vtcs0813

Victorian Tobacco Control Strategy

2008–2013

Victorian Tobacco Control Strategy

2008–2013

ii Victorian Tobacco Control Strategy 2008–2013

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Victorian Tobacco Control Strategy 2008–2013 iii

Contents

Foreword iv

1 Success in the fi ght against the harms of smoking 1

1.1.1 Local government 2

1.1.2 Anti-smoking advertisements and services to help smokers quit 2

1.1.3 Research to improve tobacco policy 2

2 The challenge ahead 5

2.1.1 Tobacco––the leading cause of avoidable illness and death 5

2.1.2 Tobacco––a leading cause of social inequalities in health 5

2.1.3 Tobacco––an avoidable cost 5

2.2 Our ambition 6

2.3 Our strategic targets 6

2.4 Smoking prevalence in the whole of the Victorian population 6

2.4.1 Smoking prevalence among pregnant women 7

2.4.2 Smoking prevalence among Aboriginal and other

high-prevalence groups 7

2.5 Achieving our ambitions 8

3 Key actions 11

3.1 Banning tobacco point-of-sale displays in retail outlets 11

3.2 Reviewing penalties and tougher enforcement of the Tobacco Act 12

3.3 Supporting families 12

3.3.1 Banning smoking in cars carrying children 12

3.3.2 Promoting smoking cessation in pregnancy 13

3.3.3 Banning sales of cigarettes from temporary outlets 13

3.3.4 Providing the Minister for Health the power to ban tobacco

products and packaging that appeal to young people 14

3.3.5 Banning smoking on school grounds 14

3.4 Helping smokers to quit––improving cessation services 15

3.5 Social marketing 16

4 Implementation and evaluation 19

4.1 Measuring success 19

4.2 Evaluation 19

References 20

Figure 1: Disease burden attributed to selected risk factors by sex,

Victoria, 2001 5

Figure 2: Smoking prevalence in Victoria from 1998 to 2007

and projection to 2013 7

Figure 3: Daily smokers by socioeconomic status 8

Table 1: Key actions of the Victorian Tobacco Control Strategy

2008–2013 mapped against international best practice 9

iv Victorian Tobacco Control Strategy 2008–2013

Foreword

For over 20 years the Victorian Government has led the world in tackling the avoidable illness and death which result

from tobacco smoke. Since its introduction, the Victorian Tobacco Act 1987 has set the pace for international efforts to

control the epidemic of tobacco use. Throughout this period, various initiatives and legislative reforms have resulted in

fewer Victorians starting to smoke, greater numbers quitting and more Victorians than ever before protected from the

harmful effects of second-hand smoke. In 21 years, adult smoking prevalence in Victoria has reduced from 34 per cent to

17 per cent.

Though much progress has been made, smoking remains the leading avoidable cause of many cancers, respiratory,

cardiovascular and other diseases. In Victoria, smoking costs approximately 4,000 lives and $5 billion each and every

year. Smoking rates remain disproportionately high in many of our communities, causing avoidable hardship and ill-health

among many of the people who can least afford it.

Tackling cancer is one of the Victorian Government’s highest health priorities, with the allocation of $150 million extra

funding in the 2008–09 budget for prevention, early detection, improved treatment and research in relation to cancer. The

emphasis on the prevention of avoidable risk factors for cancer will build on Victoria’s existing successes in reducing the

burden of smoking in the community.

The Victorian Tobacco Control Strategy 2008–2013 is a major new Victorian Government initiative which will make

important advances in the fi ght against cancer and the epidemic of preventable chronic disease.

In August 2008, the Government undertook a public consultation to listen to community opinions on the next steps for

tobacco control in Victoria. We received a large number of submissions from the general public and other stakeholders,

including the tobacco industry and health sector. The consultation found substantial support for the legislative reforms

and other proposals contained in the Strategy.

This Strategy will see determined action to drive down smoking rates and assist those in our community with the greatest

need and capacity to benefi t from Government action. We have set three challenging targets to focus our efforts and to

realise this ambition. By 2013 we aim to:

• reduce smoking among adults by 20 per cent, from 17.3 per cent to 13.8 per cent of Victorian adults;

• reduce smoking among pregnant women by 50 per cent, from 9.3 per cent to 4.7 per cent; and

• reduce smoking among Aboriginal and other high prevalence groups by at least 20 per cent, from 50 per cent to

40 per cent among Aboriginal people and from 20 per cent to 16 per cent in socio-economically disadvantaged areas.

To achieve this goal, we will extend our collaboration with local governments, the health sector and other tobacco control

organisations. We will also continue to work closely with the Commonwealth Government to ensure that national policy

maximises the impact of our actions here in Victoria. We will implement legislation and other interventions in the key areas

where we know our efforts will make the most difference to smoking rates in Victoria.

Victorian Tobacco Control Strategy 2008–2013 v

We will ban tobacco point-of-sale displays in retail outlets other than specialist tobacconists. Reducing the visibility of

tobacco products in shops will reduce the number of young people who start smoking and make it easier for quitters to

remain non-smokers.

There will be tougher enforcement of tobacco laws that control the supply and use of tobacco, especially the sale of

cigarettes to minors. This work will be underpinned by a review of the penalties prescribed in the Tobacco Act.

Families will be supported to adopt non-smoking attitudes and behaviours, by:

• banning smoking in cars carrying children under 18 years of age;

• helping pregnant smokers to quit and stay quit;

• banning the sale of tobacco at temporary outlets;

• providing a ministerial power to ban youth-orientated tobacco products and packages, such as fruit-fl avoured cigarettes;

and

• making Government school grounds smoke-free.

