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Smoking in Public Places
A Consultation on Reducing Exposure to Second Hand Smoke
Key Findings from Focus Group Research

CHAPTER ONE: BACKGROUND

BACKGROUND

1.1 The detrimental effects of smoking have been a major public health concern since 1962 when the Royal College of Physicians published " Smoking and Health". This groundbreaking report clearly evidenced a direct link between smoking and life threatening diseases such as lung cancer and coronary heart disease, and called for urgent governmental intervention recommending actions such as a public education programme, increased taxation, restrictions on tobacco advertising, greater steps to restrict the sale of tobacco to children and restrictions on smoking in public places.

1.2 Since then, progress has been made to reduce levels of smoking, and establish smoke free zones through a variety of measures and policies. However, there is still a long way to go. Smoking is a habit that is deep rooted within Scottish society, particularly within deprived communities ¹. Recent figures show that 31% of adult males and females are smokers ². The habit remains the biggest single cause of preventable illness and premature death in Scotland, placing considerable strain on the National Health Service. Smoking is estimated to cost the NHS between 1.4bn and 1.7bn annually in the UK ³ whilst the NHS in Scotland spends an estimated 200 million per annum (at present day prices) on hospital treatment for diseases caused by tobacco use ⁴.

1.3 The issue of passive smoking has recently been brought to the fore, in the light of research evidence to indicate that second hand smoke increases the risk of a number of life threatening illnesses and other conditions. ⁵Passive smoking is consequentially now a matter of major public health concern.

1.4 The Scottish Executive is tackling the problem of smoking in Scotland as part of a wider policy to improve the health of the nation, increase life expectancy across the whole population and narrow the gap between deprived communities and the better off ⁶. The first ever action plan on tobacco control for Scotland, " A Breath of Fresh Air for Scotland" ⁷, was published in January 2004. This document builds on the work of NHS Scotland and ASH Scotland ⁸ and outlines action in a range of areas including prevention and education, the provision of smoking cessation services, and protection and controls to reduce the attractiveness and availability of cigarettes. One of the key elements of the plan is to minimise the harm caused by second hand smoke.

1.5 It is recognised that policies of persuasion are very often more likely to be successful than those of coercion. Indeed, voluntary approaches to reducing smoking in public places have had some degree of success in the past and restrictions on smoking have been introduced into many work places in recent years ⁹. However, it is estimated that a quarter of employees are still exposed to tobacco smoke in the workplace, particularly those working in leisure areas such as restaurants, bars and pubs ¹⁰. Whilst there has been progress through the Voluntary Charter on Smoking in Public Places to improve smoke-free provision in such venues, its impact is limited and there is recognition that more needs to be done ¹¹.

1.6 The Scottish Executive is committed to improving the level of smoke-free provision, either through enhancing the current voluntary approach, introducing a ban on smoking in public places Scotland-wide either complete or targeted at specific places, giving powers to local authorities to regulate smoking in public places or a combination of targeted statutory controls and voluntary action.

1.7 The Scottish Executive recognises that any action to restrict or prohibit smoking in public places through legislation is a highly controversial issue. Many individuals consider smoking to be a matter of personal choice and a basic right. Moreover, general public awareness of the health implications of second hand smoking is still limited, and the justification for such legislation may not be widely understood. In this context, the Scottish Executive realises the importance of a public debate and consultation, both to generate awareness of the health risks of second hand smoke as well as providing opportunities for various interested parties to express their opinions on the issue.

1.8 The Scottish Executive defines "public places" as any enclosed or semi-enclosed area that members of the public have access to that provides a business or service. It includes workplaces, buildings and transport. An "enclosed place" is defined as a single space completely enclosed on all sides of any opening.

1.9 The Tobacco Control Action Plan announced the Executive's decision to consult the people of Scotland on the issue of passive smoking targeting individuals, businesses, representative groups and other organisations, and enabling them to contribute to the policy process.

1.10 The consultation ran from 7 June until the end of September 2004. Its aim was to obtain feedback on possible approaches to minimising the harm caused by second hand smoke. The aim of the consultation was to capture the breadth of views on a range of issues raised across different groups who may be affected by smoking in public places. The consultation aimed to capture the range of views amongst members of the general public about whether further action should be considered and, if so, what that action might be.

1.11 The consultation process has involved 4 key elements

• A programme of awareness raising activity, carried out by NHS Health Scotland.

• Research and evidence gathering Three pieces of research have been commissioned by NHS Health Scotland, on behalf of the Scottish Executive:

• • A study of smoking policies in small, medium sized and large enterprises

  • An international review of the health and economic impact of action to control passive smoking

  • A morbidity and mortality analysis of the impact of passive smoking in Scotland.

• Public consultation:

• • Publication of consultation materials including a written consultation document which were made widely available to organisations, businesses and members of the public. Responses could be made by hard copy, e-mail or on-line

  • A number of regional public seminars throughout Scotland

  • A series of focus groups with targeted sections of the population

  • Activities conducted with young people by the Young Scot organisation

  • A national conference held on 9 September 2004

  • An opinion survey of a representative sample of the Scottish population.

• Assessment and conclusions from this work, feeding into an evidence report.

Role of George Street Research

1.12 George Street Research was commissioned to undertake a number of key strands of the consultation process:

1) Analysis of responses to the public consultation materials using qualitative and quantitative methods

2) Qualitative research using focus groups with specific groups of workers and members of the public

3) Production of the final evidence report, incorporating the findings from each of the associated strands. This report identifies the principal themes and key outcomes from each of the separate aspects of the consultation and research activities that have been ongoing since June 2004.

1.13 The specific objectives of the focus group component were to:

• Obtain the views of key target audiences on smoking in public places and passive smoking and its role in the general health of the population as a whole

• Assess levels of awareness of the health implications of smoking in public places and passive smoking and gauge reactions to statistics and research evidence relating to the issue

• Explore possible options for change of policy to prohibit or restrict smoking in enclosed public places

• Identify perceived consequences of introducing legislation prohibiting smoking in public spaces

• Gather reactions to the implementation of bans and restrictions on smoking in public places in other countries (drawbacks, advantages, feasibility for Scotland etc)

• Identify the key practical challenges to introducing legislation to prohibit smoking in public places and make recommendations of ways to overcome these

• Identify additional feasible ways of reducing the health damage caused by second hand smoking.

1.14 This document constitutes the report on findings from the focus group strand of the consultation.

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