Category: News & Events

Stark findings highlight increased health risk smokers face from COVID-19.

Current smokers are 80 per cent more likely to be admitted to hospital and significantly more likely to die from COVID-19 compared with those who have never smoked, new research has revealed.

The study led by researchers from Oxford University in the UK, analysed data from primary care records, COVID-19 test results, hospital admissions data and death certificates to look for associations between smoking and COVID-19 infection severity from January to August 2020 in 421,469 participants of the UK Biobank, all of whom had had their genetic make-up analysed when they agreed to take part in 2006-10. 

This was the first study of its kind to examine observational and genetic data on smoking and COVID-19.

During the study period, 13,446 people took a COVID-19 swab (PCR) test, 1,649 of whom tested positive; 968 required admission to hospital; and 444 died as a result of their infection. 

The majority of those involved in the study or 59 per cent had never smoked; over a third (37%) were former smokers; and only 4 per cent were current smokers. Among current smokers, most (71%) were light or moderate smokers (1-19 cigarettes/day); only 29 per cent were heavy smokers (20+/day).

Compared with those who had never smoked, current smokers were 80% more likely to be admitted to hospital and significantly more likely to die from COVID-19.

The researchers also assessed whether a genetic predisposition to smoking and heavy smoking might have a role in COVID-19 severity among 281,105 of the original participants living in England. 

This revealed that a genetic predisposition to smoking was associated with a 45 per cent higher risk of infection and a 60 per cent higher risk of hospital admission for COVID-19. 

It also revealed that a genetic predisposition to smoke more heavily was associated with a more than doubling in the risk of infection; a 5-fold increase in the risk of hospital admission; and a 10-fold increase in the risk of death from the virus.

While the researchers acknowledged that they relied only on hospital COVID-19 test data rather than on more representative community data, they nevertheless point to the similarity of the findings in both sets of analyses. 

Commenting Norma Cronin, chairperson of ASH Ireland, Council of the Irish Heart Foundation said, “The stark findings of this latest piece of research highlights the increased health risk that smokers face from the dangers of COVID-19. We would always encourage smokers to quit for the enormous health benefits, but particularly now with COVID-19 still live in our communities, we would implore those smoking to avail of all HSE quit supports and kick the habit once and for all.

“The COVID-19 pandemic has been tragic for all of us so we are deeply concerned for the health and safety of the hundreds of thousands of smokers in Ireland as this research suggests that they are up to 80 per cent more likely to be admitted to hospital with Coronavirus. Countless lives have been lost tragically to Covid-19, so in light of this research, we would urge smokers to quit once and for all.’’

In a linked podcast, lead researcher Dr Ashley Clift had a clear message for smokers. 

“Our results strongly suggest that smoking is related to your risk of getting severe COVID, and just as smoking affects your risk of heart disease, different cancers, and all those other conditions we know smoking is linked to, it appears that it’s the same for COVID. So now might be as good a time as any to quit cigarettes and quit smoking.”

Support is available to stop smoking

Quit.ie is Ireland’s dedicated smoking cessation service and smokers can give themselves the best chance of stopping by following the plan, which sees thousands of people successfully give up each year.

The HSE QUIT service provides personalised, free support by phone, email, SMS and live chat. Smokers can free call 1800 201 203 or visit www.QUIT.ie for stop smoking tips and resources, a free QUIT Kit, and to create a QUIT Plan. Peer-to-peer support is available on the QUIT Facebook Page www.facebook.com/HSEQUIT or on Twitter at HSE QUIT @HSEQuitTeam  #TheLastStop #QuitandWin.

(Smoking and COVID-19 outcomes: an observational and Mendelian randomisation study using the UK Biobank cohort doi:10.1136/thoraxjnl-2021-217080)

Background

A report investigating the growing popularity of e-cigarettes among young people in Ireland was carried and prepared for on behalf of the HSE Tobacco Control Operational Unit. The report can be found below, along with a background to it and a statement from Dr. Patrick Doorley, chair of ASH Ireland, Council of the Irish Heart Foundation.

With the growth in popularity of e-cigarettes in recent years, there is concern in terms of their use by young people. In Ireland, there is no mandatory age restriction on the sale of e-cigarettes and their marketing may promote adolescent use. Nicotine exposure can harm adolescent brain development, and may act as a ‘gateway’ to smoking initiation among the youth. The study aimed to obtain an in-depth understanding of current knowledge, attitudes and behaviour of schoolchildren in terms of e-cigarette use.

Eight focus groups were undertaken in a convenience sample of three schools. This included an all-boy (Cavan), an all-girl (Sligo), and a mixed gender (Louth) school. Each focus group discussed vaping among schoolchildren in Ireland, attitudes to e-cigarettes/vaping, the accessibility and availability of e-cigarette products, the health effects of vaping, and the combined use of vaping, smoking and alcohol. All focus groups were audio recorded and transcribed, from which a number of key themes were identified.

