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Read summary: Why we need a smokefree law |
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Polls: A range of surveys on smokefree issues: View |
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Smoking prevalence in England: How would comprehensive smoking bans affect prevalence rates? Read more here |
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Going smokefree: the case for all pubs and clubs: download |
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ASH Factsheet: Secondhand smoke in the home: view |
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The Myths and Realities of Smokefree England, Oct 2007: view |
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Health evidence paper: printable version |
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Economic evidence: printable version |
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Workplace health & safety: printable version |
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Why We Need a Smokefree Law
for more detail see also the case for legislation
Secondhand smoke is a killer
At work, it causes at least 600 premature deaths every year, nearly three times the number of people killed in industrial injuries and accidents.
If you breathe in other people’s smoke you have more chance of getting both lung cancer and heart disease. Secondhand smoke can cause cot death, middle ear disease and asthma in children. See health paper
Everyone has a right to a smokefree workplace
Secondhand smoke is a workplace health and safety issue. Workers don’t have a choice about where they work. More than two million people in Great Britain still work in places where smoking is allowed throughout. Another ten million people work in places where smoking is allowed somewhere on the premises. The Government’s proposed exemptions for pubs that don’t serve prepared food and for private membership clubs would just leave the most exposed workers least protected. See workplace health and safety paper
Smokefree laws help people quit smoking
Most smokers want to stop, and a smokefree law will help them succeed. A smokefree law could cut smoking rates from about one in four of the adult population to closer to one in five. Poorer communities would benefit most. See Regulatory Impact assessment (pdf)
Smokefree laws are good for business
A comprehensive smokefree law could benefit the British economy by up to £2.7 billion. This could include up to £680m by having healthier employees producing more goods and services, £140m saved through fewer sick days, £430m saved because less production would be lost to cigarette breaks and £100m saved by not having to clean up behind smokers. See economics paper
Ventilation doesn’t work
The tobacco industry and the groups it funds (such as FOREST) often claim that ventilation systems can remove smoke from the air. But they can’t. Ventilation may remove the smell of smoke but not the dangers, there is no safe level of secondhand smoke.
And separate smoking areas don’t work either, because smoke drifts. See ventilation paper
A smokefree law would be good for everyone – except the tobacco firms and their paid lobbyists. We need a smokefree law now. It’s about health and it’s about time.

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For the first time, a major new opinion poll reveals that the general public in all four countries of the United Kingdom overwhelmingly back a new law to end all smoking in the workplace. They also back specific action to ensure that all pubs and bars are smokefree. The news fatally undermines the Government’s claim that exemptions from smokefree legislation for non-food pubs and clubs are needed in England , because the English public will not back the comprehensive law being introduced in Scotland , Wales and Northern Ireland .
The poll was conducted by polling firm You Gov and commissioned by Cancer Research UK and Action on Smoking and Health (ASH). Asked if they would support legislation to make all workplaces smokefree, including pubs and restaurants, 71% said yes. The figure for England was 71%, the same as for Scotland . Given a list of possible smokefree venues, 67% across the UK said that all pubs and bars should be smokefree by law. The figure for England was 66%.
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YouGov poll of smoking attitudes, December 2005 (pdf) |
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IFF survey of pubs and bars (pdf) |
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YouGov Poll of smoking attitudes,August 2005 (pdf) |
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BMRB poll: attitudes to smoking in the workplace, July 2005 (pdf) |
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BMRB Poll: attitudes to smoking in the workplace, January 2005 (pdf) |
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Mori Poll on smoking in public places, 2004 (pdf) |

YouGov Poll December 2005
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Cancer Research UK and Action on Smoking and Health (ASH) commissioned YouGov to poll the public on their attitudes to smoking in the workplace and other public spaces, these are the results.
Download pdf
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IFF Poll
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IFF Research were commissioned by ASH and Cancer Research UK to collect primary data on the issues surrounding smoking in enclosed work spaces to be fed into the government consultation on the Health Bill. This is the report of their findings.
Download pdf
(1.4mb) |

YouGov Poll August 2005
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ASH commissioned YouGov to poll the public on their attitudes to smoking in the workplace and other public spaces, these are the results.
Download pdf
(51kb) |

BMRB poll July 2005
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BMRB were commissioned by ASH to collect attitudes to smoking in workplaces and other public places, these are their findings
Download pdf
(27kb) |

BMRB poll January 2005
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BMRB were commissioned by ASH to collect attitudes to smoking in workplaces and other public places, these are their findings from January 2005
Download pdf
(27kb) |

Mori Poll 2004
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ASH commissioned Mori to poll the public on their attitudes to smoking public places, these are the results.
Download pdf
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Asthma UK and Action on Smoking and Health (ASH) have used the Government’s own forecasts to show how comprehensive smokefree legislation can help cut smoking prevalence rates across England.
