Beneficial impacts of a national smokefree environments law on an indigenous population: A multifaceted evaluation

Abstract

Background. Smokefree environments legislation is increasingly being implemented around the world. Evaluations largely find that the legislation is popular, compliance is high and report improved air quality and reduced exposure to secondhand smoke (SHS). The impact of the legislation on disadvantaged groups, including indigenous peoples has not been explored. We present findings from a multifaceted evaluation of the impact of the smokefree workplace provisions of the New Zealand Smokefree Environments Amendment Act on Mori people in New Zealand. Mori are the indigenous people of New Zealand. The Smokefree Environments Amendment Act extended existing smokefree legislation to almost all indoor workplaces in December 2004 (including restaurants and pubs/bars). Methods. Review of existing data and commissioned studies to identify evidence for the evaluation of the new legislation: including attitudes and support for the legislation; stakeholders views about the Act and the implementation process; impact on SHS exposure in workplaces and other settings; and impact on smoking-related behaviours. Results. Support for the legislation was strong among Mori and reached 90% for smokefree restaurants and 84% for smokefree bars by 2006. Mori stakeholders interviewed were mostly supportive of the way the legislation had been introduced. Reported exposure to SHS in workplaces decreased similarly in Mori and non-Mori with 27% of employed adult Mori reporting SHS exposure indoors at work during the previous week in 2003 and 9% in 2006. Exposure to SHS in the home declined, and may have decreased more in Mori households containing one or more smokers. For example, the proportion of 14-15 year old Mori children reporting that smoking occurred in their home fell from 47% in 2001 to 37% in 2007. Similar reductions in socially-cued smoking occurred among Mori and non-Mori. Evidence for the effect on smoking prevalence was mixed. Mori responded to the new law with increased calls to the national Quitline service. Conclusion. The New Zealand Smokefree Environments Amendment Act had a range of positive effects, including reducing SHS exposure among Mori communities. If the experience is replicated in other countries with indigenous populations, it suggests that comprehensive smokefree environments legislation will have beneficial effects on the health of indigenous groups and could contribute to reducing inequalities in health within societies.