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.
Victorian Tobacco Control Strategy 2008–2013 3
2 The challenge ahead
Victorian Tobacco Control Strategy 2008–2013 5
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
6 Victorian Tobacco Control Strategy 2008–2013
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
Victorian Tobacco Control Strategy 2008–2013 7
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
8 Victorian Tobacco Control Strategy 2008–2013
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
Victorian Tobacco Control Strategy 2008–2013 9
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
Victorian Tobacco Control Strategy 2008–2013 11
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.
12 Victorian Tobacco Control Strategy 2008–2013
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.
Victorian Tobacco Control Strategy 2008–2013 13
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
The Victorian Government will
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
The Victorian Government will
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.
14 Victorian Tobacco Control Strategy 2008–2013
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.
Victorian Tobacco Control Strategy 2008–2013 15
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.
16 Victorian Tobacco Control Strategy 2008–2013
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
Aboriginal and other high-prevalence
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
Victorian Tobacco Control Strategy 2008–2013 17
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
Victorian Tobacco Control Strategy 2008–2013 19
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,
Aboriginal and other high-prevalence
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.
20 Victorian Tobacco Control Strategy 2008–2013
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