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One mechanism to make progress towards reducing the enormous health burden from tobacco smoking is to expand smokefree public areas. For many high-income countries, this now means an increased focus on outdoor public settings, where smokefree policies are much less common than for indoor public settings. Such policies are intended to reduce the exposure of workers and the public to tobacco-smoke pollution and contribute to the denormalisation of smoking by reducing its visibility.[[1,2]] A perception of smokefree parks or outdoor dining policies has been associated with increased quit attempts,[[3]] and not being exposed to smoking in Ontario bar/restaurant outdoor areas increased quit attempts and decreased smoking relapses.[[4]] In New York, smokefree policies for parks and beaches were followed by reduced tobacco-related litter, observed smoking and public perceptions of smoking.[[5,6]] In the Netherlands, the introduction of an inner-city outdoor smokefree zone was associated with a substantial decline in the number of smokers in the zone.[[7]]

There is often majority public support for a number of types of outdoor smokefree areas (eg, based on surveys in the USA and Canada,[[8]] Spain,[[9]] Australia[[10,11]] and the UK[[12]]). There is even majority support for some outdoor smokefree areas by smokers (eg, in New Zealand,[[13]] Spain,[[9]] Italy,[[14]] Australia[[11]] and North America[[8]]).

Internationally, the most progress towards outdoor smokefree policy has generally been achieved in areas explicitly associated with children (eg, schools, playgrounds, urban parks),[[15]] with some movement in outdoor hospitality areas (eg, outside bars and cafés).[[16]] However, smokefree policies for central urban pedestrian areas have increased in California[[17]] and some larger Australian cities.[[18]] New York has smokefree policies for “Pedestrian plazas such as those at Times Square and Herald Square.”[[19]]

In New Zealand, exposure to second-hand smoke is a serious problem associated with an estimated 347 premature deaths per year in 2019.[[20]] When morbidity from this smoke is also considered, this health loss amounted to an estimated 9,022 lost disability-adjusted life years (DALYs) in 2019.[[20]] Fortunately, there has been some progress with voluntary or “educational” outdoor smokefree areas over the last two decades.[[21–23]] Nevertheless, various issues have been identified in terms of the extent of coverage and quantity/quality of the signage (eg, hospitality settings,[[24]] schools,[[25]] children’s playgrounds,[[26]] hospital grounds,[[27]] racecourses and sports facilities,[[28]] railway stations,[[29]] airports[[30]] and various other settings[[31]]). These limitations are problematic in the context of the country’s Smokefree 2025 goal, which aims for fewer than 5% of New Zealanders to be smokers by 2025.[[32]]

Despite the research mentioned above, there has been little work in New Zealand on evaluating the extent of smokefree pedestrian-only areas (plazas/malls/boulevards). In 2019, 12 months after the adoption of a smokefree policy in Rotorua’s pedestrian Eat Street, a local hospitality hub, a count found relatively few people smoking (0.6% of those observed; 36/6530; personal communication). The measurement of the prevalence of smoking in a few such places has occurred in Wellington, either before or after the adoption of smokefree policies.[[33,34]]

Given this background and the revived New Zealand Government interest in progressing tobacco control,[[35,36]] in this study we aimed to describe the smokefree status and signage of outdoor pedestrian-only plazas/malls/boulevards in 10 New Zealand local government (council) areas. Smokefree status includes whether the local authority has designated the area smokefree and whether ash trays are present on dining/drinking tables in the area, including temporary tables associated with cafés, restaurants and pubs. Councils sometimes prohibit ash trays on tables used by cafés, restaurants and pubs on public land.

Methods

Sample selection: The 10 council areas were a convenience sample based on where the authors lived and their travel plans (from north to south, the areas were: Hastings, Napier, Palmerston North, Masterton, South Wairarapa, Porirua, Upper Hutt, Hutt City and Wellington in the North Island and Queenstown Lakes in the South Island). A systematic attempt was made to identify all the outdoor pedestrian-only plazas/malls/boulevards on public land with permanent seating in these council areas. We then selected the five largest of these (measured by paved/gravel area) within each council area (or 10 in the case of councils with 100,000+ populations: Wellington and Hutt City).

Smokefree policies: The website of each council was examined in May 2021 to identify the smokefree policy. Key features of each policy were documented, particularly how it related to the selected sites.

Site inclusion criteria: For the purposes of this study, we used the following definitions for site inclusion in the survey:

  • An “outdoor plaza with seating” was an outdoor area that was at least 50% paved or gravel surfaced, had some distinguishing structures to prevent vehicle access (eg, bollards or planter boxes) and had at least one permanent seat. In some cases, these plazas were still officially called “parks” (eg, Grey Street Pocket Park in Wellington City). Also, we identified plaza areas within larger park settings, where the plaza was well defined by surrounding structures. Where a plaza or boulevard was an extended area (or series of connected areas) of the footpath, we required that the area including the extension was at least twice the width of the nearest normal width of footpath. We took a broad interpretation of seating that included seating with no back support (eg, concrete block or wooden benches that could be sat on).
  • A “pedestrianised mall/boulevard” was defined as an outdoor area that was fully pedestrianised for its entire width, was wider than a typical footpath and had at least one permanent seat.

Site identification: For each local authority, the following steps were performed up to May 2021:

  • We examined Google Maps and Google Street View and undertook our own observations within each council area to identify all relevant sites.
  • We examined the local authority website for smokefree policies, and for the areas designated as smokefree. These policies typically included mention of specific pedestrianised plazas, malls and boulevards (for references to website links, see Table 1).
  • We conducted a Google search to identify news items around smokefree areas within each city. For example, some documents specifically identified city plazas (eg, for Hastings[[37]]).
  • Sites that were outside of a council’s jurisdiction were excluded (eg, on private land, university and hospital campuses and parts of national monuments, etc). We also excluded any of the potential sites if construction was underway at the time of the field visit.

Data collection at site visits: On field visits to each site, we identified the presence or absence of the features required for inclusion (see site inclusion criteria above). For sites meeting such criteria, we then collected these data:

  • The presence of all smokefree and vapefree signage (with photographs taken of all signs). For the study, we did not include data on smokefree signage that met our definition of low-visibility (ie, under 10cm by 10cm in size and on a sign over two meters above the ground). We also did not include smokefree signage on temporary tables at the site.
  • The presence or absence of dining/drinking tables, including temporary ones associated with cafés, restaurants and pubs. Temporary tables were included so as to provide a full denominator for all tables (with and without ash trays).
  • The presence or not of ash trays on any of the tables or special bins for cigarette butts.

Three sites were examined by two authors together to confirm the feasibility of the definitions and methods. Then the rest of the sites were examined by one of the authors alone, albeit with site photographs examined by the other authors. All site visits were conducted during business hours to ensure that any cafés/restaurants and pubs would have any tables set up outside. The field survey covered the period 2 January 2021 to 13 May 2021.

Results

Of the 10 councils, all had details of smokefree outdoor policies on their websites (Table 1). There was also evidence of specific commissioned research on the topic that had been published.[[38]] The average time since the smokefree policy was last updated was four years (ie, in 2017; range 2006 to 2020; Table 1). Policies with components covering smokefree outdoor plazas/malls/boulevards were common (80%; 8/10 councils), with the policy of one of the remainders (South Wairarapa) being classified as “unclear.” Only Queenstown Lakes had no component of the pedestrian-only plazas/malls/boulevards covered. But only five councils (50%) included a vapefree policy for the outdoor areas covered. Most councils (80%) had some policy around smokefree signage. In three of these (30%), the signage policy specifically mentioned signage in te reo Māori, but only two mentioned vapefree signage. The Hutt City policy specifically stated: “Signage does not include a ‘no vaping’ message”.

A total of 60 relevant pedestrianised sites with permanent seating were identified and surveyed (52 plazas, six malls and two boulevards; Table 2). As per the sample method, this meant five sites each for Hastings, Napier, Palmerston North, Masterton, South Wairarapa, Porirua, Upper Hutt and Queenstown Lakes, and ten each for Hutt City and Wellington. Of these, 63% were officially designated smokefree in the council’s smokefree policy. Smokefree signage was only present in 15% (9/60) of the total sites and in 24% (9/38) of the designated smokefree sites. In these designated sites, the average number of smokefree signs was 1.4 (range: 0 to 14; Table 2). In the sites with smokefree signage, 44% had at least some signs with te reo Māori wording (eg, Figure 1) and 22% had some signs where the smokefree message was just part of a larger sign (eg, Figure 2). There were no vapefree signs at any of the sites and no signs mentioned any enforcement details (eg, telephone numbers for complaints). Qualitative issues included some very small smokefree signs (under 10 cm by 10 cm in area; Figure 2), and some signs were located where the intent was unclear (eg, on the side of a building where the sign could potentially be interpreted as indicating a smokefree indoor area).

At sites where tables were present, 12% had ash trays on the tables. But none of the designated smokefree sites had ash trays present on the tables.

Table 1: City councils (CC) and district councils (DC) in the sample and how their smokefree policies at May 2021 related to outdoor pedestrian-only plazas/malls/boulevards. View Table 1.

Table 2: Results for pedestrianised sites (plazas/malls/boulevards) in the 10 council areas (with site specific details available on request from the authors). View Table 2.

Figure 1: Example of a relatively large smokefree sign with a clear “no smoking” symbol and prominent use of te reo Māori wording (photograph by the second author).

Figure 2: Example of a type of a very small smokefree sign included in this study, with this also being part of a much larger sign for another purpose (the smokefree symbol is in the lower right side of the sign; photograph by the second author).

