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Opinion | Making a case to dispel smoke

Recent debate over proposals to introduce smoke-free outdoor areas has elicited diverse responses; however, some comments overlook important research, practical experiences, as well as public opinion.

At the extreme, we read predictable rhetoric invoking proponents of this measure as moralising “fun police”, hellbent on victimising those with the temerity to deviate from narrowly defined “healthy” behaviours.

However, if we probe further, we find a strong evidence base supporting these proposals.

In a curious restating of the tobacco industry’s claims, opposition to smoke-free local areas frames smoking as entirely a matter of individual choice, conveniently overlooking the fact that addiction compromises any choice smokers might once have had. The fact smokers do not have a proper choice is a key reason why the vast majority (more than 80%) regret having started and wish they were smoke free. They dislike the way their addiction controls their lives and resent the costs (health, financial and social) it imposes on them.

Having spoken with many smokers in our research, nearly all want to be smoke free, and none has ever wished their children would grow up to be smokers. Most smokers make several quit attempts each year, further evidence they wish to be rid of this addiction.

Quitting smoking is often difficult.

Smokers may need many serious quit attempts. Successful quitting requires strength, determination, resilience, and support. The first three attributes are traits smokers must largely find within themselves, but the last one – support – is something we can all offer.

Sometimes this is highly personal: a sympathetic health worker or a caring and understanding partner and family.

But support can take other forms: from smoking colleagues who don’t undermine quit attempts to the non-smoking colleagues who offer practical encouragement; from smoke-free workplaces to in-house quit programmes, and from smoke-free outdoor areas to the widespread availability of cessation products.

Our environments exert a powerful influence over our behaviour. How many of us last shopped without making unplanned impulse purchases?

Our choices are far more determined by external influences than we might wish to believe. Smoke-free environments make it clear that smoking is not a normal social behaviour. In so doing, they help achieve two important goals: they support smokers trying to quit by reducing the sight and smell of others’ smoking, cues that are proven factors in triggering relapse. Second, they reduce children and young people’s exposure to smoking, so that they are less likely to view smoking as a normal adult behaviour to which they might aspire.

This objective is important because young people consistently over-estimate the proportion of people who smoke, and those with the highest overestimates also have the highest risk of experimenting with smoking.

So, far from trying to “hound” smokers, measures proposing smoke-free outdoor areas actually support smokers. The evidence shows most want to quit, a difficult challenge at the best of times, let alone in an environment redolent with smoking cues.

Overseas and local experience suggests smoke-free outdoor areas do work, don’t require heavy-handed policing, are widely supported by smokers and non-smokers alike, and improve the environment for children, adult non-smokers, and the high proportion of smokers trying to quit.

Some reports have implied the public do not support stronger tobacco control policies, a claim that public opinion surveys show is incorrect. There has been majority public support for the removal of tobacco retail displays, the introduction of plain packages, smoke-free cars where children are passengers, and the creation of smoke-free outdoor areas for some time.

Recent evidence shows more than three-quarters of the New Zealand public want all outdoor places where there are likely to be children to be smoke free. Unfortunately, public opinion often exceeds politicians’ willingness to act.

Some arguments against smoke-free outdoor areas have drawn on evidence that price triggers behaviour change.

However, just because price is an effective behaviour change tool does not mean other policies are not also important. Research shows that smokers respond to different interventions, thus implementing varied measures is likely to enhance the overall impact on smoking prevalence.

This is why we need larger health warnings, plain packaging, fewer retail outlets selling tobacco, greater access to cessation services, and smoke-free outdoor areas.

Achieving the national Smokefree 2025 goal requires a comprehensive suite of evidence-based policies that reduce the visibility, affordability, and accessibility of tobacco products while, at the same time, increase access to effective and targeted quit support.

Claims that smoke-free outdoor areas will set us on the slippery slope to a society in which individual freedoms no longer exist are as illogical as they are wrong.

Similarly, arguments that education will achieve similar outcomes are incorrect. If education alone changed behaviour successfully, the Smokefree 2025 goal would already be achieved, drink-driving would be an unknown phenomenon, and family violence unheard of. Used alone, education is not strong enough to change entrenched or addictive behaviours. To support these changes, we need to create supportive environments. Once we have these, education can help explain and promote new behaviours, but it is largely useless to effect change if the wider environment does not also support that change.

Given most smokers want to quit, and given we want to protect children and minimise the likelihood they will start to smoke, we need environments that will help achieve these goals.

International evidence suggests smoke-free outdoor areas support those trying to quit while promoting smoke-free behaviour as the norm. This topic is too important to allow uninformed rhetoric to undermine debate. Instead, let’s focus on logic and scientific evidence.

~ Janet Hoek, Richard Edwards, Nick Wilson and George Thomson, University of Otago.

Originally published in the Otago Daily Times, Monday 20 February 2012.