoke Smokers were asked if they modified their smoking behaviour when in the company of non-smoking adults or children. They did modify behaviour Did not smoke at all Smoked less 83% 45% 38% Smokers tended to impose stricter controls on their smoking in the presence of children. 67% said they would not smoke at all if they were in a room with children. 74% of light smokers would not smoke at all in front of a child. Smoking at work In December 1998, the Department of Health published Smoking Kills – a White Paper on Tobacco. This paper outlined the kind of smoking policies that employers should operate to comply with health and safety legislation. 51% of respondents who were in work said that smoking was not allowed at all on the premises, an increase since 1996 of 40%. Page 49 Review of Smoking in Torbay 37% of respondents worked at premises where smoking was permitted in a designated smoking room. Smoking in public places Respondents were asked whether they thought there should be restrictions on smoking in certain places. Respondents felt that certain areas should have restrictions as follows: Other public places such as banks and post offices Indoor sports and leisure centres Restaurants Work Indoor Shopping Centres Indoor areas at railway and bus stations Pubs 93% 93% 91% 88% 87% 82% 65% 94% of those who had never smoked and 90% of ex-smokers were in favour of smoking restrictions. Those who were the most likely to be in favour of restrictions were those: • • • • Aged over 35 Who have never smoked In managerial and professional occupations Aware of the effect of second-hand smoking on the health of children and non-smoking adults With specific reference to pubs, respondents stated that: Smoking should not be allowed anywhere Should be mainly non-smoking Should be smoking with a non-smoking area Should be no restrictions 31% 47% 16% 5% When asked a general question, 65% of respondents said they agreed that there should be smoking restrictions in pubs. However when presented with a list of restrictions, 90% would prefer smoking restrictions in pubs. When asked how often respondents would visit pubs with restrictions on smoking, the results are as follows: Non-smokers would visit more often Smokers would visit as often as they do now Smokers would visit less often 30% 85% 12% Page 50 Review of Smoking in Torbay 46% of respondents considered whether or not a place has a non-smoking area as an important factor when deciding where to go for a meal (higher than the 41% in 2003). The text within this document has been taken from the 146 page report Smoking-related Behaviour and Attitudes – Office for National Statistics (2004), to provide a summary of information for the Smoking Review Panel. Page 51 Review of Smoking in Torbay Review of Smoking Questionnaire 2005 The local picture The local survey was produced by the Service Manager, Democratic Services (Scrutiny) and the Council’s Consultation and Research Team. The national survey ‘Smoking-related Behaviour and Attitudes 2004’ was taken into consideration during the creation of the Torbay survey. The consultation period occurred between August and September 2005 and 173 respondents completed the questionnaire. In this report numbers appearing in brackets represent the number of respondents who answered a specific question. Of the 164 people who provided details of their gender, 65% were women and 35% were men. Of the 167 respondents who stated that they ‘had’ or ‘had never’ smoked 39% had smoked (or were currently smokers) and 61% had never smoked. The majority of respondents were aged between 35 and 54 (40%). Of those that smoked (65 Respondents) Aware of the dangers and risks with smoking and passive smoking: Fully aware (57) Have some knowledge (6) Do smoke around family members (21) Do smoke around children (9) Have attempted to give up smoking (47) 90% 10% 36% 15% 84% Within Section 1 of the survey smokers were asked: When you tried giving up smoking please tell us a) where you went to get advice and b) how helpful you found that advice? Respondents were offered a number of options including ‘not applicable / no opinion’ and ‘I did not take advice’. The results of the survey indicate that some respondents may have selected the option of ‘not applicable / no opinion’ to mean that they did not take advice. However the intention of the option ‘not applicable / no opinion’ was to indicate where the respondent had no opinion of the service that they had received from the following: Page 52 Review of Smoking in Torbay • • • • • • • General Practitioner Someone else working in the GPs surgery or Health Centre A Pharmacist Someone at the local Stop Smoking