Statement from Dr. Patrick Doorley, chair of ASH Ireland, Council of the Irish Heart Foundation

Vaping is less harmful than smoking but still not safe . E-cigarettes contain thousands of chemicals many of which are toxic, but there are not many programmes which educate children about the their harmful effects. While e-cigarettes may assist hardened smokers to quit, recent reports, such as this focus group which indicate an increased use of these devices among young people in Ireland is exceptionally alarming, particularly as they have been found to be a gateway to traditional smoking.

Therefore, to protect young people from taking up e-cigarettes and transitioning to smoking, it is imperative that the government introduce all measures that will protect adolescents from taking it up.

This focus group study among schoolchildren indicated that e-cigarettes are popular among Irish schoolchildren but there is a lack of information about e-cigarettes from school education programmes. This must be remedied as young people will make the right decision based on their health when provided the right information.

Unsurprising e-cigarettes are used in a number of different settings, particularly in under age discos. Peer pressure in social settings such as these drives take-up of harmful habits such as e-cigarettes, smoking, and drinking alcohol. Clearly devious tactics on social media by these e-cigarette companies, many of them owed by traditional tobacco companies, have marketed these products to young people as cool must-have devices, without highlighting the addictive or health-harming consequences.

Sweet and fruity flavours are among the most popular and are relatively easy to access through social media and other channels.

While most participants had discussed smoking with their parents,there was a lack of awareness of the warning labels concerning e cigarettes. Tobacco cigarettes remain more popular than e cigarettes, particularly at discos and  alcohol consumption may be a contributory factor in the decision to experiment

In light of these alarming trends, the report recommends the following measures, which ASH Ireland, Council of the Irish Heart Foundation fully support.

• Legislation on e-cigarette sales should be fast tracked by the Department of Health and a comprehensive plan to prevent initiation of e cigarette use by children developed.
• Government should develop a regulatory system to oversee and control online sales of tobacco and e cigarettes.
• Restrictions in terms of product placement, accessibility and visibility at the point of sale is recommended.
• There should be mandatory e-cigarette warnings in outlets selling e-cigarettes
• There should be restrictions on flavours which are attractive to children.
• There should be better communication on the effects of e-cigarettes and the impact of those communications should be evaluated.
• Anti-smoking education programmes should be incorporated into the school curriculum which should include up to date information on the adverse health effects.
• The governance of underage discos should be reviewed.

Background
A target date of 2025 has been set for Ireland to become tobacco free, i.e., less than 5% of the population smoking . A key recommendation of Tobacco Free Ireland is to “promote tobacco free campuses for all third-level institutions in consultation with key stakeholders”. (Department of Health, 2013)

Establishing smoke-free campuses in third-level institutions is an important step in de-normalising smoking and acting as a deterrent to young people first taking up smoking while in third-level education.

In order to record the number of third-level institutions that have implemented or plan to implement a smoke-free campus in Ireland, ASH Ireland, Council of the Irish Heart Foundation conducted a survey of third-level institutions in Ireland.

Methods

Sample
A list of Health Promotion Officers or other individuals responsible for healthy campus life was identified by internet research and referrals. Using this list, ASH Ireland, Council of the Irish Heart Foundation emailed the contacts in the third-level institutions with a questionnaire in relation to their policies on a smoke-free campus.

Response Rate
A total of twenty-seven third-level institutions around the island of Ireland were identified and sent questionnaires via email between April and May 2019. Ten full responses were received from the first round and one additional response was received from the second round. No other responses were received thereafter, giving a total of 11 out of 27 responses (41% response rate).

Data requested

Each questionnaire to the third-level institutions included the following questions:

1. Is your University/College/IT a smoke-free campus? (if no, please skip to question 9, N/A will apply for intervening questions)?

2. If yes to the above, in what year did it implement a smoke-free campus?

3. Is the smoke-free campus enforced? If so, please describe how.

a. Please describe the levels of compliance and describe how this is measured’

4. Do you know how many of your students/staff smoke?

5. How welcoming are or were the students and staff to having a smoke-free campus?

6. What were the top 5 complaints/challenges against implementing a smoke-free campus? (e.g. where do smokers go, how will it be enforced?)

7. What were the top 5 benefits? (e.g. Reduction in litter in smoke-free campus?)

8. Have there been any unintended or unforeseen consequences arising from having a smoke-free campus? (e.g. people congregating in one area just outside the campus premises to smoke, etc.)

9. If the University/College/IT has not introduced smoke-free campus yet, is it planning on becoming a smoke-free campus and if so, by what year?

10. If the University/College/IT is not planning on implementing a smoke-free campus, what are the reasons behind this?

Results

1. Is your University/College/IT a smoke-free campus?

Of the eleven responses received, three third-level institutions replied that they had implemented a smoke-free campus (11% of all third-level institutions or 27% of those that responded). The remaining eight third-level institutions that replied stated that they did not have smoke-free campuses.

