June 2009 by gjjur4356



                               Impact of Tobacco-Free Policies within Sports Teams

                                                  Written by Sireesha Bobbili
                                                                                                            May 2010

This document provides a summary of available scientific literature regarding the impact of tobacco-free
policies within sport teams. In particular, it addresses sports organizations as health-promoting environments,
the intended effects of tobacco-free sport and recreation policies, and policy outcomes within sport settings.

Sports Organizations as Health-Promoting Environments

Influencing population health through policy is a well-recognized public health technique (Priest, Armstrong,
Doyle & Waters, 2008). The Ottawa Charter for Health Promotion emphasizes building healthy public policy as
part of a comprehensive approach to health promotion (World Health Organization [WHO], 1986). Priest and
colleagues (2008) define policies as regulations that alter the physical and/or socio-cultural environment, such
as smoke-free policies or anti-discrimination policies.

The Ottawa Charter stresses the importance of creating supportive environments to promote healthy behaviours
among individuals (WHO, 1986). Sporting organizations that control, organize and administer sporting events
are increasingly being recognized as environments where health issues can be addressed (Priest et al., 2008).
The combination of healthy policies with sport organizations as a setting provides a unique opportunity to reach
a large portion of the community and target high-risk behaviours, such as smoking, alcohol consumption,
excessive sun exposure and unhealthy eating (Casey, Payne, Eime & Brown, 2009a; Priest et al., 2008).

Intended Effects of Tobacco-free Sport and Recreation Policies

Tobacco-free sport policies intend to address the use of all types of tobacco products. While much of the
literature does not define ‘tobacco-free sport policies’, it is implied such policies require that “participants,
spectators, coaches and leaders do not smoke, snuff, dip or chew tobacco while engaged in the activities” of a

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sporting organization (Play, Live, Be Tobacco-Free, n.d.). The intention is to impact those involved in
organized sporting events and activities in the following ways.

Protection from Second-hand Smoke
One of the main intentions behind establishing tobacco-free sport policies is to prevent and reduce exposure to
second-hand smoke (SHS) where people congregate (Repace, 2008). The US Surgeon General’s Report entitled
"The Health Consequences of Involuntary Exposure to Tobacco Smoke" concludes there is no safe level of
exposure to SHS (Centers for Disease Control [CDC], 2006). It should be noted this report mainly focuses on
indoor exposure to SHS. However research by Klepeis and colleagues (2007) suggests exposure to outdoor
tobacco smoke (OTS) is hazardous to the health of adults and children and may be life threatening to high-risk
populations, such as those with asthma or other chronic illnesses (Klepeis, Ott & Switzer, 2007). Their research
also suggests the level of OTS exposure is dependent on an individual’s proximity to the source of the OTS (the
smoker), wind conditions and the number of smokers present (Klepeis et al., 2007).

Denormalization & Positive Role-Modeling
Tobacco-free sport policies are also intended to encourage the denormalization of tobacco use to children
(Thomson, Wilson, Edwards & Woodward, 2008). Health has been shown to be an important motivator for
male teens (aged 14-16 in Finland) to participate in sport club activities (Kokko, 2010). This indicates the
potential for health promotion via coaches to greatly influence young people involved in sport. Since youth tend
to mimic behaviours of coaches as well as parents, peer athletes and older athletes, role models who
demonstrate positive health behaviours encourage good decision-making (Henriques, Newton & Marshak,
2003). Research also indicates positive role-modeling prevents young people from initiating tobacco use
(Wakefield & Chaloupka, 2000). Therefore, it is important to establish an environment where tobacco-free sport
and lifestyles are considered to be the norm (WHO, 2005). For more evidence on the relationship between role-
modeling and adolescents’ tobacco use, please see the LEARN backgrounder “Adolescents’ smoking behaviour
and role modeling” (June 2009).

Promoting Cessation
Positive role-modeling in the context of tobacco-free sport and recreation policies also intend to assist those
who are attempting to quit (WHO, 2005). Tobacco-free policies may assist with increasing motivation for
tobacco cessation (Thomson et al., 2008). Studies have shown indoor smoking bans in workplaces and homes
reduce cigarette consumption as well as encourage smokers to quit (Fichtenberg & Glanz, 2002; Shields, 2007).

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Thus, we can expect outdoor smoking bans may also encourage smokers to reduce their cigarette consumption
or quit smoking.

Environmental Protection
Finally, tobacco-free sport and recreation policies may be introduced in order to protect the environment (Klein,
Forster, McFadden & Outley, 2007). Every year, over 845,000 tons of cigarette butts are littered worldwide
(Novotny, Lum, Smith, Wang & Barnes, 2009). Cigarette filters are composed of acetate cellulose, a type of
plastic, which is photodegradable, but not biodegradable (Novotny et al., 2009). The sun’s ultraviolet rays break
down filters into smaller parts, however they remain in the environment and toxic chemicals leach from
cigarette butts, polluting land and water nearby (CDC, 1997). Pets, birds and fish often swallow butts, which
can result in malnutrition, starvation and death (Klein et al., 2007). Small children are also at risk of swallowing
and choking on discarded butts. This may cause vomiting or more severe irregular heartbeat and seizures (CDC,

Policy Outcomes within Sport Settings
Evaluating health-related policies in a sport environment is very complex (Priest et al., 2008). Influences on
health behaviours are multi-faceted, making it difficult to determine whether a specific policy actually produced
a behavioural or environmental change leading to a desired health outcome, such as preventing youth from
initiating smoking.

