A Consultation on Electronic Cigarettes and Strengthening Tobacco Control in Scotland

Tobacco Control

The Scottish Government is determined to see Scotland remain at the forefront of those countries around the world committed to bold action to reduce the harm caused by tobacco. Reducing smoking prevalence to 5% or lower will make an important contribution to reducing health inequalities. We have been clear about our ambition to create a tobacco-free Scotland and we remain committed to introducing the necessary measures that will help us achieve our goal.

However, until we realise our vision of a smoke-free Scotland, we must continue to protect people from the harmful effects of second-hand smoke (smoke caused by someone else smoking tobacco) and promote the health, safety, comfort, convenience, and welfare of society by supporting smoke-free environments.

In 2006, Scotland was the first country in the UK to introduce legislation to ban smoking in enclosed public spaces. Implementation of the legislation has been accompanied by very high levels of compliance. Evaluations have shown a significant reduction in exposure to second-hand smoke in public places and a range of positive health outcomes including: reduced heart attack admissions to hospital, reduced childhood asthma admissions to hospital and fewer premature births^[31]. More generally, the legislation has also helped raise awareness and understanding of the impacts of second-hand smoke.

Despite the clear public health benefits that smoke-free legislation has delivered, the harms from second-hand smoke remain. Doctors say second-hand smoke in the UK accounts for over 300,000 consultations a year with children. Children exposed to second-hand smoke at home are more at risk of coughs, colds, ear problems, chest infections, wheezing, asthma, phlegm, breathlessness and poorer lung function. Every year, 9,500 children in Britain are admitted to hospital because of the effects of second-hand smoke^[32].

We want Scotland to be the best place in the world for children to grow up. Scottish Ministers have introduced legislation to ensure that every child and young person should be safe, healthy, achieving, nurtured, active, responsible, respected and included. We therefore have an obligation to protect children from risks to their life and health caused by exposure to environmental tobacco smoke^[34]. Growing up in a smoke-free environment is an important part of that. While existing legislation goes some way towards achieving this, cars and homes remain significant sources of exposure to second-hand smoke, particularly for children as they have less control over their environment. Where children are medically at risk, due to conditions such as asthma, the harmful effects of second-hand smoke can be especially severe.

Earlier this year, we announced our ambition to reduce the number of children exposed to second-hand smoke in Scotland to 6% by 2020. This is the first such target in the world. Our most recent social marketing campaign, Take it Right Outside, supports this ambition.^[35] The aim of this campaign was to raise awareness of the risks of second-hand smoke to children and to encourage people who smoke to keep their homes and cars smoke free.

The harm caused by second-hand smoke is clear. We know that children who live with parents or siblings who smoke are up to 3 times more likely to become smokers themselves than children of non-smoking households^[36]. It is therefore essential that children are not only protected from exposure to second-hand smoke but that measures are taken to protect them from behaviours which could establish smoking as the 'norm'.

Smoking in Cars carrying children aged under 18

When someone smokes in a car, the harmful chemicals in second-hand smoke reach dangerously high levels very quickly. Exposure to second-hand smoke in cars is harmful to all occupants, but especially to children because they breathe faster than adults, have smaller airways and their immune systems are not fully developed^[37].

As many as 60,000 children in Scotland may be exposed to second-hand smoke within a car each week^[38].

Our Strategy committed to monitoring the impact of efforts to reduce children's exposure to second-hand smoke to inform future steps. An initial evaluation of our Take it Right Outside campaign showed an increased awareness that smoking in a car with children is harmful and that some people have taken action to stop smoking in cars. However, it also suggests that more needs to be done to promote behaviour change amongst Scotland's heaviest smokers^[39].

Last year, Jim Hume, MSP and Liberal Democrat Health Spokesperson, consulted on proposals to ban smoking in cars with children. He received strong support for this proposal from those who responded to the consultation and from within the Scottish Parliament^[40]. A recent survey also suggests that 75% of adults in Scotland support a ban on smoking in cars when children and young people aged under 18 are present^[41].

Proposals to introduce such legislation in England and Wales are well underway. It is our belief that legislation to ban smoking in cars with children should also be introduced in Scotland on public health grounds.

Our proposal is that it would be an offence for anyone aged 18 and over to smoke in a car while carrying a child or young person who is under the age of 18. Police Scotland may be best placed to enforce this legislation; they enforce the law on travelling in a car without a seatbelt^[42] and driving whilst using a mobile phone. The offence will result in a fixed penalty notice of £100^[43] or will be referred to court.

We are also minded to propose that vehicles that are also people's homes (e.g. caravans or motor caravans) would have an exemption.

21.Do you agree that it should be an offence for an adult to smoke in a vehicle carrying someone under the age of 18?

22.Do you agree that the offence should only apply to adults aged 18 and over?