2. If yes to the above, in what year did it implement a smoke-free campus?

All three third-level institutions that had implemented a smoke-free campus had initiated it in different years – 2013, June 2015, and 2019

3. Is the smoke-free campus enforced? If so, please describe how.

Compliance is enforced in two out of three third-level institutions that have smoke-free campuses. In the first of these institutions, there are student and staff inductions and thereafter Estate and Support Services actively enforce the policy.

The second institution enforces compliance by having a blue line that everyone is asked to go outside the line if they wish to smoke. At the third institution, compliance is not enforced but rather requested by ambassadors who circuit the campus four times per week reminding people of the policy.

3a. Please describe the levels of compliance and describe how this is measured’?

Of the three third-level institutions with smoke-free campuses, one reported an 83% compliance to tobacco free zones, the second reported that compliance is normally very good and that CCTV is used to observe boundaries and anyone observed breaching the policy is spoken to and asked to move away from the campus.

The final of the three institutions reported that compliance is not measured but that smokers congregate at the gates outside the designated blue line so people have made the permanent switch to smoking off campus.

4. Do you know how many of your students/staff smoke?

Only one of the eleven institutions that responded to the questionnaire provided information on this question. They provided details of student smoking but stated they do not have data on staff.

5. How welcoming are or were the students and staff to having a smoke-free campus?

All three third-level institutions that had implemented a smoke-free campus reported a generally welcome approach to smoke-free campuses by the student and staff body. One institution reported that initially the support was neutral 50:50 but rose to 71% by 2019.

6. What were the top 5 complaints/challenges against implementing a smoke-free campus?

Two of the three third-level institutions that had implemented smoke-free campuses provided data on this question. A summary of the complaints/challenges faced can be seen below:

• Where do residents go at night
• What about people using the 24-hour library. If they go off-campus they can’t get back on
• What about banquets and conferences on campus
• What about on-campus pub
• What about visitors or tourists who visit the campus?
• Shelter for smokers
• How to enforce the policy, deal with non-compliance
• Whether to include vaping

7. What were the top 5 benefits?

Two of the three third-level institutions that had implemented smoke-free campuses provided data on this question. A summary of the benefits reported can be seen below:

• Opportunity to raise smoking as an issue when people are becoming addicted rather than in 20 years’ time (most 20-year olds are 40 before they stop)
• Clean campus
• Fresh air
• Obtain budget for health promotion in general
• Healthier workplace
• Nice to walk in the doors without having to walk through a crowd of smokers as happened in the past
• More support/promotion of quitting
• People report they have cut down/quit
• It came in time to prevent the use of vaping on campus, before this habit became so commonplace

8. Have there been any unintended or unforeseen consequences arising from having a smoke-free campus

All three third-level institutions that had implemented smoke-free campuses reported consequences arising from having a smoke-free campus.
Some of these consequences are summarised below:

• Cohort of undergraduate students who were not interested in the policy and continued to smoke
• Students congregating just outside the designated smoke-free campus and smoking there – often nearby other businesses, buildings and hotels
• ‘Hidden’ areas where smoking takes place around campus
• Cigarette ends, coffee cups and other litter accumulating in these areas where smokers are congregating

9. If the University/College/IT has not introduced a smoke-free campus yet, is it planning to and if so, by what year?

Eight of the eleven third-level institutions that had responded reported that they had not implemented a smoke-free campus. Of these eight:

• Two stated they were planning to implement smoke-free campuses in the 2019/2020 academic year
• Four stated they were in the early development/consultation process of implementing a smoke-free campus
• The remaining two had ambitions to one day become smoke-free campuses but had no plans in place yet

10. If the University/College/IT is not planning on implementing a smoke-free campus, what are the reasons behind this?

Some of the reasons reported by third-level institutions are as follows:

• Staff would resist it
• Smokers find it discriminatory
• The institution fears that it could not attract future students
• Where would the smokers go?
• No security to enforce it
• Student union shop sells cigarettes
• Students union had no interest in pursuing it when raised
• Other issues of higher priority taking precedence

Summary, Conclusion, Recommendations

Of the 27 third-level institutions surveyed during the period May – June 2019, 41% responded (n=11).

• 11% (n=3) reported that their campuses were smoke-free

• 7% (n=2) reported that they were planning to implement a smoke-free campus in the 2019/2020 academic year)

• 15% (n=4) reported that they were in the early development/consultation stages of implementing a smoke-free campus

• 7% (n=2) reported that they had no plans in place yet to implement a smoke-free campus but stated they hoped to achieve it one day

The Irish Heart Foundation continuously monitors international research on smoking-related issues to identify new and better ways to reduce smoking rates. As part of this work, the Irish Heart Foundation partnered with the Irish Cancer Society to carry out an extensive review of emerging research regarding e-cigarettes and heated tobacco products (HTP). Having considered the available evidence and the views of the major international bodies such as the World Health Organisation in relation to these products, we must urge caution in relation to e-cigarettes and HTP.

