Western Australian Branch
WHO Collaborating Centre for Research on Children’s Environmental Health
5 May 2008 Submission on Proposals to Ban Smoking in Private Motor Vehicles and Select Outdoor Settings
A. Smoking in select outdoor settings We strongly support the amendment of state legislation on smoking in public places to cover popular outdoor settings and events. We have no doubt that this initiative will be warmly welcomed by the majority of Western Australians, and interstate and overseas visitors to this State. Today most people don’t smoke, are well aware of the harms caused by tobacco smoke and are accustomed to smoke-free environments. Increasingly, the community is demanding more public spaces be smoke-free, recognising that even smoking outdoors can cause annoyance and irritation and sometimes even health problems when people are close together. Discarded cigarette butts are a danger to small children who may ingest the butts as might wildlife that frequent many popular outdoor recreational settings. Cigarette butts are one of the most pervasive types of litter. In 2006, a national
1
audit of litter found that cigarette butts accounted for 53% of the litter stream in Western Australia.1 Carelessly discarded cigarette butts also pose an additional and significant fire risk for this State causing more than 600 bushfires in 2006-07.2 Collins and Lapsley in their review of the social costs of smoking in Western Australia for the period 2004-05 estimated that fires caused by cigarettes cost in excess of $16 million.3 This is a highly conservative estimate, as it excludes valuations of public property damage, such as national parks, loss of animals, and of amenity while bushland regenerates.3 Furthermore, estimates on the health and societal costs of fires caused by smoking, do not take into account the emotional distress and financial hardship endured by burns victims and their families, as well as risks taken by fire and emergency services staff in responding to fire emergencies and the trauma they too experience.4 Bans on smoking in popular outdoor settings will serve to improve the safety and amenity of public facilities, and promote the health and wellbeing of the community in the longer-term. Globally a number of governments and local communities have banned smoking in a range of outdoor settings for reasons other than inherent attributable health risks of exposure to second-hand smoke. Key reasons cited are reducing fire risk and litter and protecting the public from nuisance.5 We are firmly of the view that current legislation should be amended to cover outdoor eating areas, beaches, parks, sporting arenas (includes outdoor swimming pools), children’s playgrounds, transport waiting areas, outdoor markets and entertainment venues. Specifically, we recommend smoking be prohibited: In any outdoor eating or drinking area where food or drink is provided as part of a business; Between the flags of patrolled beaches (or within the perimeters of outdoor swimming pools, natural or artificial); Within the boundaries of recreational parks and reserves; Within the boundaries of sporting arenas; Within 10 metres of children's playground equipment ordinarily open to the public;
McGregor Tan Research. Keep Australia Beautiful national litter index: Western Australia. Frewville, South Australia: McGregor Tan Research, 2006. 2 Fire and Emergency Services Authority of Western Australia. Annual report 2006-2007. Perth: FESA, 2007. 3 Collins DJ, Lapsley HM. The social costs of smoking in Western Australia in 2004/05 and the social benefits of public policy measures to reduce smoking prevalence. Perth: The Cancer Council Western Australia. In press. 4 Chapman S, Balmain A. Reduced-ignition propensity cigarettes: a review of policy relevant information. Prepared for the Commonwealth Department of Health and Ageing, March 2004. 5 Bloch M, Shopland D. Outdoor smoking bans: more than meets the eye. Tobacco Control 2000; 9:99.
1
2
At transport waiting areas (e.g. taxi stands, railway platforms, bus stops); In outdoor market areas; and Within the grounds of publicly or privately owned venues used for entertainment that the public, or a section of the public, is entitled to use; or is open to, or is being used by the public, or a section of the public, whether on payment of money, by virtue of membership of a club or other body, or otherwise (e.g. outdoor film festivals or concerts held in publicly or privately owned parks and other properties).6 In addition, we recommend: Smoking be prohibited within a minimum 5 metres of entrances to nonresidential buildings and a minimum of 10 metres of ventilation ducts; and Counsels against provision for Designated Outdoor Smoking Areas (DOSAs) under future legislation on smoking in select outdoor areas. In November 2004, the then Premier Geoff Gallop announced that from 1st January 2005 smoking would be banned within five metres of entrances and 10 metres of air-conditioning vents to State Government buildings. The ban was brought in as a policy of government. Nonetheless, there is a perception among some in the community that the policy affects all buildings used by or open to the public. As a consequence, a number of non-government and government health agencies receive complaints from members of the public who falsely believe smoking adjacent to the entrances of buildings is prohibited. The Perth Domestic and International Airports are the source of many complaints made to many of these agencies. Two Australian states, Tasmania and Queensland, have introduced legislation prohibiting smoking within 3 to 4 metres respectively of entrances to nonresidential buildings. Under Tasmanian legislation smoking is also prohibited within 10 metres of any air intake for ventilation equipment on or in a multiple-use building or a non-domestic building. The legislation has been well-accepted in those states. In New South Wales, health groups are calling for a prohibition on smoking within 7 metres of entrances to buildings.7 In Western Australia, a prohibition of smoking within a minimum 5 metres of entrances to non-residential buildings and a minimum of 10 metres of ventilation ducts would bring legislation in line with community expectations and that of other leading states. On the matter of DOSAs, as described under Queensland legislation, we are of the view the provision of such areas would be problematic (as has been the experience in Queensland) and merely serve to facilitate the behaviours that the legislation aims to curb, namely smoking and the exposure of others to secondhand smoke.
