persisting secondhand smoke hazard in urban public places: results from fine
particulate (PM2.5) air sampling
Nick Wilson, Richard Edwards, Rhys Parry
the need for additional smokefree settings, by measuring secondhand smoke (SHS)
in a range of public places in an urban setting.
Methods Measurements were made in
Wellington City during the 6-year period after the implementation of
legislation that made indoor areas of restaurants and bars/pubs smokefree in
December 2004, and up to 20 years after the 1990 legislation making most indoor
workplaces smokefree. Fine particulate levels
(PM2.5) were measured with a portable real-time
airborne particle monitor. We collated data from our previously published work
involving random sampling, purposeful sampling and convenience sampling of a
wide range of settings (in 2006) and from additional sampling of selected indoor
and outdoor areas (in 2007-2008 and 2010).
Results The “outdoor” smoking
areas of hospitality venues had the highest particulate levels, with a mean
value of 72 µg/m3 (range of maximum values
51–284 µg/m3) (n=20 sampling
periods). These levels are likely to create health hazards for some workers and
patrons (i.e., when considered in relation to the WHO air quality guidelines).
National survey data also indicate that these venues are the ones where SHS
exposure is most frequently reported by non-smokers. Areas inside bars that were
adjacent to “outdoor” smoking areas also had high levels, with a
mean of 54 µg/m3 (range of maximum values:
18–239 µg/m3, for n=13
In all other settings mean levels were lower (means:
2–22 µg/m3). These other settings
included inside traditional style pubs/sports bars (n=10), bars (n=18),
restaurants (n=9), cafés (n=5), inside public buildings (n=15), inside
transportation settings (n=15), and various outdoor street/park settings (n=22).
During the data collection in all settings made smokefree by law, there was only
one occasion of a person observed smoking.
Conclusions The results suggest that
compliance in pubs/bars and restaurants has remained extremely high in this city
in the nearly six years since implementation of the upgraded smokefree
legislation. The results also highlight additional potential health gain from
extending smokefree policies to reduce SHS exposure in the “outdoor”
smoking areas of hospitality venues and to reduce SHS drift from these areas to
Secondhand smoke (SHS) is a proven
carcinogen1 and “causes disease and
premature death in children and adults who do not
smoke”.2 There are now at least six
meta-analyses showing that exposure to SHS increases the risk of coronary heart
disease (as reviewed in Sims et al3). Another
supportive line of evidence is that a similar hazard, outdoor particulate air
pollution, is a well established cause of adverse cardiovascular
effects4 and increased mortality
Major reviews have found that smokefree area policies reduce
exposure to SHS.7–11 Even small
reductions in SHS and fine particulate levels may have large public health
benefits because exposure is common and the dose-response relationship appears
to be highly non-linear (i.e., relatively more hazardous at lower
A number of recent studies have also demonstrated a
reduction in hospitalisations from myocardial infarction after the
implementation of smoke-free public places (as reviewed in Sims et
al3). A review of economic aspects of smokefree
policies indicated that these were highly cost-effective, and there was evidence
for large net cost savings to society.11
There is also good evidence that smokefree laws in New
Zealand have been effective in reducing exposure to SHS, including for the law
passed in 199013 and for the more recent
revision of the law that became operational in 2004 (which included an extension
to bars, pubs and all of
One study suggested possible benefits for reduced
hospitalisations in Christchurch for acute myocardial infarction after the 2004
law,19 but this trend was not found in a
More recently a national
survey of teachers found that 89% considered the school or early childhood
centre (ECC) environment was compliant with the smokefree law “all or most
of the time”.20 Only 6% of teachers
indicated that their school/ECC was compliant “some or none of the
Some level of compliance
also appears to occur with local outdoor smokefree area policies in New Zealand.