We will promote and support attempts to quit among Aboriginal people and other groups with high rates of smoking.

Anti-smoking social marketing will be continued as a powerful tool to motivate smokers to quit and stay quit, and to

prevent young people from taking up the habit in the fi rst place.

A Taskforce will be set up to drive this challenging agenda forward, ensuring that we deliver the key strategic actions and

make real progress towards the bold targets set in the Strategy. The Taskforce will include the leaders on tobacco control

in Victoria who will work collaboratively to identify new opportunities, innovative approaches, new partnerships and

networks and monitor implementation of the Strategy.

We are confi dent that, with the continued support of the public, health professionals, industry and the non-government

sector, these important and worthwhile actions can and will make a real difference to the lives of Victorians, by reducing

both the number of smokers in our community and the harm that results from tobacco smoking.

HON JOHN BRUMBY MP HON DANIEL ANDREWS MPPREMIER OF VICTORIA MINISTER FOR HEALTH

vi Victorian Tobacco Control Strategy 2008–2013

1 Success in the fi ght against

the harms of smoking

Victorian Tobacco Control Strategy 2008–2013 1

Regular smoking among

Victorian adults has declined

from 21.6 per cent in 1999 to

17.3 per cent in 2007.

Victoria is a world leader in tackling

the avoidable illness and death

that result from tobacco smoke.

The Victorian Tobacco Act 1987 set

the pace for international efforts

to control the epidemic of tobacco

use. We achieved this by banning

outdoor tobacco advertising and

using cigarette taxes both to fund

the world’s fi rst health promotion

foundation, the Victorian Health

Promotion Foundation (VicHealth) and

by buying out tobacco sponsorship of

sport and the arts.

In the 21 years since this landmark

legislation was enacted, the Victorian

Government has advanced successive

waves of reform, working closely

with and funding key agencies inside

and outside Government to help

smokers quit, reduce the number

of people taking up the habit and

protect non-smokers from harmful

second-hand smoke.

This concerted and coordinated effort

has brought considerable success,

and improved opportunities for all

Victorians to live healthy and long

lives. The rate of tobacco smoking in

the Victorian population has steadily

declined, and is now amongst the

lowest in the developed world.

Since 1999, regular smoking among

Victorian adults has declined from

21.6 per cent to 17.3 per cent in 2007

(Germain et al., 2008).

In 2002, World Health Organization

(WHO) statistics showed that the

smoking rate was 19.5 per cent in

Australia as a whole, compared to

26.5 per cent in the UK and 23.5 per

cent in the US (MacKay and Eriksen,

2002).

The Victorian Government has helped

create and sustain a robust tobacco

control infrastructure in Victoria.

This includes support and funding

for local councils to enforce the

Act, anti-smoking social marketing,

smoking cessation services to help

people quit and research to help make

better tobacco policies.

1 Success in the fi ght against the harms of smoking

Legislative reformsSince 1999, the government has

enacted a series of legislative reforms

to better regulate tobacco use and

protect public health, including:

• reforms addressing youth smoking,

such as increasing the penalties

for selling cigarettes to minors

(November 2000)

• smoke-free dining laws (July 2001)

• smoke-free shopping centre laws

(November 2001)

• further restrictions on tobacco

advertising and displays within

tobacco retail outlets (July 2001)

• further smoking restrictions in

licensed premises, gaming and

bingo venues and the casino

(September 2002)

• smoking bans in enclosed

workplaces, at underage music and

dance events and in covered areas of

train station platforms, tram shelters

and bus shelters (March 2006)

• bans of ‘buzz marketing’ and

non-branded tobacco advertising

(March 2006)

• strengthened laws to enforce the ban

on cigarette sales to young people

(March 2006)

• smoking bans in enclosed licensed

premises (July 2007).

2 Victorian Tobacco Control Strategy 2008–2013

1.1.1 Local government

Local government action is crucial

to making tobacco legislation

work across Victoria.

Environmental health offi cers lead

a range of activities in their council

areas, including regular visits and

inspections to tobacco retailers,

licensed premises and other

venues, to ensure a high level of

compliance with the Act. The Victorian

Government provides funding to local

councils for these activities.

1.1.2 Anti-smoking advertisements and services to help smokers quit

Informing the public of the

dangers of smoking and the

benefi ts of quitting is a proven

way to reduce the likelihood

young people take up the habit

and help prompt smokers to quit.

Although the vast majority of smokers

quit unaided, it is important to

provide smoking cessation services

to support quitters. Research shows

that such investment increases

the number of successful quit

attempts. The Victorian Government

has committed $7.7 million to Quit

Victoria to conduct anti-smoking

social marketing activities during

2006–2010.

Quitline is a confi dential and free

telephone information, advice and

assistance service for people who

want to quit smoking. The Victorian

Government has committed

$2.5 million over 2006–2010 to

enhance existing Quitline services.

1.1.3 Research to improve tobacco policy

VicHealth provides $3.5 million

annually for research and other

activities to reduce harm from

tobacco. The Victorian Government

also provides $270,000 annually in

direct funding to the Cancer Council

of Victoria to undertake research to

develop tobacco policy and programs.

The policy contextIn 2004, the Commonwealth

Government became a signatory to the

World Health Organization Framework

Convention on Tobacco Control. The

Australian National Tobacco Strategy

2004–2009 refl ects this commitment.

