Evaluation of the City of Woodstock’s Outdoor Smoking By-law: A Longitudinal Study of Smokers and Non-Smokers
Kennedy, Ryan David
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PURPOSE: To evaluate Canada’s most comprehensive outdoor smoke-free ordinance, in Woodstock, Ontario, using both quantitative (longitudinal cohort survey) and qualitative methods (key informant interviews with policy makers). Measures include levels of support for outdoor smoking restrictions, smoking behaviour in outdoor environments, measures of the social denormalization of smoking, measures of concern about litter or fires caused by discarded cigarette butts, and reported changes in use of services, facilities or businesses that were regulated by the by-law. This study also sought to understand aspects of the policy development process and determine to how relevant the findings may be to other communities across Canada, and the world. BACKGROUND: The City of Woodstock, Ontario created a comprehensive outdoor smoke-free ordinance (OSFO) that came into effect on September 1, 2008. This by-law restricted or banned smoking in 5 different outdoor environments owned or regulated by the city including patios on downtown sidewalk cafés, parks and recreational fields, areas around transit stops and shelters, and doorways of city run facilities such as city hall. The by-law also created two schedules to further regulate smoking in other outdoor environments if elected by citizens in the community; one for non-city-owned properties such as private business to regulate smoking in their doorway environments and a second schedule for outdoor events organized by groups in the community. The schedules allowed council to pass a by-law that could easily regulate and enforce additional smoke-free environments, as requested by citizens, without the need for council approval. METHODS: Qualitative and quantitative methods were used to address the research objectives. Quantitative measures were collected using a pre-post survey design, interviewing smokers and non-smokers, in the City of Woodstock, and a neighbouring community (Ingersoll) in the same county (Oxford County). Before the by-law was enacted, two surveys were conducted. The telephone survey (August 13-28, 2008) was a random digit dialled (RDD) general adult population survey of non-smokers (n=373) and smokers (n=234). A face-to-face survey (August 13-19, 2008) was conducted among a targeted sample of smokers who were observed smoking in one of the outdoor areas that was to become smoke-free in accordance with the by-law (n=176). Face-to-face interviewers used handheld Palm III devices to assist in the interviewing of these respondents. Surveying both samples ensured the beliefs, attitudes, and behaviour of those smokers who, given circumstances of their recruitment, would be more likely to be affected by the by-law, would be measured in this evaluation study. Using a longitudinal cohort design, respondents from both Wave 1 surveys were re-contacted by telephone in approximately one year after the ban was implemented (August 18-September 15, 2009), to measure changes in the key outcome variables. The Wave 2 survey was conducted entirely by telephone with no replenishment. The Wave 2 survey included respondents that were successfully re-contacted from the general population sample (non-smokers n=299, smokers n=182), and respondents from the targeted sample (n=61). This qualitative study sought to identify any specific lessons or findings from the process undertaken that would be applicable or helpful to other communities. The qualitative study involved 6 key informant interviews with identified public health and city staff and an elected official who were involved in different aspects of the by-law, from development to enforcement. The data collected from the key informant interviews was analysed using an inductive qualitative method called the ‘framework approach’. RESULTS: After the Woodstock outdoor smoking restrictions had been in place for approximately 1 year, most respondents from the general population survey, smokers, (71%), and non-smokers (93%), supported or strongly supported the by-law. Most smokers (82%) and non-smokers (96%) agreed or strongly agreed that the by-law had been good for the health of the children of Woodstock. The by-law was also associated with increased quit intentions; 15% of the smokers from the general population sample reported that the smoke-free by-law made them more likely to quit, and approximately 26% of the smokers from the targeted sample reported the by-law made them more likely to quit. Smokers from both the general population (30%) and the targeted sample (42%) reported that the smoke-free outdoor by-law had helped them cut down on the number of cigarettes they smoke. There were 30 respondents in the Wave 1 survey that were smokers, who had successfully quit at the time of the Wave 2 survey. Of these ‘quitters’, 33% reported that they outdoor smoke-free by-law had helped them to quit smoking, and approximately half (48%) reported that they by-law had helped them to stay a non-smoker. The overwhelming majority of smokers reported that the by-law did not impact their use of facilities or businesses that had been regulated by the by-law. The key informant interviews revealed that the outdoor smoke-free ordinance was developed by following a standard public health policy development process that involved community (public) participation, exploration of policy options, and a political decision made by the city’s elected officials. It was identified that the implementation of two schedules in the by-law, which allows for expansion of the environments regulated and enforced by the city, was an effective strategy to gradually increase smoke-free spaces without burdening the City Council with regular needs to amend or update a by-law. Appropriate public relations were engaged including disseminating information about the by-law, and publicizing it through established networks in the community. Signage in the regulated environments, and enforcement were considered critical by the implementation team. City staff members recommended that other communities should consider passing similar by-laws and dedicate more effort to implementing and enforcing restrictions, rather than discussing or debating whether or not to enact a by-law. An analysis of the key informant interviews revealed that there were no unique features or circumstances specific to Woodstock that would suggest this by-law could not be developed or passed in another area municipality provided the community already has established smoke-free policies in indoor or enclosed public spaces. If Woodstock is unique in any way, it was in the presence of conditions such as high smoking prevalence and close proximity to tobacco growing regions that make it less likely to have successfully enacted an outdoor smoke-free ordinance. CONCLUSION: Support for the Woodstock comprehensive outdoor smoking by-law is high among smokers and non-smokers. The overwhelming majority of residents interviewed supported the by-law and felt that the by-law was good for the health of the children of Woodstock. The by-law has not had negative impacts on use of facilities including parks and recreational fields. Further, a third of smokers reported that the outdoor by-law has helped them to cut down how much they smoke and almost a fifth of smokers reported that the by-law has made them more likely to quit smoking. Approximately half of the quitters in the sample also reported the by-law helped them to stay quit. These findings suggest that expanding smoke-free ordinances to include a range of outdoor environments will be supported by citizens, and will help smokers to reduce how much they smoke, encourage quitting and help those that quit, remain abstinent. The findings from the key informant interviews suggest that other jurisdictions should explore expanding their smoke-free ordinances to include outdoor environments, particularly environments frequented by children.