A study in Upper Hutt City found some evidence of both compliance with the
‘educational’ smokefree parks policy, but also non-compliance by
This study obtained
observational data of park users, self-reports of interviewed smokers and
accumulation of butt litter. Butt litter surveys in parks before and after
smokefree parks policies were introduced also suggest reduced smoking in
Rotorua.23 There is also national survey data
indicating that most New Zealand smokers support new forms of smokefree
laws e.g., for cars with children in them (at 97%) and for various outdoor
Another national survey indicated that 56% of those surveyed
wanted smokefree outdoor public dining areas.26
Majority support for local smokefree park laws has also been reported (reviewed
Some progress with new
smokefree policies has occurred with new smokefree policies introduced at the
local level. In particular there is the growing number of new smokefree settings
including: parks,28 marae/cultural
events,29 and grounds around tertiary education
organisations (e.g., university campuses). There is also some citizen advocacy
around concern for smoking in busy city streets, such as along the “Golden
Mile” in central Wellington.30
Given this background,
we aimed to collect new data to inform assessment of the need for additional
smokefree laws in New Zealand. In particular, we aimed to measure particulate
levels from SHS levels in a range of public places within an urban
The setting for our air quality work was Wellington
City, for reasons of convenience. Like the majority of New Zealand cities it has
smokefree hospital grounds and some smokefree tertiary education campuses, but
has not yet adopted smokefree parks policies.
The methods of our initial research in 2006 on SHS in
Wellington have been detailed elsewhere.16 Our
additional subsequent work (presented in this article) included the
sampling of pubs/bars (primarily to measure the extent of SHS drift from outdoor
smoking areas to the indoors);
measurement along the full length of Wellington City’s ‘Golden
Mile’ route of major city streets (from the western end of Lambton Quay to
the eastern end of Courtenay Place);
sampling along the Golden Mile route in sites where smoking was common;
sampling of a range of other settings where smoking is illegal (e.g. enclosed
transportation settings and indoor public places) and where it remains legal
(e.g. parks in Wellington).
For these various
approaches, details on sampling dates, times and frequencies are included in
To guide the approach to measuring air quality work in
2010, we identified the most common sources of SHS exposure using unpublished
national survey data from the “New Zealand Tobacco Use Survey 2008”
from online data files.31 We selected key
findings and only considered the age-standardised data.
In all the sampling we measured fine particulates
(PM2.5, i.e., particles ≤ 2.5 µm in
diameter) using a portable real-time airborne particle monitor (the TSI
SidePak AM510 Personal Aerosol Monitor, TSI Inc, St Paul, USA). The use
of the monitor followed a protocol modified from one developed for a global air
quality monitoring project32 and which was
adapted for other studies by some of the authors in the United
Kingdom33 and New
Zealand.16 The bag with the sampling equipment
was carried on the investigator’s back or placed on a seat or table
wherever possible to sample the ambient air close to the breathing zone.
To avoid affecting occupants’ behaviour in
indoor/semi-enclosed settings, investigators behaved as normal customers (i.e.,
bought drinks and/or food in the pubs/restaurants).
As particulates from different pollution sources vary
in size and density, a calibration factor (0.32) for SHS based on empirical
validation studies with the SidePak
monitor34 was applied (i.e., adjusted in the
monitor’s internal settings). The monitor was zero-calibrated prior to
each day of field work and was fitted with a 2.5 μm impactor with an air
flow rate of 1.7 L/min. The air flow rate has previously been validated in the
New Zealand setting using a pneumotachograph (Hans Rudolph 4813
pneumotachograph, Vacuumed differential pressure transducer 4500, Vacumetrics,
California, USA), and was within 10% of the stated flow rate.
A length of Tygon™ tubing was attached to the
inlet of the SidePak, with the other end left protruding (slightly)
outside the bag carried by the investigator. In all the settings we looked for
evidence of smoking behaviour (actual observable smoking, the presence of ash
trays and discarded cigarette butts).
To put the data into context we also searched for
information relating to legal action for breaches of the smokefree law using
searches of media databases (e.g., Factiva) and we communicated with Ministry of
Health staff. Ethical approval was obtained through the Category B ethics
approval process of the University of Otago and the investigators were cognisant
of the ethical issues involved in this type of
data (national survey)—
Table 1 presents data on SHS exposure
extracted from online data files for the New Zealand Tobacco Use Survey of 2008.