Although it is generally accepted that e-cigarettes are less harmful than tobacco, there is insufficient research to date on their long-term impact on users. Several studies have also highlighted that they are less effective than other smoking cessation tools at helping people quit for good. The Irish Heart Foundation is also deeply concerned about how a whole new generation of children are at risk of becoming addicted to nicotine due to cynical marketing tactics directed at them by e-cigarette brands.

You can read the full paper here – Position paper on e-cigarettes and HTP ICS and IHF and view the accompanying infographic here – Infographic e-cigarettes.

Date: 28/02/2019

Recipient: Department of Health

Re: Tobacco industry-funded organization is not a partner of public health

We, ASH Ireland, Council of the Irish Heart Foundation, a group that advocates for reduced tobacco use and associated disease, disability and death, join almost 300 organizations and experts from around the world in welcoming the World Health Organization (WHO)’s reiteration that “WHO will not partner with the Foundation (for a Smoke-Free World [FSFW]). Governments should not partner with the Foundation and the public health community should follow this lead.”

This reiteration was made in response to FSFW’s outreach to the WHO Executive Board recently. FSFW is an entity funded entirely by Philip Morris International (PMI), which has a “known history of funding research to advance its own vested interest.”

With a whopping $1-billion committed funding from PMI, FSFW is offering to fund research on agriculture, economics, and medical science, including so-called smoking alternatives such as electronic nicotine delivery systems (including IQOS, a device PMI aggressively markets).

As a Party to the WHO Framework Convention on Tobacco Control (WHO FCTC), the Irish government is obliged to protect its public health and tobacco control policies against tobacco industry interference under Article 5.3 of the WHO FCTC. Compliance with this treaty provision requires governments to, among others, reject contributions and partnerships from the tobacco industry and those furthering its interests like FSFW.

The tobacco industry is a peril to the health and welfare of the Irish public. The tobacco industry has a long-established record of blocking, delaying or diluting any kind of tobacco control policy that is aimed at reducing the prevalence of smoking in Ireland. ASH Ireland, Council of the Irish Heart Foundation will continue to advocate for increased tobacco taxation, a greater level of investment in smoking cessation support services and additional tobacco control measures.

Only this month, another powerful tobacco company, British American Tobacco (BAT), announced its latest global tobacco marketing strategy—promote its vaping products in Formula One. In the past, such a tie-up to promote cigarette brands had facilitated worldwide exposure of tobacco products to millions of people due to Formula One’s “considerable appeal among youth and young adults.”

It is in this new era of global marketing strategies by an industry whose addictive, lethal products kill millions of people that we are urging your office to be vigilant about preventing industry interference including the PMI-funded FSFW. We also urge your office to reject funding from any entity or research funded by the tobacco industry and those furthering its interests.

Likewise, we appeal to your office to send a letter to the Health Research Board and other similar research institutes and educational institutions to warn them that research results from the tobacco industry and those funded by it such as FSFW must be rejected or disregarded by the government.

We must not be complicit in any act that supports an industry determined to undo the public health gains that took years of hard work to achieve. We look forward to working with you on effective measures to protect health policies from tobacco industry interference.

Sincerely,

Dr. Patrick Doorely,

Chairperson, ASH Ireland, Irish Heart Foundation

ASH Letter to Government WHO PMI

The Lancet Global Health journal published an article in June 2018 stating that Ireland has the highest prevalence in the world of smoking in pregnancy. In November, they published this response from Dr Patrick Doorley and Dr Joan Hanafin, ASH Ireland.

 

Smoking and pregnancy in Ireland

Pat Doorley and Joan Hanafin

In their paper “National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysis”[1], Shannon Lange and colleagues report the results of a systematic review and meta-analysis of the scientific literature from 1985-2016 to estimate the prevalence of smoking during pregnancy by country, WHO region, and globally. Smoking during pregnancy leads to adverse effects for women and children and this much-needed report is welcome. Estimates for smoking during pregnancy were calculated via meta-analysis for 43 countries and via statistical modelling for 131 countries and, at 38%, Ireland was reported to have the highest estimated prevalence of all countries.

We enter a note of caution in relation to the figure for Ireland. The five studies (1992, 1996, 2006, 2008, 2011) used to calculate estimates for Ireland had small sample sizes (n=100; 127; 151; 450; 1011), and the two very high prevalence rates (62% and 60.6%) were published in 1992 and 1996 respectively. In recent decades, Ireland has introduced a suite of tobacco control measures leading to substantial decreases in smoking prevalence in the general population and among pregnant women, specifically as a result of the 2004 Smoking Ban[2]. Smoking prevalence for women in Ireland was 32% in 1998[3] and had decreased to 14.7%[4] in 2017, although it was highest in the 25-34 year age group at 26.1%.