Discussion

A key finding of this survey was that all the 10 councils had details of smokefree outdoor policies on their websites and most (80%) of these policies had components that covered smokefree outdoor plazas/malls/boulevards (Table 1). Nevertheless, out of the 60 pedestrianised sites with permanent seating that we examined, only 63% were officially designated smokefree as per the council website policy (and in some cases this status was unclear or just applied to part of the site). Furthermore, only 24% of the designated smokefree sites had any smokefree signage. This signage was often suboptimal in terms of size, extent and quality. Also, 12% of sites had tables with ash trays, which send a potentially problematic, pro-smoking signal.

These various problems that we found are inconsistent with the New Zealand Government’s Smokefree Aotearoa 2025 goal,[[32]] as indeed are the extensive limitations with other outdoor smokefree areas in the country (see the introduction). They are also inconsistent with local government efforts to make their localities more attractive to workers, shoppers and tourists; to have a healthier and more productive population;[[48]] and to improve the environment with reduced tobacco-related pollution, litter and cleaning costs.[[49]]

Given these problems, there is a case for an upgrade to national smokefree legislation, as is used for indoor public and workplaces. Such legislation appears to have worked well for another type of outdoor area in New Zealand (eg, school grounds throughout the country[[23]]), and a national approach has recently been taken with smokefree vehicles.[[50]] In contrast to local government initiatives, national legislation has the advantage of providing consistent messaging throughout the country, allowing for integration with national smokefree media campaigns and for economies of scale from centralised sign production/distribution. Specific features of a new national law smokefree law that encompassed these sites could state:

  • All outdoor pedestrianised plazas, malls and boulevards that have any permanent seating are smokefree and vapefree (along with a 10-metre zone from their boundaries).
  • All these sites are required to have smokefree signage that meet minimum government specifications (ie, for number of signs per area, size, use of te reo Māori and messaging including “no vaping”).

Nevertheless, until a national approach is adopted, local government can still take additional initiatives to upgrade their smokefree policies and build them into bylaws. The range of approaches for the use of locally based laws for smokefree outdoor areas in New Zealand has been detailed previously.[[51]]

A strength of our study was that it appears to be the first survey (to our knowledge) of the smokefree status these type of outdoor pedestrianised areas in Australasia. Study limitations include the sample of just 10 council areas (out of a potential 67 territorial authorities in the country) and the sample being a convenience one, owing to this being an unfunded study. Also, within the council areas, it is possible that we may have missed identifying some of the largest 5–10 sites, owing to our mechanisms for identifying them (eg, via Google Maps, Google Street View and local observations).

In summary, smokefree plazas/malls/boulevards in this survey had multiple policy and signage deficiencies that are inconsistent with achieving the national Smokefree 2025 goal. There is scope to address these issues and others highlighted in research on smokefree outdoor policies in Aotearoa, and scope for a major upgrade to the national smokefree law to help de-normalise smoking and to help ex-smokers be smokefree. This fundamental move on smokefree policies would be in line with the innovative ideas in the New Zealand Government’s Proposals for a Smokefree 2025 Action Plan.[[35]]

Summary

Abstract

Aim

To describe the smokefree status and signage of outdoor pedestrian-only plazas/malls/boulevards in 10 New Zealand local government (council) areas.

Method

The 10 council areas were a convenience sample. Council websites were examined for smokefree policies, and a systematic attempt was made to identify the five largest pedestrian-only sites with permanent seating in each council area (10 sites each for two larger cities). Field visits were conducted to all selected sites during January–May 2021.

Results

Smokefree policies with components covering smokefree outdoor plazas/malls/boulevards were common (80%; 8/10 councils), albeit with some gaps (eg, around signage and vaping policy). A total of 60 relevant pedestrianised sites with permanent seating were identified and surveyed. Of these, 63% were officially designated smokefree. Smokefree signage was only present in 15% (9/60) of all the sites and in 24% (9/38) of the designated smokefree sites. In these designated sites, the average number of smokefree signs was only 1.4 (range: 0 to 14). Issues identified with the signs included small size, being only a small part of a larger other sign, limited use of te reo Māori wording and not covering vaping. At sites where tables were present, 12% had ash trays on the tables (none at smokefree sites).

Conclusion

Smokefree plazas/malls/boulevards in this survey had multiple policy and signage deficiencies that are inconsistent with achieving the national Smokefree 2025 goal. There is scope to address these issues with an upgrade to the national smokefree law.

Author Information

Nick Wilson: Department of Public Health, University of Otago Wellington. Niveditha Gurram: Te Hiringa Hauora/Health Promotion Agency, Wellington. Leah Grout: Department of Public Health, University of Otago Wellington. George Thomson: Department of Public Health, University of Otago Wellington.

Acknowledgements

Correspondence

Prof Nick Wilson, Department of Public Health, University of Otago Wellington

Correspondence Email

nick.wilson@otago.ac.nz

Competing Interests

Although one of the authors (NG) works for Te Hiringa Hauora/Health Promotion Agency, this research work was performed independently and none of the views expressed in this article necessarily reflect the views of this agency or the New Zealand Government.

1. Sureda X, Bilal U, Fernandez E, Valiente R, Escobar FJ, Navas-Acien A, Franco M. Second-hand smoke exposure in outdoor hospitality venues: Smoking visibility and assessment of airborne markers. Environ Res. 2018;165:220-7.

2. Pearson AL, Nutsford D, Thomson G. Measuring visual exposure to smoking behaviours: a viewshed analysis of smoking at outdoor bars and cafes across a capital city's downtown area. BMC Public Health. 2014;14:300.

3. Zablocki RW, Edland SD, Myers MG, Strong DR, Hofstetter CR, Al-Delaimy WK. Smoking ban policies and their influence on smoking behaviors among current California smokers: a population-based study. Prev Med. 2014;59:73-8.

4. Chaiton M, Diemert L, Zhang B, Kennedy RD, Cohen JE, Bondy SJ, Ferrence R. Exposure to smoking on patios and quitting: a population representative longitudinal cohort study. Tob Control. 2016;25:83-8.

5. Johns M, Coady MH, Chan CA, Farley SM, Kansagra SM. Evaluating New York City's smoke-free parks and beaches law: a critical multiplist approach to assessing behavioral impact. Am J Community Psychol. 2013;51:254-63.

6. Johns M, Farley SM, Rajulu DT, Kansagra SM, Juster HR. Smoke-free parks and beaches: an interrupted time-series study of behavioural impact in New York City. Tob Control. 2015;24:497-500.

7. Breunis LJ, Bebek M, Dereci N, de Kroon MLA, Rado MK, Been JV. Impact of an inner-city smoke-free zone on outdoor smoking patterns: a before-after study. Nicotine Tob Res. 2021. Online June 1. doi: 10.1093/ntr/ntab109

8. Thomson G, Wilson N, Collins D, Edwards R. Attitudes to smoke-free outdoor regulations in the USA and Canada: a review of 89 surveys. Tob Control. 2016;25:506-16.

9. Sureda X, Fernandez E, Martinez-Sanchez JM, Fu M, Lopez MJ, Martinez C, Salto E. Secondhand smoke in outdoor settings: smokers' consumption, non-smokers' perceptions, and attitudes towards smoke-free legislation in Spain. BMJ Open. 2015;5:e007554.

10. Walsh R, Paul C, Tzelepis F, Stojanovski E, Tang A. Is government action out-of-step with public opinion on tobacco control? Results of a New South Wales population survey. Aust N Z J Public Health. 2008;32:482-8.

11. Rosenberg M, Pettigrew S, Wood L, Ferguson R, Houghton S. Public support for tobacco control policy extensions in Western Australia: a cross-sectional study. BMJ Open. 2012;2:e000784.

12. Brenner G, Mann K, Lee D, Burrows J, Crosby S. Attitudes towards smokefree high streets: a survey of local shoppers in a northern UK town. Perspect Public Health. 2018;138:325-8.

13. Wilson N, Blakely T, Edwards R, Weerasekera D, Thomson G. Support by New Zealand smokers for new types of smokefree areas: national survey data. N Z Med J. 2009;122(1303):80-9.

14. Gallus S, Rosato V, Zuccaro P, Pacifici R, Colombo P, Manzari M, La Vecchia C. Attitudes towards the extension of smoking restrictions to selected outdoor areas in Italy. Tob Control. 2012;21:59-62.

15. Martinez C, Guydish J, Robinson G, Martinez-Sanchez JM, Fernandez E. Assessment of the smoke-free outdoor regulation in the WHO European Region. Prev Med. 2014;64:37-40.

16. American Non-Smokers Rights Foundation. Municipalities with Smokefree Outdoor Dining and Bar Patio Laws. Berkeley: American Nonsmokers' Rights Foundation, 2021. Available from: http://no-smoke.org/wp-content/uploads/pdf/SmokefreeOutdoorDining.pdf

17. Center for Tobacco Policy & Organizing. Comprehensive outdoor secondhand smoke ordinances. Sacramento: Center for Tobacco Policy & Organizing: American Lung Association of California, 2012. Available from: https://www.otago.ac.nz/wellington/otago671072.pdf

18. Thomson G. Smokefree Wellington: Context, options and evidence. Wellington: University of Otago, Wellington, 2015. Available from: https://www.otago.ac.nz/wellington/otago304204.pdf

19. New York City Department of Parks & Recreation. Smoke-Free Parks and Beaches. New York: New York City Department of Parks & Recreation, 2021. Available from: https://www.nycgovparks.org/facility/rules/smoke-free

20. Institute of Health Metrics and Evaluation. GHDx (Global Health Data Exchange); Results for New Zealand (on 24 May 2021). Seattle; Institute of Health Metrics and Evaluation. Available from: http://ghdx.healthdata.org/gbd-results-tool

21. Marsh L, Robertson LA, Kimber H, Witt M. Smokefree outdoor areas in New Zealand: how far have we come? N Z Med J. 2014;127(1389):51-66.