As a signatory to the national strategy,

the Victorian Government aims to

control the negative impact of tobacco

use, by:

• further use of regulation

• increasing promotion of Quit and

Smokefree messages

• improving the quality of and access

to services for the treatment of

smokers

• providing more useful support for

parents, carers and educators to help

children to develop a healthy lifestyle

• advocating policies that reduce

smoking in disadvantaged groups

• tailoring messages and services to

ensure access by disadvantaged

groups

• obtaining the information needed to

fi ne-tune policies and programs

• fostering collaboration in program

development and policy.


2 The challenge ahead


2 The challenge ahead

Despite considerable progress,

approximately 700,000 Victorians

regularly smoke, and every day, young

people continue to take up the habit.

2.1.1 Tobacco––the leading cause of avoidable illness and death

Smoking remains the leading

cause of avoidable disease and

death in Victoria.

Tobacco kills one-third to one-half

of all people who use it, on average,

15 years prematurely. Every year

smoking causes 4,000 unnecessarily

early deaths. In comparison, just

over 300 deaths are caused by

accidents on our roads each year, and

approximately 900 deaths are due to

alcohol and other drugs.

Smoking also causes the most

signifi cant proportion of avoidable

chronic illness and hospitalisation

from conditions such as cancer,

cardiovascular disease and chronic

obstructive pulmonary disease

(Victorian Department of Human

Services, 2005a). Tobacco use

causes 90 per cent of all lung cancer,

three-quarters of chronic bronchitis

and emphysema and one-quarter of

all ischaemic heart disease (MacKay

and Eriksen, 2002).

2.1.2 Tobacco––a leading cause of social inequalities in health

Smoking rates remain high in

particular social groups, some

of which are among the most

disadvantaged and vulnerable

communities in Victoria. As a result,

smoking causes health inequalities

and compounds disadvantage by

reducing available income.

Smoking is the leading avoidable

cause of poor Aboriginal health.

In 2004–05, 50 per cent of Aboriginal

adults in Victoria were daily smokers,

and this rate had not signifi cantly

declined in at least ten years (ABS,

2006). Smoking accounts for 10 per

cent of the total health gap between

Aboriginal and non-Aboriginal people,

and 20 per cent of all Aboriginal

deaths (Vos et al., 2007).

Renewed effort is needed to ensure

that tobacco control policies and

programs reach groups that will most

benefi t from them. In particular,

targeting smoking cessation services

to disadvantaged groups represents

one of the best opportunities to

reduce social inequalities in health in

Victoria in the short to medium term.

2.1.3 Tobacco––an avoidable cost

Smoking costs Victorians over

$5 billion each year.

Although individuals bear the

majority of these costs, business

losses associated with reduced

workplace productivity amount to

$510 million. Tobacco use also costs

a further $190 million in healthcare

expenditure. It is estimated that

better public policy could reduce the

total costs of tobacco smoking by

approximately 45 per cent (Collins

and Lapsley, 2006).

DALYs

Female YLDs

Female YLLs

Tobacco

Physical inactivity

Obesity

High blood cholesterol

Low fruit and vegetable intake

High blood pressure

Alcohol benefit*

Alcohol harm

Illicit drugs

Unsafe sex

Occupation

Intimate partner violence

Air pollution (urban)

-40,000 -30,000 -20,000 -10,000 0 10,000 20,000 30,000

Male YLDs

Male YLLs

Figure 1: Disease burden attributed to selected risk factors by sex, Victoria, 2001

The DALY (Disability-Adjusted Life Year) is a health gap measure that combines time lost as a result of

both premature mortality and illness.

DALY = YLL + YLD

YLL = Years of life lost as a result of premature mortality

YLD = Health years lost as a result of illness

Source: Victorian Burden of Disease Study, 2005


Given the magnitude of these costs,

investment in tobacco control

is sound economic policy: every

dollar spent on tobacco control

can save two dollars in health care

expenditure alone. A fi ve per cent

reduction in smoking rates would

provide $2,034 million in benefi ts

over a 20-year period, representing

$10,291 for each person prevented

from smoking by anti-smoking

interventions (Collins and Lapsley,

2006).

2.2 Our ambition

This Strategy will improve the

health of the Victorian population

by reducing the social costs and

inequalities caused by smoking.

To guide this effort and express the

key objectives under this broad aim,

the Strategy sets three ambitious

targets to be achieved by 2013. These

require a redoubling of our efforts to

accelerate the current rates of decline

in smoking prevalence. For the fi rst

time, such targets are based on

measures of smoking prevalence in

the Victorian community.

This Strategy challenges the Victorian

Government, in partnership with key

stakeholders, the community and

individuals, to intensify our efforts

to eliminate the harms of smoking.

Signifi cant gains can be made from

achieving our targets by 2013 that

focus on adults, smoking in pregnancy

and high-prevalence groups.

2.3 Our strategic targetsThe key targets of this Strategy are to:

1. reduce smoking among adults by

20 per cent, from 17.3 per cent to

13.8 per cent1

2. reduce smoking among pregnant

women by 50 per cent, from

9.3 per cent to 4.7 per cent2

3. reduce smoking among high-

prevalence groups by at least

20 per cent, from 50 per cent to

40 per cent3 of Aboriginal adults,

and from 20 per cent to 16 per

cent4 in socio-economically

disadvantaged areas.

2.4 Smoking prevalence in the whole of the Victorian population

The greatest gains in health

improvement will be made by

reducing the total number of

people in the Victorian population

who smoke.

Our achievements to date are

refl ected in the decline in regular adult

smoking from 21.6 per cent in 1999 to

17.3 per cent in 2007 (Germaine et al.,

2008). The whole-of-population target

established in this Strategy requires

an almost doubling of the current

annual decline in smoking prevalence.

