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Secondhand Smoke and
Legislating Clean Indoor Air
Jonathan Samet, MD, MS
Heather Wipfli, MA
Institute for Global Tobacco Control
Johns Hopkins Bloomberg School of Public Health
Section A
SHS and the Health Effects of Passive Smoking
Definition of SHS and Passive Smoking
„
SHS
− Mixture of sidestream smoke released by the
smoldering cigarette and the mainstream
smoke that is exhaled by the smoke
„
Passive Smoking
− Inhalation of tobacco smoke by nonsmokers.
Also referred to as involuntary smoking
4
SHS or ETS?
„
Some Terminology
− Active smoking
− Passive smoking
− Involuntary smoking
„
SHS or ETS
− SHS preferred
− ETS originated with industry
5
Some Selected Contents of SHS
„
Irritants and Toxicants
− Ammonia, formaldehyde, carbon monoxide,
nicotine, toluene, nitrogen dioxide, hydrogen
cyanide, acrolein, acetaldehyde
„
Carcinogens
− Benzo[a]pyrene, 2-napthylamine, 4aminobiphenyl, benzene, vinyl chloride, arsenic,
chromium, polonium-210
6
Where SHS Exposure Occurs
„
Homes, workplaces, transportation, public places
„
Exposure varies with time-activity pattern
„
Exposure in multiple locations adds up to total
personal exposure
7
Personal Exposure to CO across a Day
Source: Klepeis, N.E. 1999. An Introduction to the Indirect Exposure Assessment Approach: Modeling Human Exposure
Using Microenvironmental Measurements and the Recent National Human Activity Pattern Survey. Environmental Health
Perspectives Supplements 107 (S2).
8
CO and RSP Measured in a Smoky Bar/Restaurant
Source: Klepeis, N.E. 1999. An Introduction to the Indirect Exposure Assessment Approach: Modeling Human Exposure
Using Microenvironmental Measurements and the Recent National Human Activity Pattern Survey. Environmental Health
Perspectives Supplements 107 (S2).
9
Time Spent in Location
Other, indoor
226
Bar/restaurant
112
School/public bldg.
284
Mall/store
119
Other, outdoor
199
Near vehicle
The 24-hour average time NHAPS
respondents spent in each location
78
95
In vehicle
Residential, outdoors
156
996
Residential, indoors
0
200
400
600
800
1000
1200
24-Hour Average Duration (minutes)
Data source: Klepeis, N.E. 1999. An Introduction to the Indirect Exposure Assessment Approach: Modeling Human
Exposure Using Microenvironmental Measurements and the Recent National Human Activity Pattern Survey. Environmental
10
Health Perspectives Supplements 107 (S2).
Exposure to SHS in Each Location
The 24-hour average time NHAPS respondents spent exposed to SHS in each location
Other, indoor
255
Bar/restaurant
143
School/public bldg.
249
Mall/store
198
Office/factory
363
Other, outdoor
247
Near vehicle
160
In vehicle
79
Residential, outdoor
178
Residential, indoor
305
0
50
100
150
200
250
300
350
400
24-Hour Average Duration (minutes)
Data source: Klepeis, N.E. 1999. An Introduction to the Indirect Exposure Assessment Approach: Modeling Human
Exposure Using Microenvironmental Measurements and the Recent National Human Activity Pattern Survey.
Environmental Health Perspectives Supplements 107 (S2).
11
Exposure to SHS in Each Location
Other, indoor
6
Bar/restaurant
22.7
School/public bldg.
5.8
Mall/store
The percentage of NHAPS respondents
exposed to SHS in each location
6.6
9.9
Office/factory
Other, outdoor
8.3
Near vehicle
10
In vehicle
33.1
Residential, outdoors
10.4
58.3
Residential, indoors
0
10
20
30
40
50
60
70
Percentage of Respondents
Data source: Klepeis, N.E. 1999. An Introduction to the Indirect Exposure Assessment Approach: Modeling Human
Exposure Using Microenvironmental Measurements and the Recent National Human Activity Pattern Survey.
Environmental Health Perspectives Supplements 107 (S2).
