Tobacco Control Strategy - Creating a Tobacco-Free Generation

Chapter 5 Protecting People from Second-Hand Smoke

Current Position

In 2006, Scotland was the first country in the UK to introduce legislation to ban smoking in enclosed public spaces. This was a major step towards improving public health by protecting people that do not smoke from the harmful effects of tobacco smoke (otherwise known as second-hand smoke).

Implementation of the legislation has been accompanied by very high levels of compliance. Evaluations have shown that there has been a significant reduction in exposure to second-hand smoke in public places. There has also been a range of positive health outcomes including: reduced heart attack admissions to hospital, reduced childhood asthma admissions to hospital and fewer premature births^[27]. More generally, the legislation has also helped raise awareness and understanding of the impacts of second-hand smoke.

Challenge

Despite the clear public health benefits that smoke-free legislation has delivered, the harms from second-hand smoke remain. In 2011, a World Health Organization study found that around 603,000 people, including 165,000 children, die each year worldwide as a result of exposure to second-hand smoke^[28].

Seven years on from Scotland's historic legislation, it is time to consider what further action is required to eliminate the harms from second-hand smoke as we move towards a smoke-free Scotland. Furthermore, we should consider what other opportunities exist for the public sector in Scotland to act as an exemplar for promoting smoke-free environments across its estates.

Approach

Reducing the harm caused by second-hand smoke

Reducing children's exposure to second-hand smoke in enclosed spaces

We have an obligation to protect children from risks to their life and health caused by exposure to environmental tobacco smoke^[29]. We want every child in Scotland to have the best start in life. 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.

In addition to the focus on smoking cessation in pregnancy discussed elsewhere in this Strategy, supporting new parents to create a smoke-free home for their children should be a core feature of all ante- and post-natal services as well as adoption, foster, kinship and residential care services. In particular, pregnant mothers and partners should receive advice on the dangers of second-hand smoke and should be encouraged to take steps to create a smoke-free home for their children both before and after birth.

Action: Advice on creating a smoke-free home should be a feature of all ante- and post-natal services and adoption, foster, kinship and residential care services. Therefore, in keeping with GIRFEC principles, service providers should ensure that practitioners have access to appropriate resources to support families to make their homes smoke-free.

Lead: NHS Boards/Local Authorities/Third Sector

Action: We will ensure that advice to reduce exposure to second-hand smoke, as well as cessation advice and support, is fully incorporated in the range of services offered by Scotland's public health nurses, including the reintroduced 27 to 30-month review, as set out in the Parenting Strategy.

Lead: NHS Boards

There are a number of interventions which have shown themselves to be effective in encouraging families to make their home smoke-free. The REFRESH Project uses simple devices to raise awareness about the impact of tobacco smoke on air quality in the home. The findings from REFRESH indicate that parents can be supported to make changes to reduce their children's exposure to second-hand smoke. NHS Boards are also making important advances and should be encouraged to continue to develop work in this area.

Action: We will continue to support and promote interventions such as REFRESH to help families make their homes smoke-free.

Lead: Scottish Government/NHS Boards/NHS Health Scotland/ASH Scotland

It will be important to monitor the extent to which these interventions have resulted in reduced exposure to second-hand smoke in enclosed spaces. The 2012 Scottish Health Survey has been modified to provide more detailed information on adult and children's exposure to second-hand smoke. In keeping with our vision of a tobacco-free generation, we believe we should be ambitious in reducing children's exposure to second-hand smoke.

Action: We will make use of baseline data provided by the 2012 Scottish Health Survey to set a target for achieving a substantial reduction in children's exposure to second-hand smoke by 2020.

Lead: Scottish Government

If someone smokes inside a car, the concentration of second-hand smoke increases very quickly due to the confined space of the vehicle. Even if windows are opened or air conditioning is used, the harmful particles remain in the atmosphere long after the visible smoke has disappeared. A recent UK study^[30] found that the average concentration of second-hand smoke in a car was around a third of that found in Scottish pubs prior to smoke-free legislation and around three times WHO air quality guidelines^[31].