22. Thomson G, Wilson N. Local and regional smokefree and tobacco-free action in New Zealand: highlights and directions. N Z Med J. 2017;130:89-101.

23. Wilson N, Oliver J, Thomson G. Ten years of a national law covering smoke-free school grounds: a brief review. Tob Control. 2016;25:122.

24. Wilson N, Delany L, Thomson GW. Smokefree laws and hospitality settings: an example from New Zealand of a deficient approach. Tob Control. 2020;29:460.

25. Wilson N, Thomson G, Edwards R. The potential of Google Street View for studying smokefree signage. Aust N Z J Public Health. 2015;39:295-6.

26. Thomson G, Wilson N. Smokefree signage at children's playgrounds: Field observations and comparison with Google Street View. Tob Induc Dis. 2017;15:37.

27. Wilson N, Thomson G. Suboptimal smokefree signage at some hospitals: Field observations and the use of Google Street View. N Z Med J. 2015;128(1415):56-9.

28. Thomson G, Wilson N. Smokefree signage at New Zealand racecourses and sports facilities with outdoor stands. N Z Med J. 2017;130:80-86.

29. Wilson N, Thomson G. Smokefree signage at railway stations: a survey of 54 stations in 11 local government areas. N Z Med J. 2019;132:59-61.

30. Wilson N, Jones AC, Thomson GW. Poor smoke-free status of airports in a country with a smoke-free goal: New Zealand. Tob Control. 2020. Online 24 July 2020. doi: 10.1136/tobaccocontrol-2020-055894

31. Wilson N, Thomson G. Surveying all outdoor smokefree signage in contrasting suburbs: methods and results. Health Promot J Austr. 2017;28:264-65.

32. New Zealand Government. Government Response to the Report of the Māori Affairs Committee on its Inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Māori (Final Response). Wellington: New Zealand Parliament, 2011. Available from: http://www.parliament.nz/en-nz/pb/presented/papers/49DBHOH_PAP21175_1/government-final-response-to-report-of-the-m%c4%81ori-affairs

33. Gurram N, Thomson G. The point prevalence of smoking and vaping in downtown locations in Wellington: Report for the Wellington City Council on observations in November 2018. Wellington: University of Otago Wellington, November 29, 2018. Available from: https://www.otago.ac.nz/wellington/departments/otago711611.pdf

34. Thomson G, Pathamanathan N. The point prevalence of smoking in selected sports fields and downtown locations in Wellington: Observations in November 2015. University of Otago, Wellington, January 2016. Available from: http://www.otago.ac.nz/wellington/otago610430.pdf

35. Ministry of Health. Proposals for a Smokefree Aotearoa 2025 Action Plan: Discussion document. Wellington: Ministry of Health 2021. Available from: https://www.health.govt.nz/system/files/documents/publications/proposals_for_a_smokefree_aotearoa_2025_action_plan-final.pdf

36. Daube M, Maddox R. Impossible until implemented: New Zealand shows the way. Tob Control 2021. 2021;30:361-362.

37. Hastings District Council. Hastings City Centre Revitalisation Plan. Hastings District Council, 2019 (February). Available from: https://www.hastingsdc.govt.nz/assets/Document-Library/Plans/Hastings-City-Centre-Public-Spaces-Revitalisation-Plan/Hastings-City-Centre-Public-Spaces-Revitalisation-Plan.pdf

38. Gurram N. The point prevalence of smoking and vaping in Grey Street pocket square, Wellington: Report for the Wellington City Council on observations in Grey Street, Wellington in December 2018. 2019. Available from: https://www.otago.ac.nz/wellington/departments/otago711699.pdf

39. Hastings District and Napier City Councils. Hastings District and Napier City Councils Smokefree Policy Napier: Hastings District and Napier City Councils, 2016. Available from: https://www.napier.govt.nz/assets/Document-Library/Policies/smokefree-policy.pdf

40. Palmerston North City Council. Palmerston North Auahi Kore Smokefree and Vapefree Policy 2020. Palmerston North, NZ: Palmerston North City Council, 2020. Available from: https://www.pncc.govt.nz/media/3133544/auahi-kore-smokefree-and-vapefree-policy-2020.pdf

41. Masterton District Council. Smokefree policy. Masterton: Masterton District Council, 2017. Available from: https://mstn.govt.nz/wp-content/uploads/2017/02/Smokefree-Policy_Current.pdf

42. South Wairarapa District Council. Smoke-Free Environment Policy. Martinborough: South Wairarapa District Council, 2015. Available from: https://swdc.govt.nz/wp-admin/admin-ajax.php?action=wpmf_onedrive_business_download&id=01CTNIGYECBXJBHTTMBBB3QHHUKFT6IOL7&link=true&dl=0

43. Porirua City Council. Smokefree outdoor public places policy. Porirua: Porirua City Council, 2019. Available from: https://storage.googleapis.com/pcc-wagtail-media/documents/Smokefree_Outdoor_Public_Places_Policy_-_2019.pdf

44. Upper Hutt City Council. Smokefree Policy. (Accessed 5 April 2021). Available from: https://www.upperhuttcity.com/Your-Council/Plans-policies-bylaws-and-reports/Policies-and-bylaws/Smokefree-Upper-Hutt

45. Hutt City. Smokefree Lower Hutt. (Updated 20 July, 2020). Available from: http://www.huttcity.govt.nz/Our-City/live-here/smokefree-lower-hutt/

46. Wellington City Council. Smokefree Wellington. (Accessed 17 January, 2021). Available from: https://wellington.govt.nz/your-council/plans-policies-and-bylaws/policies/smokefree-wellington

47. Queenstown Lakes District Council. Smokefree and Vapefree. 2021 (accessed 12 April) Available from: https://letstalk.qldc.govt.nz/smokefree

48. Hahn EJ. Smokefree legislation: a review of health and economic outcomes research. Am J Prev Med. 2010;39:S66-76.

49. Torkashvand J, Farzadkia M. A systematic review on cigarette butt management as a hazardous waste and prevalent litter: control and recycling. Environ Sci Pollut Res Int. 2019;26:11618-30.

50. Wilson N, Thomson G, Edwards R. Smoke-free cars legislation: it works but New Zealand should still rigorously evaluate its upcoming law. N Z Med J. 2020;133:99-103.

51. Thomson G, Martin J, Gifford H, Parata K. Expanding smokefree outdoor areas in Wellington City: Rationale and options. Wellington: University of Otago, 2016. Available from: https://www.otago.ac.nz/wellington/otago603825.pdf

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One mechanism to make progress towards reducing the enormous health burden from tobacco smoking is to expand smokefree public areas. For many high-income countries, this now means an increased focus on outdoor public settings, where smokefree policies are much less common than for indoor public settings. Such policies are intended to reduce the exposure of workers and the public to tobacco-smoke pollution and contribute to the denormalisation of smoking by reducing its visibility.[[1,2]] A perception of smokefree parks or outdoor dining policies has been associated with increased quit attempts,[[3]] and not being exposed to smoking in Ontario bar/restaurant outdoor areas increased quit attempts and decreased smoking relapses.[[4]] In New York, smokefree policies for parks and beaches were followed by reduced tobacco-related litter, observed smoking and public perceptions of smoking.[[5,6]] In the Netherlands, the introduction of an inner-city outdoor smokefree zone was associated with a substantial decline in the number of smokers in the zone.[[7]]

There is often majority public support for a number of types of outdoor smokefree areas (eg, based on surveys in the USA and Canada,[[8]] Spain,[[9]] Australia[[10,11]] and the UK[[12]]). There is even majority support for some outdoor smokefree areas by smokers (eg, in New Zealand,[[13]] Spain,[[9]] Italy,[[14]] Australia[[11]] and North America[[8]]).

Internationally, the most progress towards outdoor smokefree policy has generally been achieved in areas explicitly associated with children (eg, schools, playgrounds, urban parks),[[15]] with some movement in outdoor hospitality areas (eg, outside bars and cafés).[[16]] However, smokefree policies for central urban pedestrian areas have increased in California[[17]] and some larger Australian cities.[[18]] New York has smokefree policies for “Pedestrian plazas such as those at Times Square and Herald Square.”[[19]]

In New Zealand, exposure to second-hand smoke is a serious problem associated with an estimated 347 premature deaths per year in 2019.[[20]] When morbidity from this smoke is also considered, this health loss amounted to an estimated 9,022 lost disability-adjusted life years (DALYs) in 2019.[[20]] Fortunately, there has been some progress with voluntary or “educational” outdoor smokefree areas over the last two decades.[[21–23]] Nevertheless, various issues have been identified in terms of the extent of coverage and quantity/quality of the signage (eg, hospitality settings,[[24]] schools,[[25]] children’s playgrounds,[[26]] hospital grounds,[[27]] racecourses and sports facilities,[[28]] railway stations,[[29]] airports[[30]] and various other settings[[31]]). These limitations are problematic in the context of the country’s Smokefree 2025 goal, which aims for fewer than 5% of New Zealanders to be smokers by 2025.[[32]]

Despite the research mentioned above, there has been little work in New Zealand on evaluating the extent of smokefree pedestrian-only areas (plazas/malls/boulevards). In 2019, 12 months after the adoption of a smokefree policy in Rotorua’s pedestrian Eat Street, a local hospitality hub, a count found relatively few people smoking (0.6% of those observed; 36/6530; personal communication). The measurement of the prevalence of smoking in a few such places has occurred in Wellington, either before or after the adoption of smokefree policies.[[33,34]]

Given this background and the revived New Zealand Government interest in progressing tobacco control,[[35,36]] in this study we aimed to describe the smokefree status and signage of outdoor pedestrian-only plazas/malls/boulevards in 10 New Zealand local government (council) areas. Smokefree status includes whether the local authority has designated the area smokefree and whether ash trays are present on dining/drinking tables in the area, including temporary tables associated with cafés, restaurants and pubs. Councils sometimes prohibit ash trays on tables used by cafés, restaurants and pubs on public land.