It indicates that the most common source of self-reported exposure to SHS for
New Zealand non-smokers was the “outdoor area of a restaurant or
bar” (at 32% in the past month), followed by “a sports event”
The commonest exposure from an “illegal”
activity was smoking “inside a restaurant bar or nightclub” but this
finding is difficult to interpret since some technically “outdoor”
smoking areas may often appear to actually be “indoors”. Also some
respondents who were indoors may be reporting on perceived SHS that drifted in
through windows or doors from outdoors. The persisting problem of workplace
exposure (24% in the last month) was notable, but again this may partly reflect
“legal” smoking in outdoor areas at a worksite.
This same data source also showed that exposure to SHS was
sometimes higher in the more deprived population. For example, the most deprived
quintile of the employed non-smoker population (using the small area deprivation
measure “NZDep2006”), were more likely to be exposed to SHS at work
than the least deprived quintile (36.5%, 95%CI: 31.2–41.8; versus 19.0%,
Other results from the survey were that most respondents who
were non-smokers agreed or strongly agreed with the statement “it bothers
you if someone is smoking cigarettes within a couple of metres of you”
(Māori: 61.6%, Pacific: 69.5%, Asian: 77.0% and European/Other: 70.5%).
These results were consistent with the belief held by the majority of
non-smokers that “smoke from other peoples cigarettes is harmful to
you” (Māori: 90.2%, Pacific: 87.6%, Asian: 94.3% and European/Other:
92.9%; all for “agree” or “strongly agree” with the
statement). Even a majority of current smokers held this belief about harm
(Māori: 60.0%, Pacific: 57.1%, Asian: 74.2% and European/Other: 69.4%).
Air quality data (Wellington)—The
results indicate a very wide range of fine particulate
(PM2.5) levels in different settings (Table 2).
The “outdoor” smoking areas of hospitality venues had the highest
particulate levels (weighted mean value for four sampling strategies: 72
µg/m3; range of maximum values:
51–284 µg/m3; n=20 sampling
periods). Areas inside bars that were adjacent to “outdoor” smoking
areas also had high levels (mean: 54
µg/m3; range of maximum values:
18–239 µg/m3, for n=13
In all other settings mean levels were lower (means:
2–22 µg/m3). These other settings
included traditional style pubs/sports bars (n=10), bars (n=18), restaurants
(n=8), cafés (n=5), inside public buildings (n=15), inside transportation
settings (n=15), and various outdoor street/park settings (n=22). There were
four groupings of settings in Table 2 (various indoor settings, transportation
settings and parks) that had mean levels of ≤3
µg/m3. For the levels inside the
hospitality settings (but not adjacent to the “outdoor” smoking
area), the mean values obtained in the year 2006 were similar to those obtained
Observational data—In all the
different types of settings listed in Table 1, illegal smoking was only observed
on one occasion. This was in hospital grounds (within four metres of the main
hospital entrance) and involved just one individual smoker. Grounds in this
hospital also have extensive cigarette butt litter that is at least tens of
metres from the hospital grounds boundary, which also suggests some on-going
level of non-compliance. In contrast, we saw no ash trays or butts in any of the
other settings where smoking is illegal.
Population and setting
Comment on smoking
In the outdoor area of a restaurant or bar
Legal—if the walls
and roofing comply with the law.
At a sports event
Generally legal except for
indoor settings. Some councils have smokefree sports
fieldsb and stadia
Outside at a building entrance
Generally legal (except on
some tertiary education campuses)
At a bus stop or train station
Bus stops legal but illegal
inside train stations and on some platforms
Inside a restaurant bar or nightclub
At a shopping mall
On a street
At a park
Generally legal but some
councils have smokefree “educative”
At a concert
Illegal if indoors. Some
councils have smokefree facilities/grounds used for concerts
At a marae
Some marae have smokefree
Specific groups of non-smokers (comprising the
Employed—exposed at work
Illegal (indoors but not
Aged 15-16 years—exposed at school
Māori—exposed at a marae
Some marae have smokefree
a There was little
variation from the non age-standardised percentages (usually under 1, and at the
most 1.9 percentage points for the point estimate). Data for the 15-16 year old
group was not age-standardised.