Two recent Irish studies (2012, 2017) [5] [6] from the time period of the study, with large sample sizes indicate that smoking prevalence in pregnancy is greatly less than the estimated 38% and continues to fall annually. Data from the national longitudinal study Growing Up in Ireland reported by McCrory and Layte (2012) show that 28% of mothers whose children were born between 1997 and 1998 reported that they smoked during pregnancy, and this fell to 18% of mothers whose children were born in 2007. A study of over 42,500 women who passed through the Coombe maternity hospital in Dublin (Reynolds et al. 2017) recorded annual decreases in smoking during pregnancy, with prevalence dropping from 14.3% to 10.9% between 2011 and 2015.

The decrease in smoking during pregnancy is a positive development for public health policy in Ireland but further efforts are needed, especially among disadvantaged populations, if smoking-related risk to pregnant mothers, their infants and children is to be further reduced.

Patrick Doorley & Joan Hanafin, Submitted June 2018; Published November 2018 in The Lancet Global Health

References

[1] Lange, S, Probst, C, Rehm, J, and Popova, S. (2018). National, regional, and global prevalence of smoking during pregnancy in the general population: a systematic review and meta-analysis. (published online May 30.) Lancet Glob Health. 2018; http://dx.doi.org/10.1016/S2214-109X(18)30223-7

[2] Kabir, Z, Daly, S, Clarke, V, Keogan, S, and Clancy, L. (2013). Smoking Ban and Small-For-Gestational Age Births in Ireland. PLoS ONE, 8(3): e57441. doi:10.1371/journal.pone.0057441

[3] Brugha, R., Tully, N., Dicker, P., Shelley, E., Ward, M. and McGee, H. (2009) SLÁN 2007: Survey of Lifestyle, Attitudes and Nutrition in Ireland. Smoking Patterns in Ireland: Implications for policy and services, Department of Health and Children. Dublin: The Stationery Office. p.8. https://health.gov.ie/wp-content/uploads/2014/03/slan_smokingreport.pdf. Accessed 24th October 2018.

[4] https://www.hse.ie/eng/about/who/tobaccocontrol/research/tracker-2017-update.pdf

[5] McCrory, C. & Layte, RJ. (2012). Prenatal Exposure to Maternal Smoking and Childhood Behavioural Problems: A Quasi-experimental Approach. Journal of Abnormal Child Psychology, 40(8): pp. 1277-1288.

[6] Reynolds, CME, Egan, B, McKeating, A, Daly, N. Sheehan, SR and Turner, MJ. (2017). Five year trends in maternal smoking behaviour reported at the first prenatal appointment. Irish Journal of Medical Science, 186(4), pp. 971-979.

 

 

Allen Carr‘s Easyway to Stop Smoking is a highly effective treatment to help smokers quit, according to a new study just published in the prestigious BMJ’s Tobacco Control journal. The study was carried out in Dublin by the Tobacco Free Research Institute Ireland and is the first published Randomised Clinical Trial (RCT) in the world about Allen Carr’s Easyway to Stop Smoking. RCTs are the most rigorous way of determining whether a cause-effect relation exists between treatment and outcome, and are considered the gold standard method of assessing effectiveness.

The Allen Carr method has been widely used for over 30 years and is available in 150 centres in over 50 different countries. It consists of a one-off 5-hour seminar which does not involve the use of any form of medication. Many celebrity testimonials endorse its effectiveness and there are claims that it has helped more than 30 million smokers quit. Despite this there has never been a published report from a scientific trial supporting its use in a general population.

This trial involved 300 adult smokers equally randomised to Allen Carr and the online HSE Quit.ie service and followed up for 1 year. Result showed a quit rate of 38% at 1 month, 26% at 3 months, 23% at 6 months, and 22% at 1 Year in the Allen Carr Group.  This was almost twice the quit rate achieved in the Quit.ie group.  These success rates are similar to those from the best available treatment programmes currently used for smoking cessation.

Close to 6000 of our citizens die annually from tobacco related disease, and smoking cessation is a very important element of Ireland’s plan to become Tobacco Free by 2025. In that context one of the study’s authors, Professor Luke Clancy, Director General, TFRI said that “Allen Carr is a hugely under-used treatment method which has great potential to help Ireland achieve its ambitious targets in Tobacco Control”.

The study’s first author, Sheila Keogan, TFRI’s Director of Research and Communications said, “We hope that our study showing the success of Allen Carr’s Easyway method of helping smokers to quit will be of great benefit, and may be especially useful for people who are reluctant to take any medication, for instance pregnant smokers”.

The full paper is to be found here.

Smokefree policy, practice, signage and bye-laws in playgrounds in Ireland

Joan Hanafin

Background

A target date of 2025 has been set for Ireland to become tobacco free, i.e., less than 5% of the population smoking (Department of Health, 2013). This target requires reducing prevalence of adult and child smoking, and preventing children from starting to smoke. A key recommendation of Tobacco Free Ireland is “to further develop the tobacco free playgrounds initiative in conjunction with the local authorities by voluntary measures or by the introduction of bye-laws” (Department of Health 2013, p.42). Moving towards smokefree zones where children congregate is an important step in de-normalising smoking, increasing its social unacceptability, and reducing prevalence. International research demonstrates that there is strong public support for tobacco free children’s playgrounds (Department of Health, 2013). Ireland’s first smokefree playgrounds were introduced in Donegal in 2010 and, since then, many County, City and Town Councils have introduced similar initiatives in playgrounds under their control (Department of Health, 2013; ASH Ireland, 2018). A previous survey carried out by ASH Ireland showed that a high percentage of City and County Councils had introduced such measures. This follow-up survey seeks to update earlier findings about City and County Councils’ policies, practices, signage and bye-laws regarding smokefree playgrounds under their control.