1 Based on the prevalence of adult regular smokers in 2007, published by the Centre for Behavioural

Research in Cancer.

2 Based on the prevalence of women reporting smoking in the month prior to delivery during 2005–06,

obtained from the Victorian Admitted Episode Database.

3 Based on the prevalence of adult daily smoking in 2004–05, published by the Australian Bureau of

Statistics.

4 Based on the prevalence of adult daily smoking in the 40 per cent most socio-economically

disadvantaged areas (as measured by the Index of Relative Socio-Economic Disadvantage), during the

2006 period obtained from the Victorian Population Health Survey.

Victorian Tobacco Control Strategy: Objectives and Priority Action Areas

OBJECTIVES Improved health outcomes and health equality

OUTCOME Reduced prevalence of disease caused by smoking

PRIORITY ACTION AREAS

Reduced smoking among adults

Reduced smoking among pregnant women

Reduced smoking among adult Aboriginal and other

high prevalence groups

STRATEGIES

Education and information

Legislation

Research and evaluation

Monitoring and surveillance


2.4.1 Smoking prevalence among pregnant women

Almost 1 in 10 pregnant women

currently smoke in the month

prior to birth.

Smoking during pregnancy is bad

for the health of both mother and

child. The health workforce is highly

motivated to support women in their

attempts to quit, and has achieved

tremendous successes in reducing

this avoidable harm. However, much

more is required to reduce the harm

further and remove the inequalities

that result from smoking during

pregnancy.

The Victorian Children’s Health and

Wellbeing Survey shows that while

22 per cent of women are smoking

when they fi rst become pregnant,

around 10 per cent give up as soon

as they know they are pregnant,

and another 3 per cent quit as their

pregnancy progresses. While this

behaviour is encouraging, almost 1 in

10 mothers still smoke at the birth

of their child. Many more resume

smoking once they have given birth.

There are also substantial social

inequalities in smoking during

pregnancy. For example, 38 per cent

of Aboriginal mothers in Victoria

reported that they smoked in the

month prior to birth (Department of

Human Services, 2007).

Data from Victorian hospital

admissions statistics show that

9 per cent of women smoke in the

month prior to birth. Based on this

study and other reports, pregnant

Victorian women are more likely to be

smokers if they have lower education

attainment, lower economic status or

income, live rurally, and are between

20 and 30 years of age.

2.4.2 Smoking prevalence among Aboriginal and other high-prevalence groups

Tobacco use is an important

cause of health inequalities.

Smoking is more common

among younger people, men and

socio-economically deprived groups

(Germaine et al., 2008). Smoking

prevalence is much higher in specifi c

disadvantaged groups. People with

mental health problems, for example,

are approximately twice as likely to

smoke as the rest of the community,

and prevalence is especially high

in severe mental illnesses such as

schizophrenia (Ministerial Council

on Drug Strategy, 2005; Baker et

al., 2005).

Smoking is the leading avoidable

cause of the health gap between

Aboriginal people and the rest of

the Australian population (Vos et

al., 2007). Differences in smoking

behaviour explain almost half of the

inequality in premature mortality

between more and less disadvantaged

men in developed nations (Jha et

al., 2006).

Smoking during pregnancySmoking during pregnancy is one of

the most signifi cant, avoidable threats

to the health of both mother and child

during and after pregnancy.

Smoking cuts approximately seven

years from a woman’s life expectancy.

Smoking increases the risks of

infertility, ectopic pregnancy and many

other conditions.

Babies born to women who smoke

during pregnancy have a signifi cantly

greater chance of premature birth,

low birth weight, stillbirth and sudden

death. There are also long-term effects

on the health of the child, including

increased risk of asthma, childhood

obesity, high blood pressure and other

conditions (Centers for Disease Control

and Prevention, 2004).

Quitting early in pregnancy brings the

greatest benefi ts. Women who quit

smoking in the fi rst three to four months

of pregnancy give birth to infants of

similar weight to infants of women

who have never smoked (Bernstein

et al., 2005).

Pe

r ce

nt

regu

lar

smo

kers

19

98

19

99

20

00

20

01

20

02

20

03

20

04

20

05

20

06

20

07

20

08

20

09

2010

2011

2012

2013

10

15

20

25

Currenttrend

Target (13.8%)

Figure 2: Smoking prevalence in Victoria from 1998 to 2007 and projection to 2013

Source of actual smoking prevalence: Centre for Behavioural Research in Cancer, 2006 and

source of projected and target smoking prevalence: Department of Human Services


Whole-of-population interventions,

such as increases in tobacco taxes or

bans on smoking in licensed premises

(for instance, those introduced in

Victoria during 2007) have had some

effect on reducing these inequalities,

because low-income groups are more

affected by increases in tax and suffer

more exposure to second-hand smoke

in their workplaces (Thomas et al.,

2008). However, tailored interventions

are also needed to reduce smoking

prevalence in specifi c groups and to

level the social gradient in tobacco

use across the Victorian community

by improving the health of the least

advantaged.

High rates of smoking exist in

socio-economically disadvantaged

areas. The 2006 Victorian Population

Health Survey shows that the daily

smoking rate among adults living

in the 40 per cent most socio-

economically disadvantaged areas

was 8 per cent higher than those

living in the 40 per cent most

advantaged areas.

Recent statistics show that 50 per

cent of Aboriginal people in Victoria

are daily smokers, and that this rate

has not declined in ten years (ABS,

2006). Action to reduce smoking

among Aboriginal people should

therefore make a major contribution

to closing the life expectancy gap

within a generation.