Methods

Sample selection: The 10 council areas were a convenience sample based on where the authors lived and their travel plans (from north to south, the areas were: Hastings, Napier, Palmerston North, Masterton, South Wairarapa, Porirua, Upper Hutt, Hutt City and Wellington in the North Island and Queenstown Lakes in the South Island). A systematic attempt was made to identify all the outdoor pedestrian-only plazas/malls/boulevards on public land with permanent seating in these council areas. We then selected the five largest of these (measured by paved/gravel area) within each council area (or 10 in the case of councils with 100,000+ populations: Wellington and Hutt City).

Smokefree policies: The website of each council was examined in May 2021 to identify the smokefree policy. Key features of each policy were documented, particularly how it related to the selected sites.

Site inclusion criteria: For the purposes of this study, we used the following definitions for site inclusion in the survey:

  • An “outdoor plaza with seating” was an outdoor area that was at least 50% paved or gravel surfaced, had some distinguishing structures to prevent vehicle access (eg, bollards or planter boxes) and had at least one permanent seat. In some cases, these plazas were still officially called “parks” (eg, Grey Street Pocket Park in Wellington City). Also, we identified plaza areas within larger park settings, where the plaza was well defined by surrounding structures. Where a plaza or boulevard was an extended area (or series of connected areas) of the footpath, we required that the area including the extension was at least twice the width of the nearest normal width of footpath. We took a broad interpretation of seating that included seating with no back support (eg, concrete block or wooden benches that could be sat on).
  • A “pedestrianised mall/boulevard” was defined as an outdoor area that was fully pedestrianised for its entire width, was wider than a typical footpath and had at least one permanent seat.

Site identification: For each local authority, the following steps were performed up to May 2021:

  • We examined Google Maps and Google Street View and undertook our own observations within each council area to identify all relevant sites.
  • We examined the local authority website for smokefree policies, and for the areas designated as smokefree. These policies typically included mention of specific pedestrianised plazas, malls and boulevards (for references to website links, see Table 1).
  • We conducted a Google search to identify news items around smokefree areas within each city. For example, some documents specifically identified city plazas (eg, for Hastings[[37]]).
  • Sites that were outside of a council’s jurisdiction were excluded (eg, on private land, university and hospital campuses and parts of national monuments, etc). We also excluded any of the potential sites if construction was underway at the time of the field visit.

Data collection at site visits: On field visits to each site, we identified the presence or absence of the features required for inclusion (see site inclusion criteria above). For sites meeting such criteria, we then collected these data:

  • The presence of all smokefree and vapefree signage (with photographs taken of all signs). For the study, we did not include data on smokefree signage that met our definition of low-visibility (ie, under 10cm by 10cm in size and on a sign over two meters above the ground). We also did not include smokefree signage on temporary tables at the site.
  • The presence or absence of dining/drinking tables, including temporary ones associated with cafés, restaurants and pubs. Temporary tables were included so as to provide a full denominator for all tables (with and without ash trays).
  • The presence or not of ash trays on any of the tables or special bins for cigarette butts.

Three sites were examined by two authors together to confirm the feasibility of the definitions and methods. Then the rest of the sites were examined by one of the authors alone, albeit with site photographs examined by the other authors. All site visits were conducted during business hours to ensure that any cafés/restaurants and pubs would have any tables set up outside. The field survey covered the period 2 January 2021 to 13 May 2021.

Results

Of the 10 councils, all had details of smokefree outdoor policies on their websites (Table 1). There was also evidence of specific commissioned research on the topic that had been published.[[38]] The average time since the smokefree policy was last updated was four years (ie, in 2017; range 2006 to 2020; Table 1). Policies with components covering smokefree outdoor plazas/malls/boulevards were common (80%; 8/10 councils), with the policy of one of the remainders (South Wairarapa) being classified as “unclear.” Only Queenstown Lakes had no component of the pedestrian-only plazas/malls/boulevards covered. But only five councils (50%) included a vapefree policy for the outdoor areas covered. Most councils (80%) had some policy around smokefree signage. In three of these (30%), the signage policy specifically mentioned signage in te reo Māori, but only two mentioned vapefree signage. The Hutt City policy specifically stated: “Signage does not include a ‘no vaping’ message”.

A total of 60 relevant pedestrianised sites with permanent seating were identified and surveyed (52 plazas, six malls and two boulevards; Table 2). As per the sample method, this meant five sites each for Hastings, Napier, Palmerston North, Masterton, South Wairarapa, Porirua, Upper Hutt and Queenstown Lakes, and ten each for Hutt City and Wellington. Of these, 63% were officially designated smokefree in the council’s smokefree policy. Smokefree signage was only present in 15% (9/60) of the total sites and in 24% (9/38) of the designated smokefree sites. In these designated sites, the average number of smokefree signs was 1.4 (range: 0 to 14; Table 2). In the sites with smokefree signage, 44% had at least some signs with te reo Māori wording (eg, Figure 1) and 22% had some signs where the smokefree message was just part of a larger sign (eg, Figure 2). There were no vapefree signs at any of the sites and no signs mentioned any enforcement details (eg, telephone numbers for complaints). Qualitative issues included some very small smokefree signs (under 10 cm by 10 cm in area; Figure 2), and some signs were located where the intent was unclear (eg, on the side of a building where the sign could potentially be interpreted as indicating a smokefree indoor area).

At sites where tables were present, 12% had ash trays on the tables. But none of the designated smokefree sites had ash trays present on the tables.

Table 1: City councils (CC) and district councils (DC) in the sample and how their smokefree policies at May 2021 related to outdoor pedestrian-only plazas/malls/boulevards. View Table 1.

Table 2: Results for pedestrianised sites (plazas/malls/boulevards) in the 10 council areas (with site specific details available on request from the authors). View Table 2.

Figure 1: Example of a relatively large smokefree sign with a clear “no smoking” symbol and prominent use of te reo Māori wording (photograph by the second author).

Figure 2: Example of a type of a very small smokefree sign included in this study, with this also being part of a much larger sign for another purpose (the smokefree symbol is in the lower right side of the sign; photograph by the second author).

Discussion

A key finding of this survey was that all the 10 councils had details of smokefree outdoor policies on their websites and most (80%) of these policies had components that covered smokefree outdoor plazas/malls/boulevards (Table 1). Nevertheless, out of the 60 pedestrianised sites with permanent seating that we examined, only 63% were officially designated smokefree as per the council website policy (and in some cases this status was unclear or just applied to part of the site). Furthermore, only 24% of the designated smokefree sites had any smokefree signage. This signage was often suboptimal in terms of size, extent and quality. Also, 12% of sites had tables with ash trays, which send a potentially problematic, pro-smoking signal.

These various problems that we found are inconsistent with the New Zealand Government’s Smokefree Aotearoa 2025 goal,[[32]] as indeed are the extensive limitations with other outdoor smokefree areas in the country (see the introduction). They are also inconsistent with local government efforts to make their localities more attractive to workers, shoppers and tourists; to have a healthier and more productive population;[[48]] and to improve the environment with reduced tobacco-related pollution, litter and cleaning costs.[[49]]

Given these problems, there is a case for an upgrade to national smokefree legislation, as is used for indoor public and workplaces. Such legislation appears to have worked well for another type of outdoor area in New Zealand (eg, school grounds throughout the country[[23]]), and a national approach has recently been taken with smokefree vehicles.[[50]] In contrast to local government initiatives, national legislation has the advantage of providing consistent messaging throughout the country, allowing for integration with national smokefree media campaigns and for economies of scale from centralised sign production/distribution. Specific features of a new national law smokefree law that encompassed these sites could state:

  • All outdoor pedestrianised plazas, malls and boulevards that have any permanent seating are smokefree and vapefree (along with a 10-metre zone from their boundaries).
  • All these sites are required to have smokefree signage that meet minimum government specifications (ie, for number of signs per area, size, use of te reo Māori and messaging including “no vaping”).

Nevertheless, until a national approach is adopted, local government can still take additional initiatives to upgrade their smokefree policies and build them into bylaws. The range of approaches for the use of locally based laws for smokefree outdoor areas in New Zealand has been detailed previously.[[51]]

A strength of our study was that it appears to be the first survey (to our knowledge) of the smokefree status these type of outdoor pedestrianised areas in Australasia. Study limitations include the sample of just 10 council areas (out of a potential 67 territorial authorities in the country) and the sample being a convenience one, owing to this being an unfunded study. Also, within the council areas, it is possible that we may have missed identifying some of the largest 5–10 sites, owing to our mechanisms for identifying them (eg, via Google Maps, Google Street View and local observations).

In summary, smokefree plazas/malls/boulevards in this survey had multiple policy and signage deficiencies that are inconsistent with achieving the national Smokefree 2025 goal. There is scope to address these issues and others highlighted in research on smokefree outdoor policies in Aotearoa, and scope for a major upgrade to the national smokefree law to help de-normalise smoking and to help ex-smokers be smokefree. This fundamental move on smokefree policies would be in line with the innovative ideas in the New Zealand Government’s Proposals for a Smokefree 2025 Action Plan.[[35]]

Summary

Abstract

Aim

To describe the smokefree status and signage of outdoor pedestrian-only plazas/malls/boulevards in 10 New Zealand local government (council) areas.

Method

The 10 council areas were a convenience sample. Council websites were examined for smokefree policies, and a systematic attempt was made to identify the five largest pedestrian-only sites with permanent seating in each council area (10 sites each for two larger cities). Field visits were conducted to all selected sites during January–May 2021.