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This ASH factsheet contains information on secondhand smoke in the home and provides evidence and information on this subject and related facts and myths. Key facts demonstrated are that:
- Children’s exposure to secondhand smoke is most likely to take place in the home.
- There is no published, peer-reviewed evidence to show that smokefree laws lead to an increase in smoking in the home.
- Where smoke-free workplaces and public places are the norm, parents are more likely to make their own home a tobacco-free zone.
- Banning smoking in the home is the only reliable way of reducing exposure to secondhand smoke as partial restrictions are not effective
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England has been smokefree since July 1 2007. There were plenty of scare stories circulating beforehand, many were recycled from previous jurisdictions and we will surely see them again as more jurisdictions prepare to go smokefree. So have we seen increase in pub closures? Has there been mass protest and civil disobedience? Have there really been "armies" of undercover enforcement officers secretly filming drinkers? ASH have reviewed the major allegations and matched them to the real experience of Smokefree England:
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Download as a pdf (349kb) |

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This document, produced by Smokefree Action, clearly and concisely presents the case for all pubs and clubs to go smokefree.
Download pdf
(250kb)
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This presentation is a comprehensive summary of the arguments for smokefree places, it is intended for use primarily by local government officers but would be useful for anyone wanting to present the smokefree case. |
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“ It is evident that no infant, child or adult should be exposed to secondhand smoke…..secondhand smoke represents a substantial health hazard.”
Conclusion of the UK Government’s Scientific Committee on Tobacco and Health, 2004.
Definition of Secondhand Smoke
Breathing other people's smoke is called passive, involuntary or secondhand smoking. Secondhand smoke is a mixture of air-diluted ‘sidestream’ smoke from the burning tip of the cigarette, and exhaled ‘mainstream’ smoke that has been initially inhaled and then exhaled by the smoker. The proportions of sidestream and exhaled mainstream smoke can differ but sidestream smoke is usually the larger constituent.
Composition of Secondhand Smoke
Mainstream smoke inhaled by a smoker contains over 4000 chemicals (both particles and gases), including many chemical irritants and almost 70 carcinogens (cancer causing substances). Sidestream smoke has a similar composition but the relative quantities of chemicals can differ.
Harmful particles in mainstream smoke include tar (itself composed of many chemicals), N-Nitrosamines, benzene, benzo(a)pyrene, dioxins and heavy metals including chromium, lead and cadmium. Harmful gases include carbon monoxide, ammonia, sulphur dioxide, dimethylnitrosamine, formaldeyhde, hydrogen cyanide and acrolein.
Secondhand smoke contains many chemicals, but is different in composition from both mainstream smoke and sidestream smoke due to its dilution and dispersion in indoor air. The concentrations of various chemicals can also change over time and in different environmental conditions.
The Health Risks From Secondhand Smoke
Overview
secondhand smoke has immediate health effects. It can reduce lung function and exacerbate respiratory problems; trigger asthma attacks; reduce coronary blood flow; irritate eyes; and cause headaches, coughs, sore throats, dizziness and nausea.
But secondhand smoke also has longer-term health effects. During the 1980s, a number of comprehensive reviews of the effects of secondhand smoke were published. [1] [2] [3] [4] These were summarized in a major review by the US Environmental Protection Agency. [5] More recently, further major reviews have been published, including the UK Government’s Scientific Committee on Tobacco and Health report (SCOTH) [6] , academic epidemiological reviews [7] , a World Health Organization (WHO) consultation report on Environmental Tobacco Smoke and Child Health [8] and a review by the International Agency for Research on Cancer (IARC). [9]
From these reviews and other sources, it has emerged that secondhand smoke increases the risk of lung cancer, heart disease strokes and respiratory illnesses, especially asthma. In children, it increases the risk of respiratory illnesses, asthma attacks, sudden infant death syndrome and middle ear diseases. In utero, it can affect foetal growth and decrease eventual birth-weight.
Secondhand smoke is a major source of indoor air pollution because there is currently no recognised safe level of exposure and hundreds of people die every year from secondhand smoke exposure at home and work in the UK. The greater the exposure, the greater the health risks. However for heart disease, even small amounts of tobacco smoke have a large effect on heart disease risk and further exposure only has a small additional effect.
Detailed information and references are provided below.
Secondhand Smoke Increases the Risk of Lung Cancer
Secondhand smoke has been classified as a ‘class A’ (i.e. a ‘known) human carcinogen by the US Environmental Protection Agency. [10] Other Class A carcinogens include asbestos, arsenic, benzene and radon gas. In total around 50 international studies of secondhand smoke and lung cancer risk in never smokers have been published over the past 25 years. Most recently in 2004, the World Health Organisation’s International Agency for Research on Cancer (IARC) [11] also reviewed the literature and concluded that secondhand smoke is cancer causing and that non-smokers living with smokers increase their lung cancer risk by approximately 20% for women and 30% for men. For non-smokers exposed in the workplace, the risk of lung cancer is increased by 16-19%. The Government’s own advisory committee on the effects of smoking recently concluded that there is an increased risk of lung cancer for non-smokers of about 24%. [12]
It cannot be concluded presently that secondhand smoke causes cancer in sites other than the lung, although tentative associations have been shown between secondhand smoke and certain neck and throat cancers (e.g. naso-pharyngeal [13] ), and cancers in other organs e.g. the breast and kidney [14] .