Definition of “public place” drawn for the Tobacco Control Products Act 2006. The Cancer Council New South Wales. Outdoor smoking – a background paper [online]. 2008 [cited 2008 April 24]. Available from http://www.cancercouncil.com.au/editorial.asp?pageid=2255
7 6
3
Overall, experience shows that the vast majority of smokers are respectful of the rights of others and policies or laws that restrict where and when they may smoke. The provision of DOSAs seems unnecessary, gives license to smoke and makes smoking more visible in the community fuelling misconceptions about the prevalence of smoking, particularly among the young, and undermining the efforts of smokers or recent quitters to quit or stay stopped.8
B. Private Motor Vehicles Laws prohibiting smoking in vehicles carrying children have been adopted in the U.S. states of Arkansas and Louisiana, the U.S. municipalities of Bangor (Maine), Keyport (New Jersey), and Rockland County (New York), as well as Puerto Rico and the Australian states of South Australia and Tasmania. Bills are currently before several U.S. state legislatures, and the South African Parliament. The Governments of the Australian Capital Territory and New South Wales are also considering bringing forward such legislation.9 Research conducted by reputable state and national health organisations indicate a groundswell of community support and high acceptance of legislative bans on smoking in cars carrying children. Research commissioned by The Cancer Council WA to inform development of its smoke-free home and car campaign conducted in 2007 shows the majority of people, including smokers, support bans on smoking in private vehicles carrying children and this support has continued to grow over successive waves of the campaign (87% and 86% waves 1 and 2 post-campaign vs. 80% pre-campaign [p=.061]).10 While there is ongoing need for education to address mistaken beliefs among some parents about the hazards of second-hand smoke for children, there are clear limits to what can be achieved through educational approaches alone. Children continue to be reliant on parents and carers to voluntarily adopt smoking restrictions to protect them from second-hand smoke. Smoking in vehicles raises the concentration of second-hand smoke in the vehicle to alarming levels, with levels of small particles well above outdoor air standards and comparable to levels found in bars that allow smoking.11.12,13,14
Centre for Health Research and Psycho-oncology. Tracking NSW community attitudes and practices in relation to tobacco: A biennial telephone survey. March 2007. Unpublished report to The Cancer Council NSW. 9 DeRosenroll M, Cunningham R. Laws banning smoking in vehicles carrying children – international overview. August 2007. Unpublished report by the Canadian Cancer Society. 10 Carter O, Donovan R, Jalleh G. Evaluation of the Make Smoking History campaign: Smoke Free Home and Car (Waves 17 & 18). April 2007. Unpublished report to The Cancer Council WA. 11 Edwards R, Wilson N, Pierse N. Highly hazardous air quality associated with smoking in cars: New Zealand pilot study. N Z Med J 2006;119(1244):U2294. 12 Sendzik T, Fong GT, Travers MJ, Hyland A. An experimental investigation of tobacco smoke pollution in cars. Special Report. Toronto: Ontario Tobacco Research Unit, March 2008.
