In recent years, one of the most important issues in smoking control has been passive smoking or environmental tobacco smoke (ETS). While the detrimental ...
Environmental tobacco smoke: Public opinions and behaviour Lisa Trotter Robyn Mullins
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Quit Evaluation Studies No 9 1996–1997
Introduction In recent years, one of the most important issues in smoking control has been passive smoking or environmental tobacco smoke (ETS). While the detrimental health effects of active smoking have been known for decades, it was not until the mid-eighties that major reviews concluded that passive smoking was harmful to non-smokers. For example, in 1986, the US Surgeon General’s Report found that passive smoking caused disease in non-smokers and that children whose parents smoked were more likely to suffer respiratory problems (US Department of Health and Human Services 1986). It also concluded that simply separating smokers and non-smokers in the same space did not eliminate exposure to ETS, though it might reduce it. In the same year Australia’s National Health and Medical Research Council published a report which concluded that passive smoking increased the risks of some diseases in children and adults, particularly respiratory diseases and disorders (National Health and Medical Research Council 1987). In addition to publicity about the medical evidence regarding the harmful effects of passive smoking, there have been a series of legal decisions about passive smoking which have evoked some controversy. One major case saw the Tobacco Institute of Australia (TIA), a lobbying organisation representing tobacco companies, taken to court over claims made in newspaper advertisements in 1986 that ‘There is little evidence and nothing which proves scientifically that cigarette smoking causes disease in nonsmokers’. In February 1991, the court ruled that this claim was misleading, and that passive smoking causes lung cancer, asthma attacks and respiratory disease in children. This decision was upheld under appeal in December 1992. In May 1992, Liesal Scholem became the first Australian to receive a damages payout after a jury decision determined that her disease had been caused by exposure to environmental tobacco smoke in the workplace. In previous cases, payouts had resulted from out-of-court settlements. One of Quit’s aims is to reduce people’s exposure to ETS, both in public places and in their homes. To this end, Quit tries to educate Victorians about the risks of passive smoking; encourages and assists workplaces, restaurants and other public places to become smokefree or to provide smokefree areas and promotes the concept of smokefree homes. This chapter examines survey data which has been collected on behalf of the Centre for Behavioural Research in Cancer to address a number of issues around passive smoking. The data was collected by the Roy Morgan Research 28
Chapter 2: Environmental tobacco smoke: Public opinions and behaviour Centre in annual face-to-face surveys. In 1985, a question was first introduced into the household survey about whether respondents thought the health of non-smokers could be damaged by other people’s smoke. Also in that year, the respondents’ beliefs about whether separate smoking and non-smoking areas should be provided in restaurants, and where they would prefer to sit if given the choice were included for the first time. In 1988, questions were introduced about workplace smoking policies and in 1991 questions about smoking in the home were added. In 1995, questions about allowing smoking in public places other than restaurants and cafes were introduced. This chapter details the findings on these issues, with the exception of the information on workplace smoking, which is discussed in Chapter 10.
Method The household surveys were commissioned from a large market research company, which interviewed a representative sample of Victorians in their own homes. The questions designed by the Centre for Behavioural Research in Cancer form part of an omnibus survey that is conducted over eight weeks, beginning on the first weekend in October each year. The method used to collect the information was the same in all years and is described fully in Hill and Gray (1984).
Sample The sample size was approximately 2500 in each year, and was a representative sample of Victorians. Chapter 1 has full details of the sample size for each year presented by smoking status.
Statistical analysis To test for the significance of relationships between variables the chi-square test has been used. Details of statistical tests of significance are not usually included in the text. Where relationships between variables are reported, the probability level of significance was less than 0.01, indicating less than a 1 in 100 probability that the effect was caused by chance.
Results Beliefs about the harm of passive smoking In order to investigate current beliefs about the harm of passive smoking held by people of different smoking status, respondents to the household 29
Quit Evaluation Studies No 9 1996–1997 survey were asked ‘In your opinion, can the health of non-smokers be damaged by other people’s cigarette smoke, or not?’. This question was asked in 1987, 1988, 1989, 1991, 1992, 1995 and 1996. The survey results have shown a consistent difference in the proportion of smokers, ex-smokers and never smokers who believe that non-smokers’ health can be damaged by other people’s smoke. In each year, those who have never smoked were most likely to think passive smoking is harmful, followed by ex-smokers, and finally the current smokers. The proportion of smokers, ex-smokers and people who have never smoked who believe that non-smokers’ health can be damaged by other people’s smoke increased through the late eighties but has not changed through the nineties. In 1996, as in all previous years, the majority of people (82%) believed that passive smoking can damage non-smokers’ health (see Table 1). As in previous years, those who have never smoked were most likely to believe passive smoking to be harmful (90%), the ex-smokers (80%) were less likely to accept this and current smokers (69%) the least likely. Only one smoker in five did not accept that passive smoking was harmful, and one in ten was uncertain.