Secondhand Smoke Increases the Risk of Heart Disease and Stroke
A number of studies have shown an elevated risk of coronary heart disease (CHD) in non-smokers who live with a smoker of approximately 25%, after controlling for other contributing risk factors such as diet: A 1997 review showed an increased risk of 23%; [15] a 1999 review a 25% increased risk; [16] and in 2004 the UK Government-appointed Scientific Committee on Tobacco and Health (SCOTH) appraised all available evidence and concluded an increased risk of ischaemic heart disease of about 25%. [17]
A recent study used biomarkers to assess exposure to secondhand smoke, rather than relying on self-reports. This suggested that secondhand smoke exposure might substantially increase heart disease risk more than has generally been reported. [18]
Exposure to even small amounts of secondhand smoke have a large effect on CHD risk and further exposure only has a small additional effect. The scale of the risk associated with secondhand smoke is around half that of smoking 20 cigarettes a day, even though the exposure is only about 1% that of active smoking. [19]
Precisely how secondhand smoke causes CHD is unknown. However, even small amounts of exposure can increase blood platelet activity, causing the blood to thicken and become more likely to clot. Recent research has shown that even half an hour’s exposure to secondhand smoke by non-smokers is enough to damage the lining of the coronary arteries and cause them to constrict, reducing blood flow to the heart. [20] Increased blood clotting and reduced blood flow increases the risk of a heart attack.
Evidence is also emerging that regular exposure to secondhand smoke increased the risk of stroke in non-smokers by 82%. [21]
Secondhand Smoke Increases the Risk of Respiratory Diseases, Especially Asthma
Secondhand smoke also worsens respiratory symptoms and reduces lung function in adults. [22] [23] In particular, it can trigger asthma attacks and make the symptoms more severe. [24] In the UK, 5.2 million people have asthma - 1 in 10 children and 1 in 12 adults, and smoke exposure at work is reported as the second most common trigger of adult asthma attacks.
Secondhand Smoke Increases the Risk of Respiratory Illnesses, Asthma Attacks, Sudden Infant Death Syndrome and Middle Ear Diseases in Children, and Can Affect Foetal Growth and Decrease Eventual Birth Weight
Secondhand smoke increase the risk of serious respiratory illnesses and asthma attacks in children. [25] Each year, more than 17,000 children aged under five are admitted to UK hospitals because of secondhand smoke. [26] Respiratory illnesses include pneumonia and bronchitis and decreased lung function. [27] [28] [29] In particular, secondhand smoke can also trigger the development of asthma and subsequent attacks. [30] [31] Children with asthma whose parents smoke at home are at least twice as likely to have asthma symptoms all year compared to the children of non-smokers. [32]
Exposure to secondhand smoke can also cause sudden infant death syndrome (cot death) and middle ear disease, including recurrent ear infections in children. [33] [34] It can also slow foetal growth and decrease birth weight. [35] [36]
There is also some evidence that children exposed to secondhand smoke on a daily basis, and for many hours, may face over three times the risk of lung cancer than those who grow up in smoke-free environments. [37]
Hundreds of People Die in the UK Every Year from Secondhand Smoke Exposure at Home and at Work
It is estimated that almost 11,500 people die every year in the UK from secondhand smoke. This equates to 1,570 lung cancer deaths, almost 5,600 heart disease deaths and almost 4,300 stroke deaths. [38]
Exposure at home may cause over 2,700 deaths every year in people aged 20 – 64 years (approaching eight per day) and about a further 8,000 deaths a year among people aged 65 or over, mainly from strokes and heart disease.
Exposure at work may cause more than 600 deaths, including over 50 people employed in the hospitality industry (pubs, bars, nightclubs, hotels and restaurants). This equates to almost one hospitality worker per week.
The Tobacco Industry Has Tried to Subvert and Cover Up the Evidence On the Health Impact of Secondhand Smoke.