Service A consultant or a hospital doctor Any other health professional The NHS Helpline, Quitline or an alternative Therefore the following results for this question should be viewed with caution. Of the 47 smokers who had attempted to give up, 28 did not seek assistance. The remaining 19 smokers that had sought advice and answered the multiple choice question (87 responses) responded as follows: (This information is based on the assumption that those selecting the option ‘not applicable / no option’ had no opinion of the service in question). General Practitioner (17) A Pharmacist (13) NHS Helpline, Quitline or other (14) Someone else at the GP surgery (12) Stop Smoking Service (12) Consultant / Hospital Doctor (9) Other Health Professional (9) 20% 15% 17% 14% 14% 10% 10% When asked of the likelihood that in one year, respondents would still be smoking (60): Will be smoking (8) Probably will be smoking (9) Might or might not (7) Probably will not (4) Definitely will not (32) Of those that had never smoked (102) Aware of the dangers and risks of passive smoking: Fully aware (73) Have some knowledge (29) 72% 28% 13% 15% 12% 7% 53% Live with someone that smokes (16) 16% That person smokes around family (7) 7% All respondents Page 53 Review of Smoking in Torbay Respondents were asked what restrictions were imposed at their place of work (160): No smoking at all (60) Only in designated areas (34) No restrictions (7) Don’t work in building with other people (4) Not applicable (55) 38% 21% 4% 3% 34% Of the 4% of respondents (7) that worked in places with no restrictions, the majority stated that they would like the work place to be smoke-free. 83% (143) of the total number of those surveyed favoured a national ban on smoking in enclosed public spaces and workplaces. 81% (140) of the total number of those surveyed would like to see Torbay enforce a ban earlier than the national ban. Respondents (168) agreed strongly that restrictions should be enforced in the following: National Places where there are likely to be children under the age of 16 (144) Restaurants (143) Public places like banks and post offices (139) Indoor Sports and Leisure Centres (137) Indoor areas in bus and rail stations (124) Indoor Shopping Centres (122) Pubs (110) 87% 91% 93% 93% 82% 87% 65% Local 87% 85% 84% 83% 75% 74% 66% 76% of all those surveyed locally (173) would be more likely to visit a restaurant if smoking were banned and 68% would be more likely to visit a pub should a ban be implemented. When asked which statement best describes the restrictions preferred in a pub, responses (170) were as follows: Page 54 Review of Smoking in Torbay Local No smoking allowed anywhere (111) Mainly non-smoking (41) Mainly smoking (12) Smoking permitted throughout (4) No comment (2) Comments from respondents 65% 24% 7% 3% 1% National 31% 47% 16% 5% 1% Within the survey respondents were provided with space to record their own comments about smoking. Whilst the comments were varied, some common themes can be identified: • • • • • Smoking as a personal choice Support for a total ban in public places Suggestion of separate smoking areas in public places Negative impacts of smoking upon health Encouragement for smokers to quit Local and national responses The surveys conducted locally and nationally cannot be directly compared due to many factors including: • • • Sample size Socio-economic information Extent, detail and sophistication of information and analysis However some valid general comparison can be made between the local and national views pertaining to advice given to smokers, restrictions on smoking in public places and risks to health from second-hand smoke. Advice Of the current smokers that said they had been given advice (in the national survey), 37% had been given advice by a General Practitioner (compared with a local figure of 20%) and 19% had consulted with somebody else at the surgery (compared with a local figure of 14%). Smoking restrictions National data would indicate that the majority of smokers are willing to adapt their smoking behaviour around non-smoking adults and children. This would also appear to be reflected locally as the majority of respondents Page 55 Review of Smoking in Torbay agreed strongly that smoking should be restricted in places where there are likely to be children. A larger percentage of respondents in Torbay (65%) stated that smoking should not be allowed anywhere within a pub, compared with a national figure of 31%. On a national level, the majority of respondents (47%) favoured mainly nonsmoking pubs, with designated smoking areas. Smoking at work With regard to smoking at work, 51% of respondents