Table 1: Belief in harm of passive smoking by smoking status (1996) Total
Smokers
Ex-smokers
Never smoked
n=
2349
570
674
1105
Yes
82%
69%
80%
90%
No
10%
20%
11%
4%
8%
12%
10%
6%
Can’t say
Smoking in private homes Behaviour of smokers in their own homes In 1995, 1996 and 1997 respondents were asked where they or any other regular smokers living in their household smoked. They were presented with five options from which to choose: Always smoke inside Usually smoke inside Sometimes smoke inside and sometimes smoke outside 30
Chapter 2: Environmental tobacco smoke: Public opinions and behaviour Usually smoke outside Always smoke outside. It is difficult to determine exactly what respondents mean when they say they ‘usually’ behave in a particular way, and there was no opportunity to explore when or why their behaviour differed. Previous telephone surveys have indicated that smokers may vary where they smoke according to the weather, the presence of children or non-smokers, or a multitude of other factors (Mullins, Scollo & Borland, 1994). What we can be certain of is that these people are not maintaining a totally smokefree home. For this reason, in Table 2 the categories of ‘always’ and ‘usually’ smoke inside have been collapsed.
Table 2: Household smoking habits by year 1995
1996
1997
n=
917
832
887
Always/usually inside
39%
28%
25%
Sometimes in, sometimes out
30%
33%
33%
Usually outside
11%
13%
14%
Always outside
20%
23%
28%
* Can’t say not reported, but included in the denominator
In just two years there has been a decline from 39% to 25% in the proportion of respondents who say the smoker(s) in their household always or usually smoke inside. At the same time the proportion that always smoke outside (thus maintaining a smokefree household) has increased from 20% to 28%. The data were also analysed by whether there were any children and/or any non-smoking adults in the house. Children who live in a household with a smoker are substantially better off if there is another adult in the house who does not smoke. In these mixed households 43% of the smokers say they always smoke outside (see Table 3). In households where there are no non-smoking adults, but there are children, only 18% of the smokers say they always go out to smoke. It seems that the presence of a non-smoking adult is a key factor in encouraging a smokefree home, as in mixed households without children 35% of the smokers always went outside.
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Quit Evaluation Studies No 9 1996–1997
Table 3: Proportion of smokers who always smoke outside at home by household composition 1995
1996
1997
Children
9%
14%
18%
No children
5%
8%
6%
Children
31%
37%
43%
No children
25%
26%
35%
All smoker(s)
Mixed
Smoking in the presence of children In 1989, 1992, 1994 and 1996, respondents to the annual household survey were asked if their smoking consumption was influenced by the company of children. Smokers were asked ‘When you’re with children do you smoke more than normally, less than normally, about the same amount or not at all?’ Table 4 presents this information over the four years. Since 1989 the number of smokers who said there was no effect on their smoking consumption when around children has fallen from 31% to 19% and the number of smokers who do not light up at all when with children has increased from 14% in 1989 to 33% in 1996 (see Table 4). This is an improvement, however, it remains disappointing that the majority of smokers continue to smoke around children, even though they do reduce their consumption of cigarettes in most cases.
Table 4: Smoking in the presence of children by year 1989
1992
1994
1996
n=
654
606
615
574
Smoke more
1%
2%
1%
1%
No effect
31%
22%
22%
19%
Smoke less
50%
51%
45%
44%
Don’t smoke at all
14%
23%
29%
33%
4%
3%
3%
3%
Can’t say
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Chapter 2: Environmental tobacco smoke: Public opinions and behaviour In 1996, as in other years we have studied it, the data also showed that smokers living in households with children aged under 16 were less likely to stop smoking when children are around than smokers who are in households with no children (see Table 5). Smokers with children in the house are more likely to reduce their consumption or do nothing but are less likely to not smoke at all.
Table 5: Smoking behaviour and young children living in household Total
Children under 16
No children under 16
n=
570
223
347
Smoke more
1%
1%
1%
No effect
19%
26%
15%
Smoke less
44%
47%
42%
Don’t smoke
33%
25%
38%
3%
1%
5%
Can’t say
Discouraging visitors from smoking Respondents to the household survey have been asked intermittently since 1989 if they discourage visitors from smoking in their household. Due to the small number of people who said they discouraged visitors ‘sometimes’, that it ‘depended on the situation’, or that ‘there was no such situation’, these respondents have been combined.
