Smoke-free outdoor areas: A rationale
Introduction
Exposure to second-hand smoke increases the risk of lung cancer and heart disease. Evidence shows that exposure in some outdoor settings is substantial enough to cause harm. Those outdoor areas of particular concern are those where people congregate together and are therefore exposed to high concentrations of smoke drift, and places where children are present and are therefore likely to be exposed directly to smoke or to positive reinforcement of smoking.
The areas Cancer Council NSW would like to see made smoke-free include:
- children’s playgrounds
- sporting grounds
- alfresco dining
- shopping malls and plazas
- covered bus stops and taxi ranks.
Local Government
Councils are closer and potentially more responsive to their local communities so they present an ideal opportunity for communities to express their desire to live in an environment which is free from contamination by cigarette smoke. Under the NSW Local Government Act 1993 councils have the authority to erect signs in public places which control or prohibit certain activities. They currently already do this e.g. to control dogs, ban alcohol, reduce litter etc. We therefore believe that it is a simple and reasonable ask for councils to add a no-smoking sign in those areas. Councils can also control smoking in some alfresco dining areas, i.e. those leased by private businesses from council. Cancer Council NSW recognises the legitimacy of local government introducing outdoor smoking bans based on public interest considerations such as fire and litter control and nuisance.
State Government
Although some local councils have shown leadership in passing policies for smoke-free outdoor places within their control, local policies alone cannot be the solution. It would be far more effective, and fairer, for the state to create a uniform approach by introducing legislation that covers all of NSW.
The health impact of second-hand smoke
There is substantial evidence linking exposure to second-hand smoke (second-hand smoke) with a range of serious and life threatening health impacts including heart disease, lung cancer and a number of other respiratory problems. 1
Epidemiological evidence linking second-hand smoke with ill health is supported by knowledge of the chemical make-up of second-hand smoke and its biological effects. It is estimated that tobacco smoke contains over 4000 chemical compounds, including 43 known carcinogens (cancer causing agents). 2 It is generally accepted within the scientific community that there is no safe dose for many carcinogens. Individual constituents of tobacco smoke e.g. 1,3 butadiene are banned in the workplace, and continued exposure of the public through the medium of tobacco smoke is an environmental health anomaly.
Furthermore, many tobacco smoke constituents are pharmacologically active, toxic and mutagenic (facilitating genetic mutations). Given the similarity of the chemical composition of second-hand smoke and mainstream tobacco smoke (smoke inhaled directly into a smoker’s lungs), it is plausible that non-smokers exposed to second-hand smoke will be at risk of contracting the same diseases as active smokers.
Second-hand smoke at outdoor settings
Regular second-hand smoke exposure in indoor areas has been established as a cause of serious disease including cancer. Exposure levels indoors have been well characterised. Evidence is now emerging that shows second-hand smoke levels outdoors can approximate those that are known to cause serious diseases after regular indoor exposure. 3, 4, 5, 6
The Environmental Protection Agency Air Resources Board (ARB) of the State of California measured air concentration of nicotine adjacent to outdoor smoking areas in five locations – an airport, a college campus, a public building, and an amusement park. Eight-hour and one-hour mean concentrations were measured over three days in each location. Concentrations attained relates to the number of cigarettes smoked. (see Table 1)
Table 1: Air nicotine levels adjacent to outdoor smoking areas in California, USA. 6
| Site Tested | Eight hour range g/m 3 | Cigarettes smoked/hr | One hour range g/m 3 | Cigarettes smoked/hr |
| Airport | 0.48-0.99 | 37 | 0.36-1.5 | 61-75 |
| College | 0.013-0.044 | 4 | 0.017-0.15 | 5 |
| Local Govt Centre | 0.042-0.073 | 7 | 0.039-0.18 | 12 |
| Office Complex | 0.11-0.15 | 33 | 0.10-0.28 | 30 |
| Amusement Park | 2.4-3.1 | 90 | 0.66-4.6 | 91-148 |
These results show that even in areas that are completely outdoors, it is possible to attain substantial exposures to second-hand smoke.
In another study, ambient second-hand smoke constituents in indoor and outdoor areas of a cruise ship underway at sea were measured. It was found that outdoor smoking areas were contaminated with the second-hand smoke constituents measured to nearly the same extent as a popular smoking-permitted casino on the ship. 7
In the city of Copenhagen in Denmark, a study found that measured second-hand smoke reached significant levels outdoors in different parts of the city where smokers gathered to smoke. 8
In Australia, a 2009 journal paper reported on air quality measurement research undertaken at 69 Melbourne alfresco dining venues. The researchers concluded that exposure to second-hand smoke in particular outdoor locations poses significant health risks.9
An understanding of the atmospheric dispersion of second-hand smoke in outdoor settings can help explain the relatively high levels found by the research. In brief, a cigarette smoke plume will rise but rapidly cool therefore losing upward momentum and then subsiding. If there is no wind the smoke will saturate the area. The effect is exacerbated where there are groups of smokers. Even where there is wind, those downwind can be adversely affected. 10
Current legislative status of outdoor bans
New South Wales
Smoking in “enclosed” public places in NSW is regulated by the Smoke-free Environment Act 2000 11 and related amendments that came into force in June 2007. 12 This legislation makes no provision for the control of outdoor smoking. Public places that are not defined under the Act as enclosed, such as outdoor seating areas in restaurants and cafés, and pub beer gardens are not required to be smoke-free under the Act. Both staff and patrons in such areas are in most instances exposed to second-hand smoke. This contrasts with the situation in Queensland where such areas are subject to strong regulation (see under ‘Jurisdictions other than NSW’).