from the national survey stated that smoking was not permitted at all on the premises, compared with 38% of respondents in Torbay. This differential however cannot be viewed with accuracy, as the Torbay data does not allow evaluation in terms of socio-economic classifications and subsequent types of workplaces. Risks to health Determining respondents’ knowledge of risks to health cannot be directly compared between the national and local data. Within the national survey a series of questions was used to determine respondents’ actual knowledge of risk, determining that whilst the majority of individuals were aware of the increased risks to a children of chest infections and asthma, there was a lesser knowledge of other risks to health. The local survey asked respondents whether they were fully aware, or had some knowledge of the risks of smoking and second-hand smoke. This information however, cannot be analysed to determine level of awareness or perception. Further Information A copy of the national report ‘Smoking-related Behaviour and Attitudes 2004’ can be accessed via www.statistics.gov.uk. Page 56 Review of Smoking in Torbay Appendix 6 Glossary ASH Ammonia Action on Smoking and Health Colourless gas with pungent smell and strong alkaline reaction The concise Oxford Dictionary Benzene Mixture of liquid hydrocarbons got from petroleum and used as solvent The concise Oxford Dictionary BMA Cadmium British Medical Association Cadmium has a very long half-life, accumulating in liver and kidney, and longterm exposure can cause renal tubular dysfunction, disturbed calcium metabolism resulting in osteomalacia and osteoporosis, and probably an increased risk of lung and prostate cancer. Tobacco is a significant source of cadmium. Cigarette smokers have raised blood and tissue cadmium concentrations and heavy smoking (2 packs per day) can result in a 20 year accumulation of 15mg/kg. http://www.trace-elements.org.uk/Cadmium.htm on 24th October 2005 (NHS Scotland) Carbon Monoxide Colourless, odourless, poisonous gas, produced by incomplete burning of carbon-based fuels, including gasoline, oil, and wood. Carbon monoxide is also produced from incomplete combustion of many natural and synthetic products. For instance, cigarette smoke contains carbon monoxide www.google.co.uk/search on 24th October 2005 Carcinogen Any agent that increases the chance of a cell becoming cancerous, including various chemical compounds, some viruses, X-rays, and other forms of ionizing radiation. The term Page 57 Review of Smoking in Torbay is often used more narrowly to mean chemical carcinogens only. http://www.tiscali.co.uk/reference/encyclopaedia on 24th October 2005 Cerebrovascular Pertaining to blood vessels in the brain www.google.co.uk on 24th October 2005 Cessation Ceasing; pause The concise Oxford Dictionary Ethanol Produced through fermentation of agricultural raw materials (biomass), ethanol is used for various applications: drinks, pharmaceuticals, cosmetics, solvents, chemicals and more and more often in fuels, either in the form of an additive to gasoline (ETBE: Ethyl Tertiary-Butyl Ether) or blended directly with hydrocarbonbased gasoline www.google.co.uk/search on 24th October 2005 FOREST Formaldehyde Freedom Organisation for the Right to Enjoy Smoking and Tobacco Aldehyde of formic acid, used as disinfectant and preservative and in manufacture of synthetic resins The concise Oxford Dictionary Hydrogen Cyanide Colourless gas with a faint, bitter, almond-like odour. It is used in electroplating and metallury, in the production of other chemicals, and in some cases, fumigation. www.google.co.uk/search on 24th October 2005 Ischemic Insufficient blood flow and oxygen to the body tissues www.google.co.uk/search on 24th October 2005 National Clean Air Award The National Clean Air Award, an initiative by the Roy Castle Lung Cancer Foundation, is the first UK wide scheme to reward employers who implement effective workplace no-smoking policies by giving them a prestigious nationally Page 58 Review of Smoking in Torbay recognised award and providing guidance to help get their policy right. www.cleanairaward.org.uk on 4th November 2005 Nicotine Poisonous alkaloid extracted as oily liquid from tobacco The concise Oxford Dictionary NHSP NRT PHSCE Tar National Healthy Schools Programme Nicotine Replacement Therapy Personal Health Social and Citizenship Education Tar is a viscous black liquid derived from the destructive distillation of organic matter. Most tar is produced from coal as a by-product of coke production, but it can also be produced from petroleum, peat or wood www.google.co.uk/search on 24th October 2005 Page 59