8
4
The confined space of a car increases exposure to tobacco smoke and opening windows does not help reduce the risk. Unlike other environments, children can't escape from cars when their parents are smoking. Being exposed to secondhand smoke as a child may lead to respiratory problems later in life. Evidence shows that exposure to smoking in cars increases the risk of asthma in children by 50 per cent, and can cause asthma in children who haven’t had it before and trigger attacks for those with the condition. 15 Scientific proof of the effects of second-hand smoke on non-smokers together with strong community support for bans on smoking in cars carrying children has culminated in a world-wide campaign; I love my smoke-free childhood16. Spearheaded by the International Union Against Cancer (UICC), the campaign promotes smoke-free environments for children. The UICC endorses bans on smoking cars in which children are passengers. Public health efforts in Western Australia would be significantly boosted if there were legislation in place prohibiting smoking in private vehicles carrying children. Ultimately we would like to see smoking banned in cars entirely, much like use of mobile phones, given not only the health but known risks to road safety. A 2003 review of the literature on driver distraction by the Accident Research Centre based at Monash University found that there are several international studies that show smoking while driving increases the risk of being involved in motor accidents. The review concludes that "it is clear that smoking while driving is a hazard." One study cited connects it with over 2,000 accidents a year.17 There is now an impressive literature on the relationship between smoking and injury with Wen et al.’s paper the definitive work on the issue.18 We recommend: A prohibition of smoking in private motor vehicles in which children under the age of 18 years are passengers
C. Monitoring and Enforcement
13
Ott W, Klepeis N, Switzer P. Air change rates of motor vehicles and in-vehicle pollutant concentrations from secondhand smoke. Journal of Exposure Science and Environmental Epidemiology 2007;1-14. 14 Rees VW, Connolly GN. Measuring air quality to protect children from secondhand smoke in cars. Am J Prev Med 2006; 31(5):363-368. 15 Sly PD, Deverell M, Kusel MM & Holt PG. Exposure to environmental tobacco smoke in cars increases the risk of persistent wheeze in adolescents. MJA 2007;186(6):322. 16 http://www.worldcancercampaign.org/index.php?option=com_content&task=view&id=129&Itemid=388 17 Young KL, Regan MA & Hammer M. Driver distraction: a review of the literature. Melbourne: Monash University Accident Research Centre, November 2003. 18 Wen CP, Tsai SP, Cheng TY, Chan HT, Chung WS, Chen CJ. Excess injury mortality among smokers: a neglected tobacco hazard. Tobacco Control 2005 June; 14 Supplement 1:i28-32.
5
Responsibility for compliance with legislation prohibiting smoking in select outdoor areas should rest with the proprietor or manager of that place, with responsibility for monitoring of compliance and enforcement of the legislation vested in authorities currently responsible for tobacco control legislation. We are firmly of the view that the legislation will be largely self-enforcing given the strong community demand for more public spaces to be smoke-free. We accept that there will be a period of adjustment as the public and proprietors or managers of public places become fully aware of their obligations and the places to which the legislation applies. We are cognisant too of obstacles that various stakeholders may raise, namely the potential for abuse from disgruntled patrons asked to refrain from smoking, and concerns of local government arguments about workloads and the timeliness of responses to complaints especially for remote and sparsely populated communities. Past experience shows, however, that patrons are accepting of bans on smoking where there is clarity about where and when they may smoke and where bans are applied uniformly across like settings. Similarly, monitoring and enforcement of legislation, when supported by a majority of the community, can be accommodated within existing duties and resources. This is also more likely where there is adequate support for training and education, and back-up in dealing with the occasional recalcitrant proprietor or manager of a venue that is in breach of legislation.
D. Public Education Smoking is on the decline consistent with improvements in people’s understanding of the harms it causes to the individual and non-smokers. Most indoor spaces such as workplaces and public venues are now smoke-free. Nevertheless, many smokers continue to light up in their home and car, often unaware of the health risks they impose on others. There is still a low level of awareness and misconceptions about the harms of second-hand smoke, including a common misconception that only visible smoke is harmful. Some smokers mistakenly believe that smoking in another room, winding down car windows or blowing smoke away from a child will protect against its harmful effects. Public education on second-hand smoke has an important and complementary role to play in addressing mistaken beliefs about the effects of second-hand smoke, and effectiveness of measures for protecting children and others against exposure to it.
E. Other Comment We are well aware that the smooth introduction of legislation is greatly assisted when it is: 6
Consistent – in how the legislation is applied to the various outdoor settings Clear – about the roles, responsibilities and scope of legislation Simple – so there are clear and common understandings of the legislation Equitable – is not perceived to provide a commercial advantage, real or otherwise, to managers or proprietors of like venues Widely promoted – as a positive and reasonable response to an issue of concern to the public Given that the vast majority of enclosed public places and workplaces are now all smoke-free, and we are now moving to extend bans on smoking to a range of popular outdoor settings, the exemption for Burswood International Gaming Room is strange and difficult to understand. We, therefore, strongly recommend that the exemption for the Burswood International Gaming Room is removed. On the timing for the introduction of the prohibitions proposed in this and the Department of Health’s discussion paper, we recommend they be introduced within 6 months of legislative amendments being passed by the Parliament.
7