12
Section B
Health Effects of Passive Smoking
Health Effects of Passive Smoking
„
SHS is tobacco smoke—tobacco smoke kills
− Similar irritants, toxicants, and carcinogens found
in SS and MS
− No evidence of a threshold dose for health effects
of active smoking, e.g., lung cancer
− Biomarkers of tobacco smoke, such as cotinine,
show that SHS is taken up by nonsmokers
− Epidemiologic studies provide evidence that SHS
causes diseases in children and adults
14
Scientific Evidence That SHS Kills
Initial epidemiological investigations reported in the
late 1960s focused on parental smoking and illness in
children
Standardised mortality rate for lung cancer
per 100,000
„
Cigarette
smokers
32-79
30
Non smoker
Familial passive
smoking (+)
15-50
20
10
Non smoker
Familial passive
smoking (-)
8-70
Total
108,905
0
21895
69645
17366
Population at enrollment
(Non smoker
wives of non
smoker husbands)
(Non smoker
wives of husbands
with smoking
habits)
(Women with
smoking habits)
Data source: Hirayama T. 1981. Non-smoking
wives of heavy smokers have a higher risk of lung
cancer: a study from Japan. BMJ 282:183–5
Continued
15
Scientific Evidence That SHS Kills
„
First major studies on lung cancer reported in
1981 from Japan and Greece
Hirayama T. 1990 Life-Style and Mortality: a LargeScale Census-Based Cohort Study in Japan (Vol)6
(Contributions to Epidemiology and Biostatistics)
Basel: Karger.
Trichopoulos D, Kalandidi A, Sparros L, MacMahon B.
Lung cancer and passive smoking. Int J Cancer. 1981
Jan 15;27(1):1-4.
Notes: Hirayama. (1981); Trichopoulos et al. (1981).
16
BMJ Letters Concerning the Hirayama Study
„
„
„
„
Misclassification
− Active smoking
− Passive smoking
Confounding
Statistical error
Plausibility
17
Statistical Error?
„
“Error Invalidates Japanese Smoking Study, Experts Say”
„
“Independent statisticians have confirmed a fundamental
arithmetical error which invalidates the claim in a widely publicized
Japanese study that environmental cigarette smoke is associated
with lung cancer in non-smokers.”
„
“One of the authorities who found the error is Professor Nathan
Mantel of the George Washington University Biostatistics Center. He
is co-author of the statistical test which was used in the Japanese
study, and in which the arithmetical error occurred.”
Source: Tobacco Observer. (1981).
18
1986 Surgeon General’s Report
Former U.S. Surgeon General
C. Everett Koop, M.D.
Photo source: http://profiles.nlm.nih.gov/QQ/B/B/D/M/
accessed 1/3/06
Source: 1986 Surgeon General’s Report
http://www.cdc.gov/tobacco/sgr/sgr_1986/
accessed 1/3/06
19
1986: Three Key Reports
„
„
„
Evaluation of the Carcinogenic Risk of Chemicals to
Humans: Tobacco Smoking
The Health Consequences of Involuntary Smoking
Environmental Tobacco Smoke
• International Agency for Research on Cancer, Tobacco smoking, in IARC
monographs on the evaluation of the carcinogenic risk of chemicals to
humans. 1986, IARC: Lyon. p. 127-35.
• US Department of Health and Human Services (1986). The Health
Consequences of Involuntary Smoking: A Report of the Surgeon General.
Washington, DC, US Department of Health and Human Services.
• National Research Council. Board on Environmental Studies and Toxicology.
Committee on Passive Smoking (1986). Environmental Tobacco Smoke.
Measuring Exposures and Assessing Health Effects. Washington, DC, National
Academy Press.
20
1992 EPA Risk Assessment
Health effects of passive
smoking: Assessment of lung
cancer in adults and respiratory
disorders in children. U.S. EPA.
May 1990
„
„
„
„
Based on meta-analysis of 31 studies
Extensively criticized by the tobacco industry
Federal court decision around methods
Policy implications key
21
IARC 2002
“Involuntary smoking
(exposure to secondhand or 'environmental’
tobacco smoke)
is carcinogenic
to humans.”