Along with health issues, tobacco-related litter – cigarette butts being washed into Sydney Harbour for instance – has been a motivating factor for the introduction of outdoor smoking bans by local councils. Fire risk to bushland from discarded cigarettes is another obvious concern in NSW.
A growing number of local councils are moving to enact stricter controls than those in place at state level. The first to take such action were Manly and Mosman councils in December 2004. Many NSW councils have followed Manly and Mosman’s lead by introducing smoke-free outdoor area policies. Among the settings covered by these policies are alfresco dining, playgrounds, sporting fields, beaches , pools and bus shelters. A list of NSW councils with smoke-free outdoor area policies and the outdoor areas covered can be accessed in the National Heart Foundation publication Smoke-free policy in outdoor areas – A 2010 survey of NSW councils.
Jurisdictions other than NSW
Outdoor smoking restrictions are becoming more prevalent nationally and internationally. Within Australia, Queensland’s Tobacco and Other Smoking Products Act 1998 comprises the strongest regulations. It prohibits smoking at outdoor areas of specific major sports stadia; patrolled beaches (between the flags); specific artificial beaches; within 10 metres of children’s playground equipment ordinarily open to the public; and within 4 metres of a non-residential building entrance. The Act also prohibits smoking at outdoor eating and drinking areas where food or drink is provided as part of a business. Liquor-licensed premises are able to able for permission to establish Designated Outdoor Smoking Areas however these are subject to strong conditions in the interest of minimising exposure to second-hand smoke.
In Tasmania, under the Public Health Act 1997, “smoke-free areas” include any area of an outdoor sporting or cultural venue containing reserved seating; within 3 metres of a non-domestic building entrance; in at least 50 per cent of outdoor dining areas. 13
A number of local councils in other States also have established outdoor smoking bans at a range of settings.
In the USA, California was the first State to implement legislation. The Californian Health and Safety Code Section 104495 prohibits smoking any cigarette, cigar, or other tobacco-related product within the boundaries of a playground or “tot lot” sandbox area.14 Many cities in the US have implemented restrictions on outdoor smoking at a wide range of settings.
A number of provinces and cities in Canada have implemented restrictions in particular outdoor settings. Nova Scotia and Vancouver are two such jurisdictions.
Increasingly, smoking bans are being implemented in the outdoor settings of hospitals and educational institutions.It should be noted that various communities and specific facilities around the world 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.15
References
1. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General . Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006. (accessed 3 August 2011).
2. U.S.Department of Health and Human Services. How Tobacco Smoke Causes Disease: The Biology and Behavioral Basis for Smoking-Attributable Disease: A Report of the Surgeon General. Atlanta, GA: , 2010. Atalanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. (accessed 3 August 2011).
3. Cains T, Cannata S, Poulos R, Ferson MJ, Stewart BW. Designated ‘‘no smoking” areas provide from partial to no protection from environmental tobacco smoke. Tobacco Control 2004;13:17–22. (accessed 3 August 2011).
4. National Health and Medical Research Council (NHMRC), The Health Effects of Passive Smoking—A Scientific Information Paper . Commonwealth of Australia. Canberra, November 1997.
5. Klepeis NE, Ott WR, Switzer P. Real-Time Measurement of Outdoor Tobacco Smoke Particles. Journal of the Air and Waste Management Association 2007; 57:522-534.(accessed 11 February 2010).
6. California Environmental Protection Agency Air Resources Board. Proposed Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant . Sacramento, 2005. (accessed 3 August 2011).
7. Repace JL. Indoor and Outdoor Carcinogen Pollution on a Cruise Ship in the Presence and Absence of Tobacco Smoking. Research presented at the 14 th Annual Conference of the International Society of Exposure Analysis, Oct. 17-21, Philadelphia, PA. (accessed 3 August 2011)
8. Boffi R, Ruprecht A, Mazza R, Ketzel M Invernizzi G.. A day at the European Respiratory Society Congress: passive smoking influences both outdoor and indoor air quality (letter). European Respiratory Journal. 2006; 27: 862-863. (accessed 3 August 2011)
9. Cameron M, Brennan E, Durkin S, Borland R, Travers MJ, Hyland A, Spittal MJ, Wakefield M. Secondhand smoke exposure (PM2.5) in outdoor dining areas and its correlates. Tobacco Control 2010;19:19-23. (accessed 9 August 2011).
10. Repace JL. Banning outdoor smoking is scientifically justifiable. Tobacco Control 2000; 9: 98 (Spring) (accessed 8 March 2007). (accessed 9 August 2011)
11. (NSW) Smoke-free Environment Act 2000 . No 69. Sydney; 2000.
12. (NSW) Smoke-free Environment Regulation 2007 . Sydney; 2007. (accessed 3 August 2011)
13. TasmanianPublic Health Act 1997 , Section 67B (accessed 15 March 2007).
14. California State Legislature. California Codes. Health and Safety Code 104495. (accessed 27 June 2011)
15. Bloch M, Shopland D. Outdoor smoking bans: more than meets the eye. Tobacco Control 2000; 9:99. (accessed 3 August 2011)
