Informing outdoor smokefree policy: Methods for measuring the proportion of people smoking in outdoor public areas George Thomson n , Marie Russell, Gabrielle Jenkin, Vimal Patel, Nick Wilson University of Otago, Wellington Mein St, Wellington, New Zealand article info Article history: Received 21 September 2012 Received in revised form 10 November 2012 Accepted 28 November 2012 Available online 7 December 2012 Keywords: Observation methods Smokefree outdoor policy Smoking prevalence abstract Introduction: To advance the design and implementation of outdoor smokefree area policies, we aimed to develop simple, low-cost methods for measuring smoking in a variety of public places. Methods: Two methods were developed and were used by solo observers during March 2011–February 2012 to measure the proportion of people smoking at a variety of sites. Results: Both methods performed well (n ¼5553 people observed); the first at 58 sites in the UK and New Zealand (n ¼3191 observed); the second at 33 sites in New Zealand (n ¼2362 observed), with significant differences found between the smoking at types of sites and between countries. For the two countries combined, the proportions of people smoking (amongst those over 12 years) in children’s play areas was significantly lower compared to all the other sites combined (risk ratio ¼0.39; 95%CI: 0.20 to 0.76; p ¼0.002). Conclusions: Solo observers can establish the proportion of people smoking in a range of outdoor sites. Such methods can inform outdoor smokefree area policymaking by providing baseline and post-policy data to enable location targeting and policy evaluation. & 2012 Elsevier Ltd. All rights reserved. 1. Background There has been an international increase in smokefree outdoor area policies over the last ten years (Thomson et al., 2009; American Nonsmokers’ Rights Foundation, 2011; Ueda et al., 2011; New South Wales Parliament, 2012). The drivers for the increase include the denormalisation of smoking to protect health, reducing nuisance effects, reducing littering, fire risk and improving the image of localities (Klein et al., 2007; Tay and Thomson, 2008; Klein et al., 2012; Russell et al., 2012). Denorma- lisation may help smokers who are trying to quit and those who have recently quit, and reduce the example of smoking to children (Thomson et al., 2008). Perceptions of smoking acceptability appear to increase with smoking visibility (Alesci et al., 2003) and visibility may be a risk factor for smoking (Eisenberg and Forster, 2003). The US Surgeon General reports that ‘changes in smokefree policies and norms are effective in reducing the initiation, prevalence, and intensity of smoking among youth and young adults’ (U.S. Department of Health and Human Services, 2012). However, there has been little research on the proportion of people smoking in outdoor areas, and particularly in densely populated pedestrian areas such as shopping streets. While survey data can give some indication of the places and frequency of where people smoke outdoors in public places, observation has advantages. The behaviour in question can be measured for specific places, and the method avoids recall and social desirability bias (Bailey, 2007) although other biases need to be considered (Petticrew et al., 2007). Observational fieldwork methods have been used in New Zealand, Australia, North America and England to assess smoking in outdoor or semi-open areas. In New Zealand, data were collected: for parks in Upper Hutt (Stevenson et al., 2008), Opotiki (Toi Te Ora, 2008), Rotorua (Toi Te Ora Public Health Service, 2009), and for streets in the Wellington Region (Parry et al., 2011; Wilson et al., 2011; Patel et al., 2012). In Australia studies have included: stadia (Pikora et al., 1999; Giles-Corti et al., 2001), hospital grounds (Nagle et al., 1996), and alfresco dining/drinking areas (Brennan et al., 2010; Cameron et al., 2010; Stafford et al., 2010). Elsewhere, studies have observed areas near doorways in Toronto, Canada (Kaufman et al., 2010), university campuses in the USA (Harris et al., 2009; Fallin, 2011), parks in New York (Johns et al., 2012), and street settings in Newcastle upon Tyne in England (Nettle, 2010). For one of the studies the observational data were principally to provide context for air quality measure- ments, so only observed the number of smoking instances (Stafford et al., 2010). In another study, the number of patrons and people smoking in the outdoor areas of bars appears to have been collected, but not published (Cameron et al., 2010). The observation methods used in such research have included a static visual scan by a stationary observer of the area of interest every Contents lists available at SciVerse ScienceDirect journal homepage: www.elsevier.com/locate/healthplace Health & Place 1353-8292/$ - see front matter & 2012 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.healthplace.2012.11.006 n Corresponding author. Tel.: þ64 4 918 6954; fax: þ64 4 389 5319. E-mail addresses: george.thomson@otago.ac.nz (G. Thomson), marie.russell@otago.ac.nz (M. Russell), gabrielle.jenkin@otago.ac.nz (G. Jenkin), vimal.patel@otago.ac.nz (V. Patel), nick.wilson@otago.ac.nz (N. Wilson). Health & Place 20 (2013) 19–24