Tobacco-free policy development in sport and recreation settings represents a growing area of interest and
effort. Most articles regarding policies in sport settings document the implementation process. As a result, there
is limited evidence evaluating the actual outcomes of health policies in sport settings; in fact, only a few
published articles were found that specifically addressed and measured policy outcomes. Due to this lack of
data, the remainder of this backgrounder focuses on the results of these published articles that provide evidence
for the effectiveness of such policies.

American Male College Athletes and Smokeless Tobacco Use
The National Collegiate Athletic Association (NCAA) implemented a policy in 1994 to prohibit student athletes
from using tobacco during practice and competition. It was developed to denormalize the use of smokeless
tobacco (ST) in sports and reduce public perception that ST is linked with athleticism and a healthy lifestyle
(Chakravorty, Ahmed & Buchanan, 2000). Chakravorty and colleagues (2000) examined the impact of this
policy on users of ST products. Men’s NCAA football, wrestling, tennis and baseball team players were
surveyed during two waves in 1996 and 1997 through self-reported questionnaires. While the same colleges

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were solicited during both waves, players who voluntarily responded in 1996 did not necessarily participate
during the second wave in 1997. 589 respondents from 1996 and 583 respondents from 1997 who reported
using ST at least once a week for the past 90 days were included in the report (Chakravorty et al., 2000).

Denormalization & Positive Role-Modeling
Since this study only focused on ST use, no information regarding the influence of NCAA tobacco-free policy
on protection from SHS as well as environmental protection was reported. Over the course of the study,
attitudes toward the NCAA ST policy became increasingly positive. Forty-three percent of ST users agreed,
“the NCAA’s policy is a good one” during wave I, which increased to 51% during wave II (Chakravorty et al.,
2000). In addition, disapproval was associated with using ST while competing during wave I, whereas in wave
II, disapproval was associated with using ST during both competition and practice (Chakravorty et al., 2000).

Promoting Cessation
Respondents showed a significant decrease in ST use during practices over the course of the study. Eighty-six
percent of males reported using ST at practices during wave I in 1996. This declined to 32% by wave II in 1997
(Chakravorty et al., 2000). On the other hand, ST use during competition remained stable, at 22% in 1996 and
23% in 1997 (Chakravorty et al., 2000). Also, most users indicated the policy had no effect on their overall
consumption of ST. However, 17% of users admitted the policy influenced the amount of ST used in 1996,
which increased to 23% in 1997 (Chakravorty et al., 2000).

Limitations of the Study
As this study focused on US NCAA college athletes who participated in selected sports, the findings of this
study may not apply to other populations (Chakravorty et al., 2000). In addition, since the data is cross-
sectional and was collected after policy implementation, changes in ST use cannot be causally linked to policy
adoption (Chakravorty et al., 2000).

The Western Australian Health Promotion Foundation (Healthway)
In 1991, the Western Australian Health Promotion Foundation, also known as Healthway, was established with
funding from a levy collected through the wholesale distribution of tobacco products (Oddy, Holman, Corti &
Donovan, 1995). Health promotion foundations were designed to replace sport sponsorship funds that were
previously provided by tobacco companies. Healthway mainly provided sponsorship grants to sport
organizations in order to “promote healthy messages, facilitate healthy environments and increase participation
in healthy activities” (Government of Western Australia, n.d.). Simultaneously, Healthway awarded grants to
independent health agencies to assist sport organizations with promoting healthy messages such as Be Smoke
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Free, Drinksafe, Eat More Fruits and Vegetables and Be Active Everyday (Oddy et al., 1995). In accordance
with sponsorship guidelines, sport organizations were required to create healthy environments by introducing
‘structural changes’, such as smoke-free policies, safe alcohol serving practices, provision of healthy food
choices and sun protection measures (Corti, Holman, Donovan, Frizzell & Carroll, 1995).

Protection from Second-hand Smoke
In 1997 and 1998, Pikora and colleagues (1999) conducted observational studies at outdoor seating areas at two
major sporting venues, Subiaco Oval and Western Australian Cricket Association (WACA) stadium, in Western
Australia. Estimations were developed regarding the proportion of smokers in the stands, which ranged from
21% smokers at Subiaco Oval to 15% at WACA stadium (Pikora, et al., 1999). The observational areas were
representative of those used by the general population at Subiaco Oval (n=4616) and WACA stadium (n=3,596)
(Pikora et al., 1999). During the observation period, 8 people out of an estimated 969 smokers at Subiaco Oval
were observed smoking; no one was observed smoking at WACA (Pikora et al., 1999). A cigarette butt count
was completed following the games to validate the observations; six butts were found at Subiaco Oval and two
were found at WACA stadium (Pikora et al., 1999). Spectators were still able to smoke in designated smoking
areas, which were located away from the stands. If the indoor and outdoor seating areas at the venues were not
smoke-free, Pikora and colleagues (1999) estimated 926 packs of cigarettes (20 cigarettes per pack) could have
been smoked at Subiaco Oval and 367 packs could have been smoked at WACA in the seated areas. These
results indicate smoke-free policies are “highly effective in protecting non-smokers from the effects of
environmental tobacco smoke” (Pikora et al., 1999).