2.5 Achieving our ambitionsTo help countries fulfi l the promise

of the World Health Organisation

Framework Convention on Tobacco

Control (FCTC), WHO established

MPOWER, a package of the six most

important and effective tobacco

control policies. These policies are

proven to reduce tobacco use, and

they underpin the action the Victorian

Government will undertake to achieve

the targets of this Strategy, as shown

in the table below.

Most disadvantaged

(Q 1 and 2)

Q 3 and 4 Least disadvantaged

(Q 5)

0%

5%

10%

15%

20%

25%

Pe

r ce

nt

of

daily

sm

oke

rs

IRSED (2006) Quintiles

Figure 3: Daily smokers by socioeconomic status

Source: Victorian Public Health Survey, 2006


Table 1: Key actions of the Victorian Tobacco Control Strategy 2008–2013 mapped against international best practice

MPOWER framework––

international best practice

for tobacco control

Key actions of the Victorian Tobacco Control Strategy

2008–2013

Strategic targets

All

Vic

tori

an

s

Pre

gn

an

cy

Ab

ori

gin

al

Dis

ad

van

taged

Monitor tobacco use and

prevention policies

Quantifi ed smoking prevalence targets ✔ ✔ ✔ ✔

Enhanced data collections for vulnerable groups ✔ ✔ ✔

Protect people from

second-hand tobacco

smoke

Ban smoking in cars carrying children under 18 years of age ✔ ✔

Offer help to quit

tobacco use

Help women quit during pregnancy ✔ ✔ ✔

Improve access to smoking cessation services for Aboriginal and

other high-prevalence groups

✔ ✔

Warn about the dangers

of tobacco

Anti-smoking social marketing ✔ ✔ ✔ ✔

Enforce bans on tobacco

advertising, promotion

and sponsorship

Ban tobacco point-of-sale displays in retail outlets ✔ ✔ ✔ ✔

Review of penalties and tougher enforcement of the Tobacco Act ✔ ✔ ✔ ✔

Ban the sale of tobacco at temporary outlets and provide

Ministerial power to ban youth-orientated tobacco products and

packages, such as fruit-fl avoured cigarettes

✔ ✔ ✔ ✔

Raise taxes on tobacco The Commonwealth Government has jurisdiction over tobacco excises. The National

Preventative Health Taskforce has included increase of tobacco excise and customs duty

in their recent discussion paper Australia: the Healthiest Country by 2020.

3 Key actions


3 Key actions

3.1 Banning tobacco point-of-sale displays in retail outlets

Banning tobacco point-of-sale

displays will reduce the promotion

and advertising of tobacco to

Victorians.

Rationale

Despite bans on tobacco advertising,

cigarettes remain more visible and

more widely available than any

other consumer product in Australia,

including milk and bread (Ministerial

Council on Drug Strategy, 2005).

Point-of-sale displays raise the

profi le of tobacco and create the

impression that cigarettes are far

more popular than is actually the

case. This increases the likelihood

that young people will start smoking,

encourages smokers to buy more

tobacco products and makes it harder

for quitters to stay quit (Wakefi eld et

al., 2007).

In recognition of the fact that a small

number of retail businesses derive

their income solely or signifi cantly

from tobacco products an exemption

from the point-of-sale display

ban will be provided for specialist

tobacconists.

Public consultation found a very

high level of support for such a

ban among members of the public,

health care and non-government

organisations. A complete ban on

these displays would make it easier

for retailers to comply with legislation,

thereby maximising the impact of

legislative reform.

Implementation

The Victorian Government will

introduce a complete ban on tobacco

point-of-sale displays in retail outlets

by 1 January 2011, with an exemption

for specialist tobacconists.

All tobacco retailers will be permitted

to inform customers of the available

products for sale on a price board or

similar prescribed tool, which will be

required to include a graphic health

warning such as those currently

displayed on cigarette packs.

Specialist tobacconists must apply

to the Secretary, Department of

Human Services, for certifi cation

as a specialist tobacconist. To

obtain certifi cation, the specialist

tobacconist must demonstrate the

relevant trading premises derived at

least 80% of its gross turnover in the

preceding 12 months from the sale of

tobacco products.

A person proposing to open a

new specialist tobacconist may

receive certifi cation if the person

demonstrates to the Secretary’s

satisfaction that 80% of the projected

gross turnover at the trading premises

in the fi rst calendar year of operation

will be derived from the sale of

tobacco products.

Additional requirements will include

that the premises are not located

within another retail outlet and are

not a thoroughfare to gain entry to

another retail outlet. The Secretary

will have discretionary provision to

ensure that the business is consistent

with the common understanding of

what a specialist tobacconist is. For

example, a newsstand with very high

tobacco sales would not qualify as

a specialist tobacconist, even if its

gross turnover of tobacco products

was over 80%. The current restriction

to 4 square meters of display area

for tobacco products will continue to

apply. The application and renewal

fees, if any, will be prescribed.

It is not the intention of this

exemption that there should be a

large proliferation in the number of

specialist tobacconists. To monitor

this there will be a review of the

appropriateness of the exemption

12 months after the point-of-sale

changes commence.

Actions of the Strategy1. Banning tobacco point-of-sale displays in retail outlets.

2. Reviewing penalties and tougher enforcement of the Tobacco Act.

3. Supporting families:

a. banning smoking in cars carrying children

b. promoting smoking cessation in pregnancy

c. banning sales of cigarettes from temporary outlets

d. providing the Minister for Health the power to ban tobacco products and

packaging that appeal to young people

e. banning smoking on school grounds.