Table 6: Visitors discouraged from smoking in home by year 1989
1991
1992
1994
1995
1996
1997
n=
2314
2432
2334
2462
2425
2413
2352
Discouraged
27%
34%
40%
48%
48%
50%
53%
Not discouraged
68%
60%
54%
47%
47%
38%
39%
5%
6%
5%
5%
5%
11%
7%
Sometimes/Depends/ No situation
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Quit Evaluation Studies No 9 1996–1997 As the data in Table 6 indicate, people are increasingly more likely to discourage visitors from smoking in their house. In 1989, only 27% of respondents said they discouraged visitors from smoking and by 1997 this had risen to 53%. Households where there are no smokers were the most likely to discourage visitors from smoking. In 1997, 64% of households where there were no smokers discouraged visitors from smoking. This compares to 36% of households with a smoker. In households where there is a smoker, but the smoker always goes outside to smoke, 78% discourage visitors from smoking – indicating a genuine attempt to maintain a smokefree home. Of those smokers who always smoke inside, 94% also allowed visitors to smoke inside.
Smoking in public places In order to investigate the views of Victorians on placing restrictions on smoking in public places, respondents were asked what level of smoking should be permitted in restaurants, public bars, gambling areas and indoor shopping centres. Respondents were shown a card and asked which of three statements best described their views on smoking in each of the areas: not allow smoking at all, allow smoking in special areas and allow smoking anywhere. Respondents who could not give a response were excluded from the analysis. As smoking in restaurants has been an area of special interest, it is discussed later. Smoking in public bars Among those who had never smoked, opinion was fairly evenly divided about whether smoking should be totally banned or allowed in special areas, but just one in ten of this group favoured unrestricted smoking (Table 7). Around half of the smokers and ex-smokers favoured allowing smoking in special areas, but most of the rest of the smokers favoured unrestricted smoking whereas more ex-smokers thought smoking shouldn’t be allowed at all. Overall, just 20% of respondents favoured allowing unrestricted smoking. Public opinion on this issue has remained much the same over 1995, 1996 and 1997.
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Chapter 2: Environmental tobacco smoke: Public opinions and behaviour
Table 7: Views on smoking in public bars by smoking status (1997) Total
Smokers
Exsmokers
Never smokers
n=
2365
611
683
1060
Not allow smoking at all
29%
5%
29%
42%
Allow smoking in special areas
49%
51%
52%
46%
Allow smoking anywhere
20%
42%
17%
10%
Smoking in gambling areas Respondents indicated less support for allowing unrestricted smoking in gambling venues, with just 12% saying that smoking should be allowed anywhere (see Table 8). Again, those who had never smoked were fairly evenly split over whether they thought smoking should be totally banned or just restricted, with very few supporting unrestricted smoking. There was little support for unrestricted smoking among the ex-smokers either, with just one in ten supporting this option. Half the ex-smokers supported allowing smoking in special areas, as did 62% of smokers. Few smokers supported not allowing smoking at all.
Table 8: Views on smoking in gambling areas by smoking status (1997) Total
Smokers
Exsmokers
Never smokers
n=
2372
611
701
1060
Not allow smoking at all
36%
10%
39%
49%
Allow smoking in special areas
50%
62%
50%
44%
Allow smoking anywhere
12%
26%
10%
5%
Smoking in shopping centres The strongest support for a total ban on smoking was for shopping centres, with three-quarters of respondents supporting a total ban (see Table 9). Support was strongest amongst those who had never smoked, but even 60% of smokers were in favour of a total ban. There was almost no support for allowing unrestricted smoking among any group. 35
Quit Evaluation Studies No 9 1996–1997
Table 9: Views on smoking in shopping centres by smoking status (1997) Total
Smokers
Exsmokers
Never smokers
n=
2354
611
683
1060
Not allow smoking at all
75%
60%
76%
84%
Allow smoking in special areas
21%
33%
20%
14%
4%
6%
4%
2%
Allow smoking anywhere Changes over time
Questions about smoking restrictions were asked in 1995, 1996 and 1997 for public bars and shopping centres and in 1995 and 1997 for gambling areas. Although opinions on smoking restrictions in public bars and gambling places have stayed much the same over time. There has been a significant shift in opinions on restrictions in shopping centres. The percentage of respondents who thought that smoking should not be allowed in shopping centres at all increased from 58% in 1995 to 75% in 1997. It is notable that this has accompanied increases in restrictions in such places. Smoking in restaurants Respondents to the household survey have been asked over the years about their beliefs concerning smoking in restaurants. In early surveys they were simply asked whether they believed smokefree areas should be provided in restaurants and cafes (1985, 1988), and later what level of restriction, if any, should be applied in cafes and restaurants (1990, 1991). These questions have not been repeated because by 1991 only 3% of respondents believed smoking should be allowed in restaurants without any restriction at all. After 1991, a personalised question was asked so that respondents were not simply asked what should be done, but where they would prefer to sit. In 1997 a question about what should be permitted in restaurants was re-introduced, as part of the series on restricting public place smoking described above. There was very little support for allowing unrestricted smoking in restaurants (see Table 10). Even among smokers, only 9% believed smoking should be allowed anywhere. Not allowing smoking anywhere was the most popular option for those who had never smoked, allowing it in 36
Chapter 2: Environmental tobacco smoke: Public opinions and behaviour special areas was supported by most smokers, and ex-smokers were split evenly between these two options.
