5.14 Opportunity to smoke

Last updated April 2012 

While smoking was once commonplace in the working environment, in shopping centres, on public transport, in restaurants and elsewhere, public health concerns about exposure to secondhand smoke have led to the introduction of 'clean air' acts and other smoking restrictions at the national, state/territory and local government levels. Most workplaces and other public places are now smokefree, and increasing numbers of Australian households have chosen to ban smoking in their homes1 (see Chapter 4, Section 4.4). Smokefree homes appear to be particularly important in influencing smoking behaviour among teenagers.2 For further detail on the effects of home smoking policies on adolescent smoking behaviours, see Section 5.7.3. Schools in Australia are also now all smokefree environments. In past decades in Australia, and difficult to imagine now, schools were one of the settings where smoking experimentation often occurred among adolescents, often stereotyped as surreptitiously taking place 'behind the school shed', 'out on the oval' or in the school toilets.

5.14.1 Influence of smoking restrictions in schools on youth smoking

In some countries, smoking is not so universally prohibited on school grounds. Canadian research investigated how this is perceived by students–at the time of the study, around one-third of school districts in the province of British Columbia did not ban smoking outright on school grounds, and smoking was permitted in designated areas in some schools.3 Focus groups were conducted with high school students (14–18 years) attending schools with smoking areas regarding their perceptions of school smoking policies. The researchers reported that students expressed surprise and concern that smoking was permitted on school property, and felt that it encouraged the perception that neither the school nor staff took student smoking seriously. Some students also noted that the presence of a readily accessible smoking area hampered their own cessation attempts.3

It has been argued that one of the most inexpensive actions a school can take to reduce smoking is to introduce and enforce a no-smoking policy.4,5 A number of studies have investigated the effectiveness of school tobacco policies in reducing student smoking, and overall, the evidence is somewhat mixed: some studies finding a more comprehensive policy associated with decreased smoking6-8 and others finding no effect.9, 10 A study comparing the impact of school tobacco policies on student smoking in the US state of Washington and in Victoria, Australia (investigated as part of the International Youth Development Study) found little evidence of an association between likelihood of smoking and comprehensive smoking bans.9

Other research has suggested that the consistency with which schools enforce policy responses (regardless of the type of sanction imposed) is a crucial component of policy effectiveness:11 student perceptions of policy and behaviours are influenced largely by school actions in response to policy violations rather than the mere existence of policies.9, 12 An analysis of smoking and policy at 55 schools demonstrated an association between policy strength, policy enforcement and the prevalence of smoking among pupils.13

What a school does beyond just smoking bans is also important. As discussed in Section 5.20, school-based youth smoking prevention efforts are most effective when comprehensive and multi-modal.14 Hence smoking bans in schools are ideally complemented by a range of other strategies within the school, and even more ideally, within the broader community. This is evident in a study by Lovato and colleagues, which found that students were less likely to smoke if they attended a school with a focus on tobacco prevention, stronger policies prohibiting tobacco use and fewer students smoking on the peripheries than in schools without these characteristics.15

5.14.2 Influence of smoking restrictions in other settings on youth smoking

US longitudinal research among teenagers aged 12–16 years has identified greater perceived difficulty of smoking in public places and home smoking bans as associated with a lower likelihood of smoking.16 Participants rated how difficult it is for someone under the age of 18 to smoke in a variety of public places on a four-point scale from 'very hard' to 'not at all hard'. Perceived difficulty of finding a place to smoke had a similarly powerful effect on both the prevention of and a reduction in adolescent smoking.16 The researchers found reduced odds of adolescents being on a smoking trajectory (e.g. non-smoker to occasional or established smoker) for each unit increase in perceptions of difficulty in public smoking. The magnitude of the effect of perceived public smoking difficulty was almost sufficient to offset (and for more advanced levels of smoking did counteract) the influence of pro-smoking factors such as parental smoking.17

There is some evidence–from a US study following young people aged 12–17 years over four years–that living in a town where legislation bans smoking in restaurants is associated with a significantly reduced likelihood of progressing from experimental to established smoking.18 This research also found that adolescents in a household with no smoking ban, whether living with a smoker or with non-smokers, were more likely to perceive high rates of adult smoking. Those who lived with non-smokers in a household with no smoking ban were more likely than those with a home ban to experiment with smoking at an early age.19

As well as physically reducing the places where smoking may occur, reducing opportunities to smoke and making it more difficult to smoke helps to challenge perceptions that smoking is normal behaviour20 and reduce the social acceptability of smoking.17 As discussed further in Section 5.24, young people are greatly influenced by their sense of what is normal and attractive.21 One Canadian study found that the more frequently young people observe smoking occurring in a range of settings, the more likely they are to have the view that smoking is both socially acceptable and normal.22 Hence bans on smoking in restaurants and other public places can help to reduce the 'normalcy' of seeing people smoking, thereby helping to reshape community norms and perceived social acceptability regarding smoking22, 23. Publicity supporting bans on smoking in cars in Australia is likely to strengthen this view.24

For further discussion see Section 5.29 and Chapter 15, Section 15.6.3.