Exposure to second-hand smoke in cars is harmful to all occupants, but especially to children who have little or no control over their environment. There is clearly more to be done to raise awareness of the level of harm caused by second-hand smoke in confined spaces.

Action: The Scottish Government recognises the continued importance of awareness-raising campaigns in support of this Strategy. We will run a social marketing campaign in 2013 to raise awareness of second-hand smoke in enclosed spaces and to support people to reduce the harm it can cause. The campaign will be designed and delivered in partnership with NHS Boards and Third Sector organisations.

Lead: Scottish Government

We recognise that this will require a sustained effort over a number of years. As part of the Scottish Government's ongoing commitment to social marketing activity, the 2013 campaign will be fully evaluated to inform future campaigns. We will make use of data tracking progress towards the 2020 second-hand smoke target to assess the success of the awareness-raising campaigns and the requirements for further action including legislative options.

Prisons

Under smoke-free legislation, smoking is allowed in certain parts of a prison. In continuing to offer dedicated cessation services for prisoners, further consideration should be given to ensuring all prisoners and staff are protected from the harms caused by second-hand smoke. In line with developments across Scotland, creating a smoke-free prison service should be seen as a key step on our journey to creating a smoke-free Scotland.

Action: The Scottish Government will work in partnership with the Scottish Prison Service and local NHS Boards to have plans in place by 2015 that set out how indoor smoke-free prison facilities will be delivered.

Lead: Scottish Government/Scottish Prison Service/NHS Boards

Mental Health Facilities

While existing smoke-free legislation includes an exemption for designated rooms in psychiatric hospitals and psychiatric units, following consultation, guidance was issued in 2010 to help service providers move towards a smoke-free mental health service.

Action: Taking account of the outcome of the Judicial Review of the State Hospital decision to prohibit smoking, mental health services should ensure that indoor facilities are smoke-free by 2015.

Lead: NHS Boards

Promoting smoke-free environments

Smoke-free hospital grounds

Guidance was issued to NHSScotland and local authorities in 2005 encouraging them to demonstrate leadership in implementing smoking policies and promoting smoke-free lifestyles. This was subsequently reinforced in the Health Promoting Health Service: HPHS CEL (1) 2012^[32].

In moving towards a Scotland where choosing not to smoke is the norm, NHS Boards should be exemplars in providing smoke-free environments. In order to ensure the consistent and effective implementation of smoke-free policies, employers should provide training for staff, in awareness raising and enforcement skills, as well as appropriate cessation support for employees.

NHS Boards should also consider enforcement measures, exercising mandatory Health and Safety requirements where appropriate, and mechanisms to communicate smoke-free policies to patients and visitors. This should include advice and support on managing temporary abstinence during visits to hospital grounds, as well as access to specialist smoking cessation services for those motivated to quit.

Action: All NHS Boards will implement and enforce smoke-free grounds by March 2015. Smoke-free status means the removal of any designated smoking areas in NHS Board buildings or grounds. We will work with Boards to raise awareness of the move to smoke-free hospital grounds. This action will not apply to mental health facilities.

Lead: NHS Boards

Local Authority smoke-free policies

Like NHSScotland, Local Authorities have a role in exemplifying Scotland's smoke-free ambitions. In addition to having robust smoke-free policies across the built estate, Local Authorities should also consider scope for extending this approach to outdoor areas within their jurisdiction. This should focus on areas likely to be frequented by children such as play parks with the aim of reducing their exposure to smoking behaviours.

In taking this forward, Local Authorities should adopt asset-based approaches and work with local communities to achieve voluntary bans. For example, local projects in England have used signage, inspired by local children's artwork to convey the message that the move to create healthy play spaces is being driven by children themselves^[33].

Action: All Local Authorities should implement fully smoke-free policies across their properties and surrounding grounds by 2015, including setting out appropriate enforcement measures. Opportunities to extend smoke-free policies to other outdoor areas should be included in local tobacco control plans in support of SOAs.

Lead: COSLA/Local Authorities

We will also ensure that these interrelated commitments by NHS Boards and Local Authorities are followed through in their joint arrangements within the wider context of the integration of adult health and social care.