Results

Smokefree policies with components covering smokefree outdoor plazas/malls/boulevards were common (80%; 8/10 councils), albeit with some gaps (eg, around signage and vaping policy). A total of 60 relevant pedestrianised sites with permanent seating were identified and surveyed. Of these, 63% were officially designated smokefree. Smokefree signage was only present in 15% (9/60) of all the sites and in 24% (9/38) of the designated smokefree sites. In these designated sites, the average number of smokefree signs was only 1.4 (range: 0 to 14). Issues identified with the signs included small size, being only a small part of a larger other sign, limited use of te reo Māori wording and not covering vaping. At sites where tables were present, 12% had ash trays on the tables (none at smokefree sites).

Conclusion

Smokefree plazas/malls/boulevards in this survey had multiple policy and signage deficiencies that are inconsistent with achieving the national Smokefree 2025 goal. There is scope to address these issues with an upgrade to the national smokefree law.

Author Information

Nick Wilson: Department of Public Health, University of Otago Wellington. Niveditha Gurram: Te Hiringa Hauora/Health Promotion Agency, Wellington. Leah Grout: Department of Public Health, University of Otago Wellington. George Thomson: Department of Public Health, University of Otago Wellington.

Acknowledgements

Correspondence

Prof Nick Wilson, Department of Public Health, University of Otago Wellington

Correspondence Email

nick.wilson@otago.ac.nz

Competing Interests

Although one of the authors (NG) works for Te Hiringa Hauora/Health Promotion Agency, this research work was performed independently and none of the views expressed in this article necessarily reflect the views of this agency or the New Zealand Government.

1. Sureda X, Bilal U, Fernandez E, Valiente R, Escobar FJ, Navas-Acien A, Franco M. Second-hand smoke exposure in outdoor hospitality venues: Smoking visibility and assessment of airborne markers. Environ Res. 2018;165:220-7.

2. Pearson AL, Nutsford D, Thomson G. Measuring visual exposure to smoking behaviours: a viewshed analysis of smoking at outdoor bars and cafes across a capital city's downtown area. BMC Public Health. 2014;14:300.

3. Zablocki RW, Edland SD, Myers MG, Strong DR, Hofstetter CR, Al-Delaimy WK. Smoking ban policies and their influence on smoking behaviors among current California smokers: a population-based study. Prev Med. 2014;59:73-8.

4. Chaiton M, Diemert L, Zhang B, Kennedy RD, Cohen JE, Bondy SJ, Ferrence R. Exposure to smoking on patios and quitting: a population representative longitudinal cohort study. Tob Control. 2016;25:83-8.

5. Johns M, Coady MH, Chan CA, Farley SM, Kansagra SM. Evaluating New York City's smoke-free parks and beaches law: a critical multiplist approach to assessing behavioral impact. Am J Community Psychol. 2013;51:254-63.

6. Johns M, Farley SM, Rajulu DT, Kansagra SM, Juster HR. Smoke-free parks and beaches: an interrupted time-series study of behavioural impact in New York City. Tob Control. 2015;24:497-500.

7. Breunis LJ, Bebek M, Dereci N, de Kroon MLA, Rado MK, Been JV. Impact of an inner-city smoke-free zone on outdoor smoking patterns: a before-after study. Nicotine Tob Res. 2021. Online June 1. doi: 10.1093/ntr/ntab109

8. Thomson G, Wilson N, Collins D, Edwards R. Attitudes to smoke-free outdoor regulations in the USA and Canada: a review of 89 surveys. Tob Control. 2016;25:506-16.

9. Sureda X, Fernandez E, Martinez-Sanchez JM, Fu M, Lopez MJ, Martinez C, Salto E. Secondhand smoke in outdoor settings: smokers' consumption, non-smokers' perceptions, and attitudes towards smoke-free legislation in Spain. BMJ Open. 2015;5:e007554.

10. Walsh R, Paul C, Tzelepis F, Stojanovski E, Tang A. Is government action out-of-step with public opinion on tobacco control? Results of a New South Wales population survey. Aust N Z J Public Health. 2008;32:482-8.

11. Rosenberg M, Pettigrew S, Wood L, Ferguson R, Houghton S. Public support for tobacco control policy extensions in Western Australia: a cross-sectional study. BMJ Open. 2012;2:e000784.

12. Brenner G, Mann K, Lee D, Burrows J, Crosby S. Attitudes towards smokefree high streets: a survey of local shoppers in a northern UK town. Perspect Public Health. 2018;138:325-8.

13. Wilson N, Blakely T, Edwards R, Weerasekera D, Thomson G. Support by New Zealand smokers for new types of smokefree areas: national survey data. N Z Med J. 2009;122(1303):80-9.

14. Gallus S, Rosato V, Zuccaro P, Pacifici R, Colombo P, Manzari M, La Vecchia C. Attitudes towards the extension of smoking restrictions to selected outdoor areas in Italy. Tob Control. 2012;21:59-62.

15. Martinez C, Guydish J, Robinson G, Martinez-Sanchez JM, Fernandez E. Assessment of the smoke-free outdoor regulation in the WHO European Region. Prev Med. 2014;64:37-40.

16. American Non-Smokers Rights Foundation. Municipalities with Smokefree Outdoor Dining and Bar Patio Laws. Berkeley: American Nonsmokers' Rights Foundation, 2021. Available from: http://no-smoke.org/wp-content/uploads/pdf/SmokefreeOutdoorDining.pdf

17. Center for Tobacco Policy & Organizing. Comprehensive outdoor secondhand smoke ordinances. Sacramento: Center for Tobacco Policy & Organizing: American Lung Association of California, 2012. Available from: https://www.otago.ac.nz/wellington/otago671072.pdf

18. Thomson G. Smokefree Wellington: Context, options and evidence. Wellington: University of Otago, Wellington, 2015. Available from: https://www.otago.ac.nz/wellington/otago304204.pdf

19. New York City Department of Parks & Recreation. Smoke-Free Parks and Beaches. New York: New York City Department of Parks & Recreation, 2021. Available from: https://www.nycgovparks.org/facility/rules/smoke-free

20. Institute of Health Metrics and Evaluation. GHDx (Global Health Data Exchange); Results for New Zealand (on 24 May 2021). Seattle; Institute of Health Metrics and Evaluation. Available from: http://ghdx.healthdata.org/gbd-results-tool

21. Marsh L, Robertson LA, Kimber H, Witt M. Smokefree outdoor areas in New Zealand: how far have we come? N Z Med J. 2014;127(1389):51-66.

22. Thomson G, Wilson N. Local and regional smokefree and tobacco-free action in New Zealand: highlights and directions. N Z Med J. 2017;130:89-101.

23. Wilson N, Oliver J, Thomson G. Ten years of a national law covering smoke-free school grounds: a brief review. Tob Control. 2016;25:122.

24. Wilson N, Delany L, Thomson GW. Smokefree laws and hospitality settings: an example from New Zealand of a deficient approach. Tob Control. 2020;29:460.

25. Wilson N, Thomson G, Edwards R. The potential of Google Street View for studying smokefree signage. Aust N Z J Public Health. 2015;39:295-6.

26. Thomson G, Wilson N. Smokefree signage at children's playgrounds: Field observations and comparison with Google Street View. Tob Induc Dis. 2017;15:37.

27. Wilson N, Thomson G. Suboptimal smokefree signage at some hospitals: Field observations and the use of Google Street View. N Z Med J. 2015;128(1415):56-9.

28. Thomson G, Wilson N. Smokefree signage at New Zealand racecourses and sports facilities with outdoor stands. N Z Med J. 2017;130:80-86.

29. Wilson N, Thomson G. Smokefree signage at railway stations: a survey of 54 stations in 11 local government areas. N Z Med J. 2019;132:59-61.

30. Wilson N, Jones AC, Thomson GW. Poor smoke-free status of airports in a country with a smoke-free goal: New Zealand. Tob Control. 2020. Online 24 July 2020. doi: 10.1136/tobaccocontrol-2020-055894

31. Wilson N, Thomson G. Surveying all outdoor smokefree signage in contrasting suburbs: methods and results. Health Promot J Austr. 2017;28:264-65.

32. New Zealand Government. Government Response to the Report of the Māori Affairs Committee on its Inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Māori (Final Response). Wellington: New Zealand Parliament, 2011. Available from: http://www.parliament.nz/en-nz/pb/presented/papers/49DBHOH_PAP21175_1/government-final-response-to-report-of-the-m%c4%81ori-affairs

33. Gurram N, Thomson G. The point prevalence of smoking and vaping in downtown locations in Wellington: Report for the Wellington City Council on observations in November 2018. Wellington: University of Otago Wellington, November 29, 2018. Available from: https://www.otago.ac.nz/wellington/departments/otago711611.pdf

34. Thomson G, Pathamanathan N. The point prevalence of smoking in selected sports fields and downtown locations in Wellington: Observations in November 2015. University of Otago, Wellington, January 2016. Available from: http://www.otago.ac.nz/wellington/otago610430.pdf

35. Ministry of Health. Proposals for a Smokefree Aotearoa 2025 Action Plan: Discussion document. Wellington: Ministry of Health 2021. Available from: https://www.health.govt.nz/system/files/documents/publications/proposals_for_a_smokefree_aotearoa_2025_action_plan-final.pdf

36. Daube M, Maddox R. Impossible until implemented: New Zealand shows the way. Tob Control 2021. 2021;30:361-362.

37. Hastings District Council. Hastings City Centre Revitalisation Plan. Hastings District Council, 2019 (February). Available from: https://www.hastingsdc.govt.nz/assets/Document-Library/Plans/Hastings-City-Centre-Public-Spaces-Revitalisation-Plan/Hastings-City-Centre-Public-Spaces-Revitalisation-Plan.pdf