Recent news and research

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1. Australian Institute of Health and Welfare. Australia's health 2006. Australia's health series, no.10, cat. no. AUS 73. Canberra: AIHW, 2006. Available from: http://www.aihw.gov.au/publications/aus/ah06/ah06-c00.pdf

2. Wakefield M, Chaloupka F, Kaufman N, Orleans C, Barker D and Ruel E. Effect of restrictions on smoking at home, at school and in public places on teenage smoking: cross sectional study. British Medical Journal 2000;321:333-7. Available from: http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=27448

3. Baillie L, Lovato C, Taylor E, Rutherford M and Smith M. The pit and the pendulum: the impact on teen smokers of including a designated smoking area in school tobacco control policy. Health Education Research 2008;23(6):1008–15. Available from: http://her.oxfordjournals.org/content/23/6/1008.long

4. Penilla J, Gonzalez B, Barber P and Santana Y. Smoking in young adolescents: an approach with multilevel discrete choice models. Journal of Epidemiology and Community Health 2002;56:227-32. Available from: http://www.ncbi.nlm.nih.gov/pubmed/11854347

5. Barnett T, Gauvin L, Lambert M, O'Loughlin J, Paradis G and McGrath J. The influence of school smoking policies on student tobacco use. Archives of Pediatrics & Adolescent Medicine 2007;161:842-8. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17768283

6. Lovato C, Pullman A, Halpin P, Zeisser C, Nykiforuk C, Best F, et al. The influence of school policies on smoking prevalence among students in grades 5-9, Canada, 2004-2005. Preventing Chronic Disease 2010;7(6):A129. Available from: http://www.cdc.gov/pcd/issues/2010/nov/09_0199.htm

7. Overland S, Aaro L and Lindbak R. Associations between schools' tobacco restrictions and adolescents' use of tobacco. Health Education Research 2010;25(5):748-56. Available from: http://her.oxfordjournals.org/cgi/content/full/cyq023v1?view=long&pmid=20363827

8. Sabiston C, Lovato C, Ahmed R, Pullman A, Hadd V, Campbell H, et al. School smoking policy characteristics and individual perceptions of the school tobacco context: are they linked to students' smoking status? Journal of Youth and Adolescence 2009;38(10):1374–87. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2758151/?tool=pubmed

9. Evans-Whipp TJ, Bond L, Ukoumunne OC, Toumbourou JW and Catalano RF. The impact of school tobacco policies on student smoking in Washington State, United States and Victoria, Australia. International Journal of Environmental Research and Public Health 2010;7(3):698–710. Available from: http://www.mdpi.com/1660-4601/7/3/698/pdf

10. Wiium N, Burgess S and Moore L. Brief report: multilevel analysis of school smoking policy and pupil smoking behaviour in Wales. Journal of Adolescence 2010;34(2):385-9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20307905

11. Adams M, Jason L, Pokorny S and Hunt Y. The relationship between school policies and youth tobacco use. Journal of School Health 2009;79(1):17–23. Available from: http://www.ingentaconnect.com/content/bpl/josh/2009/00000079/00000001/art00003

12. Lipperman-Kreda S, Paschall M and Grube J. Perceived enforcement of school tobacco policy and adolescents' cigarette smoking. Preventive Medicine 2009;48(6):562–6. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2748128/

13. Moore L, Roberts C and Tudor-Smith C. School smoking policies and smoking prevalence among adolescents: multilevel analysis of cross-sectional data from Wales. Tobacco Control 2001;10(2):117-23. Available from: http://tobaccocontrol.bmj.com/cgi/content/abstract/10/2/117

14. Lynagh M, Perkins J and Schofield M. An evidence-based approach to health promoting schools. Journal of School Health 2002;72:300-2. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12357912

15. Lovato C, Zeisser C, Campbell H, Watts A, Halpin P, Thompson M, et al. Adolescent smoking effect of school and community characteristics. American Journal of Preventive Medicine 2010;39(6):507–14. Available from: http://www.ajpm-online.net/article/S0749-3797%2810%2900510-6/fulltext

16. Bernat DH, Erickson DJ, Widome R, Perry CL and Forster JL. Adolescent smoking trajectories: results from a population-based cohort study. Journal of Adolescent Health 2008;43(4):334–40. Available from: http://www.jahonline.org/article/PIIS1054139X08001572/fulltext

17. Song A and Glantz S. Pushing secondhand smoke and the tobacco industry outside the social norm to reduce adolescent smoking. Journal of Adolescent Health 2008;43(4):315–17. Available from: http://www.jahonline.org/article/S1054-139X(08)00235-8/fulltext

18. Siegel M, Albers AB, Cheng DM, Hamilton WL and Biener L. Local restaurant smoking regulations and the adolescent smoking initiation process: results of a multilevel contextual analysis among Massachusetts youth. Archives of Pediatrics and Adolescent Medicine 2008;162(5):477. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2948204/

19. Albers AB, Biener L, Siegel M, Cheng DM and Rigotti N. Household smoking bans and adolescent antismoking attitudes and smoking initiation: findings from a longitudinal study of a Massachusetts youth cohort. American Journal of Public Health 2008;98(10):1886–93. Available from: http://ajph.aphapublications.org/cgi/content/full/98/10/1886?view=long&pmid=18703438

20. Alesci N, Forster J and Blaine T. Smoking visibility, perceived acceptability, and frequency in various locations among youths and adults. Preventive Medicine 2003;36(3):272-81. Available from: http://www.ncbi.nlm.nih.gov/pubmed/12634018

21. Hastings G and Angus K. Forever cool: the influence of smoking imagery on young people. London: British Medical Association, Board of Science, 2008. Available from: http://www.management.stir.ac.uk/about-us/?a=19777

22. Smart R and Stoduto G. Interventions by students in friends' alcohol, tobacco, and drug use. Journal of Drug Education 1997;27:213-22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/9366127

23. Eureka Strategic Research. Youth tobacco prevention research project. Undertaken for the Australian Government Department of Health and Ageing. Canberra: Department of Health and Ageing, 2005. Available from: http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-pub-tobacco-literature-cnt.htm

24. Freeman B, Chapman S and Storey P. Banning smoking in cars carrying children: an analytical history of a public health advocacy campaign. Australian and New Zealand Journal of Public Health 2008;32(1):60-5. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1753-6405.2008.00167.x/full

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