22
Image source: http://www.who.int/bookorders/anglais/detart1.jsp?sesslan=1&codlan=1&codcol=72&codcch=83# accessed 3/1/06
Tobacco Industry’s Attack on Science
“The massive effort launched across the
tobacco industry against one scientific
study is remarkable.”
- Ong, E. K. and Glantz, S. A. 2000. Tobacco industry
efforts subverting International Agency for Research on
Cancer’s second-hand smoke study. The Lancet 355
(9211): 1253–1259.
23
SHS and Controversy?
„
„
„
„
„
Maintained controversy about SHS control
Health effects
Extent of exposure
Control strategies
Costs of control measures
24
FCTC Preamble and Article 8
“Parties recognize that scientific evidence has
unequivocally established that exposure to
tobacco smoke causes death, disease, and
disability.”
25
Health Effects in Children
„
„
„
„
„
„
Sudden infant death syndrome (SIDS)1
Acute respiratory illnesses2
Chronic respiratory symtoms3
Reduced lung function growth4
Asthma and exacerbation of
asthma symptoms5
Acute and chronic middle ear disease6
Source: 1. CALEPA/C; UK/A; WHO/C
2. SG ’84/A; SG’86/A; EPA/C; CALEPA/C; UK/C; WHO/C for increased prevalence or respiratory illnesses
and SG ’84/A; SG’86/A; EPA/A; CALEPA/C; WHO/C for increased frequency of bronchitis and pneumonia
3. SG’86/A; WHO/C
4. SG ’84/A; SG’86/A; EPA/A; CALEPA/A; WHO/C
5. EPA/C; CALEPA/C; WHO/C for exacerbation and EPA/A;CALEPA/C for new cases
6. SG ’86/A; EPA/C; CALEPA/C; UK/A; WHO/C
26
Health Effects in Adults
„
„
Established
− Lung cancer1
− Cardiovascular disease2
Possible
− Reduced lung function
− Other cancers
− Exacerbation of asthma3
− Respiratory symptoms4
Source: 1. SG ’86/C; EPA/C; CALEPA/C; UK/C; IARC/C
2. CALEPA/C; UK/C; WHO/A
3. CALEPA/C
4. SG ’84/A
27
Is There a Safe Level of SHS?
„
There is no safe level of SHS!
Warning: You don’t have to smoke to
die from it. Second-hand smoke kills.
28
Section C
Controlling Passive Smoking
Reducing Exposure to SHS
„
„
„
„
„
Control source
− Reduce smoking
Change the source
Separate smokers and nonsmokers
Increase ventilation
Use air cleaning
30
The Mass-Balance Model
„
Concentration of SHS depends on—
− Strength of source
X Number of smokers and smoking pattern
X Emissions from cigarettes
− Ventilation
X Rate of exchange of outdoor with indoor air
− Air cleaning
31
What Works?
„
What works?
− Elimination of the source
„
What does not work?
− Separation of smokers and
nonsmokers in the same space
− Ventilation
− Air cleaning
32
Accommodation and Ventilation
“. . . our ultimate objective is to
maintain the ability for our
consumers to enjoy our
products in public venues, such
as restaurants, hotels, bowling
centers, and shopping malls.”
- Philip Morris and the
Hospitality Industry
33
Alternative Products
“FOR IMMEDIATE RELEASE
JT to Accelerate Expansion of
“Reduced Odor Cigarette Segment”
Tokyo, October 6, 2003 --- Japan Tobacco Inc. (JT) (TSE:2914) announced today an initiative
aimed at the “reduced odor cigarette segment” through the launch of “Mild Seven Prime Super
Lights Box” (Mild Seven Prime/JPY 300 per pack) and a sales area expansion of “Lucia Citrus
Fresh Menthol” (Lucia/JPY 300 per pack), starting November 4, 2003.
In its latest medium-term management plan, JT PLAN-V, JT stated that the company is creating a
new category of cigarettes with reduced tobacco odors. The creation of this new segment is part of
JT's commitment to allow smokers and non-smokers to more easily coexist.
