Rapid Fire Session 2014 World Cancer Congress

Smoking on the Margins: An Equity Analysis of a Municipal Outdoor Smoke-free Policy (#531)

Ann Pederson 1 , Chizimuzo Okoli 2 , Natalie Hemsing 3 , Renee O'Leary 3
  1. BC Women's Hospital + Health Centre, Vancouver, BC, Canada
  2. Nursing, University of Kentucky, Lexington, Kentucky, United States
  3. BC Centre of Excellence for Women's Health, Vancouver, British Columbia, Canada


The City of Vancouver introduced a complete ban on smoking in its parks and recreation facilities and sites, including 220 parks and a dozen beaches, in 2010. This study reports on the introduction of that ban from the perspective of health equity. 



 This study examined three key aspects of the ban in Vancouver and their engagement with issues of health equity: public and official support for the ban; smoking rates before and after implementation; and enforcement.


 Informed by critical multiplism and health equity frameworks, this study combined evidence from nine sources: document review; key informant interviews; field observations; a telephone survey; focus groups with smokers and non-smokers; media analysis; focus groups with enforcement officers; citations for policy infractions; and beach litter data.


 Findings demonstrate that equity issues were not considered during policy formulation or implementation. Although there is evidence of both public and official support for the policy, concern has been expressed that it may be ineffective and unfair.  Observational data suggest that smoking initially declined following the ban, particularly at beaches, but that rates of smoking in the parks vary by location in the city. We also found evidence suggesting differences in both enforcement and compliance between the city’s parks and beaches, and between different populations of park and beach users.

Conclusions: The current smoke-free policy appears uneven in its ability to meet tobacco control’s aims.  Given current smoking prevalence in Vancouver, the ban may be unintentionally increasing health inequities because it appears that the least enforcement of the ban and greatest levels of smoking continue to occur in the least advantaged areas of the city. Jurisdictions considering outdoor smoke-free policies should consider tailored messaging and adequate resource allocation to enhance voluntary compliance and support enforcement to meet both tobacco control and health equity objectives.