Smoke-free laws

As a consequence of the health risks associated with second-hand smoke, smoke-free regulations in indoor public places, including restaurants, cafes, and nightclubs have been introduced in a number of jurisdictions, at national or local level, as well as some outdoor open areas. 1 Ireland was the first country in the world to institute an comprehensive national smoke-free law on smoking in all indoor workplaces on 29 March 2004. Since then, many others have followed suit. The countries which have ratified the WHO Framework Convention on Tobacco Control (FCTC) have a legal obligation to implement effective legislation "for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places." (Article 8 of the FCTC) The parties to the FCTC have further adopted Guidelines on the Protection from Exposure to Second-hand Smoke which state that "effective measures to provide protection from exposure to tobacco smoke ... require the total elimination of smoking and tobacco smoke in a particular space or environment in order to create a 100% smoke-free environment."[161] Opinion polls have shown considerable support for smoke-free laws. In June 2007, a survey of 15 countries found 80% approval for smoke-free laws.[162] A survey in France, reputedly a nation of smokers, showed 70% support.[72] Effects In the first 18 months after the town of Pueblo, Colorado enacted a smoke-free law in 2003, hospital admissions for heart attacks dropped 27%. Admissions in neighbouring towns without smoke-free laws showed no change, and the decline in heart attacks in Pueblo was attributed to the resulting reduction in second-hand smoke exposure.[163] In April, 2010 the Canadian Medical Association Journal published a study evaluating the effects of a 10-year, three-stage smoke-free regulatory programme in Toronto. The study found that during the implementation of a restaurant smoke-free ordinance, hospital admissions for cardiovascular conditions declined by 39%, and admissions for respiratory conditions declined by 33%. No significant reductions in hospital admissions occurred in other cities which did not have smoke-free ordinances. The authors concluded that the study justified further efforts to reduce public exposure to tobacco smoke. In May 2006, Ontario instituted a comprehensive province-wide smoke-free law which extended the restrictions to all cities and municipalities in Ontario.[164] However, not all researchers agree that this was a causal relationship, and a 2009 study of many smoke-free ordinances in the United States disagreed with these conclusions.[165] In 2001, a systematic review for the Guide to Community Preventative Services acknowledged strong evidence of the effectiveness of smoke-free policies and restrictions in reducing expose to second-hand smoke. A follow up to this review, identified the evidence on which the effectiveness of smoking bans reduced the prevalence of tobacco use. Articles published until 2005, were examined to further support this evidence. The examined studies provided sufficient evidence that smoke-free policies reduce tobacco use among workers when implemented in orksites or by communities.[166] While a number of studies funded by the tobacco industry have claimed a negative economic impact from smoke-free laws, no independently funded research has shown any such impact. A 2003 review reported that independently funded, methodologically sound research consistently found either no economic impact or a positive impact from smoke-free laws.[167] Air nicotine levels were measured in Guatemalan bars and restaurants before and after an implemented smoke-free law in 2009. Nicotine concentrations significantly decreased in both the bars and restaurants measured. Also, the employees support for a smoke-free workplace substantially increased in the post-implementation survey compared to pre-implementation survey. The result of this smoke-free law provides a considerably more healthy work environment for the staff.[168] Public opinion Recent surveys taken by the Society for Research on Nicotine and Tobacco demonstrates supportive attitudes of the public, towards smoke-free policies in outdoor areas. A vast majority of the public supports restricting smoking in various outdoor settings. The respondents reasons for supporting the polices were for varying reasons such as, litter control, establishing positive smoke-free role models for youth, reducing youth opportunities to smoke, and avoiding exposure to secondhand smoke.[169] Alternative forms Alternatives to smoke-free laws have also been proposed as a means of harm reduction, particularly in bars and restaurants. For example, critics of smoke-free laws cite studies suggesting ventilation as a means of reducing tobacco smoke pollutants and improving air quality.[170] Ventilation has also been heavily promoted by the tobacco industry as an alternative to outright bans, via a network of ostensibly independent experts with often undisclosed ties to the industry.[171] However, not all critics have connections to the industry. The American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) officially concluded in 2005 that while completely isolated smoking rooms do eliminate the risk to nearby non-smoking areas, smoking bans are the only means of completely eliminating health risks associated with indoor exposure. They further concluded that no system of dilution or cleaning was effective at eliminating risk.[172] The U.S. Surgeon General and the European Commission Joint Research Centre have reached similar conclusions.[154][173] The implementation guidelines for the WHO Framework Convention on Tobacco Control states that engineering approaches, such as ventilation, are ineffective and do not protect against second-hand smoke exposure.[161] However, this does not necessarily mean that such measures are useless in reducing harm, only that they fall short of the goal of reducing exposure completely to zero. Others have suggested a system of tradable smoking pollution permits, similar to the cap-and-trade pollution permits systems used by the Environmental Protection Agency in recent decades to curb other types of pollution.[174] This would guarantee that a portion of bars/restaurants in a jurisdiction will be smoke free, while leaving the decision to the market.