Based on internal documents from the tobacco industry, studies have show that the industry has sought to systematically distort the scientific evidence on the harmful effects of tobacco, especially in relation to secondhand smoke. [39] For example, attempts have been made to infiltrate scientific institutions such as the International Agency for Research on Cancer (IARC); [40] studies have been commissioned to cast doubt on the evidence of the harmful effects of secondhand smoke either by producing findings counter to major influential studies [41] or by proposing other factors such as diet as the harmful factors. [42] . Various front-bodies have also been funded to publish studies and hold conferences that aim to criticise the accepted evidence on secondhand smoke, such as the ‘European Science and Environment Forum’ and ‘The Centre for Indoor Air Research’. [43] [44] [45]
Smoke-Free Laws Have Improved People’s Health
Smokefree laws can reduce health problems in a surprisingly short time. In the isolated American town of Helena, Montana, smoking was banned in all public buildings including restaurants, bars and casinos in 2002. The law was later over-turned following a campaign by tobacco lobbyists. It was found that admissions to the local hospital for acute myocardial infarctions (heart attacks) fell in the six months when the ban was in effect (June- November 2002) compared with the same months in the years before the law was introduced and after it was overturned. [46]
Smokefree laws have also helped to reduce exposure to second-hand smoke in the home [47] through encouraging smokers to give up [48] and through increasing the proportion of smokefree homes/homes with smoking restrictions. [49] [50] [51]

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[1] Environmental tobacco smoke: Measuring exposures and assessing health effects. US National Research Council, 1986
[2] The health consequences of involuntary smoking. A report of the US Surgeon General, USDHHS,1986
[3] Effects of passive smoking on health. National Health and Medical Research Council. Australian Government Publishing Service, 1987.
[4] Fourth report of the Independent Scientific Committee on Smoking and Health, DHSS, 1988
[5] Respiratory health effects of passive smoking: Lung cancer and other disorders. The Report of the US Environmental Protection Agency,1993.
[6] Secondhand smoke: review of evidence since 1998: update of evidence on health effects of secondhand smoke. London: Department of Health, 2004. Online at:http://www.advisorybodies.doh.gov.uk/scoth/PDFS/scothnov2004.pdf
[7] Brownson, R et al. Epidemiology of Environmental tobacco smoke exposure. Oncogene 2002; 21: 7341- 7348.
[8] International Consultation on Environmental Tobacco Smoke (ETS) and child health. WHO Tobacco Free Initiative, WHO/NCD/TFI/99.10. 1999
[10] Respiratory health effects of passive smoking: Lung cancer and other disorders. The Report of the US Environmental Protection Agency,1993.
[12] Secondhand smoke: review of evidence since 1998: update of evidence on health effects of secondhand smoke. London: Department of Health, 2004. Online at:http://www.advisorybodies.doh.gov.uk/scoth/PDFS/scothnov2004.pdf
[13] British Medical Bulletin (1996; 52(1))
[14] Jinfu Hu, Ugnat, AM and the Canadian Cancer Registries Epidemiology Research Group. Active and passive smoking and risk of renal cell carcinoma in Canada. European Journal of Cancer 2005; 41: 770–778
[15] Law MR, Morris JK and Wald NJ. Environmental tobacco smoke exposure and ischaemic heart disease: an evaluation of the evidence. BMJ 1997; 315: 973-80.
[16] He J, Vupputuri S, Allen K, Prerost M, Hughes J and Whelton P. Passive smoking and the risk of Coronary Heart Disease – A Meta-Analysis of Epidemiologic Studies. New Engl J Med 1999; 340: 920-26.
[17] Secondhand smoke: review of evidence since 1998: update of evidence on health effects of secondhand smoke. London: Department of Health, 2004. Online at:http://www.advisorybodies.doh.gov.uk/scoth/PDFS/scothnov2004.pdf
[18] Whincup, P et al. Passive smoking and risk of coronary heart disease and stroke: prospective study with cotinine measurement. BMJ 2004; 329: 200 – 205.
[20] Otsuka R et al. Acute effects of passive smoking on the coronary circulation in healthy young adults. JAMA 2001; 286: 436-41.
[21] Bonita R, Duncan J, Truelsen T, Jackson RT, Beaglehole R. Passive smoking as well as active smoking increases the risk of acute stroke. Tobacco Control 1999; 8: 156-160.
[22] Secondhand smoke: review of evidence since 1998: update of evidence on health effects of secondhand smoke. London: Department of Health, 2004. Online at:http://www.advisorybodies.doh.gov.uk/scoth/PDFS/scothnov2004.pdf
[23] Chen R, Tunstall-Pedoe H, Tavendale R. Environmental tobacco smoke and lung function in employees who never smoked: the Scottish MONICA study. Journal of Occupational and Environmental Medicine 2001; 58(8): 563-568.
[24] Ulrick CS and Lange P. Cigarette smoking and asthma. Monaldi Archives for Chest Disease 2001; 56: 349-53.
[25] Secondhand smoke: review of evidence since 1998: update of evidence on health effects of secondhand smoke. London: Department of Health, 2004. Online at:http://www.advisorybodies.doh.gov.uk/scoth/PDFS/scothnov2004.pdf
[26] Royal College of Physicians. Smoking and the Young. Pitman Medical: London. 1992.
[27] World Health Organisation.International Consultation on Environmental Tobacco Smoke and Child Health. Consultation Report. 1999.
