SMOKING IN PUBLIC PLACES

The Chief Medical Officer has called on government to consider introducing legislation to ban smoking in all enclosed public places. Several other countries have already introduced such laws. This briefing considers the evidence that passive smoking causes disease; describes government policy on passive smoking; and discusses options for reducing exposure of staff and customers in public places to tobacco smoke.

Background
Changes in public attitudes both to the health and comfort aspects of exposure to tobacco smoke mean that it is now common practice for smoking to be banned in workplaces such as offices and in other enclosed public places such as cinemas, buses and trains. This trend has not been widely followed by pubs and restaurants. The current debate around smoking in public places is thus focused on these premises. Health effects of passive smoking Evidence on the health effects of passive smoking comes from population studies. As outlined in the box on page 2, when such studies are taken individually they are generally inconclusive, tending to show a positive, but not statistically significant, relation between passive smoking and coronary heart disease/lung cancer. However, when the results from such studies are pooled and re-analysed (a method known as meta-analysis), they show statistically significant links between passive smoking and both lung cancer and coronary heart disease, increasing the risk for each by around 25%. In addition, it is well established that passive smoking exacerbates asthma and can cause various respiratory disorders. National and international public health bodies along with many in the scientific community have interpreted such results as clear evidence that passive smoking can seriously harm health (see box on page 2).1 For instance, the British Medical Association (BMA) recently concluded that that there is no safe level of exposure to tobacco smoke and the International Agency for Research on Cancer has classified environmental tobacco smoke as a cancer-causing agent.2 However, some scientists have questioned the process used to derive these results,3 suggesting that meta analysis may over-estimate the risks of passive smoking.4 The Tobacco Manufacturers Association (TMA), suggests that the evidence base is too weak to draw the conclusions above and that there is thus room for debate

over the extent to which passive smoking affects health.

Government policy
The Department of Health (DH) works on the assumption that smoke-free is the ideal.5 It wants to make rapid progress towards increasing the number of smoke-free pubs and restaurants because: it believes there would be significant health gains because of the reduction in passive smoking (see box); and smokers may stop smoking, leading to greater health gains. Regional tobacco alliances A network of 42 regional tobacco alliances across England was established by DH in 2000. Each alliance brings health services, local authorities and others together to implement DH tobacco policy at a local level. Reducing passive smoking was set by DH as the priority area for 2002/03 and a number of alliances have called on local councils to work towards smoke-free policies for public places in their areas.
postnote October 2003 Number 206 Smoking in public places Page 2

Health effects of passive smoking

Lung cancer and coronary heart disease research in this are investigates the health of people who have never smoked. Studies usually compare the health of those with low exposure to environmental tobacco smoke with that of those who live or work in a smoky environment. Taken individually, the results of such studies are equivocal: For lung cancer, of 37 studies reviewed, 31 reported an increase in risk. This was found to be statistically significant in 7 of the studies. 6 For coronary heart disease, 18 studies have been reviewed.7 All reported an increase in risk; this was also found to be statistically significant in 7 studies. Pooling the results of the individual studies and reanalysing them provides a potentially powerful tool for identifying links between passive smoking and disease. Applying this technique to the studies above suggests that passive smoking significantly increases the risk of lung cancer and coronary heart disease, each by around 25%.7,8 For lung cancer this represents an increase in cases from a typical 10 per 100,000 non-smokers to 12.5 per 100,000. However, there is still some scientific debate over the method used to derive these figures. One potential source of error is misclassification; the possibility that some of those classified as never having smoked in a study may actually once have smoked.3,4 Given the strong link between smoking and lung cancer (over 80% of cases are attributed to smoking), this could have a significant affect on the results. Another is publication bias; the possibility that studies yielding positive results are more likely to be published. A recent study concluded that a modest degree of publication bias leads to a substantial reduction in risk. 8 Other health effects -passive smoking has been found to cause a range of respiratory disorders, including reducing lung function and increasing respiratory symptoms such as coughing. Passive smoking can also exacerbate asthma. Exposure to tobacco smoke in the home has been found to be harmful to children, being linked with low birthweight, sudden infant death syndrome, and middle ear disease.