23.If you answered 'no' to Question 22, to whom should the offence apply?

24.Do you agree that Police Scotland should enforce this measure?

25.If you answered 'no' to Question 24, who should be responsible for enforcing this measure?

26.Do you agree that there should be an exemption for vehicles which are also people's homes?

27.If you think there are other categories of vehicle which should be exempted, please specify these?

28.If you believe that a defence should be permitted, what would a reasonable defence be?

Smoke-free (tobacco) NHS grounds

Since 2005, guidance has been issued to NHS Scotland and local authorities which encouraged them to demonstrate leadership by implementing smoking policies that go beyond the requirements of existing smoke-free legislation^{[44] [45]} . Guidance issued by the National Institute for Health Care and Excellence also recommended that health care authorities develop policies for smoke-free grounds.^[46].

In moving towards a Scotland where choosing not to smoke is the norm, our current Tobacco Control strategy recognises that National HS Boards should be exemplars in providing smoke-free environments and calls on NHS Boards to implement and enforce smoke-free policies across all NHS grounds by April 2015. NHS Boards are making good progress. However, NHS Chief Executives have expressed concern about a lack of enforcement powers and about poor compliance. They have called for national legislation.

There is public support for smoke-free hospital grounds. A recent survey indicated that the majority (73%) of the Scottish population would be in favour of a complete ban on smoking in hospital grounds^[47]. There are some international examples of smoke-free health grounds, for example in various states in the USA^[48], Canada, Australia, and New Zealand^[49].

A review of a large number of studies found in a range of settings that there is potential for high second-hand smoke in some outdoor spaces and indoor locations adjacent to outdoor smoking areas. This review showed that high smoker density, highly enclosed outdoor areas, low wind conditions, and close proximity to smokers generate higher outdoor second-hand smoke concentrations^[50].

The Scottish Government remains open-minded about the need to introduce legislation which would make it an offence to smoke in health grounds and / or the need for further voluntary measures. We therefore invite views on this matter.

29. Should national legislation be introduced to make it an offence to smoke or allow smoking on NHS grounds?

30. If you support national legislation to make it an offence to smoke on NHS grounds, where should this apply:
a)All NHS grounds (including NHS offices, dentists, GP practices)
b)Only hospital grounds;
c)Only within a designated perimeter around NHS buildings; or
d)Other suggestions?

31. If you support national legislation, what exemptions, if any, should apply (for example, grounds of mental health facilities and / or facilities where there are long-stay patients)?

32. If you support national legislation, who should enforce it?

33. If you support national legislation, what should the penalty be for non-compliance?

34. If you do not support national legislation, what non-legislative measures could be taken to support enforcement of, and compliance with, the existing smoke-free grounds policies?

Smoke-free (tobacco) children and family areas

We believe that children and young people have a right to learn, play and take part in sport in a tobacco-free environment.

Our current Tobacco Control strategy, which is supported by the Convention of Scottish Local Authorities, includes an action for local authorities to extend tobacco-free policies to outdoor areas within their jurisdiction. This should focus on areas likely to be frequented by children, such as play parks, in order to reduce their exposure to second-hand smoke, smoking behaviour and cigarette related litter which is one of the most common forms of litter in Scotland.^[51]

There is public support for smoke-free play areas. A recent survey indicated that a majority of the Scottish population (75%) would be in favour of a complete ban on smoking in outdoor children's play areas^[52].

Outdoor smoke-free areas are increasingly being introduced in many countries, especially in areas which are used by children. An international review of public attitudes data detected a growing trend in support for smoke-free outdoor areas.^[53]. Some examples of smoke-free outdoor areas for children include children's play parks, schools, nurseries, beaches and sports and leisure facilities.

Our Strategy calls on local authorities to work with the NHS and other local partners to include policies for smoke-free areas within local Tobacco Control Plans. While there are no confirmed plans for legislation, the Scottish Government remains committed to increasing the number of outdoor areas which are free from tobacco use. We believe that there are a number of options that could achieve this, this includes but is not limited to:

• That the Scottish Government takes no action;
• Further voluntary measures at a local level to increase the number of smoke-free areas;
• Introducing national legislation that defines smoke-free areas across Scotland; or
• That the Scottish Government ensures sufficient local powers to allow decisions at a local level as to what grounds should be smoke-free?

We invite your views on the best way to achieve smoke-free children and family areas.

35. Do you think more action needs to be taken to make children's outdoor areas tobacco free?

36. If yes, what action do you think is required:
a) Further voluntary measures at a local level to increase the number of smoke-free areas;
b) Introducing national legislation that defines smoke-free areas across Scotland;
c)That the Scottish Government ensures sufficient local powers to allow decisions at a local level as to what grounds should be smoke-free; or
d) Other actions?

37. If you think action is required to make children's outdoor areas tobacco-free, what outdoor areas should that apply to?