Lucia is the first product in this category, launched in the Tokyo metropolitan area, in February of
this year. Following its successful market entry in Tokyo, the brand’s sales area was expanded into
the neighboring four prefectures in August. Since its launch, Lucia has maintained market share at
levels almost twice as large as other newly marketed brands, and from November 4 onwards it will
be available nationwide.”
- JT delight world
Source: http://www.jti.co.jp/JTI_E/Release/03/no28.html retrieved 3/2/06
34
ASHRAE-62
ASHRAE Standard
Ventilation for
acceptable indoor air
quality
(American Society of Heating
Refrigerating and Air
Conditioning Engineers, Inc.)
“This standard is under
continuous maintenance by a
Standing Standard Project
Committee (SSPC) for which the
Standards Committee has
established a documented
program for regular publication
of addenda or revisions,
including procedures for timely,
documented, consensus action
on requests for change to any
part of standard.”
35
Establishing Smoke-free Public Places
„
Public places comprise a broad spectrum of enclosed
areas to which the public is invited or in which the
public is permitted, including but not limited to—
−
−
−
−
−
−
Banks
Educational facilities
Health care facilities
Public transportation
Reception areas
−
−
−
−
−
Retail food/markets
Shops/shopping malls
Sport arenas
Theaters
Waiting rooms
Restaurants
36
Benefits of Controlling SHS
„
Short-term
− Reduction in respiratory effects
− Evidence of reduction in heart attacks
− Economic savings
„
Long-term
− Reduction in prevalence
− Increase in cessation
− Reduction in lung cancer
− Changing societal norms
37
History of Effort to Protect Nonsmokers in U.S. From SHS
Cigarette consumption per capita
1st report to
review ETS effects
(Jan. 1972)
S.G. Jesse
Steinfeld calls
for nonsmokers bill
of rights
(Jan. 1971)
ICC restricts smoking to rear 20%
of interstate buses
MN passes 1st law
requiring employees
to protect nonsmokers
(June 1975)
1st epidem.
Studies published linking
ETS w/lung
cancer
(Jan. 1981)
NAS (Nov. 1986) and
surgeon general
(Dec. 186) release Congress eliminates
reviews on health smoking aboard
effects of ETS
commercial flights
(Feb. 1991)
CAB requires smoking and nonsmoking
seating on airlines
(July 1973)
1970
1975
CalEPA links ETS to CHD
Congress imposes
and SIDS deaths (1997)
temporary ban
aboard flight <2hrs.
(1988)
NCI publishes
airline study
which shows those
in nonsmoking
sections signifcantly
exposed to ETS
(Feb. 1989)
1980
1985
1990
EPA issues major
report on ETS in
adults and children
(Jan. 1993)
1995
Data source: Tobacco Outlook Report, Economic Research Service, U.S. Dept. of Agriculture.
2000
38
Airline Action to Restrict Smoking
1973
1972
1987
U.S. Federal Aviation
Commission outlaws
smoking in airplane
lavatories
Introduction of
separate smoking
and nonsmoking
sections
Association of Flight
Attendants
endorses complete
ban on smoking on
commercial flights
Continued
39
Airline Action to Restrict Smoking
1987
1988
1992
Air Canada
introduces first nonsmoking flights
Ban on smoking
aboard U.S.
domestic flights
less than two
hours
ICAO resolves to
eliminate smoking
on international
commercial flights
by 1996
Continued
40
Airline Action to Restrict Smoking
1994
1998
2000
Some airlines have
smoke-free
international flights
Some airlines
have bans on
smoking on ALL
flights
U.S. bans smoking
on all domestic and
international
flights
Singapore Airlines
American Airlines
Cathay Pacific
British Airways
Virgin Atlantic
Delta
United
Finnair
Aer Lingus
British Airways
Lufthansa
SAS
41
Airport Smoking Lounges
“Many of the largest airports [in the U.S.] already restrict
smoking to designated smoking lounges, but air inside these
airports is still unhealthy, according to a recent study by the
U.S. Centers for Disease Control and Prevention.
The CDC says these smoking lounges - even if they have
separate ventilation systems - don't contain all smoke.