b These are rarely
actual local government by-laws, but rather are “educative smokefree
policies” with supporting signage.
c A marae is a meeting
place registered as a reserve under the Te Ture Whenua Māori Act 1993
(“The Māori Land Act”) and each marae has a group of trustees
who are responsible for the operations of the marae. Such operations will
determine the extent to which a marae is a “public place”, in terms
of its beneficiaries of iwi (tribes), hapū (sub-tribes) or whānau
d Some of this
exposure at work may arise from outdoor smoking and some may reflect the drift
of smoke indoors from outside settings (i.e., a previous national survey
conducted in 2006, found that 2.5% of respondents reported that although there
is no smoking indoors at work, smoke comes in from the
Smoking was frequently observed (and smelt by the
investigators) on streets, in parks and in the smoking areas of hospitality
venues. Sometimes doors connecting with the “outdoor smoking area”
of such venues were left open, allowing tobacco smoke to drift inside and be
smelt by the investigators.
We also noticed that some of these “outdoor”
smoking areas in hospitality venues were highly enclosed e.g., with only one
partially open side or with roofing that had only a narrow gap for air around
the margins. Some of these settings used adjustable plastic or canvas sheeting
so that the smoking area could become more or less enclosed, depending on the
weather conditions. In one of these “outdoor” smoking areas workers
were observed to be continuously based in this area (i.e., staffing a bar area
with drink supplies).
Mean sampling time
[Ranges give the results
arising for each sampling episode separately]
Fairly-enclosed “outdoor” smoking
“Outdoor” smoking areas of bars (n=2,
purposeful sampling in the CBD, in June
“Outdoor” smoking areas of bars (purposeful
sample of n=7 bars in the CBD, with 13 individual measurements (1-3 per bar) in
April, June & August 2007 and January 2008)
“Outdoor” smoking areas of
bars/pubs/restaurants (n=4, random selection in the CBD, in May/June
“Outdoor” smoking areas of bar (n=1,
purposeful sampling in the CBD, in April 2010)
Inside area of bars but adjacent to the entrance to the
“outdoor” smoking area (purposeful sample of n=7 bars in the CBD,
with 13 individual measurements (1-3 per bar) in April, June & August 2007
and January 2008)
Bars (n=8, random selection in the CBD, in May/June
Restaurants (n=8, random selection in the CBD, in
Bars (n=10, purposeful sampling of more traditional style
bars in the CBD, in June 2006)a
Traditional pubs and “sports bars” (n=10,
purposeful sampling in the CBD and suburbs on Friday and Saturday nights in
Cafés (n=5, purposeful sampling in the CBD and
suburbs in August 2010)
Selected restaurant venue with a history of official
investigation for non-compliance with the smokefree law (September 2010)
Transportation settings (n=10, convenience sample
including: buses (n=5), taxi, train, bus station, train station and airport; in
Other indoor settings (n=9, convenience sample including:
cafés (2), offices (2), hospital, library, club, shopping centre and
supermarket; in May/June 2006)a
Transportation settings (n=5, convenience sample
including: buses (n=3); underground car park [4.30 to 6pm Friday night]; inside
a train station and covered platforms, August/September 2010)
Other indoor settings (n=6, convenience sample including:
hospital, libraries (n=2), shopping centre and supermarket, museum, indoor
sports venue; in August 2010)a
Along the Golden Mileb
route of major streets, usually with overhanging roofing (n=7, purposeful
sampling at sites where smoking was more common, including the
“outdoor” smoking area of a hospitality venue, March/April
Full length of the Golden
Mileb route as a pedestrian (n=4 episodes,
when: “quiet” (Sunday afternoon), “moderately busy”, and
“busy”—Friday night [n=2]) (March/April 2010)
Various outdoor settings (n=6 purposeful and convenience
samples at: parks (2), roadsides (2), a walkway and a legally smokefree walkway
(Cable Car lane), in May/June 2006)a
Selected areas along the Golden
Mileb route with at least one person smoking
nearby (n=6, purposeful sampling and usually no overhanging roof) (March/April
Parks/sports grounds (n=5, including sidelines of a
football match, August/September 2010)
Routine monitoring of
PM2.5 in Auckland City air (1998 to
2001)37 (Wellington City airshed data are for
PM2.5 = 11.0
µg/m3 (range 2.1 to 37.6)
a Previously published
data.16 For these data sampling was set for
determining average values at 60 second logging intervals (all the other
sampling reported in this table was at 30 second logging intervals).