[29] Mannino D, Moorman J , Kingsley B, Rose D, Repace. J. Health effects related to environmental tobacco smoke exposure in children in the United States. Arch. Pediatr., Adolesc. Med. 2001; 155: 36-41.
[30] Strachan, DP and Cook DG. Health effects of passive smoking: parental smoking and childhood asthma: longitudinal and case-control studies. Thorax 1988; 53, 204-212.
[31] National Asthma Campaign. The Impact of Asthma Survey. London, UK.1996.
[32] Slish KK. et al. Frequency and factors associated with year round asthma symptoms. Presented at the American Thoracic Society Annual Meeting, Orlando, Florida, April 2004. Available online at: http://www.news-medical.net/?id=1205 (Accessed 06/01/05)
[33] World Health Organization. International consultation on environmental tobacco smoke and child health: consultation report.
WHO: Geneva. 1999.
[34] American Academy of Pediatrics Committee on Environmental Health Environmental tobacco smoke: a hazard to children. Pediatrics 1997; 99: 639-642.
[35] Kharrazi M. et al. Secondhand smoke and pregnancy outcome. Epidemiology 2004; 15: 660-670.
[36] Windham GC, Eaton A, Hopkins B. Evidence for an association between environmental tobacco smoke exposure and birth weight: a meta-analysis and new data. Paediatr. Perinat. Epidemiol. 1999; 13 (1): 35-57.
[38] Jamrozik K. Estimate of deaths attributable to passive smoking among UK adults: database analysis. BMJ Online: 2 March 2005.
[39] Bero L, Barnes DE, Hanauer P, Slade J, Glantz SA. Lawyer control of the tobacco industry's external research program. The Brown and Williamson documents. JAMA. 1995; 274 (3): 241-247.
[40] Ong EK, Glantz SA. Tobacco industry efforts subverting International Agency for Research on Cancer’s second-hand smoke study. Lancet 2000; 355 (9211): 1253-9.
[41] Hong M-K, Bero L. How the tobacco industry responded to an influential study of the health effects of secondhand smoke. BMJ 2002; 325: 1413-16
[42] Rylander R, Axelsson G, Megevand Y, Dahlberg C, Liljeqvist T, Sundh V. Dietary habits for non-smoking females living with smokers or non-smokers. Eur J Public Health 1999; 9: 142-5.
[43] Muggli M, Forster J, Hurt R, Repace J. The Smoke You Don’t See. Uncovering Tobacco Industry Scientific Strategies Aimed Against Environmental Tobacco Smoke Policies. American Journal of Public Health 2001; 91: 1419-1423.
[44] Drope J, Chapman S. Tobacco industry efforts at discrediting scientific knowledge of environmental tobacco smoke: a review of internal industry documents. J Epidemiol Community Health 2001; 55: 588-94.
[45] Ong EK, Glantz SA. Tobacco industry efforts subverting International Agency for Research on Cancer’s second-hand smoke study. Lancet 2000; 355 (9211): 1253-9
[46] Sargent, RP, Shepard, RM, Glantz, SA. Reduced incidence of admissions for myocardial infarction associated with public smoking ban: before and after study. BMJ; 2002; 328: 977-980.
[47] Jarvis MJ, Goddard E, Higgins V, Feyerabent C, Bryant A, Cook DG. Children’s exposure to passive smoking in England since the 1980s: cotinine evidence from population survey. BMJ 2000 321: 343-5.
[48] Fichtenberg CM and Glantz SA . Effect of smoke-free workplaces on smoking behaviour: systematic review. British Medical Journal 2002; 325:188.
[49] Borland R, Mullins R, Trotter L, et al. Trends in environmental tobacco smoke restrictions in the home in Victoria, Australia. Tobacco Control 1999; 8: 266–71.
[50] Gilpin EA, Farkas AJ, Emery SL, Ake CF, Pierce JP. Clean indoor air: advances in California, 1990-1999. American Journal of Public Health. 2002; 92 (5): 785-91.
[51] Merom D, Rissel C. Factors associated with smoke-free homes in NSW: results from the 1998 NSW Health Survey. Australian and New Zealand Journal of Public Health 2001; 25(4): 339-45.
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(An excellent pamphlet on the economic impact of smoking restrictions has been produced by Luk Joossens and others for Smokefree Europe and can be downloaded from http://www.smokefreeeurope.com/economic_report.htm)
The tobacco lobby and sections of the hospitality trade claim that ending smoking in workplaces and enclosed public places, including pubs and restaurants, would have a negative effect on trade and employment.
However, the objective evidence does not support this argument.
A comprehensive review of 97 studies published before September 2002 on the economic effects of the smokefree policies on the hospitality industry found:[1]
· Of the 35 studies on this topic published that found a negative impact, none were funded by a source clearly independent of the tobacco industry, and none both used objective measures and were peer reviewed.
