SECOND OPINION:We must be careful to avoid the 'forbidden fruit' syndrome, writes JACKY JONES
MINISTER FOR Health James Reilly may ban smoking in cars when children are present. This is an obnoxious habit and an image comes to mind of children in their car seats being smoked like kippers, particularly on long journeys.
There is no risk-free exposure to second-hand smoke and children are more vulnerable in confined spaces, but banning smoking in cars may be a step too far.
Regulation is a very useful tool of public health policy and Ireland is a world leader in relation to tobacco legislation. The ban on smoking in public places has been a major success and a recent report from the Office for Tobacco Control on the removal of “point of sale” tobacco promotion has had a big effect on young people.
Ireland is the first country in the EU to introduce this legislation and, as a result, the percentage of young people who believe children their own age smoke, decreased from 62 to 46 per cent. Recall of tobacco displays has reduced from 81 to 22 per cent.
These findings mean that smoking is being de-normalised, which is an important step in making Ireland a tobacco-free society. Children now go into shops and are not confronted with the idea that buying cigarettes is as normal as buying milk or eggs.
The smoking ban has also had a significant impact on smoking in the home. A 2006 survey showed that the proportion of households where smoking is not allowed anywhere in the home increased from 42 to 50 per cent following the ban.
Legislation does work but it has to be used sparingly or it can be seen as hectoring and “nanny state” by the public. It may then have the opposite effect to what is intended, where more people engage in the banned behaviour or the “forbidden fruit” syndrome.
The 2006 survey also asked about smoking behaviours in cars. Significantly more smokers (58 per cent) allowed people to smoke in their cars compared to non-smokers (13 per cent). However, 91 per cent do not allow smoking in their car when children are present.
Since the vast majority of people are already behaving appropriately when children are around, we need to ask whether we need more tobacco legislation or is there something else that might work just as well.
A report last month from the British House of Lords describes the different types of interventions that are used by governments around the world to influence human behaviour while avoiding harmful side effects.
First, governments can regulate individuals by eliminating or restricting choice, for example banning smoking in public places. They can also use fiscal incentives and disincentives such as tax breaks on bicycles or car congestion charges, to encourage people to cycle and walk more or use public transport.
Non-fiscal measures are also widely used by governments such as allowing breastfeeding breaks or using persuasion such as the “Quit Smoking” or “Stop the Spread” obesity campaigns.
“Nudge” techniques and choice architecture are increasingly being used. Nudges do not forbid any options but change the environment within which people make choices, often in ways that are not even noticed. Examples of nudges are putting fruit and vegetables at eye level in shops and canteens, and designing buildings with fewer lifts.
The most important finding in the House of Lords report is that, although there are many ways of intervening to change behaviour, these are often not used appropriately or are not based on scientific evidence. For example, the evidence shows that the traffic light colour-coded system of food labelling is better understood than others, yet this was recently voted down by the EU because of intense lobbying by the food industry.
Smoking in cars has a safety dimension, which is an additional reason for a ban, but how would it be policed? Fiscal incentives may be more effective, for example fitting all cars with a smoke detection device and non-smoking cars could be given a higher trade-in value subsidised by government.
We need to do our research before introducing more tobacco regulation as we have a lot already and people are obeying the law. Any additional legislation might be seen as provocative and could undo the good work already in relation to smoking.
Dr Jacky Jones is a former regional manager of health promotion with the HSE