38. Gurram N. The point prevalence of smoking and vaping in Grey Street pocket square, Wellington: Report for the Wellington City Council on observations in Grey Street, Wellington in December 2018. 2019. Available from: https://www.otago.ac.nz/wellington/departments/otago711699.pdf

39. Hastings District and Napier City Councils. Hastings District and Napier City Councils Smokefree Policy Napier: Hastings District and Napier City Councils, 2016. Available from: https://www.napier.govt.nz/assets/Document-Library/Policies/smokefree-policy.pdf

40. Palmerston North City Council. Palmerston North Auahi Kore Smokefree and Vapefree Policy 2020. Palmerston North, NZ: Palmerston North City Council, 2020. Available from: https://www.pncc.govt.nz/media/3133544/auahi-kore-smokefree-and-vapefree-policy-2020.pdf

41. Masterton District Council. Smokefree policy. Masterton: Masterton District Council, 2017. Available from: https://mstn.govt.nz/wp-content/uploads/2017/02/Smokefree-Policy_Current.pdf

42. South Wairarapa District Council. Smoke-Free Environment Policy. Martinborough: South Wairarapa District Council, 2015. Available from: https://swdc.govt.nz/wp-admin/admin-ajax.php?action=wpmf_onedrive_business_download&id=01CTNIGYECBXJBHTTMBBB3QHHUKFT6IOL7&link=true&dl=0

43. Porirua City Council. Smokefree outdoor public places policy. Porirua: Porirua City Council, 2019. Available from: https://storage.googleapis.com/pcc-wagtail-media/documents/Smokefree_Outdoor_Public_Places_Policy_-_2019.pdf

44. Upper Hutt City Council. Smokefree Policy. (Accessed 5 April 2021). Available from: https://www.upperhuttcity.com/Your-Council/Plans-policies-bylaws-and-reports/Policies-and-bylaws/Smokefree-Upper-Hutt

45. Hutt City. Smokefree Lower Hutt. (Updated 20 July, 2020). Available from: http://www.huttcity.govt.nz/Our-City/live-here/smokefree-lower-hutt/

46. Wellington City Council. Smokefree Wellington. (Accessed 17 January, 2021). Available from: https://wellington.govt.nz/your-council/plans-policies-and-bylaws/policies/smokefree-wellington

47. Queenstown Lakes District Council. Smokefree and Vapefree. 2021 (accessed 12 April) Available from: https://letstalk.qldc.govt.nz/smokefree

48. Hahn EJ. Smokefree legislation: a review of health and economic outcomes research. Am J Prev Med. 2010;39:S66-76.

49. Torkashvand J, Farzadkia M. A systematic review on cigarette butt management as a hazardous waste and prevalent litter: control and recycling. Environ Sci Pollut Res Int. 2019;26:11618-30.

50. Wilson N, Thomson G, Edwards R. Smoke-free cars legislation: it works but New Zealand should still rigorously evaluate its upcoming law. N Z Med J. 2020;133:99-103.

51. Thomson G, Martin J, Gifford H, Parata K. Expanding smokefree outdoor areas in Wellington City: Rationale and options. Wellington: University of Otago, 2016. Available from: https://www.otago.ac.nz/wellington/otago603825.pdf

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One mechanism to make progress towards reducing the enormous health burden from tobacco smoking is to expand smokefree public areas. For many high-income countries, this now means an increased focus on outdoor public settings, where smokefree policies are much less common than for indoor public settings. Such policies are intended to reduce the exposure of workers and the public to tobacco-smoke pollution and contribute to the denormalisation of smoking by reducing its visibility.[[1,2]] A perception of smokefree parks or outdoor dining policies has been associated with increased quit attempts,[[3]] and not being exposed to smoking in Ontario bar/restaurant outdoor areas increased quit attempts and decreased smoking relapses.[[4]] In New York, smokefree policies for parks and beaches were followed by reduced tobacco-related litter, observed smoking and public perceptions of smoking.[[5,6]] In the Netherlands, the introduction of an inner-city outdoor smokefree zone was associated with a substantial decline in the number of smokers in the zone.[[7]]

There is often majority public support for a number of types of outdoor smokefree areas (eg, based on surveys in the USA and Canada,[[8]] Spain,[[9]] Australia[[10,11]] and the UK[[12]]). There is even majority support for some outdoor smokefree areas by smokers (eg, in New Zealand,[[13]] Spain,[[9]] Italy,[[14]] Australia[[11]] and North America[[8]]).

Internationally, the most progress towards outdoor smokefree policy has generally been achieved in areas explicitly associated with children (eg, schools, playgrounds, urban parks),[[15]] with some movement in outdoor hospitality areas (eg, outside bars and cafés).[[16]] However, smokefree policies for central urban pedestrian areas have increased in California[[17]] and some larger Australian cities.[[18]] New York has smokefree policies for “Pedestrian plazas such as those at Times Square and Herald Square.”[[19]]

In New Zealand, exposure to second-hand smoke is a serious problem associated with an estimated 347 premature deaths per year in 2019.[[20]] When morbidity from this smoke is also considered, this health loss amounted to an estimated 9,022 lost disability-adjusted life years (DALYs) in 2019.[[20]] Fortunately, there has been some progress with voluntary or “educational” outdoor smokefree areas over the last two decades.[[21–23]] Nevertheless, various issues have been identified in terms of the extent of coverage and quantity/quality of the signage (eg, hospitality settings,[[24]] schools,[[25]] children’s playgrounds,[[26]] hospital grounds,[[27]] racecourses and sports facilities,[[28]] railway stations,[[29]] airports[[30]] and various other settings[[31]]). These limitations are problematic in the context of the country’s Smokefree 2025 goal, which aims for fewer than 5% of New Zealanders to be smokers by 2025.[[32]]

Despite the research mentioned above, there has been little work in New Zealand on evaluating the extent of smokefree pedestrian-only areas (plazas/malls/boulevards). In 2019, 12 months after the adoption of a smokefree policy in Rotorua’s pedestrian Eat Street, a local hospitality hub, a count found relatively few people smoking (0.6% of those observed; 36/6530; personal communication). The measurement of the prevalence of smoking in a few such places has occurred in Wellington, either before or after the adoption of smokefree policies.[[33,34]]

Given this background and the revived New Zealand Government interest in progressing tobacco control,[[35,36]] in this study we aimed to describe the smokefree status and signage of outdoor pedestrian-only plazas/malls/boulevards in 10 New Zealand local government (council) areas. Smokefree status includes whether the local authority has designated the area smokefree and whether ash trays are present on dining/drinking tables in the area, including temporary tables associated with cafés, restaurants and pubs. Councils sometimes prohibit ash trays on tables used by cafés, restaurants and pubs on public land.

Methods

Sample selection: The 10 council areas were a convenience sample based on where the authors lived and their travel plans (from north to south, the areas were: Hastings, Napier, Palmerston North, Masterton, South Wairarapa, Porirua, Upper Hutt, Hutt City and Wellington in the North Island and Queenstown Lakes in the South Island). A systematic attempt was made to identify all the outdoor pedestrian-only plazas/malls/boulevards on public land with permanent seating in these council areas. We then selected the five largest of these (measured by paved/gravel area) within each council area (or 10 in the case of councils with 100,000+ populations: Wellington and Hutt City).

Smokefree policies: The website of each council was examined in May 2021 to identify the smokefree policy. Key features of each policy were documented, particularly how it related to the selected sites.

Site inclusion criteria: For the purposes of this study, we used the following definitions for site inclusion in the survey:

  • An “outdoor plaza with seating” was an outdoor area that was at least 50% paved or gravel surfaced, had some distinguishing structures to prevent vehicle access (eg, bollards or planter boxes) and had at least one permanent seat. In some cases, these plazas were still officially called “parks” (eg, Grey Street Pocket Park in Wellington City). Also, we identified plaza areas within larger park settings, where the plaza was well defined by surrounding structures. Where a plaza or boulevard was an extended area (or series of connected areas) of the footpath, we required that the area including the extension was at least twice the width of the nearest normal width of footpath. We took a broad interpretation of seating that included seating with no back support (eg, concrete block or wooden benches that could be sat on).
  • A “pedestrianised mall/boulevard” was defined as an outdoor area that was fully pedestrianised for its entire width, was wider than a typical footpath and had at least one permanent seat.

Site identification: For each local authority, the following steps were performed up to May 2021:

  • We examined Google Maps and Google Street View and undertook our own observations within each council area to identify all relevant sites.
  • We examined the local authority website for smokefree policies, and for the areas designated as smokefree. These policies typically included mention of specific pedestrianised plazas, malls and boulevards (for references to website links, see Table 1).
  • We conducted a Google search to identify news items around smokefree areas within each city. For example, some documents specifically identified city plazas (eg, for Hastings[[37]]).
  • Sites that were outside of a council’s jurisdiction were excluded (eg, on private land, university and hospital campuses and parts of national monuments, etc). We also excluded any of the potential sites if construction was underway at the time of the field visit.

Data collection at site visits: On field visits to each site, we identified the presence or absence of the features required for inclusion (see site inclusion criteria above). For sites meeting such criteria, we then collected these data:

  • The presence of all smokefree and vapefree signage (with photographs taken of all signs). For the study, we did not include data on smokefree signage that met our definition of low-visibility (ie, under 10cm by 10cm in size and on a sign over two meters above the ground). We also did not include smokefree signage on temporary tables at the site.
  • The presence or absence of dining/drinking tables, including temporary ones associated with cafés, restaurants and pubs. Temporary tables were included so as to provide a full denominator for all tables (with and without ash trays).
  • The presence or not of ash trays on any of the tables or special bins for cigarette butts.