Many airports also lack regulations that keep smokers away
from building entryways, creating an unhealthy zone that
everyone coming and going must enter.”
Source: Airports urged to go totally smoke-free, by Matt Leingang Cincinnati Enquirer [02/25/05]
http://www.no-smoking.org/feb05/02-28-05-3.html accessed 3/2/06
42
Priority Interventions—Workplaces
„
„
„
„
Workers exposed to SHS on the job are 34% more
likely to get lung cancer
− Fontham et al. (1991)
International Labor Organization reported that cancer
is the number one killer in the workplace and SHS is
estimated to cause 2.8% of all worksite cancers
− ILO. (2002)
Workplace smoking increases an employer’s potential
legal liability
Nonsmoking employees have received settlements in
cases based on their exposure to SHS
− Sweda. (1997)
Continued
43
Priority Interventions—Workplaces
„
Effectively reduce SHS exposure
− Percentage of workers reporting NO exposure to
SHS rose from 19% to 54% one year after national
smoke-free workplace legislation in Finland.
„
Major impact on cessation and prevalence
− Smoke-free workplaces are associated with a 29%
reduction in cigarette consumption
X Fichtenberg and Glantz. (2002)
Continued
44
Priority Interventions—Workplaces
„
Employee benefits
− Safer and healthier working environment
− May benefit from cessation opportunities and
support
„
Employer benefits
− Increased worker productivity
− Reduced health care costs
− Reduced maintenance costs
− Reduction in the risk of fire
45
Change in Worker Protection from SHS
70
68.6
60
63.0
Percent
50
45.8
40
30
20
10
3.0
0
1986
1992-93
1995-96
1998-99
Notes: All estimates based on 1998–99 CPS data should be considered preliminary; 1986 data
based on 18 years and older; all others—15 and older
Data source: 1986 Adults Use of Tobacco Survey; all others—Current Population Study.
46
Change in Smoke-free Workplace Policy Coverage
Change in Smoke-free Workplace Policy Coverage
among Indoor American Workers by Type of Worker
80
70
Percent
60
50
1992-93
1995-96
1998-99
40
30
0
White collar
Blue collar
56.8
50.4
34.8
51.4
44.8
27.4
76.0
71.3
10
53.7
20
Service
Notes: Self-respondents ages 15 years and older
Data source: Shopland, D.R., C.M. Anderson, D.M. Burns, K.K. Gerlach. 2004. Disparities in
smoke-free workplace policies among food service workers. JOEM 46 (4): 347-356.
47
Impact of Smoke-free Workplaces
„
If all workplaces would become smoke-free, per capita
consumption would drop by
− 4.5 percent (U.S.)
− 7.6 percent (U.K.)
„
Achieving this type of reduction would require an
increase from $0.76 to $3.05 and £3.44 to £6.59 per
pack of cigarettes
− Similar to tax increase to $1.11 and £4.26
Source: Fichtenberg C. M., Glantz S. A. (2002) Effect of smoke-free workplaces on smoking behaviour:
systematic review. BMJ, 325(7357), 188.
48
Philip Morris Document: Impact of Workplace Bans
“Smokers facing workplace restrictions have an
84 percent higher quit rate than average”
“Ten percent industry decline if smoking was
banned in all workplaces”
“Anticipate a 74 percent increase in quitting rate
if smoking was banned in all workplaces”
-Philip Morris
Impact of workplace restrictions on
consumption and incidence
49
Impact of Smoke-free Jobsites According to Philip Morris
“Total prohibition in workplaces strongly affects
industry volume.”
“Milder workplace restrictions, such as smoking only
in designated areas, have much less impact on
quitting rates and very little effect on consumption.”
-Philip Morris
Impact of workplace restrictions on
consumption and incidence
Source: Philip Morris interoffice correspondence. (1992).