Smoking in pubs and restaurants A Public Places Charter was launched by the hospitality industry in 1999 with support from DH. It is promoted

by 14 industry associations, representing sectors such as pubs, restaurants and casinos. Venues are expected to have a written smoking policy and to display signs showing which of the five levels of policy they apply: no smoking; separate smoking and non-smoking areas; ventilated premises with separate areas; ventilated premises with smoking allowed throughout; smoking allowed throughout. DH hoped that this partnership with industry would lead to increased provision for non-smoking customers in pubs and restaurants. Targets were agreed that 50% of all such premises should have a formal smoking policy and carry an external sign and that 35% of these should restrict smoking to designated and enforced areas and/or have adequate ventilation. To date, 43% have met the first standard (below target) and 53% the second (above target). DH notes that few pubs are entirely smoke-free and that around half of those complying with the Charter do so by allowing smoking throughout. Smoking in workplaces Bars and restaurants are workplaces as well as public places and, in 1998, government proposed an Approved Code of Practice on smoking. This would have given guidance to employers on how to apply general health and safety legislation to passive smoking for example, by introducing a workplace smoking ban or installing ventilation, and would have applied to the hospitality industry. However, no progress has been made since 2000 when a draft code was put to government by the Health and Safety Commission. International agreements A Framework Convention on Tobacco Control was unanimously adopted at the World Health Assembly in May 2003. The convention requires signatories firstly to recognise the dangers of passive smoking, and secondly to implement effective policies to protect people from passive smoking in indoor workplaces and public places.9 The UK was among the first countries to sign. The government hopes to ratify the convention in 2004 but has not yet established if this will require any changes in policy.

Restrictions on smoking in other countries

Bans or restrictions on smoking in public places have been introduced in other countries through legislation aimed either at workplaces or directly at public places. In California (see box on page 3), legislation introduced to protect the health of employees in all workplaces means that smoking in enclosed public places is effectively banned. New York and Boston introduced similar legislation in 2003 and Ireland plans to follow suit in 2004. In order to gain public support for such legislation, the California Department of Health Services advises that: public education about the dangers of passive smoking should be the first step;

 change should be incremental; a focus on protecting workers, rather than customers, is likely to gain most support.10 Hong Kong has focused on restricting smoking in public places. Restaurants that seat more than 200 people have had to designate one-third as non-smoking since 1997. There are now proposals to phase in a complete ban on smoking in restaurants and bars. In New South Wales, Australia, the state government introduced legislation in 2000 banning smoking in all enclosed public places, including restaurants and the dining areas of pubs and clubs, but giving exemption to bars. Compliance is reported to be high and largely enforced by staff. Legislation restricting smoking in France was introduced in 1992 without support from staff or customers and has thus largely been ignored.

Public attitudes in the UK

Public awareness of passive smoking has increased in recent decades. Today, 55% of non-smokers say that they mind if other people smoke near them. As the figure on page 3 shows, this can be for a variety of reasons relating to both health and comfort.
postnote October 2003 Number 206 Smoking in public places Page 3

0 10 20 30 40 50 60 70 123456 % 1 - unpleasant smell 2 - bad for my health 3 - makes clothes smell 4 - affects breathing 5 - makes me cough 6 - gets in my eyes

Smoking policies in California

In 1988 Californians voted to increase cigarette tax by 25 cents per packet, with 20% ring-fenced for public health education. This funded a Tobacco Control Programme that aimed to increase awareness of the harmful effects of passive smoking through local initiatives and the media. Smoking was presented not just as a personal risk decision but one that threatened the health of others too. During the early 1990s, several cities and counties within California introduced local bans on smoking in workplaces. Building on these local developments, the state-wide California Smoke-free Workplace Act was passed in 1994. This effectively banned smoking in any enclosed public place. It came into effect in 1995 but most entertainment venues were given a three year exemption until 1998. 88% of on-site alcohol consumption in California is in bars attached to restaurants. In 2001, it was reported that there was 90% compliance with the 1994 Act in these venues. At the same time, sales of alcohol at these establishments had increased. A study looking at the respiratory health and lung capacity of bar workers reported measurable improvements following the introduction of the ban. Source: See endnote 10

The Office for National Statistics reports that, in 2002,

54% of the public were in favour of restrictions on smoking in pubs; 88% in restaurants and 87% in other public places.11 A 2003 MORI poll looked in more detail at attitudes to different types of restrictions in restaurants.12 40% said that smoking should not be allowed at all in restaurants; 54% that separate smoking and non-smoking areas should be provided; and only 4% that smoking should be allowed anywhere.