Three sites were examined by two authors together to confirm the feasibility of the definitions and methods. Then the rest of the sites were examined by one of the authors alone, albeit with site photographs examined by the other authors. All site visits were conducted during business hours to ensure that any cafés/restaurants and pubs would have any tables set up outside. The field survey covered the period 2 January 2021 to 13 May 2021.

Results

Of the 10 councils, all had details of smokefree outdoor policies on their websites (Table 1). There was also evidence of specific commissioned research on the topic that had been published.[[38]] The average time since the smokefree policy was last updated was four years (ie, in 2017; range 2006 to 2020; Table 1). Policies with components covering smokefree outdoor plazas/malls/boulevards were common (80%; 8/10 councils), with the policy of one of the remainders (South Wairarapa) being classified as “unclear.” Only Queenstown Lakes had no component of the pedestrian-only plazas/malls/boulevards covered. But only five councils (50%) included a vapefree policy for the outdoor areas covered. Most councils (80%) had some policy around smokefree signage. In three of these (30%), the signage policy specifically mentioned signage in te reo Māori, but only two mentioned vapefree signage. The Hutt City policy specifically stated: “Signage does not include a ‘no vaping’ message”.

A total of 60 relevant pedestrianised sites with permanent seating were identified and surveyed (52 plazas, six malls and two boulevards; Table 2). As per the sample method, this meant five sites each for Hastings, Napier, Palmerston North, Masterton, South Wairarapa, Porirua, Upper Hutt and Queenstown Lakes, and ten each for Hutt City and Wellington. Of these, 63% were officially designated smokefree in the council’s smokefree policy. Smokefree signage was only present in 15% (9/60) of the total sites and in 24% (9/38) of the designated smokefree sites. In these designated sites, the average number of smokefree signs was 1.4 (range: 0 to 14; Table 2). In the sites with smokefree signage, 44% had at least some signs with te reo Māori wording (eg, Figure 1) and 22% had some signs where the smokefree message was just part of a larger sign (eg, Figure 2). There were no vapefree signs at any of the sites and no signs mentioned any enforcement details (eg, telephone numbers for complaints). Qualitative issues included some very small smokefree signs (under 10 cm by 10 cm in area; Figure 2), and some signs were located where the intent was unclear (eg, on the side of a building where the sign could potentially be interpreted as indicating a smokefree indoor area).

At sites where tables were present, 12% had ash trays on the tables. But none of the designated smokefree sites had ash trays present on the tables.

Table 1: City councils (CC) and district councils (DC) in the sample and how their smokefree policies at May 2021 related to outdoor pedestrian-only plazas/malls/boulevards. View Table 1.

Table 2: Results for pedestrianised sites (plazas/malls/boulevards) in the 10 council areas (with site specific details available on request from the authors). View Table 2.

Figure 1: Example of a relatively large smokefree sign with a clear “no smoking” symbol and prominent use of te reo Māori wording (photograph by the second author).

Figure 2: Example of a type of a very small smokefree sign included in this study, with this also being part of a much larger sign for another purpose (the smokefree symbol is in the lower right side of the sign; photograph by the second author).

Discussion

A key finding of this survey was that all the 10 councils had details of smokefree outdoor policies on their websites and most (80%) of these policies had components that covered smokefree outdoor plazas/malls/boulevards (Table 1). Nevertheless, out of the 60 pedestrianised sites with permanent seating that we examined, only 63% were officially designated smokefree as per the council website policy (and in some cases this status was unclear or just applied to part of the site). Furthermore, only 24% of the designated smokefree sites had any smokefree signage. This signage was often suboptimal in terms of size, extent and quality. Also, 12% of sites had tables with ash trays, which send a potentially problematic, pro-smoking signal.

These various problems that we found are inconsistent with the New Zealand Government’s Smokefree Aotearoa 2025 goal,[[32]] as indeed are the extensive limitations with other outdoor smokefree areas in the country (see the introduction). They are also inconsistent with local government efforts to make their localities more attractive to workers, shoppers and tourists; to have a healthier and more productive population;[[48]] and to improve the environment with reduced tobacco-related pollution, litter and cleaning costs.[[49]]

Given these problems, there is a case for an upgrade to national smokefree legislation, as is used for indoor public and workplaces. Such legislation appears to have worked well for another type of outdoor area in New Zealand (eg, school grounds throughout the country[[23]]), and a national approach has recently been taken with smokefree vehicles.[[50]] In contrast to local government initiatives, national legislation has the advantage of providing consistent messaging throughout the country, allowing for integration with national smokefree media campaigns and for economies of scale from centralised sign production/distribution. Specific features of a new national law smokefree law that encompassed these sites could state:

  • All outdoor pedestrianised plazas, malls and boulevards that have any permanent seating are smokefree and vapefree (along with a 10-metre zone from their boundaries).
  • All these sites are required to have smokefree signage that meet minimum government specifications (ie, for number of signs per area, size, use of te reo Māori and messaging including “no vaping”).

Nevertheless, until a national approach is adopted, local government can still take additional initiatives to upgrade their smokefree policies and build them into bylaws. The range of approaches for the use of locally based laws for smokefree outdoor areas in New Zealand has been detailed previously.[[51]]

A strength of our study was that it appears to be the first survey (to our knowledge) of the smokefree status these type of outdoor pedestrianised areas in Australasia. Study limitations include the sample of just 10 council areas (out of a potential 67 territorial authorities in the country) and the sample being a convenience one, owing to this being an unfunded study. Also, within the council areas, it is possible that we may have missed identifying some of the largest 5–10 sites, owing to our mechanisms for identifying them (eg, via Google Maps, Google Street View and local observations).

In summary, smokefree plazas/malls/boulevards in this survey had multiple policy and signage deficiencies that are inconsistent with achieving the national Smokefree 2025 goal. There is scope to address these issues and others highlighted in research on smokefree outdoor policies in Aotearoa, and scope for a major upgrade to the national smokefree law to help de-normalise smoking and to help ex-smokers be smokefree. This fundamental move on smokefree policies would be in line with the innovative ideas in the New Zealand Government’s Proposals for a Smokefree 2025 Action Plan.[[35]]

Summary

Abstract

Aim

To describe the smokefree status and signage of outdoor pedestrian-only plazas/malls/boulevards in 10 New Zealand local government (council) areas.

Method

The 10 council areas were a convenience sample. Council websites were examined for smokefree policies, and a systematic attempt was made to identify the five largest pedestrian-only sites with permanent seating in each council area (10 sites each for two larger cities). Field visits were conducted to all selected sites during January–May 2021.

Results

Smokefree policies with components covering smokefree outdoor plazas/malls/boulevards were common (80%; 8/10 councils), albeit with some gaps (eg, around signage and vaping policy). A total of 60 relevant pedestrianised sites with permanent seating were identified and surveyed. Of these, 63% were officially designated smokefree. Smokefree signage was only present in 15% (9/60) of all the sites and in 24% (9/38) of the designated smokefree sites. In these designated sites, the average number of smokefree signs was only 1.4 (range: 0 to 14). Issues identified with the signs included small size, being only a small part of a larger other sign, limited use of te reo Māori wording and not covering vaping. At sites where tables were present, 12% had ash trays on the tables (none at smokefree sites).

Conclusion

Smokefree plazas/malls/boulevards in this survey had multiple policy and signage deficiencies that are inconsistent with achieving the national Smokefree 2025 goal. There is scope to address these issues with an upgrade to the national smokefree law.

Author Information

Nick Wilson: Department of Public Health, University of Otago Wellington. Niveditha Gurram: Te Hiringa Hauora/Health Promotion Agency, Wellington. Leah Grout: Department of Public Health, University of Otago Wellington. George Thomson: Department of Public Health, University of Otago Wellington.

Acknowledgements

Correspondence

Prof Nick Wilson, Department of Public Health, University of Otago Wellington

Correspondence Email

nick.wilson@otago.ac.nz

Competing Interests

Although one of the authors (NG) works for Te Hiringa Hauora/Health Promotion Agency, this research work was performed independently and none of the views expressed in this article necessarily reflect the views of this agency or the New Zealand Government.

1. Sureda X, Bilal U, Fernandez E, Valiente R, Escobar FJ, Navas-Acien A, Franco M. Second-hand smoke exposure in outdoor hospitality venues: Smoking visibility and assessment of airborne markers. Environ Res. 2018;165:220-7.

2. Pearson AL, Nutsford D, Thomson G. Measuring visual exposure to smoking behaviours: a viewshed analysis of smoking at outdoor bars and cafes across a capital city's downtown area. BMC Public Health. 2014;14:300.

3. Zablocki RW, Edland SD, Myers MG, Strong DR, Hofstetter CR, Al-Delaimy WK. Smoking ban policies and their influence on smoking behaviors among current California smokers: a population-based study. Prev Med. 2014;59:73-8.

4. Chaiton M, Diemert L, Zhang B, Kennedy RD, Cohen JE, Bondy SJ, Ferrence R. Exposure to smoking on patios and quitting: a population representative longitudinal cohort study. Tob Control. 2016;25:83-8.

5. Johns M, Coady MH, Chan CA, Farley SM, Kansagra SM. Evaluating New York City's smoke-free parks and beaches law: a critical multiplist approach to assessing behavioral impact. Am J Community Psychol. 2013;51:254-63.

6. Johns M, Farley SM, Rajulu DT, Kansagra SM, Juster HR. Smoke-free parks and beaches: an interrupted time-series study of behavioural impact in New York City. Tob Control. 2015;24:497-500.

7. Breunis LJ, Bebek M, Dereci N, de Kroon MLA, Rado MK, Been JV. Impact of an inner-city smoke-free zone on outdoor smoking patterns: a before-after study. Nicotine Tob Res. 2021. Online June 1. doi: 10.1093/ntr/ntab109

8. Thomson G, Wilson N, Collins D, Edwards R. Attitudes to smoke-free outdoor regulations in the USA and Canada: a review of 89 surveys. Tob Control. 2016;25:506-16.