50
Industry Challenges
„
„
„
„
Industry recognized by the early 1970s that clean
indoor air restrictions would severely undermine their
business
− “Smokers facing workplace restrictions have an 84
percent higher quit rate than average”
None of the major companies fully accepts the
scientific evidence on SHS
Directly involved in activities aimed to undermine
science
− Quote from WHO report on IARC
Directly counters attempts to legislate clean indoor air
51
Economic Impact of Smoke-free Ordinances
„
What the tobacco industry is saying privately—
− “The immediate implication for our business is clear:
if our consumers have fewer opportunities to enjoy
our products, they will use them less frequently and
the result will be an adverse effect on our bottom
line.”1
− “Smoking bans are the biggest challenge we have
ever faced. Quit rate goes from 5% to 21% when
smokers work in nonsmoking environments.”2
Source: 1. Philip Morris internal document, Bates No. 2041183751/3790.
2. Philip Morris internal document, Bates No. 2054893642/3656.
Continued
52
Economic Impact of Smoke-free Ordinances
„
What the Tobacco Industry is Saying Privately—
− “Those who say they work under [smoking]
restrictions smoked about one-and-one quarter
fewer cigarettes each day than those who don’t. That
may sound light but remember we are talking about
light restrictions, too. Those 220 people in our survey
who work under smoking restrictions represent some
15 million Americans. That one-and-one quarter per
day cigarette reduction, then, means nearly 7 billion
fewer cigarettes smoked each year because of
workplace smoking restrictions. . . .”
Source: Tobacco Institute internal document, Bates No. TIMN0014554/4565.
Continued
53
Economic Impact of Smoke-free Ordinances
„
What the tobacco industry is saying privately—
− “. . . At a dollar a pack, even the lightest workplace
smoking restrictions is costing this industry 233
million dollars a year in revenue. How much more
will it cost us with far more restrictive laws such as
those in Suffolk County and Fort Collins now being
enacted?”
Source: Tobacco Institute internal document, Bates No. TIMN0014554/4565.
54
Priority Interventions—Restaurants and Bars
„
„
„
Highest levels of exposure
− 160 to 200 percent higher than in smoking offices
Nonsmoking areas are NOT effective in controlling
exposure
Smoke-free ordinances DO NOT result in lost business
or negative impacts on local economies
Continued
55
Priority Interventions—Restaurants and Bars
„
What restaurateurs are saying—
− “We have had great business. Sales have gone up
because of it. When the single-room restaurant
allowed patrons to smoke, it went everywhere. There
have been no complaints since the change.”1
− “I haven’t had anybody complain about it since the
ban. Even smokers say they don’t want to deal with
secondhand smoke when they’re eating.”2
Source: 1. Erin Ford, Manager of Hugo’s in Fayetteville, Arkansas. Quoted in: Wallworth A. (2003, June 29).
Smoke and Money. Northwest Arkansas Times.
56
Reactions of Smokers to Smoking Bans in Restaurants
Reactions of European and American smokers to smoke-free
ordinances in restaurants
Continued to eat out as frequently
Eat out less frequently
Stop eating out
100
Percentage
80
16
10
8
9
17
18
10
16
15
13
60
10
18
24
17
22
12
12
16
21
13
16
40
7
81
62
65
73
59
57
53
57
20
50
58
54
0
key
Tur
ece
Gre
Spa
in
y
Ital
nce erland
a
r
F
tz
S wi
BDR
and
den
l
e
n
i
w
F
S
UK
USA
A survey done by Philip Morris Incorporated in 1989 demonstrated that European smokers were more
accepting of smoke-free regulations than were Americans.
Data source: Minnesota Tobacco Litigation Depository (Bates No. 2500147496).
57
Smokers’ Beliefs About Where Smoking Should Be Banned
Percentage of adult respondents reporting that smoking should not be
allowed at all in each venue
U.S. minus CA '95-'96
California '95-'96
U.S. minus CA '98-'99
California '98-'99
100
Percentage
80
60
40
20
0
Restaurants
Hospitals
Work Areas
Bars
Sports Arenas
Malls
Data source: Gilpin E.A., Lee L., Pierce J.P. 2004. Changes in population attitudes about where smoking should not be
allowed: California versus the rest of the USA. Tob Control: 13(1):38-44.