· The 21 best designed studies found that smoke-free restaurant and bar laws had no negative impact on revenue or jobs.
New York
New York’s Smoke-Free Air Act came into effect on March 30, 2003. New York’s hospitality industry lobbied vigorously against the legislation, claiming that it would have a disastrous effect on bars and restaurants.
In March 2004, a report on the impact of the legislation was issued by the New York City Department of Finance, the Department of Health and Mental Hygiene, the Department of Small Business Services, and the Economic Development Corporation. It concluded that:
“One year later, the data are clear. . . Since the law went into effect, business receipts for restaurants and bars have increased, employment has risen, virtually all establishments are complying with the law, and the number of new liquor licenses issued has increased—all signs that New York City bars and restaurants are prospering.”
Key findings from the report were that:
- Business tax receipts in restaurants and bars were up 8.7%;
- Employment in restaurants and bars increased by 10,600 jobs (about 2,800 seasonally adjusted jobs);
- 97% of restaurants and bars were fully smoke-free;
- New Yorkers overwhelmingly supported the law. [2]
The 2004 Zagat New York City Restaurant Survey of nearly 30,000 New York restaurant-goers found that 23 percent of respondents said they are eating out more often because of the city’s smoke-free workplace law, while only four percent said they are eating out less. Zagat’s press release concluded:
- “The city’s recent smoking ban, far from curbing restaurant traffic, has given it a major lift.”
Elsewhere in the United States
A study was conducted by researchers at the Harvard School of School of Public Health of the Commonwealth of Massachusetts’ comprehensive statewide smoke-free law, which took effect July 5, 2004. It found that:
- “Analyses of economic data prior to and following implementation of the law demonstrated that the Massachusetts state-wide law did not negatively affect statewide meals and alcoholic beverage excise tax collections.[3]
A study conducted by researchers at the University of Kentucky’s College of Nursing and the Gatton College of Business and Economics of the Lexington-Fayette County, Kentucky comprehensive smoke-free law that took effect April 27, 2004 found that:
- “In general, selected key business indicators in Lexington restaurants, bars, and hotels have not been affected by the smoke-free law. When taking factors into account such as population size, unemployment, and seasonal variation, there was a slight increase in restaurant employment; bar employment remained stable and hotel/motel employment declined in the 10 months after the smoke-free law took effect. There was no effect of the smoke-free law on payroll withholding taxes (workers’ earnings) in restaurants, bars, or hotels/motels in the 10 months after the law went into effect, after taking seasonal variation into account. The smoke-free law was not related to business openings or closures in alcohol-serving establishments or at non-alcohol serving establishments.”[4]
In Delaware, the Clean Indoor Air Act came into effect in November 2002. Data from the Delaware Alcohol Beverage Control Commission showed that the number of restaurant, tavern and taproom licenses increased in the year after the law took effect. Data from the Delaware Department of Labor show that employment in the state’s food service and drinking establishments also increased over the same period.[5]
In California, taxable sales receipts for bars and restaurants have increased every year since 1997 (the year before the state’s smoke-free bar law took effect) through 2002 (the most current year full data is available).
[6] In addition, total employment at bars and restaurants has also increased every year since 1997.[7]While bars have seen a decrease in total employment since 1990 (seven years before the smoke-free laws implementation), this trend in bar employment has not been affected by the smoke-free bar law.
Ireland
The Irish law which ended smoking at the workplace (including bars and restaurants) came into force on 29 March 2004. The Licensed Vintners Association (LVA) which represents 95% of Dublin publicans commissioned research to evaluate the economic impact of the ban. In a press release of 9 July 2004 the association stated that:
- “Research carried out by marketing research company Behaviour and Attitudes confirms the negative economic impact of the Smoking Ban on the Dublin licensed trade, with turnover down by as much as 16%, and overall employment levels cut by up to 14% since the introduction of the Smoking Ban.” [8]
However, figures released in February 2005 by the Central Statistics Office of Ireland (www.cso.ie) do not support the claims made by the Licensed Vintners Association.
Data on the revenues of bars in Ireland are available at monthly basis until December 2004. The Retail Sales Index (RSI) is the official short-term indicator of changes in the level of consumer spending on retail goods and is published every month by the Central Statistics Office (CSO). The official figures show that the value of bar sales in Ireland were at 107.4 in the period after the ban (from April to December 2004) compared to 111.3 in the equivalent period a year earlier (from April to December 2003).[9]
This decrease in revenues of 3.5% (not the much higher figure claimed by the Irish LVA and lobbyists in the UK) simply continues a trend which started back in 2001, well before smokefree legislation was introduced. The volume of sales in bars in Ireland increased until 2000, but decreased by 3% in 2002, 4% in 2003 and 5% in 2004.