Methods

Sample

A list of the Chief Executive Officers (CEOs) and Postal Addresses for all City and County Councils in Ireland was sought from the Local Government Management Agency. An Excel file was received from the Research & Innovation section of the Local Government Management Agency. Using this list, ASH Ireland wrote by post to all City and County Councils in Ireland on 14th May 2018 (n=31[1]) to ask them about their current policies, practices, signage, and bye-laws in relation to smokefree playgrounds under their control. Councils were informed that ASH Ireland continues to promote smokefree environments for children and adults. A follow-up letter was sent by email on 9th August 2018 to all councils from which a full response had not been received.

Response Rate

Fourteen full or partial responses were received from the first round and an additional 5 responses were received from the second round. A final response from 1 more County Council was received thereafter, giving a total of 20 out of 31 responses (65% response rate).

Data requested

Each Council CEO was asked to reply to the following questions:

1.     What percentage of the playgrounds under your control are entirely smokefree?

2.     If not 100%, has a decision been made to make the others smokefree and when can we expect this to be in place?

3.     You might also let us know please if your council has erected smokefree signage in the children’s playgrounds and, if not, we request that you would consider doing so.

4.     Have any changes been introduced to the park bye-laws, so as to legislate locally for smokefree playgrounds?

Results

1. What percentage of playgrounds under your control are smokefree?

Of the 20 responses received, 16 Councils replied that their playgrounds were 100% smokefree (52% of all Councils or 80% of those that responded). Two did not answer this question; one replied that they did not know what percentage of playgrounds was smokefree and were trying to find out; and one responded that none of the playgrounds under their control were smokefree.

2. If not 100%, has a decision been made to make the others smokefree and when can we expect this to be in place?

No council answered this question directly. One council replied that they were trying to find out the answer to this question (but more particularly to questions 1 and 3).

3. Has your council erected smokefree signage in the children’s playgrounds and, if not, we request that you would consider doing so.

Seventeen Councils (55%) reported that they had erected signage. Ten (32%) had erected signage in all playgrounds. Seven (23%) had erected signage in some of the children’s playgrounds. Two Councils reported that all playgrounds would have signage completed during the coming months. One Council reported that 10 out of 14 playgrounds under their control had signage and that the Council “will consider extending the Smokefree Policy to the remaining 4 playgrounds”. One Council reported that all new signage includes “no smoking information”, and they included with their response an image of their signage which incorporates a no-smoking icon (no text). One Council did not know but was trying to find out what percentage of children’s playgrounds have no-smoking signage.

4. Have any changes been introduced to the park bye-laws, so as to legislate locally for smokefree playgrounds?

i.         Five Councils (16%) reported that they had introduced bye-laws to legislate locally for smokefree playgrounds.

ii.         Two councils reported that they did not have any bye-laws.

iii.         Twenty-seven Councils did not provide any information about bye-laws to legislate locally for smokefree playgrounds. This low response rate included Councils that provided information about the other questions asked.

iv.         One Council reported that they were working towards “having revised Bye-Laws being introduced which would ban smoking at public playgrounds”.

v.         One Council reported that they employ Community Wardens who have the power to enforce the Litter Pollution Act 1997 and provides a LoCall Environmental Hotline for members of the public to report littering.

vi.         Additionally, that Council reported that their Environment section “receives complaints from time to time re littering (including cigarette butts) in playgrounds”.

vii.         One other Council reported that Parks Bye-Laws have been enforceable since 1st September 2014 which apply to all Parks, Playgrounds, playing pitches and MUGAs and that appropriate signage has been erected in all of the parks and playgrounds with a view to notifying the general public of the bye-laws.

Summary, Conclusion, Recommendations

Of 31 City and County Councils surveyed by ASH Ireland during the period May-August 2018, 65% (n=20) responded, in three rounds. City and County Councils that responded to the survey were positive about implementing Smokefree playgrounds under their control.

·      52% (n=16) reported that playgrounds under their control were smokefree.

·      55% (n=17) had erected signage; 32% (n=10) in all playgrounds and ~23% (n=7) in some or most playgrounds under their control.

·      16% (n=5) said that they had bye-laws in place to prohibit smoking in playgrounds.

More needs to be done to increase the number of City and County Council-controlled smokefree playgrounds. Efforts to increase smokefree outdoor areas should be informed by research findings asserting that, for policy implementation and compliance, establishing the public health evidence for policy change is critical to engaging diverse stakeholders with varied tobacco-related interests (Leung et al., 2013).