Reducing exposure to smoke

Banning smoking in public places Action for Smoking and Health (ASH), a campaigning public health charity, believes that a ban on smoking in public places is the only way that the health of staff and customers can be adequately protected. Others are concerned that this would damage the hospitality industry and infringe smokers personal freedoms. It is estimated that some 20 pubs and hundreds of restaurants in England have chosen to ban smoking. This has been driven primarily by commercial considerations. For example, earlier this year smoking was banned in all 350 Pizza Hut restaurants these are family restaurants and many parents prefer not to expose their children to tobacco smoke. Pubs that have banned smoking are reported to be doing brisk business and have the added benefits of lower cleaning and insurance costs. The UK hospitality industry is concerned that a ban on smoking would seriously damage it by reducing custom and causing remaining customers to spend less time and money at a venue. However, a review of studies on the effect of smoking bans concluded that, where studies controlled for changes in economic conditions and used objective measures (e.g. sales receipts), there was no evidence for a negative economic impact on bars and restaurants.13 Studies reporting a negative impact were generally based on predictions or impressions of the effect of bans rather than on quantitative data. Why non-smokers mind if people smoke near them
Source: Office for National Statistics, 2003.

The TMA and FOREST (Freedom Organisation for the Right to Enjoy Smoking Tobacco), a campaigning organisation that defends the interests of smokers, believe that a ban would discriminate against smokers. FOREST supports policies that accommodate smokers and non-smokers, such as providing separate areas or using ventilation, as discussed below. Separate areas for smokers and non-smokers Many restaurants and pubs provide separate smoking and non-smoking areas. This ranges from offering separate rooms to allocating areas as smoking or nonsmoking. Larger venues, and those that have more than one room, have more flexibility over how they provide smoking and non-smoking areas. Some venues vary their policies with the time of day. For example, non-smoking areas may be extended when food is served at lunch times. Others focus on reducing staff exposure to tobacco smoke by banning smoking at the bar.

With separate areas, customers and staff are still exposed to tobacco smoke, but at a reduced level. While this may mean that customers are more comfortable, ASH, drawing on evidence from the BMA and others, believes that there is still an unacceptable risk to health. The hospitality industry suggests that it would not be practical for all venues to offer separate areas, particularly for smaller pubs and bars. Providing ventilation Installation of ventilation can improve air quality and provide a more comfortable environment for customers and staff. Some venues use ventilation in tandem with separate smoking and non-smoking areas, supplying outside air to non-smoking areas and bar staff, and removing stale air from smoking areas. Ventilation systems can cost ~2,000 to 50,000, and require regular maintenance for optimal performance. There is concern among public health campaigners internationally that tobacco manufacturers are promoting ventilation as a substitute for non-smoking policies. ASH points out that ventilation standards are based on creating a more comfortable atmosphere, rather than a safer one. Indeed, the BMA has concluded that ventilation does not provide effective protection against the health hazards of passive smoking. The TMA argues that indoor air may be contaminated anyway, so that proper ventilation is preferable to a smoking ban as contaminants from all sources are removed.
postnote October 2003 Number 206 Smoking in public places Page 4

Policy options
Voluntary agreements The hospitality industry has a strong preference for voluntary agreements on smoking in public places, such as the Public Places Charter. They argue that this is the only way that a diverse sector can be brought together without damaging economic consequences and that customer demand for smoking restrictions should be the driving force behind change. The TMA supports this view. Since 1997 it has funded the AIR (Atmosphere Improves Results) initiative, which provides advice to venues on implementing smoking restrictions and improving air quality. AIR was instrumental in raising the idea of establishing a hospitality industry funded Public Places Charter in 1998. The industry feels that it has made good progress with introducing the Charter. It is disappointed not to have received greater recognition from DH and is concerned that, without commitment from government, the Charter will lose momentum. In particular, venues may be unwilling to invest in ventilation systems while the governments position on a smoking ban is unclear. DH is in the process reconsidering its policies on passive smoking. A key issue is whether the Charter can be used as a way to generate change or whether it simply provides venues with a way to communicate existing policies. While the industry remains committed to the