Review by Health Scotland
An excellent review of the health and economic impacts of smoking restrictions in public places was carried out for the Scottish Executive by researchers at the Health Economics Research Unit and Department of Public Health at the University of Aberdeen[10]
The executive summary of the report states that:
· “Studies of the impact of smoking restrictions on the hospitality sector (hotels, bars and restaurants), using objective data such as sales tax and employment, have failed to find any statistically significant effect. The evidence from these studies is not as robust as the evidence relating to health effects, in terms of quantity of published studies, study design and sample size. However, the findings are consistent in demonstrating small and mainly positive effects
· These studies were carried out in the context of claims that there would be a negative impact of 30%. The studies were designed with sufficient power to detect effects of this size and they demonstrated that impacts of this size had not occurred in any of the locations studied.”
Britain: Report of the Chief Medical Officer
In his Annual Report for 2003, the Government’s Chief Medical Officer, Professor Sir Liam Donaldson, said that a comprehensive smokefree law could benefit the British economy by up to £2.7 billion.
This could include up to £680m saved by having a healthier workforce, which could produce more goods, £140m saved through fewer sick days, £430m saved because less production would be lost to cigarette breaks and £100m saved by not having to clean up behind smokers.
The CMO said evidence from abroad showed bans in pubs and restaurants have not proved to be bad for business. He added that visits to Ireland, California and New York, which have already banned smoking in public places, showed a ban could be enforced without the hospitality trade being damaged - as had been feared. He said he found bars and restaurants "thronging with people". [11]

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[5] Meconi, Vincent, Secretary of the Delaware Department of Health and Social Services, “Secondhand Smoke Deserves Regulations,” Delaware State News, (December 30, 2003). See also American Lung Association of Delaware, “Delaware’s Clean Indoor Air Act – The 1st Anniversary Story”: http://www.alade.org/main.htm
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Smoking in Workplaces and Public Places: Government Proposals
The Government published its White Paper on public health:”Choosing Health: Making Healthier Choices Easier” on 16th November 2004[1].
Chapter 4, paragraph 76 of the White Paper states:
“We propose to regulate, with legislation where necessary, in order to ensure that:
· All enclosed public places and workplaces (other than licensed premises …) will be smokefree;
· Licensed premises will be treated as follows:
- all restaurants will be smoke-free
- all pubs and bars preparing and serving food will be smoke-free
- other pubs and bars will be free to choose whether to allow smoking or to be smoke-free
- in membership clubs the members will be free to choose whether to allow smoking or to be smoke-free
- smoking in the bar area will be prohibited everywhere.”
The proposal was also put in somewhat clearer terms in the Labour Party’s General Election manifesto, which stated:
“We recognise that many people want smoke-free environments and need regulation to help them get this. We therefore intend to shift the balance significantly in their favour. We will legislate to ensure that all enclosed public places and workplaces other than licensed premises will be smoke-free. The legislation will ensure that all restaurants will be smoke-free, all pubs and bars preparing and serving food will be smoke-free; and other pubs and bars will be free to choose whether to allow smoking or be smoke-free. In membership clubs the members will be free to choose whether to allow smoking or to be smoke-free. However, whatever the general status, to protect employees, smoking in the bar area will be prohibited everywhere.
These restrictions will be accompanied by an expansion of NHS smoking cessation services to encourage and support smokers to improve their own health by giving up smoking.
Starting with the poorest areas of the country we will introduce health trainers to help people maintain their healthy choices. By 2010, through this activity we plan to reduce the health inequalities that exist between rich and poor.” [2]
Although ASH and public health experts have welcomed the Government’s commitment to end smoking in the great majority of workplaces and enclosed public places, the proposal to exempt pubs which do not serve prepared food (“wet led” pubs) and private membership clubs has been described as “confused, probably unworkable and certainly undesirable”.
The proposal is confused because there is no useful line to be drawn between pubs which “prepare and serve food” and those which do not. From their public statements, Ministers appear to have only the vaguest idea how many pubs do not serve prepared food and no idea at all where such pubs are concentrated. It is also evident that no clear definition of prepared food was arrived at before the White Paper was produced.
Chapter 4, paragraph 79 of the White Paper suggests that between 10% and 30% of pubs to be exempted. There are about 55,000 pubs across the country, so this exemption may cover anything between 5,500 and 16,500 establishments. Private clubs owned by the members could also be exempt, following a vote of members. There are 19,913 registered in England and Wales [3]
It is likely that many exempted pubs and clubs will be in poorer communities. These communities will have higher than average smoking prevalence rates, and will be suffering from the sharp health inequalities that the class distribution of smoking brings. Many membership clubs – for example Labour Clubs – will also be in such communities. For example, an analysis of local licensed premises carried out by environmental health officers for Councils and NHS Primary Care Trusts in Northamptonshire showed that 54% of pubs and bars in Northamptonshire serve only drinks and would be exempt from the controls on smoking in public places. In the borough of Corby, an area where mortality rates are significantly higher than the national
average, 85% of pubs and bars would be exempt [4]. The proposal to exempt some pubs and membership clubs therefore threatens to undermine key objectives of the White Paper – to reduce smoking prevalence rates and tackle health inequalities.
