Summary
This section describes the application of the evaluation approach described in section 1 to the evaluation of the SEAA (2003).
Objectives and guiding principles for the legislation were identified from the Act and other key documentary sources. The main aim of the aspects of the SEAA (2003) that are the subject of this evaluation, was to reduce SHS exposure among the workforce in indoor
workplaces, by extending protection to workers still exposed to SHS in these settings after the SEA (1990).
Key guiding principles identified were firstly that the SEAA (2003) should promote equity in health by improving health among groups disproportionately affected by tobacco smoking and SHS exposure, such as Māori, Pacific peoples, and low income groups. Secondly, policies should be congruent with the principles and provisions of the Treaty of Waitangi, including Māori participation, active protection of Māori interests and participation of Māori
organisations.
The Centers for Disease Control model for the evaluation of smokefree legislation and polices was adapted to the New Zealand context, and used to develop a logic model to underpin the evaluation, and the following information areas for the core process measures, and core (direct, anticipated) and non-core (indirect, possible) outcomes:
Process evaluation:
• Knowledge, attitudes and support for smokefree policies (core)
• Enforcement and compliance with smokefree policies (core)
Outcome evaluation:
• Reductions in exposure to SHS in the workplace (core, and principal outcome measure)
• Reductions in exposure to SHS in public places and private places such as homes (non- core)
• Reductions in health impacts due to active smoking and SHS exposure (core)
• Changes in smoking prevalence and smoking-related behaviours (non-core)
4.1. Identification of objectives and guiding principles of the
smokefree provisions of the 2003 Amendment
The SEA (1990) and the SEAA (2003) include three main objectives:
1. To prevent the detrimental effect of other people’s smoking on the health of people in workplaces, or in certain public enclosed public areas, who do not smoke or do not wish to smoke there.
2. To prevent young people who are being taught or cared for in registered schools or early childhood centres from being influenced by seeing other people smoke there
3. To prevent the detrimental effect of others’ smoking on the health of young people who are being taught or cared for in registered schools or early childhood centres
The second and third objectives largely concern the impact of making schools and early learning centres completely smokefree. There is little further detail in the Acts about the objectives and guiding principles behind the SEA (1990) and subsequent SEAA (2003). Since the 2003 Amendment involved the extension of the provisions on smokefree workplaces and public places in the 1990 Act, it is reasonable to assume that the main short to medium term objective of the SEAA (2003) was: to reduce SHS exposure among the workforce in indoor workplaces, by extending protection to workers still exposed to SHS in these settings after the SEA (1990).
However, this revised objective for the SEAA (2003) describes only one facet of the
objectives which could be reasonably attributed to the extension of the smokefree provisions in the SEAA (2003), and does not give the underlying principles and values. We therefore used documents from the New Zealand Ministry of Health, and other key documents such as the Health Select Committee report, supplemented where necessary by evaluation reports and studies from the international literature to determine a range of objectives, guiding values and principles, and to develop a logic model to guide the evaluation process.
Key documents accessed to identify process and outcome objectives included the five year plan for tobacco control in New Zealand, (Ministry of Health, 2005a) the Health Committee report on the SEAA (2003), (Health Committee of New Zealand Parliament, 2003) and the Ministry’s Anniversary report describing the impact of the smokefree legislation after nine
months. (Ministry of Health, 2005b) Guiding principles and values were identified from documents including: The Five Year plan for Tobacco Control in New Zealand; (Ministry of Health, 2005a) The New Zealand Health Strategy; (Ministry of Health, 2000) The New Zealand Cancer Control Strategy; (Ministry of Health, 2003b) Māori Tobacco Control Strategy; (Ministry of Health, 2003a) He Korowai Oranga, the Māori Health Strategy; (Ministry of Health, 2002) and the Health Committee report into the Smoke-free
Environments Amendment Bill. (Health Committee of New Zealand Parliament, 2003) Guiding principles identified were firstly that the SEAA (2003) should promote equity in health and reduce disparities in health, by improving health among groups disproportionately affected by tobacco smoking and SHS exposure, such as Māori, Pacific peoples, and low income groups. Secondly, policies should be congruent with the principles and provisions of the Treaty of Waitangi, by ensuring Māori participation, active protection of Māori interests and participation of Māori organisations in policy development and implementation.
4.2. Development of a logic model for evaluation of the Smoke-free
Environments Amendment Act
The CDC logic model approach to programme evaluation (MacDonald et al., 2001) and goals and indicators for evaluating smokefree policy interventions (Starr et al., 2005a, 2005b) were adapted to develop a logic model for the evaluation of the SEAA (2003) (figure 4.2.1). The logic model was also informed by a logic model used for the evaluation of the smokefree legislation in Scotland, (Haw et al., 2006) and by the objectives and guiding principles we had identified for the SEAA (2003).
The logic model distinguishes process and outcome related indicators. Process indicators include activities and outputs. Outcomes are described in the sequence in which they are expected to occur. They are differentiated into core outcomes which are the direct, anticipated outcomes (solid black boxes) which relate to the main objectives of the legislation; and non- core outcomes which are indirect, possible outcomes (dashed purple boxes) which relate to secondary objectives. The non-core outcomes are particularly likely to be affected by multiple other determinants. For simplicity, the logic model excludes possible indirect economic outcomes, though these have been incorporated into the evaluation as non-core outcomes.
Figure 4.2.1 Logic model for evaluation of the 2003 Smoke-free Environments Amendment Act