Table 10: Views on restricting smoking in restaurants by smoking status (1997) Total
Smokers
Exsmokers
Never smokers
n=
2372
611
701
1060
Not allow smoking at all
46%
14%
49%
62%
Allow smoking in special areas
50%
77%
48%
37%
4%
9%
3%
1%
Allow smoking anywhere
Personal preference for seating in restaurants Respondents were asked ‘If cafes and restaurants provided separate areas for smoking and non-smoking, which area would you prefer to sit in?’. Table 11 presents data for 1996 on the preference for seating by smoking status. It is important to note that although preference for non-smoking seating among smokers is low, this does not indicate that they would all like to sit in a smoking area – less than half (48%) of them would prefer to sit in a smoking area of a restaurant and a substantial number (36%) said they would not mind where they sat. The rest (16%) would actually prefer a non-smoking area. Clearly, a sizeable proportion of smokers see the benefits of dining in smokefree environments, or understand the need for the provision of nonsmoking areas and do not object to sitting in them. Overall, just 12% of those going to restaurants or cafes in 1996 said they would rather sit in a smoking area.
Table 11: Preference for dining area by smoking status (1996) Total
Smokers
Exsmokers
Never smoked
n=
2349
570
679
1105
Smoking
12%
48%
1%
1%
Non-smoking
71%
16%
82%
93%
Don’t mind/Can’t say
17%
36%
17%
7%
37
Quit Evaluation Studies No 9 1996–1997 Smokers made up nearly the entire number of respondents who said they preferred smoking areas of restaurants. Less than two percent of exsmokers and never smokers preferred smoking areas in restaurants (perhaps these people have friends or partners who smoke). Ex-smokers (82%) and those who have never smoked (93%) overwhelmingly preferred non-smoking seating. Changes over time In 1985, 1988 and every year since 1990, respondents have been asked the question about their preference for smoking or non-smoking dining. Overall, the proportion of people who prefer smokefree seating increased from 58% to 71% between 1985 and 1996, with the bulk of this change having occurred by 1991. In 1985, the proportion of those who had never smoked who wanted to sit in a non-smoking area was 83% and this had increased to 93% by 1996. During the same time period the preference of ex-smokers for smokefree dining increased from 67% to 81%. Only a minority of smokers prefer non-smoking dining and this has changed little (from 12% to 16%) in the period. Requests for smokefree dining Respondents who said they preferred to sit in non-smoking areas were also asked if they actually requested a non-smoking area when they book or visit a cafe or restaurant. The purpose of this was to determine whether people were actively letting restaurant and cafe staff know their seating preferences. Table 12 presents data on requests for non-smoking dining among those who would prefer to sit in a non-smoking section by smoking status for 1996.
Table 12: Requests for non-smoking areas by the group who prefer it, by smoking status Total
Smokers
Exsmokers
Never smoked
1669
91
549
1029
Always
49%
29%
46%
53%
Sometimes
20%
23%
19%
20%
Never
25%
43%
30%
21%
5%
5%
6%
5%
n=
Don’t go/Can’t say
38
Chapter 2: Environmental tobacco smoke: Public opinions and behaviour As the data in Table 12 indicate, of the respondents who preferred nonsmoking dining, those who had never smoked (53%) and ex-smokers (46%) were significantly more likely to always request this seating. When the ‘always’ and ‘sometimes’ requests are combined the data indicate that 52% of smokers, 65% of ex-smokers and 73% of never smokers who prefer non-smoking dining request it at least some of the time. Looking only at non-smoking respondents, there were some significant differences in requests for non-smoking dining for men and women, occupational groups and educational levels. Men are more likely to say they never ask for non-smoking dining (27%) than women (22%), white collar respondents are more likely to request non-smoking dining (73%) than blue collar respondents (67%) and respondents with a university degree are more likely to request non-smoking dining (79%) than respondents with Year 11 or less education (64%). Changes over time The question about requesting non-smoking dining has been asked each year since 1992. In that year, 42% of people who preferred non-smoking dining said they always asked for non-smoking areas. By 1995, this figure had increased to 56% , but decreased to 49% in 1996 (see Table 13).