58
Studies Show That Going Smoke-free Won’t Hurt Business
„
„
A large body of research—studies of more than 180
localities—shows that the passage of smoke-free
ordinances has no effect on aggregate restaurant
revenues.1
“Taxes generated by the sale of food and beverages in
the city are up 4.4 percent for the first nine months of this
year compared to the same period last year. Food and
beverage sales are up 5.8 percent over 2000, according to
the city’s treasury division. Adjusted for inflation, the
increases are about 2.8 percent and 1.6 percent,
respectively.”2
Source: 1. Glantz, S. A. (1999). Smoke-free Restaurant Ordinances
Do Not Affect Restaurant Business. Period. Journal of Public Health Management Practice.
Continued
59
Studies Show That Going Smoke-free Won’t Hurt Business
„
A 1999 study of the effects of smoke-free ordinances
in Wisconsin’s Dane County found “no support for the
dire predictions of those who opposed the smoke-free
ordinances.” The researchers controlled for economic
factors that might influence the strong showing of the
county’s restaurants. Some measures, they concluded,
suggest that the legislation helped the county’s
restaurant business.
Source: Dresser, L. (1999). Clearing the Air: The Effect of Smoke-free Ordinances on
Restaurant Revenues in Dane County. Tobacco-Free Wisconsin Coalition.
Continued
60
Studies Show That Going Smoke-free Won’t Hurt Business
„
A Massachusetts study found that 46% of nonsmoking
adults avoid smoky places, primarily because they
dislike the smell of smoke, have concerns about their
health, and suffer physical symptoms (like eye and
throat irritation). The researchers concluded that
advertising a smoke-free environment is likely to
attract patrons, especially health-conscious, welleducated nonsmokers.
Source: Biener, L. and Fitzgerald, G. (1999). Smoking Bars and Restaurants: Who Avoids Them and Why?
Journal of Public Health Management Practice.
61
Studies Show That Going Smoke-free Won’t Hurt Business
New York City after the ban. A success.
“Almost two years into cigarette ban, New York
City bars thrive and many smokers shrug”
- The New York Times
“New York smoking ban proves a success, even
among previously fiery opponents.
Predicted economic hit never came, officials say.”
- The New York Times
62
Industry Reaction to Restaurant Smoking Restrictions
„
Front Groups
− Third-party allies in the hospitality industry
− Act on tobacco industry’s behalf in opposing
smoking control laws
− Claim not to be allied with the industry but receive
funding directly from the industry
− Examples:
X Hospitality Coalition on Indoor Air Quality
X California Business and Restaurant Alliance
X National Smokers Alliance
X Beverly Hills Restaurant Association
Continued
63
Industry Reaction to Restaurant Smoking Restrictions
“What if they
passed a law that
took away 30% of
your business?”
- The Tobacco Institute
„
The Tobacco
Institute ran an ad in
the hospitality trade
press suggesting
that business tanked
after Beverly Hills
went smoke-free in
1987
64
Priority Interventions—Hospitals
„
Smoking is inconsistent with
the health goals of medical
institutions
„
Protect patients and health
staff
„
Promotes lower prevalence
and and higher quit rates
among employees, including
doctors and nurses
„
Improves ability to help
patients quit smoking and
provides strong role models
Image source: Institute for Global Tobacco Control
65
Homes
„
Governments lack authority to restrict smoking in
homes—but other public interventions and health
practitioners can—
− Educate smokers about the risks that their
smoking poses to their families
− Encourage smokers to go outside to smoke
− Stress protection of the vulnerable—children,
pregnant women, the elderly, and the ill
66
Challenges to Clean Indoor Air
„
„
„
Political will
Industry opposition
Public acceptance and enforcement
67
Elements of Successful Clean Indoor Air Campaigns
„
„
„
Focus on priority areas
Gather community support
Know industry tactics and front groups
68
Overcoming Industry Challenges
„
„
„
Reveal industry activities
Publicly engage the industry
Work at the local level
− “It’s barely controlled chaos [at the local
level]. We can’t be everywhere at once.”
Source: Merryman, Walter. (1991). Tobacco Institute.
69
Concluding Thoughts
„
„
„
SHS is tobacco smoke—tobacco smoke kills!
Prohibition of smoking, rigorously enforced, can
eliminate exposure
Exposure at home remains a challenge
70