Benefits of Smokefree playgrounds

Research from the UK, US, Australia, Canada and other countries suggest many benefits of smokefree playgrounds[2]. Smokefree playgrounds are desirable for reasons of denormalisation and positive role modelling, reducing the prevalence of smoking, avoidance of secondhand smoke dangers, and environmental benefit. Smokefree playgrounds are justified as the toxicity of smoke is a nuisance to many and poses a health risk to others. Smokefree playgrounds help users to quit smoking. There is wide public support for smokefree legislation in general and for smokefree playgrounds in particular. Smokefree playgrounds:

·      continue the denormalisation of tobacco and help reduce smoking prevalence among adults and children.

·      communicate a positive message that tobacco use is not compatible with an active, healthy lifestyle and that tobacco use and sports do not mix.

·      protect children and their carers from the harmful effects of exposure to secondhand smoke. Secondhand smoke is a human carcinogen for which there is no safe level of exposure. Even in outdoor settings, secondhand smoke levels can reach levels as high as those found in indoor facilities where smoking is permitted. Secondhand smoke causes heart disease, cancer, respiratory problems, and ear infections, and worsens asthma. Exposure to secondhand smoke is especially harmful to children and adults with asthma or other chronic conditions. Children, older adults, people with special health needs, and pregnant women are particularly vulnerable to the health risks caused by secondhand smoke exposure, even in outdoor environments. Tobacco-free parks and beaches provide families and children with healthy environments in which they are not exposed to the negative health effects of secondhand smoke.

·      enhance support for community users to quit smoking.

·      enhance users’ enjoyment of clean air and health activities.

·      reduce cigarette litter. Discarded cigarette butts pollute the land and water and are highly toxic and dangerous to children, domestic animals, and wildlife. Small children are at risk of swallowing, choking or burning themselves with discarded butts and suffering nicotine poisoning.

·      reduce maintenance costs and fire risks. Cigarette butts are the most littered item in the world and they are not biodegradable. Carelessly discarded cigarette butts are a frequent cause of fires, especially during periods of dry weather.

Recommendations for promoting smokefree playgrounds in Ireland

·      Public health campaigns should include a focus on the benefits of smokefree playgrounds to children, parents and others using these facilities (see above).

·      City and County Councils that have made efforts to make playgrounds under their control smokefree should be noted and commended.

·      Examples of good practice regarding smokefree playgrounds should be collated and circulated.

·      Those Councils that have not yet made playgrounds under their control smokefree should be encouraged to do so.

·      Those Councils that have not yet erected smokefree signage in playgrounds under their control should be encouraged to do so.

·      Councils appear to be receptive to guidance regarding signage. Several Councils attached with their survey responses examples of their signage. A range of signage suggestions could be made available to all Councils based on best practice. This would help Councils to avoid “re-inventing the wheel” and perhaps facilitate wider implementation of smokefree signage in playgrounds.

·      Some Councils appear to be receptive to guidance regarding bye-laws. Examples of good practice could be circulated to all Councils.

·      Playgrounds not under the control of City and County Councils should be informed of good smokefree practices and encouraged to implement smokefree playgrounds and to erect appropriate signage.

·      Regarding health inequalities, social class differences persist in smoking prevalence and may also exist in how playgrounds are used. Evidence[3] from other countries suggests that consideration should be given to ways of allocating sufficient resources to enhance voluntary compliance so that smokefree playground policies and bye-laws do not contribute to health inequalities.

References

ASH Ireland (2018). https://ash.ie/ash-campaigns/smoke-free-playgrounds/

Cancer Council Queensland (2018). The Benefits of Introducing Smoke-Free Public Places. Available at  https://cancerqld.blob.core.windows.net/site/content/uploads/2016/12/Local-Government_Smoke-free-public-places-benefits_FACTSHEET.pdf

Capital District Tobacco-Free Coalition (2018). Benefits of Tobacco-Free Parks and Outdoor Recreation Facilities. Available at http://smokefreecapital.org/wp-content/uploads/Benefits_FAQ_rev2016.pdf

Department of Health (2014). Healthy Ireland. A Framework for Improved Health and Well-Being 2013-2025. Dublin: Department of Health. Available at https://health.gov.ie/wp-content/uploads/2014/03/HealthyIrelandBrochureWA2.pdf

Department of Health / Healthy Ireland (2013). Tobacco Free Ireland. Report of the Tobacco Policy Review Group. Dublin: Department of Health. Available at

Click to access TobaccoFreeIreland.pdf

Kruger, J., Jama, A., Kegler, M., Marynak, K., & King, B. (2016). National and State-Specific Attitudes toward Smoke-Free Parks among U.S. Adults. International Journal of Environmental Research and Public Health, 13(9), 864. http://doi.org/10.3390/ijerph13090864. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5036697/pdf/ijerph-13-00864.pdf