4. Helping smokers to quit.

5. Promoting anti-smoking social marketing.

6. Setting targets for pregnancy, Aboriginal and other high-prevalence groups.


3.2 Reviewing penalties and tougher enforcement of the Tobacco Act

Rationale

In the 2006–07 fi nancial

year, local councils made

264 enforcement responses to

instances where tobacco laws

were broken.

Controlling the supply and use of

tobacco are key tools for reducing

tobacco-related harm. The Victorian

Government must ensure that those

who sell and distribute tobacco

products do so responsibly.

Public consultation found strong

support for tough enforcement of

and a review of penalties under the

Tobacco Act, and identifi ed a clear

prioritisation of cigarette sales to

minors as the key area for action.

Penalties for not complying with

legislation should be commensurate

with the harm that unrestricted

tobacco use is known to cause. They

also need to be severe enough to

deter people from breaking the law.

Education, information and tough

enforcement are the principal means

for ensuring that retailers, employers,

venue operators and others meet their

responsibilities to control tobacco

sales and use under the Act.

Currently, no distinction exists

between penalties for smoking

offences committed by individuals

and companies. For example, the

maximum penalty of approximately

$500 for smoking in an enclosed

workplace is inadequate to ensure

compliance by companies operating

licensed premises. In comparison, the

Victorian Public Health and Wellbeing

Act 2008 provides penalties fi ve times

greater for body corporates compared

with individuals who commit the

same offence.

Implementation

In order to provide suffi cient

motivation for companies and

individuals to comply with the law, the

Victorian Government will review all

infringement and maximum penalties

under the Tobacco Act. This will

ensure that penalties are consistent

with other Victorian legislation and

the tobacco laws of other Australian

states and territories.

Following this, the Government

will work to ensure that there

are appropriate mechanisms in

place to detect and respond to

non-compliance with the law and,

where appropriate, the Act will be

amended to enable this.

3.3 Supporting familiesHelping families adopt non-smoking

attitudes and behaviours is important.

When parents quit, this not only

improves their health, but it also

reduces the chance their children

will ever start to smoke (Bricker et

al., 2003). Not allowing smoking in

the home reduces the exposure of

children and non-smokers to harmful

environmental tobacco smoke.

3.3.1 Banning smoking in cars carrying children

Rationale

Banning smoking in cars carrying

children under the age of 18 years

will reduce children’s exposure

to second-hand smoke and

encourage adults not to smoke

around children.


There is no risk-free level of second-

hand smoke in confi ned areas such as

cars. Research shows that air quality

in a car with a window partially or

wholly down while a person smokes

is similar to that found in a smoky pub

(Edwards et al., 2006).

Even brief periods of exposure to

second-hand smoke can be harmful

to children, because they are

especially vulnerable to its effects

(US Department of Health and

Human Services, 2006). Scientifi c

studies consistently demonstrate that

children exposed to second-hand

smoke are at an increased risk

of premature death and disease,

including reduced lung function,

increased number and severity of

asthma episodes and increased risk

of lower respiratory tract infections

(Wipfl i et al., 2008).

Public consultation found

overwhelming support for a ban on

smoking in cars carrying children.

Implementation


introduce a ban on smoking in cars

carrying children under the age of

18 years on 1 January 2010.

3.3.2 Promoting smoking cessation in pregnancy

Rationale

In order to reduce the number of

women smoking in pregnancy

and help them quit earlier, an

integrated health promotion program

will be developed. This will give

every pregnant woman in Victoria

information about the dangers of

smoking while pregnant, and provide

support for pregnant women to quit

smoking and stay quit.

Public consultation found a high

level of support for targeted work to

reduce smoking during pregnancy,

highlighting the need for health

professionals to promote messages

about the dangers of smoking to

pregnant women.

Implementation

This initiative will be developed in

partnership with health professionals

and other key stakeholders, guided

and co-ordinated by the Victorian

Tobacco Strategy Taskforce.

Additional work will be undertaken

to develop sustainable smoking

cessation interventions matched

to the needs of pregnant Aboriginal

women and other groups with high

rates of smoking during pregnancy.

Priorities already identifi ed include

the need for improved approaches to

reduce smoking among Aboriginal,

rural and socio-economically

disadvantaged pregnant women and

improved data collection. Room also

exists to improve the volume, quality

and integration of smoking cessation

care provided throughout community,

primary and secondary care services.

3.3.3 Banning sales of cigarettes from temporary outlets

Rationale

The sale of tobacco from

temporary outlets will be banned

in order to protect young people

from exposure to tobacco

marketing.

Tobacco companies market their

products to young people, who

may make the transition from

experimentation to regular smoking,

by using temporary stands offering

cigarettes for sale at major events

such as the Big Day Out (Carter,

2003). It is important to prevent

advertising to this age group as

the majority of smokers make the

transition from experimentation to

regular smoking during their early

twenties (Backinger et al., 2003).

Implementation


introduce a ban on sale of tobacco

from temporary outlets on 1 January

2010. This ban will prohibit sales

of tobacco from outlets except in

circumstances where:

• the operator operates from a

permanent building or structure;

and

• the operator sells cigarettes

throughout their full hours of

operation; and

• the operator is a permanent,

registered business.


3.3.4 Providing the Minister for Health the power to ban tobacco products and packaging that appeal to young people

Rationale

The Victorian Government needs

the ability to respond quickly

to new tobacco products or

packaging designed to promote

smoking, especially those that

target young people.

Recent examples include fruit and

confectionary fl avoured cigarettes,

split-packet cigarettes and

cigarette tins.

In April 2008, the Australian Health

Ministers’ Conference agreed to ban

the sale of fruit-fl avoured cigarettes

at a state level. It was also agreed

that the Commonwealth Government

would investigate banning the

importation of fl avoured cigarettes

into Australia.

