Journal of Public Health Advance Access originally published online on September 3, 2007
Journal of Public Health 2007 29(4):376-378; doi:10.1093/pubmed/fdm056
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Impact of socioeconomic deprivation and type of facility on perceptions of the Scottish smoke-free legislation
Lorna Richmond
Environmental Health Officer, East Ayrshire Council Environmental Health Section, Western Road, Kilmarnock, Ayrshire, KA3 1LL, UK
Sally Haw
Principal Public Health Adviser, NHS Health Scotland, Rosebery House, 9 Haymarket Terrace, Edinburgh, EH12 5EZ, UK
Jill P. Pell
Professor of Epidemiology, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, 126 University Place, Glasgow G12 8TA, UK
E-mail: jill.pell{at}clinmed.gla.ac.uk
The Smoking, Health and Social Care (Scotland) Act 2005 prohibited smoking in all wholly and substantially enclosed public places in Scotland from 26 March 2006. The Act requires owners and managers to take ‘all reasonable precautions’ to prevent smoking and to maintain written records of breaches. The hospitality sector expressed concerns that a total ban might be difficult to enforce and adversely affect business.1 One year post-legislation, we administered a structured questionnaire, by telephone, to the managers of all non-food-serving bars and unlicensed cafés in East Ayrshire, Scotland, to determine perceptions of the legislation and its impact on business, and whether these varied according to whether facilities served food and alcohol, and by the deprivation category of their location.
Of the 73 non-food-serving bars and 94 unlicensed cafés, 69 (95%) and 91 (96%) respectively, participated. After implementation, 81 (50%) managers supported the ban and 82 (51%) reported that most or all customers were supportive. One hundred and twenty (76%) managers had received one or more complaints from customers. Seventy (44%) managers reported an adverse effect on business, but 50 (31%) reported that business had improved. Following the ban, customer support was higher in cafés than in bars (
2 test, P = 0.026). Sixty four (94%) non-food-serving bars had received customer complaints, compared with only 56 (62%) unlicensed cafés (2 test, P < 0.001). Fourteen (20%) bar managers reported an improvement in business and 33 (45%) a decline. This compared with 36 (40%) and 37 (41%) café managers respectively (2 test for trend, P < 0.001). After adjustment for deprivation category and the smoking status of the respondent, café managers were still more likely to report customer support (OR 4.00, 95% CI 1.82–8.33, P < 0.001) and improvements in business (OR 3.21, 95% CI 1.54–6.70, P = 0.002), and were significantly less likely to have received customer complaints (OR 0.03, 95% CI 0.01–0.12, P < 0.001) (Table 1). Managers working in deprived areas were less likely to support the ban (2 test, P < 0.001), more likely to report a decline in business and less likely to report improvements in business (2 test for trend, P < 0.001). In deprived areas, customer support was lower (2 test, P < 0.001) and complaints were more common (2 test, P < 0.001). After adjustment for the type of facility and smoking status of the respondent, managers working in deprived areas were still more likely to report customer complaints (OR 2.38, 95% CI 1.46–3.88, P = 0.001), less likely to report customer support (OR 0.45, 95% CI 0.33–0.61, P < 0.001) and less likely to report an improvement in business (OR 0.56, 95% CI 0.42–1.75, P < 0.001) (Table 1).
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Semple et al. have demonstrated a 91% overall reduction in particulate matter <2.5 µm in diameter in bars 2 months after implementation of the Scottish smoking ban,2 indicating very high early compliance overall. Studies from other countries suggest that, over the 4 years following smoke-free legislation, acceptance among bar-workers and patrons increases, and non-compliance falls.3–7 However, information has been lacking on whether patterns vary by socioeconomic factors. People living in deprived areas have greater exposure to second-hand smoke, both in public places and at work,8–11 which may contribute to health inequalities.10,11 Public houses and bars located in deprived areas are less likely to serve food.12,13 In the absence of legislation, they are more likely to allow unrestricted smoking12,13 and have a level of second-hand smoke twice that in affluent areas.8 Comprehensive smoke-free legislation, if effective, could not only produce health gain but also reduce health inequalities. However, our results suggest that smoke-free legislation is less well received in non-food-serving bars and deprived areas. If monitoring and enforcement measures are not tailored to accommodate these differences, health inequalities may not reduce, or may even increase. Longer-term studies are required to determine whether the different views held by patrons in affluent and deprived areas converge over time, and to determine the impact of smoke-free legislation on health inequalities.
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