Young lungs at play: preventing children's exposure to secondhand smoke in outdoor play areas in a steps to a healthier NY County.

The New York State Clean Indoor Air Act (Public Health Law, Article 13-E) restricts tobacco use at nearly all workplaces including school grounds (1). However, no state regulations exist prohibiting tobacco use in outdoor public areas where children play. Adult smoking negatively impacts children by exposing them to secondhand smoke, increasing their potential to choke or burn themselves with lit cigarette butts, and encouraging a negative health behavior (i.e., by seeing adults smoke) (2). In addition, cigarette butts are the most littered item in the world, causing parks and playgrounds to look dirty and incurring clean-up costs for taxpayers (3). Young Lungs at Play, developed by Steps to a HealthierNY and the Rockland County Division of Environmental Resources, is a successful and easy-to-implement public health campaign that has a substantial impact in the community (4). The goal of the campaign is to encourage local municipalities and organizations to pass regulations banning smoking in outdoor places where children play and to post signs referencing the Young Lungs at Play campaign in these tobacco-free areas. Another goal of this initiative is to increase the visibility of public health prevention and antismoking messages through the large, appealing signs posted in tobacco-free areas. The campaign has been successful in meeting its goals in many communities and has generated interest among additional organizations and municipalities in creating tobacco-free outdoor play spaces. The campaign addresses factors contributing to smoking on multiple levels of the socioecological model, including political, interpersonal, and environmental factors. In studying the successes of similar initiatives around the nation, we found that, to be most effective, municipalities must agree to adopt formal laws, ordinances, policies, or resolutions. Young Lungs at Play seeks to address interpersonal factors leading to children's beginning to smoke by changing community norms about smoking and by limiting children's exposure to adults who smoke. It also strives to provide an environment free from smoke and discarded cigarette butts and to increase antismoking messages in the environment through the posting of Young Lungs at Play signs throughout the community. This article describes the implementation of Young Lungs at Play in Rockland County, New York, a geographically small, suburban county outside of New York City. Rockland County is one of four New York State counties receiving funds from Steps to a HealthierUS, an initiative of the United States Department of Health and Human Services administered by the Centers for Disease Control and Prevention (5). Steps to a HealthierNY is an innovative chronic disease prevention program that employs a community-based and integrated approach to improving physical inactivity, poor nutrition, and tobacco-use prevention to reduce the burden of obesity, diabetes, and asthma. The smoking rate in Rockland County is 14.1% (6), significantly lower than the state's rate of 20.5% and only slightly above the Healthy People 2010 target of 12.0% (7). However, the population of Rockland County is diverse, and data suggest that large disparities in smoking rates exist within the county (8). The approach to reducing environmental exposure to tobacco used in the Young Lungs at Play campaign is likely to be well-accepted, regardless of the current attitudes toward smoking in a community, as the best way to begin changing attitudes and norms regarding smoking in places where children are affected. The campaign has now been implemented in three other New York counties with much higher smoking rates and differing attitudes toward smoking. In addition, The Community Survey conducted in Rockland County in May of 2006 showed that, even among respondents who smoke, the majority (51%) indicated they would support a ban on smoking in outdoor places where children play, whereas only a third (36%) of respondents who smoke indicated they would support a ban on smoking in other outdoor public areas (8). The total cost of the Young Lungs at Play initiative to date is approximately $18,000, of which partnering organizations contributed $11,843. The money invested in the program resulted in the posting of 449 signs indicating tobacco-free zones in 148 outdoor play areas, including municipal play areas (e.g., parks, pools, ball fields), schools, childcare centers, faith-based organizations, day camps, and housing complexes. The program was first implemented countywide in June of 2006 and is ongoing. The program steps are listed in the Table and described here in detail for other communities that want to implement Young Lungs at Play. Steps to Implementing Young Lungs at Play, Rockland County, New York, June 2006 Step 1: Assessing community interest The first step is to assess community interest in regulation that prohibits smoking in outdoor public spaces where children play, such as playgrounds, fields, and parks. To determine the community's readiness to participate in the initiative and persuade municipalities to participate, some form of survey or focus group should be conducted. The Community Survey has been conducted annually since 2001 via telephone by the Rockland County Department of Health using CATI (Computer Aided Technology, Inc, Buffalo Grove, Illinois) to track attitudes, knowledge, and smoking behaviors. The interviews last approximately 11 minutes and are conducted in English and Spanish. A cross-section sample of 1000 households in Rockland County, New York, is generated using a random-digit–dial method, and participants are interviewed by members of a professional survey research and marketing company.  The results of the Community Survey conducted in 2006 suggested that the majority of county residents were in favor of outdoor smoking bans, particularly in places where children play (8). Selected data from the survey showed that 96.5% of people surveyed indicated that they thought secondhand smoke is harmful; 68.8% of people surveyed supported regulation that prohibits smoking in outdoor public spaces where children play, such as playgrounds, fields, and parks; 56.3% of respondents indicated they would support regulation that prohibits smoking in other outdoor public spaces, such as walking trails, pools, or picnic areas. Step 2: Involving policy makers and community members The second step of implementing the program is to invite policy makers to participate and to provide education about the harmful effects of smoking in places where children play. Attending a town or village board meeting would be helpful, as would providing decision makers with a sample tobacco-free park resolution (9). Educate decision makers about the negative effects of adults smoking in places where children play, and let them know that discarded cigarettes cost taxpayers money (3); children who see adults smoking in family-friendly places, such as parks and playgrounds, view the behavior as acceptable (9); the community supports legislation prohibiting smoking in outdoor spaces. Invitational materials should also describe the other benefits municipalities would receive by participating in the program. These materials include educational brochures, free signage to let residents know about the tobacco-free play areas, and public recognition through the media. For people interested in promoting the tobacco-free areas, staff from the health department can provide a community awareness event for residents.