The intent of the Tobacco Act

1987 is to prohibit certain sales or

promotion of tobacco products. As

the Act is currently written, additional

amendments are required to ban

tobacco products that fall within the

scope of this intent.

Public consultation found a high level

of support for ministerial power to ban

youth-orientated tobacco products

and packages.

Implementation

The Victorian Government will amend

the Tobacco Act to provide the

Minister for Health with the ability to

ban tobacco products and tobacco

product packaging if it is deemed to

be designed to be appealing and to

promote a tobacco product to young

people. The Minister for Health may

ban products which fulfi l one or more

of the following criteria:

• tobacco products that possess

a distinctive fruit, sweet or

confectionary-like character;

• tobacco products that have

packaging designed to appeal to

young people;

• non-tobacco products designed to

resemble tobacco products; and

• any other product, the nature

and advertising of which might

encourage young people to smoke.

3.3.5 Banning smoking on school grounds

Rationale

Banning smoking on Victorian

Government school grounds

will provide children and young

people with an environment

that is guaranteed to be smoke

free and send a clear message

that a healthy lifestyle does not

include smoking.

Current Victorian Government policy

encourages schools to become

completely smoke-free environments.

The Department of Education and

Early Childhood Development has

drug education resources and

guidelines to help schools achieve

this. Smoking is not permitted

in Victorian Government school

buildings or outdoor enclosed spaces;

however, smoking by adults on school

grounds in unenclosed spaces and

out of view of students is currently

permitted.

Public consultation found a high

level of support for smoke-free

schools, with many respondents

suggesting that education was the

most appropriate way to promote

smoke-free messages to children and

young people.

It will further reinforce the message

that non-smoking is actively

encouraged by the Victorian

Government and help establish

health promoting behaviour among

young people.


Implementation

The Minister for Education will

exercise the power vested in the

Education and Training Reform Act

2006 Section 5.2.6(1) to issue an

Order that will ban smoking on

Victorian Government school grounds.

This ban will include all activities

that take place within the school

boundaries, including, for example,

preschools, kindergartens, out-of-

school-hours care, ovals used by

community sport groups and school

fêtes. The Department of Education

and Early Childhood Development

will support schools to implement the

policy at a local level, and a suitable

timeline for implementation will be

developed.

3.4 Helping smokers to quit––improving cessation services

Rationale

About 7 out of 10 smokers say

they want to quit (Offi ce of

National Statistics, 1997).

The benefi ts of quitting are felt not

just by the smoker, but also by the

children and other family members

around them. For example, the

potential harm from exposure to

second-hand smoke is prevented

when smokers quit, and the chances

of their children starting to smoke

are reduced.

Most smokers quit unaided, but it

usually takes between three and

fourteen attempts before a regular

smoker fi nally stops. Scientifi c

research clearly shows that the

success of individual quit attempts

can be greatly increased by the use

of a variety of smoking cessation aids

and services.

Strong evidence exists that even brief

advice and guidance from health

professionals is a highly cost-effective

way to prompt smokers to quit (Zwar,

2004). This is not because any single

patient–professional interaction will

necessarily result in a quit attempt;

rather, a persistent message from

a number of respected health

professionals gradually increases

the likelihood of quit attempts

(Lancaster, 2004).

Quitline counselling with active

call-back programs can increase

quit rates fourfold to sixfold, and

referrals to Quitline services from

general practice can further enhance

effectiveness (Chapman, 2007).

Existing cessation advice and services

work very effectively. But more work

is required to increase and support

quit attempts among groups where

smoking is much more common than

in the general community.

Supporting the Victorian

Government’s commitments in

A Fairer Victoria, targeting smoking

cessation initiatives to groups with a

high prevalence of smoking will help

reduce health and social inequalities,

and ensure that services are provided

to reach groups that will most benefi t

from them.

Existing Victorian Government

policy recognises that initiatives

to reduce smoking prevalence in

Aboriginal Victorians need to be

culturally sensitive, community

led, build partnerships between

Aboriginal and non-Aboriginal

organisations and build the capacity

of Aboriginal organisations and

workers (Department of Human

Services, 2008). Responses to

public consultation strongly support

this approach and gave widespread

support for continued social

marketing and targeted programs

for groups with a high prevalence

of smoking. Responses highlighted

the importance of initiatives that

encourage smoke-free environments

and improve the capacity of health

and other organisations to support

quit attempts.

Implementation

Little evidence exists regarding

what works to reduce smoking in

Aboriginal and other high-prevalence

communities (Thomas et al., 2008).

National policy on smoking cessationThe National Tobacco Strategy 2004–09

recommends the following ways of

improving services and treatment

for smokers:

• institutionalise treatment in all health

care services

• ensure access to cessation support

for all smokers

• increase the quality of use of

evidence-based pharmacotherapies

• focus on patients at high risk of

immediate harm

• fi nd signifi cantly more effective

means of treating patients––that is,

prevention and harm minimisation.


Therefore, innovative approaches

will need to be developed, along with

tailoring of current, proven initiatives.

The Victorian Government has already

committed over $400,000 to a social

action research project to reduce

smoking in pregnant Aboriginal

women in Victoria. Over the next

three years, the project, to be led by

the Victorian Aboriginal Community

Controlled Health Organisation, will

build the capacity of the Aboriginal

health workforce to assist pregnant

Aboriginal women and young mothers

to quit smoking.