Denormalization & Positive Role-Modeling
In order to assess agreement with and support for smoke-free policies at sporting events in Western Australia,
Giles-Corti and colleagues (2001) surveyed randomly selected spectators at three different times during the
Healthway sponsored policy implementation process.

In 1994, prior to the implementation of smoke-free policies, a total of 613 randomly selected spectators at eight
Western Australian football league clubs (football is the equivalent of soccer in North America) were surveyed
to determine their support for the introduction of smoke-free policies in sport settings (Giles-Corti et al., 2001).
Sixty-nine percent of participants supported smoke-free areas surrounding take-out food locations, however
only 20% supported implementing policies prohibiting smoking in outdoor seating or grassed areas (Giles-Corti
et al., 2001).

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In 1995, a smoke-free policy was established at Subiaco Oval, a home stadium for two Australian soccer teams,
and a total of 185 spectators were randomly selected and surveyed to determine their awareness, attitude toward
and support for smoke-free policies (Giles-Corti et al., 2001). Approximately 74% of spectators were aware of
the newly introduced policy, with the majority of these respondents supporting the policy (83%) (Giles-Corti et
al., 2001). Awareness and supportiveness did not differ between smokers and non-smokers (Giles-Corti et al.,

Finally, a spectator survey was conducted in 1998 at Subiaco Oval, where indoor and outdoor smoke-free
policies were introduced. A total of 242 spectators were surveyed to determine attitudes toward smoke-free
policies in sport settings. This final spectator survey indicated an increase in awareness for smoke-free policies
(81% in 1998 up from 74% in 1995) (Giles-Corti et al., 2001). On the other hand, support decreased from 83%
in 1995 to 79% in 1998. It should be noted that these results were not deemed to be statistically significant.
Giles-Corti and colleagues (2001) concluded the implementation of smoke-free policies may alter community
and social norms regarding smoking in public areas and may also normalize non-smoking behaviours in and
around recreational settings (Giles-Corti et al., 2001).

Pikora and colleagues (1999) did not measure how the policies affect cigarette consumption generally and did
not observe smoking levels in the smoking areas; it is unclear whether the smokers moved to the smoking
section or reduced their consumption. However, Giles-Corti and colleagues (2001) suggest smoke-free policies
may create supportive environments for non-smoking behavior. Additional research is needed to determine if
these policies affected overall tobacco consumption.

This background document has presented outcome results from implementing policies in two different sport
settings – NCAA teams in which American male college athletes participate, and sports venues in Western
Australia that received health sponsorship grants from the health promotion foundation Healthway. While the
studies reviewed provide some evidence that policies may alter smoking behaviours in sport organization
settings, there is clearly a lack of substantial evidence in the literature and more research is needed to support
the existing evidence (Priest et al., 2008). This may be because the movement to create and implement
voluntary tobacco-free sports and recreation policies is relatively young. In Ontario, for example, the Play, Live,
Be...Tobacco-Free movement began in 2008, with efforts to coordinate initiatives across the province supported
through a provincial Healthy Communities Fund grant awarded in late 2009.

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In order to understand the complex process of policy implementation and resultant behaviours, it is essential
that evaluation techniques are developed and utilized to determine the impact of policy. Validated tools for
gathering information from specific populations should be used to measure policy outcomes, such as smoking
status and sun protection habits. Efforts should also be made to develop tools in areas where none exist (Priest
et al., 2008). Giles-Corti and colleagues (2001) suggest evaluations should include process, or ongoing
evaluations, as well as outcome evaluations in order to measure behaviour changes. Information should also be
collected regarding the social, political and cultural context in order to acknowledge various factors influencing
the sport setting under study (Giles-Corti et al., 2001).

In the case of the NCAA smokeless tobacco policy, there is insufficient information regarding why the policy
did not result in changes in smokeless tobacco use during competition. The reader is left unclear about whether
the lack of behaviour change during competition was due to inadequate enforcement, role-modeling, education
about the health impacts of ST use or other factors. For this reason, it is important to design evaluations such
that the results provide insights into the specific policy factors that influence positive behaviour change.

Suggested Citation: Bobbili, S. (2010). Impact of Tobacco-Free Policies within Sports Teams. Toronto, ON: Program
Training and Consultation Centre, LEARN Project.

Comments and suggestions for this document are welcome and can be sent to erika.steibelt@cancercare.on.ca

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