Table 13: Requests for non-smoking areas by the group who prefer it 1992
1993
1994
1995
1996
n=
1593
1627
1740
1698
1669
Always
42%
45%
48%
56%
49%
Sometimes
21%
21%
18%
18%
20%
Never
30%
27%
24%
20%
25%
7%
8%
9%
6%
5%
Don’t go/Can’t say
Summary Between 1985 and 1996 the proportion of people who believed that passive smoking was harmful increased from 73% to 82%, but the bulk of this change had occurred by the early nineties, and there has been no increase in knowledge since then. Among smokers, two in ten still deny that passive smoking is harmful and one in ten is uncertain about it.
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Quit Evaluation Studies No 9 1996–1997 Preference for seating in smokefree dining showed a similar trend. Between 1985 and 1996, the number of Victorians saying they would like to sit in smokefree areas when they went to a cafe or restaurant increased from 58% to 71%, but these changes mostly occurred between 1985 and 1988. In 1996, only 12% of Victorians said they would prefer to sit in a smoking zone in a restaurant – even among smokers less than half (48%) thought the smoking area would be preferable. Half the respondents think smoking should be allowed in special areas in restaurants and 4% think it should be allowed anywhere, but only 12% say that they would prefer to sit in a smoking area. People are concerned about the rights of others to smoke if they choose, but most do not actually want to sit in the smoking area. In 1995 it appeared that there had been some progression in the willingness of people who want smokefree areas to ask for them. In 1992, when this question was first asked, only 42% of respondents who wanted smokefree dining said they always asked for it and this had increased to 56% by 1995. However, in 1996 this dropped to 49%. This could be due to lower levels of assertiveness on the part of restaurant patrons, or it could be due to the belief that there is less need to make the request since there are more nonsmoking areas available now. In either case, there is still a need to encourage patrons to request smokefree dining if they want it, so that restaurateurs come to understand the need to provide smokefree areas. There is also strong community support for restricting or banning smoking in other public places – specifically public bars (78%), gambling venues (86%) and shopping centres (96%). Not surprisingly, those who had never smoked were most likely to support bans and restrictions in these areas, followed by ex-smokers, but even among smokers very few favoured unrestricted smoking in shopping centres and less than half (42%) thought smoking should be allowed in public bars. The nineties has seen an encouraging trend in the number of people who say they discourage their visitors from smoking. In 1989, just 27% of respondents said they discouraged their visitors from smoking, and by 1997 this had risen to 53%. This was most likely to happen in households where there was no smoker (64%), but also happened in one-third (36%) of homes where there was a smoker. If there was a smoker who always went outside to smoke, 78% also encouraged visitors to smoke outside, indicating a genuine attempt to maintain a smokefree home among a small group of smokers.
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Chapter 2: Environmental tobacco smoke: Public opinions and behaviour
References Borland R, Mullins R. (1994) The increasing prevalence of workplace smoking bans in Victoria. Journal of Occupational Health and Safety – Australia New Zealand, 10, 35–40. Borland R, Morand M, Mullins R. Prevalence of workplace smoking bans in Victoria. Australia and New Zealand Journal of Public Health 1997; 21: 694–698. Hill D & Gray N. (1984) Australian patterns of tobacco smoking and health related beliefs in 1983. Community Health Studies, 8, 307–316. Mullins R, Scollo M, Borland R. (1994) Evaluation of a campaign on the effects of passive smoking on children. Chapter 8 in Quit Evaluation Studies No 7. Melbourne: Victorian Smoking and Health Program. National Health and Medical Research Council. Effects of Passive Smoking on Health. Report of the NH&MRC Working Party on the Effects of Passive Smoking on Health. Adopted at the 101st Session of the Council, June 1986. Canberra: Australian Government Publishing Service 1987. US Department of Health and Human Services. The health consequences of involuntary smoking. A report of the US Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Centre for Health Promotion and Education, Office on Smoking and Health, 1986.
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