b Golden Mile—a
selection of major streets in the Wellington CBD that runs from the western end
of Lambton Quay to the eastern end of Courtenay Place. Further detail on some of
these results is considered elsewhere.39
Main findings and interpretation:
This work identified relatively high particulate levels from SHS
in the “outdoor smoking areas” of hospitality venues (Table 2). This
setting is also the one in which non-smokers most commonly report being exposed
to SHS (Table 1). These results are not surprising given what is known about SHS
as a contributor to indoor PM2.5 levels from
international work32 and for outdoor levels (in
Canada40 and the
USA41). Of note is that the New Zealand results
for outdoor areas at hospitality venues were higher than those found in
Australian studies in Perth/Mandurah42 and in
Any level of PM2.5 is of some
concern from a health perspective given “no threshold for PM has been
identified below which no damage to health is observed” according to the
World Health Organization (WHO).44 But here we
consider our results in relation to the WHO air quality guidelines for a 24-hour
mean of 25 μg/m3 (with this level being a
target that if achieved would result in “significant reductions in risks
for acute and chronic health effects from air
Considering the weighted mean result for all
“outdoor” smoking areas (of 72
μg/m3 for data in the first four rows in
Table 2), would suggest that this WHO guideline would be exceeded after 7.2
hours (while also considering the conservative assumption of the rest of the day
having an average of only 5 μg/m3 of
exposure). But if using the annual guideline
level44 (a mean of 10
μg/m3), the time for this to be exceeded
would only be 1.8 hours. Workers frequently serving patrons in such smoking
areas may have relatively higher cumulative exposure and those frequently
working overtime could have relatively higher annual exposure.
The next highest levels of particulates were found inside of
bars but adjacent to the entrance to the “outdoor” smoking area.
Given the evidence of far lower mean levels found for measurements in bars and
restaurants from areas not adjacent to outdoor smoking areas (mean 12-22
µg/m3—see Table 2), this suggests
that there is smoke drift from SHS in the outdoor smoking areas to the inside.
This pattern corresponded with our observations of smelling tobacco smoke while
indoors where there was an open connection with an “outdoor” smoking
area. More generally the SHS drift issue was identified in a national survey
conducted in 2006 where 2.5% of respondents (95%CI: 1.9%–3.1%) reported
that although there is no smoking indoors at work, smoke drifts in from
outdoors.36 The problem of SHS drift from
outdoor to indoor areas has also been described for pubs and bars in
The relatively low levels of particulates in many other
settings and the rarity of illegal smoking being observed, are suggestive of
high compliance with the smokefree law in this city. This impression is
consistent with the rarity of prosecutions under the smokefree law (last
reported in Wellington for a café owner with an illegal
“outdoor” smoking area in 200746).
This is also the pattern at the national level where there were only five
additional prosecutions in the five years since the law was
implemented,47 with the last two being in
200848 49 (based on media database searches in
August 2010). However, Ministry of Health officials note that some additional
cases have been settled out of court and one prosecution is being appealed
[Personal communication, Brendon Baker, 3 September 2010].
Strengths, limitations and further
research—Strengths of this work are that it covered a wide range
of settings over several years post implementation of the upgraded smokefree law
and used a well-established approach to measuring SHS-related particulates in
air. Some of our sampling was purposefully of “more traditional” and
“sports bars” and this may have maximised efficiency in terms of
detecting illegal smoking (compared to a random sample that would have included
more “up-market” bars that may better comply with the smokefree law
and which may attract more law-abiding clients).