Leung, R., Mallya, G., Dean, L. T., Rizvi, A., Dignam, L., & Schwarz, D. F. (2013). Instituting a Smoke-Free Policy for City Recreation Centers and Playgrounds, Philadelphia, Pennsylvania, 2010. Preventing Chronic Disease, 10, E116. http://doi.org/10.5888/pcd10.120294 Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3711557/

MDHHS (Michigan Department of Health and Human Services) (2018). Why parks and beaches should be tobacco free. Available at https://www.michigan.gov/mdhhs/0,5885,7-339-71550_2955_2973-340373–,00.html

NHS Scotland (2009?). Smoke-Free Playgrounds in Glasgow. A Literature Review. Glasgow: NHS. Available at http://library.nhsggc.org.uk/mediaAssets/CHP%20Inverclyde/Smokefree%20Playgrounds.pdf

Pederson, Ann et al., (2016). Smoking on the margins: a comprehensive analysis of a municipal outdoor smoke-free policy. BMC Public Health 16:852

DOI: https://doi.org/10.1186/S12889-016-3466-2

Available at https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/s12889-016-3466-2

Endnotes

[1] On the Excel mailing list received from the Local Government Management Agency, 5 assistant chief executives of Dublin City Council were listed in addition to the chief executive. These 6 officers of Dublin City Council were included in the mailing in the interests of communicating with all officers named on the list. A total of 36 surveys were sent out, therefore, to a total of 31 City and Council offices. (No response has been received to date from any of the offices of Dublin City Council.)
[2] See, for example, Cancer Council Queensland (2018); Capital District Tobacco-Free Coalition (2018); Leung et al. (2016); NHS Glasgow (2009); Pederson et al. (2016).
[3] See, for example, Pederson et al. (2016).

Joan Hanafin, October 2018

Survey 2018 Summary

Between May and August 2018, ASH Ireland carried out a survey of City and County councils in Ireland about Smokefree policy, practice, signage and bye-laws in playgrounds under their control.

Four questions were asked about smokefree playgrounds:

1.     What percentage of the playgrounds under your control are entirely smokefree?

2.     If not 100%, has a decision been made to make the others smokefree and when can we expect this to be in place?

3.     You might also let us know please if your council has erected smokefree signage in the children’s playgrounds and, if not, we request that you would consider doing so.

4.     Have any changes been introduced to the park bye-laws, so as to legislate locally for smokefree playgrounds?

Results

1. 16 of 20 Councils that provided information reported that their playgrounds are 100% smokefree, representing 52% of all Councils or 80% of those that responded.

2. No Council answered directly, possibly because the great majority of those that replied had 100% smokefree playgrounds.

3. Seventeen (55%) Councils reported that signage had been erected in all (10) or some (7) playgrounds.

4. Five (16%) Councils reported that they had introduced bye-laws regarding smokefree playgrounds.

For full survey results, see separate post.

Joan Hanafin

ASH Ireland Response to Budget 2019: 50c increase welcomed

Ash Ireland welcomes the announcement by Minister Donohue in the 2019 Budget statement today to increase the price of a pack of cigarettes by 50c.  Price is widely recognised internationally, and by the World Health Organisation, as the most important way of encouraging smokers to quit and discouraging young people from experimenting with tobacco. The possible links being raised between ‘smuggling and price increase’ are totally misguided and mainly fuelled by a major vested interest, the Tobacco Industry. Smuggling must be tackled as a separate and very serious criminal issue but it should not impinge on health policy and related decisions. ASH Ireland called for a 1 euro increase in price in its pre-budget submission.

Dr Patrick Doorley, Chairman of ASH Ireland said today,  “Significant inroads have been made in regard to smoking prevalence over the past 15 years with current levels down to less than 20%, down from 29% in 2003.  However, if the Government is to achieve its stated objective of establishing a smoke-free Ireland by 2025 then it must commit to significant annual increases in the price of tobacco, including Roll Your Own tobacco. We call on the government to ring-fence funding for the purpose of supporting smokers to quit, particularly smokers in lower socio-economic groups who have  higher levels of smoking.”

Dr Doorley went on to say,  “Smuggling of tobacco into this country is a major issue for Government. However, we must be wary of Tobacco Industry efforts to use smuggling as a reason for not introducing effective measures which can improve the nation’s health.  There are many examples of jurisdictions where tobacco price has been increased for health reasons, and smuggling simultaneously tackled and reduced – such as Australia, New Zealand, UK and Spain.”

“Ireland is seen as a world leader in tobacco control. I ask the Government to intensify the public-health battle against tobacco, especially in relation to expanding smoke-free spaces. The toll to our citizens from smoking is a heavy one in terms of disease, disability and death. Smoking causes unique and catastrophic consequences for families all over Ireland as, every year, close to 6000 of our citizens die from smoking. We must do all that is possible to reduce this dreadful statistic by de-normalising smoking, and above all introducing pro-health legislation”, Dr Doorley said.

 

ENDS

Further information contact:

Tel: 0818 305055

Email: info@ash.ie