The Victorian Tobacco Strategy

Taskforce will guide and co-ordinate

the development of detailed action

plans with relevant experts and

stakeholders, ensuring a robust

evaluation framework will be put

in place to ensure best practice is

implemented across the state. This

is particularly important to ensure

that the evidence base for effective

interventions is further developed.

Making non-smoking the norm

will require the support and

encouragement of local role

models, including Aboriginal health

workers and community-controlled

organisations, to quit smoking and

become smoke-free. Social marketing

and cessation programs will need

to be tailored to the needs of the


communities. The lessons learned

should be shared so that mainstream

services can provide as high a quality

of care as specialist and community-

controlled organisations.

3.5 Social marketing

Rationale

The three most cost-effective

interventions for reducing

smoking prevalence are taxation,

smoke-free legislation and

anti-smoking social marketing

(Levy, Chlaoupka and Gitchell,

2004).

Social marketing raises community

awareness of the dangers of smoking,

thus helping to reduce the number

of young people taking up the habit

and prompting smokers to quit. One

recent study shows that almost half

of all Victorians who tried to stop

smoking said that anti-smoking

television commercials helped them

to quit—this was more than double the

number who reported a benefi t from

either nicotine replacement therapy

or the advice of health professionals

(Brennan et al., 2007).

Most smokers quit unaided, but

because social marketing prompts

quit attempts, high levels of television

advertising lead to increased numbers

of requests for help to stop smoking.

Social marketing is most effective

when it achieves a specifi c threshold

level of awareness in the target

audience (Wakefi eld et al., 2008). This

can make social marketing a highly

cost-effective means of reducing

smoking prevalence. For example,

evaluation of the Australian National

Tobacco Campaign found that the

$9 million invested in the program was

offset by benefi ts to the health system

of $740.6 million. This investment

was also found to have caused a

1.4 percentage point reduction in

smoking prevalence across Australia

(Hurley and Mathews, 2008).

Public consultation found good

support for continued high levels

of anti-smoking social marketing,

particularly as a tool that, when

appropriately tailored, can help


prompt quit attempts among

pregnant women and other high

prevalence groups.

Implementation

Currently all anti-smoking social

marketing in Victoria is conducted by

Quit Victoria and is partly funded by

the Victorian Government including

a contribution of $7.7 million for the

2006–2010 period.

While these social marketing activities

are likely to be viewed by most

Victorians their placement is targeted

at reaching 18–39 year olds of low

socio-economic status. In addition,

particular advertisements have been

developed in an attempt to target

particular groups of smokers to quit,

the most recent example of which

has been parents of children under

12 years of age. These advertisements

are regularly evaluated to assess

their effectiveness, the results of

which are used to plan future social

marketing activities.

The Victorian Government will ensure

continued investment in social

marketing to maintain population

awareness of the signifi cance of

smoking cessation and to promote

quit attempts. In particular the

priority will be to ensure that

social marketing is focused on the

priorities of supporting families and

increasing quit attempts in Aboriginal,

socio-economically disadvantaged

and pregnant Victorians.

If this is how your child feels after losing you for

a minute... just imagine if they lost you for life.

4 Implementation and

evaluation


4 Implementation and evaluation

A Victorian Tobacco Control Strategy

Taskforce will be convened to lead

delivery of the key strategic actions

outlined above, co-ordinating efforts

and reviewing progress towards

the challenging targets set by the

Strategy. The Taskforce will include

leaders in tobacco control in Victoria.

A detailed implementation plan for

the Strategy will be developed in

consultation with key experts and

organisations. The Taskforce will

oversee the development and delivery

of this plan, ensuring the milestone

achievements of the Strategy are

passed. To do this, it will be important

to measure progress and robustly

evaluate all initiatives undertaken.

4.1 Measuring success The Taskforce will track progress

against the three headline strategic

targets of smoking prevalence among

the whole adult population, antenatal,

and Aboriginal and other high

prevalence groups. This will gauge

important, measurable outcomes

from the Strategy––reductions in the

numbers of people smoking in the

Victorian community.

While we have robust, annual data

to set smoking prevalence targets

at a whole of population level, this is

not the case for smaller population

subgroups such as pregnant women,


groups. The statistics referred to in

these latter targets are based on

the best data currently available for

Victoria. As better data becomes

available, it will be possible to track

progress against these strategic

targets more accurately.

But smoking prevalence is only part

of the story. Reduced exposure to

harmful second-hand smoke is an

important goal. Furthermore, there

are important intermediate steps

before measurable reductions in

prevalence can be achieved. For

example, reducing the number of

cigarettes smoked or making a fi rst

quit attempt can be important steps in

the quitting process.

Intermediate performance indicators

to be monitored by the Taskforce

will be developed of part of the

implementation planning for the

Strategy. These indicators will be

particularly important in assessing

progress where smoking prevalence

data is weak or smoking rates

disproportionately high. In some

high prevalence communities and

settings for instance, simply having

an active smoke-free policy can be an

important indicator of change.

4.2 EvaluationIt is essential that the new legislation

and services to be developed through

the lifetime of the Strategy are

evaluated. This will help ensure the

best possible processes, outputs and

outcomes from the Strategy, enabling

the Taskforce to focus its efforts

towards those interventions that make

the most difference.

Action research will be conducted

to support policies and interventions

that aim to reduce smoking among

Aboriginal and other high prevalence

groups. This means that service

planners, providers and members of

the community themselves will be

involved in an ongoing process of

planning, implementing and reviewing

tobacco control initiatives. The best,

most successful work can then be

replicated and rolled out State-wide.

As a result, Victorian advances

will not only ensure the best

outcomes for Victorians, but also

contribute knowledge to national

and international efforts to reduce

smoking in groups with the

greatest need.


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