However, limitations of note with this work include the
relatively wide-ranging, our sampling strategy still had deficiencies in terms
of not collecting air quality data in all of the settings listed in Table 1
(e.g., due to the inconvenience of getting to a concert). Also sampling did not
occur very late at night and in the early morning when some bars remain open and
it is plausible that compliance with the law declines. Also, the sampling along
the Golden Mile route did not systematically measure levels in close proximity
to major building entrances (where smokers sometimes congregate) or around bus
sampling strategies would consider these issues and could increase the number of
samples taken at each type of setting and sample systematically across seasons
of the year (or at least winter versus summer). In particular, it could study
further the outdoor areas of hospitals (particularly entrances) where smoking
may be relatively common.
some of the indoor settings the particulate levels may have been partly due to
non-SHS sources. For example, such fine particulates can be produced by the
51 and so can be measured in establishments
that cook food (including some bars/pubs). Also, poorly ventilated fire places,
unflued gas heaters and candles on tables may contribute fine particulates,
along with the movement of outdoor air pollutants to inside settings (e.g., from
vehicle exhausts). However, we observed low levels of particulates even in
heavily trafficked areas, such as a busy intersection (mean=5
µg/m3 for two 30-minute samples in
suggests that road traffic is likely to be only a minor contributor to
particulate levels in most of the settings we studied compared to SHS, including
along the Golden Mile route. Furthermore, relative humidity levels may also have
had some influence on the results but a humidity correction curve for the
SidePak has not yet been
study may not be completely generalisable to the rest of New Zealand. Firstly,
smokers in the capital city (some of whom work for central government) may be
more compliant with smokefree laws than rural New Zealanders. Nevertheless, none
of the authors have ever observed smoking inside pubs or restaurants in other
New Zealand cities or towns over the past six years, despite regular visits to
such areas. Secondly, as Wellington has relatively high average wind speeds
compared to the New Zealand average, it is also possible that the particulate
levels we found in “outdoor” smoking areas, under-represent those
typically found in other New Zealand towns and cities.
the results of this study is also limited because of the absence of appropriate
air quality standards for high but brief exposure to particulates in SHS (e.g.,
PM2.5 for one hour or three hours). Such exposure
patterns are probably far more relevant than considering annual or 24-hour
levels. Also, existing air quality standards refer to particulates which are
often derived from traffic, industrial and domestic heating pollutants—the
hazard profile and level at which hazard occurs may be different for
particulates in SHS.
implications—In our view the most efficient solution to the
remaining SHS problem in New Zealand is to adopt endgame policies to the tobacco
epidemic which will reduce smoking prevalence to close to zero, such as phasing
out tobacco sales using a “sinking lid” on
supply.53 But we recognise that lack of strong
political leadership on this issue may mean that the country continues along a
slower incremental path of adopting smaller and more “politically
digestible” tobacco control steps.
If this approach continues, we would favour intensifying
established key tobacco control interventions (for which there is scope for
improvement in New Zealand54 55), and
specifically considering the following additional measures:
additional smokefree laws to cover 50% of the seated outdoor area of hospitality
venues as per various jurisdictions in North America and Australia (e.g., for
Queensland “the total area of all DOSAs [designated outdoor smoking areas]
must not be more than 50% of the whole outdoor liquor licensed area of the
premises”56). This could be justified on
grounds of protecting workers’ health and fairness to non-smokers (i.e.,
allowing some reasonable access to semi-smokefree outdoor seating) and is likely
to have high public and political acceptability. Nevertheless, we note that from
a public health perspective and occupational health perspective this would still
often result in exposure of non-smokers and workers to some SHS hazard and
nuisance (depending on the wind direction) and many people will consider this a
sub-optimal compromise. This is especially so given that some jurisdictions
internationally have adopted 100% outdoor smokefree areas at hospitality
the existing smokefree law to ensure adequate barriers to air flow between any
“outdoor” smoking areas and the inside of hospitality venues e.g.,
no connecting windows or doors left open and requiring a smokefree area adjacent
to the connecting doorway. Making semi-enclosed “outdoor” smoking
areas more open to wind flow would also reduce the extent to which SHS can drift
possible alternative approach to the measure described immediately above, is to
develop mandatory maximum indoor air pollutant levels for
PM2.5 in hospitality venues (e.g., for one-hour,
three-hours and a working day). This could be accompanied by a monitoring system
for determining adherence, with fines on non-complying venues covering the
monitoring costs. The Ministry of Health and District Health Boards could be the
relevant agencies involved, but occupational health authorities are an
alternative (given the important role of occupational health in past smokefree
legislation in NZ).