9. Sureda X, Fernandez E, Martinez-Sanchez JM, Fu M, Lopez MJ, Martinez C, Salto E. Secondhand smoke in outdoor settings: smokers' consumption, non-smokers' perceptions, and attitudes towards smoke-free legislation in Spain. BMJ Open. 2015;5:e007554.

10. Walsh R, Paul C, Tzelepis F, Stojanovski E, Tang A. Is government action out-of-step with public opinion on tobacco control? Results of a New South Wales population survey. Aust N Z J Public Health. 2008;32:482-8.

11. Rosenberg M, Pettigrew S, Wood L, Ferguson R, Houghton S. Public support for tobacco control policy extensions in Western Australia: a cross-sectional study. BMJ Open. 2012;2:e000784.

12. Brenner G, Mann K, Lee D, Burrows J, Crosby S. Attitudes towards smokefree high streets: a survey of local shoppers in a northern UK town. Perspect Public Health. 2018;138:325-8.

13. Wilson N, Blakely T, Edwards R, Weerasekera D, Thomson G. Support by New Zealand smokers for new types of smokefree areas: national survey data. N Z Med J. 2009;122(1303):80-9.

14. Gallus S, Rosato V, Zuccaro P, Pacifici R, Colombo P, Manzari M, La Vecchia C. Attitudes towards the extension of smoking restrictions to selected outdoor areas in Italy. Tob Control. 2012;21:59-62.

15. Martinez C, Guydish J, Robinson G, Martinez-Sanchez JM, Fernandez E. Assessment of the smoke-free outdoor regulation in the WHO European Region. Prev Med. 2014;64:37-40.

16. American Non-Smokers Rights Foundation. Municipalities with Smokefree Outdoor Dining and Bar Patio Laws. Berkeley: American Nonsmokers' Rights Foundation, 2021. Available from: http://no-smoke.org/wp-content/uploads/pdf/SmokefreeOutdoorDining.pdf

17. Center for Tobacco Policy & Organizing. Comprehensive outdoor secondhand smoke ordinances. Sacramento: Center for Tobacco Policy & Organizing: American Lung Association of California, 2012. Available from: https://www.otago.ac.nz/wellington/otago671072.pdf

18. Thomson G. Smokefree Wellington: Context, options and evidence. Wellington: University of Otago, Wellington, 2015. Available from: https://www.otago.ac.nz/wellington/otago304204.pdf

19. New York City Department of Parks & Recreation. Smoke-Free Parks and Beaches. New York: New York City Department of Parks & Recreation, 2021. Available from: https://www.nycgovparks.org/facility/rules/smoke-free

20. Institute of Health Metrics and Evaluation. GHDx (Global Health Data Exchange); Results for New Zealand (on 24 May 2021). Seattle; Institute of Health Metrics and Evaluation. Available from: http://ghdx.healthdata.org/gbd-results-tool

21. Marsh L, Robertson LA, Kimber H, Witt M. Smokefree outdoor areas in New Zealand: how far have we come? N Z Med J. 2014;127(1389):51-66.

22. Thomson G, Wilson N. Local and regional smokefree and tobacco-free action in New Zealand: highlights and directions. N Z Med J. 2017;130:89-101.

23. Wilson N, Oliver J, Thomson G. Ten years of a national law covering smoke-free school grounds: a brief review. Tob Control. 2016;25:122.

24. Wilson N, Delany L, Thomson GW. Smokefree laws and hospitality settings: an example from New Zealand of a deficient approach. Tob Control. 2020;29:460.

25. Wilson N, Thomson G, Edwards R. The potential of Google Street View for studying smokefree signage. Aust N Z J Public Health. 2015;39:295-6.

26. Thomson G, Wilson N. Smokefree signage at children's playgrounds: Field observations and comparison with Google Street View. Tob Induc Dis. 2017;15:37.

27. Wilson N, Thomson G. Suboptimal smokefree signage at some hospitals: Field observations and the use of Google Street View. N Z Med J. 2015;128(1415):56-9.

28. Thomson G, Wilson N. Smokefree signage at New Zealand racecourses and sports facilities with outdoor stands. N Z Med J. 2017;130:80-86.

29. Wilson N, Thomson G. Smokefree signage at railway stations: a survey of 54 stations in 11 local government areas. N Z Med J. 2019;132:59-61.

30. Wilson N, Jones AC, Thomson GW. Poor smoke-free status of airports in a country with a smoke-free goal: New Zealand. Tob Control. 2020. Online 24 July 2020. doi: 10.1136/tobaccocontrol-2020-055894

31. Wilson N, Thomson G. Surveying all outdoor smokefree signage in contrasting suburbs: methods and results. Health Promot J Austr. 2017;28:264-65.

32. New Zealand Government. Government Response to the Report of the Māori Affairs Committee on its Inquiry into the tobacco industry in Aotearoa and the consequences of tobacco use for Māori (Final Response). Wellington: New Zealand Parliament, 2011. Available from: http://www.parliament.nz/en-nz/pb/presented/papers/49DBHOH_PAP21175_1/government-final-response-to-report-of-the-m%c4%81ori-affairs

33. Gurram N, Thomson G. The point prevalence of smoking and vaping in downtown locations in Wellington: Report for the Wellington City Council on observations in November 2018. Wellington: University of Otago Wellington, November 29, 2018. Available from: https://www.otago.ac.nz/wellington/departments/otago711611.pdf

34. Thomson G, Pathamanathan N. The point prevalence of smoking in selected sports fields and downtown locations in Wellington: Observations in November 2015. University of Otago, Wellington, January 2016. Available from: http://www.otago.ac.nz/wellington/otago610430.pdf

35. Ministry of Health. Proposals for a Smokefree Aotearoa 2025 Action Plan: Discussion document. Wellington: Ministry of Health 2021. Available from: https://www.health.govt.nz/system/files/documents/publications/proposals_for_a_smokefree_aotearoa_2025_action_plan-final.pdf

36. Daube M, Maddox R. Impossible until implemented: New Zealand shows the way. Tob Control 2021. 2021;30:361-362.

37. Hastings District Council. Hastings City Centre Revitalisation Plan. Hastings District Council, 2019 (February). Available from: https://www.hastingsdc.govt.nz/assets/Document-Library/Plans/Hastings-City-Centre-Public-Spaces-Revitalisation-Plan/Hastings-City-Centre-Public-Spaces-Revitalisation-Plan.pdf

38. Gurram N. The point prevalence of smoking and vaping in Grey Street pocket square, Wellington: Report for the Wellington City Council on observations in Grey Street, Wellington in December 2018. 2019. Available from: https://www.otago.ac.nz/wellington/departments/otago711699.pdf

39. Hastings District and Napier City Councils. Hastings District and Napier City Councils Smokefree Policy Napier: Hastings District and Napier City Councils, 2016. Available from: https://www.napier.govt.nz/assets/Document-Library/Policies/smokefree-policy.pdf

40. Palmerston North City Council. Palmerston North Auahi Kore Smokefree and Vapefree Policy 2020. Palmerston North, NZ: Palmerston North City Council, 2020. Available from: https://www.pncc.govt.nz/media/3133544/auahi-kore-smokefree-and-vapefree-policy-2020.pdf

41. Masterton District Council. Smokefree policy. Masterton: Masterton District Council, 2017. Available from: https://mstn.govt.nz/wp-content/uploads/2017/02/Smokefree-Policy_Current.pdf

42. South Wairarapa District Council. Smoke-Free Environment Policy. Martinborough: South Wairarapa District Council, 2015. Available from: https://swdc.govt.nz/wp-admin/admin-ajax.php?action=wpmf_onedrive_business_download&id=01CTNIGYECBXJBHTTMBBB3QHHUKFT6IOL7&link=true&dl=0

43. Porirua City Council. Smokefree outdoor public places policy. Porirua: Porirua City Council, 2019. Available from: https://storage.googleapis.com/pcc-wagtail-media/documents/Smokefree_Outdoor_Public_Places_Policy_-_2019.pdf

44. Upper Hutt City Council. Smokefree Policy. (Accessed 5 April 2021). Available from: https://www.upperhuttcity.com/Your-Council/Plans-policies-bylaws-and-reports/Policies-and-bylaws/Smokefree-Upper-Hutt

45. Hutt City. Smokefree Lower Hutt. (Updated 20 July, 2020). Available from: http://www.huttcity.govt.nz/Our-City/live-here/smokefree-lower-hutt/

46. Wellington City Council. Smokefree Wellington. (Accessed 17 January, 2021). Available from: https://wellington.govt.nz/your-council/plans-policies-and-bylaws/policies/smokefree-wellington

47. Queenstown Lakes District Council. Smokefree and Vapefree. 2021 (accessed 12 April) Available from: https://letstalk.qldc.govt.nz/smokefree

48. Hahn EJ. Smokefree legislation: a review of health and economic outcomes research. Am J Prev Med. 2010;39:S66-76.

49. Torkashvand J, Farzadkia M. A systematic review on cigarette butt management as a hazardous waste and prevalent litter: control and recycling. Environ Sci Pollut Res Int. 2019;26:11618-30.

50. Wilson N, Thomson G, Edwards R. Smoke-free cars legislation: it works but New Zealand should still rigorously evaluate its upcoming law. N Z Med J. 2020;133:99-103.

51. Thomson G, Martin J, Gifford H, Parata K. Expanding smokefree outdoor areas in Wellington City: Rationale and options. Wellington: University of Otago, 2016. Available from: https://www.otago.ac.nz/wellington/otago603825.pdf

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