Chapter 4, paragraph 77 of the White Paper notes the risk that some pubs may cease to serve prepared food in order to qualify as premises that can continue to permit smoking. This fear is dismissed with the words “we believe that the profitability of serving food will be sufficient to outweigh any perverse incentive for pub owners to choose to switch”. This assertion has been contradicted by senior figures in the pub trade, for example, Tim Clarke, chief executive of restaurant and pubs group Mitchells & Butlers has warned that: "the enforced specialisation between food and smoking risks commercially incentivising more pubs than the White Paper currently anticipates to remove food and retaining smoking throughout." [5]
The proposal to prohibit smoking in the “bar area” of exempted pubs would fail to provide adequate protection for employees or members of the public. Smoke drifts. Most pubs currently have any separated smoking and non-smoking areas in the same open space. Ventilation systems are expensive, hard to maintain, and as even Philip Morris has admitted, do not provide good protection from the health effects of secondhand smoke. (“While not shown to address the health effects of secondhand smoke, ventilation can help improve the air quality”)[6]
Any attempt to exempt a category of workplaces from smokefree legislation would be subject to legal challenge. The date of “guilty knowledge” under the Health and Safety at Work Act 1974 (HSWA) has now passed in relation to secondhand smoke. The evidence, not least from the two SCOTH reports (1998 and 2004), is now sufficiently strong and sufficiently well known for any employer to be expected by the courts to know of the risks associated with exposure to secondhand smoke. Therefore, employees made ill by such exposure in the workplace will have a case for damages against their employer, claiming negligence and citing a breach of the HSWA as evidence. This would remain possible in respect of any premises exempted from a general prohibition on smoking.
Chapter 4, paragraph 77 of the White Paper also sets a relatively long time-table to implement smoking restrictions, as follows:
· “by the end of 2006, all government departments and the NHS will be smoke-free;
· by the end of 2007, all enclosed public places and workplaces, other than licensed premises (and those specifically exempted) will, subject to legislation, be smoke-free;
· by the end of 2008 arrangements for licensed premises will be in place”.
This timescale – around eighteen months longer than is proposed in Scotland – is too long and arises mainly from the excessive complexity of the proposed legislation. A simple piece of legislation ending smoking in all workplaces would be easier and quicker to introduce, as well as being subsequently easier to publicise and enforce.
Paragraphs 8 and 9 of the Regulatory Impact Assessment, published with the White Paper estimate that the ending smoking in all workplaces and enclosed public places would reduce overall smoking prevalence rates by 1.7%. 0.7% of this effect is estimated to result from the direct effect of ending smoking in employees’ own place of work, and 1% from more places outside smokers’ own place of work going smokefree. The RIA gives no assessment of the reduction in prevalence rates that would be achieved if the Government’s proposed exemptions were adopted, however it does assess the health benefits to non-employees (“customers”) of this option as worth £150 million a year, as opposed to £350 million for the full ban. In total, the RIA assesses the net benefits of a full ban at £1,344 to £1,754 million a year, compared to £998 to £1,486 million for the Government’s preferred option.[7]
The Government should drop its proposed exemptions from smokefree legislation, and opt for the comprehensive model which has been adopted in Scotland and has already proved such a success in the Irish Republic.

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[3] Source: Department for Culture, Media and Sport Statistical Bulletin Liquor Licensing, England and Wales, July 2003-June 2004.
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Ventilation |
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Voluntary |
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Displacement |
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It is often claimed by the tobacco industry that ventilation will remove the effects of secondhand smoke in public places. Of course, the tobacco industry has a vested interest in maintaining and promoting smoking in public places as effective smokefree policies in public places can reduce smoking prevalence by up to 4%. [1]
However, some of the tobacco companies that endorse ventilation systems have felt obliged to issue disclaimers about ventilation systems being able to address the health effects of secondhand smoking.
Does Ventilation Work?
No. Tobacco smoke is a toxic mix of over 4,000 chemicals including over 50 cancer-causing agents.
Ventilation may remove the smell of tobacco smoke but it does not eliminate all the cancer-causing particles and gases from the air. Just because the air is not visibly smoky, this does not mean it is safe from the invisible toxins produced by tobacco smoke. In the case of separate smoking areas with discrete ventilation systems, pollution levels may be slightly reduced but tobacco smoke drifts and staff will still have no choice but to breathe secondhand smoke. [2]
Research by D Kotzias and others at the European Commission Joint Research Centre’s INDOORTRON facility concluded that ”… changes in ventilation rates simulating conditions expected in many residential and commercial environments during smoking do not have a significant influence on the air concentration levels of ETS constituents, e | |