This approach would
mean that it could be left to the discretion of the venue management as to how
to best comply with the air quality law. This approach would also help address
the air pollution problem arising from smoky food premises (especially where
food is cooked or heated in the dining area). However, because of the complexity
of this approach, and the costs of effective implementation, we consider that
complete (100%) smoking restrictions would be preferable.
Such regulatory responses would be expected to reduce the
adverse health impacts of SHS to the general public and to workers but
potentially also act to reduce health inequalities. This is because of the
evidence for higher SHS exposure among deprived populations in New
Zealand31 and because more deprived populations
are more vulnerable to SHS in terms of having higher rates of chronic
respiratory and cardiovascular disease.
Laws requiring major pedestrian areas on city streets to be
smokefree (as proposed recently for Wellington’s Golden Mile in an
“epetition”30) are harder to
justify in terms of SHS exposure levels alone, based on these data.
Nevertheless, such laws could be adopted on the grounds of reducing
role-modelling of adult smoking behaviour (to children and
youth),59 reducing nuisance to non-smokers, and
for litter control reasons.
In Tasmania, both Hobart and Launceston have adopted
smokefree outdoor policies for the central business
districts.60 Similar arguments can apply to
making the following areas smokefree: the area around bus stops, train
platforms, children’s playgrounds, parks, sports grounds, and parts of
beaches (with some of these already operational in parts of
NZ28). Although local government could continue
to introduce new smokefree laws and policies, it is ultimately more efficient if
the major initiatives occur at a central government level.
Although this study did not re-assess the issue of SHS
exposure in cars, we consider that this is probably the priority new smokefree
law required in New Zealand (i.e., for when infants and children are in the
Our previous work indicates extremely high levels of
PM2.5 can occur inside cars (e.g. up to 3645
µg/m3 in a car with the windows
closed).61 Also there are very high levels of
public support for banning smoking in cars with children, including by New
Zealand smokers62 and exploring such a law was
recommended by the Maori Affairs Select Committee in
But despite the likely health and other benefits, most
smokefree laws are likely to be resisted by some sectors with commercial vested
interests such as the tobacco industry, the hospitality sector and possibly the
alcohol industry. This suggests that it is ideal if additional smokefree laws
are accompanied with new mass media campaigns on the hazards of SHS and setting
out the responsibility of government to protect non-smokers from this hazard.
A near zero-cost supplementary measure to such mass media
campaigns is for the government to mandate for additional pictorial warnings on
tobacco packaging that include messages on SHS hazards to children and other
adults (e.g., as already used in some jurisdictions such as
Canada64). Finally, attention by health workers
could also go to responding to misuse of information on SHS by those opposed to
smokefree laws, given the occurrence of this in New Zealand in the
Competing interests: Although we do
not consider it a competing interest, for the sake of full transparency we note
that the first two authors have previously worked for health sector
organisations working for tobacco control.
Nick Wilson, Associate
Professor; Richard Edwards, Professor; Rhys Parry,
-year medical student; Department of Public
Health, University of Otago, Wellington
Acknowledgements and funding: The authors
thank colleagues who have assisted with the air sampling work (Anthony Maher,
Anne Tucker, Jenny Näthe, and Rafed Jalali) and who have provided helpful
advice: George Thomson (University of Otago) and Mark Travers (Roswell Park
Cancer Institute). Some of the funding support for NW and RE during this period
came from the ITC Project, funded by the Health Research Council and the funding
for the SidePak came from the Wellington Medical Research Fund.
Dr Nick Wilson, Department
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