Charter, there appears to be no strategy in place for moving it forward and there are no targets for future levels of compliance. Suggestions have included extending the Charter to recognise good practice on protecting staff from tobacco smoke, and requiring all venues to have non-smoking areas within 12 months of joining. It has also been suggested that the Charter will only retain credibility if there is 100% membership.14 Regulation The Chief Medical Officer does not believe that a voluntary agreement such as the Charter can tackle the health risks from passive smoking rapidly. He has therefore called on government to consider passing legislation to ban smoking in public places.15 The Approved Code of Practice proposed by government in 1998 would have required employers to control employees exposure to tobacco smoke and been legally enforceable. The hospitality industry had a number of concerns about the Code: that it treated entertainment venues in the same way as other workplaces; that it would lead to a backdoor ban on smoking; and that it would have been too expensive for small businesses. They believe that it is the last of these points that has held up implementation of the Code. Government says that it is still considering further consultation on the Code but there is no expectation from either the hospitality industry or ASH that it will ever be implemented. In the United States and Australia smoking restrictions have been introduced at a local rather than national level. It is not clear whether this is an option in the UK as there is uncertainty over whether local authorities have the power to introduce bylaws on smoking in private properties. Any new legislation, local or national, would have to consider whether: specific restrictions or a total ban would be best; to treat the hospitality industry differently from other work places or public places; to treat the various sectors of the industry (pubs, restaurants, casinos, nightclubs etc.) differently; implementation could be phased to give venues time to adapt; measures to support enforcement would be needed.

Overview
There appears to be public support for measures to reduce exposure to tobacco smoke in public places such as restaurants both for health and comfort reasons. Reductions in exposure can be achieved by providing separate smoking and non-smoking areas, installing ventilation or banning smoking. A question is whether such measures are best encouraged through industry led voluntary agreements or through statutory requirements.
Endnotes 1 A summary of international position statements on passive smoking is given in Report on the health effects of environmental tobacco smoke in the workplace. Health and Safety Authority (Ireland), 2002. Available via www.hsa.ie 2 Towards smoke-free public places, BMA, November 2002.

3 J Bailar, New England Journal of Medicine, 340, 958-59, 1999. 4 see J Enstrom & G Kabat British Medical Journal, 326, 1057-61, 2003 and British Medical Journal, 327, 501-503 for a debate on the use of meta-analysis. 5 DH policy on smoking is set out in two key documents, available via www.doh.gov.uk. Smoking kills a white paper on tobacco. DH, 1998. NHS cancer plan. DH, 2000. 6 A Hackshaw et al, British Medical Journal, 315, 980-88, 1997 7 J He et al, New England Journal of Medicine, 340, 92-26, 1999 8 J Copas and J Shi, British Medical Journal, 320, 417-18, 2000 9 Article 8: WHO Framework Convention on Tobacco Control. 2003. Available via www.who.int 10 Eliminating smoking in bars, taverns and gaming clubs. California Department of Health Services, 2001. Available via www.dhs.ca.gov 11 Smoking related behaviour and attitudes, 2002. Office for National Statistics, 2003. Available via www.statistics.gov.uk 12 Commissioned by SmokeFree London. Available via www.mori.com/polls 13 M Scollo et al. Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry. Tobacco Control, vol 12 (2003), pp 13-20. 14 Scrutiny of smoking in public places in London. Smoking in public places investigative committee, London Assembly, 2002. Available via www.london.gov.uk 15 Annual report of the Chief Medical Officer, 2002. DH, 2003.
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Why Do We Smoke Cigarettes? from The Psychology of Everyday Living by Ernest Dichter 1947 None of the much flaunted appeals of cigarette advertisers, such as superior taste and mildness, induces us to become smokers or to choose one brand in preference to another. Despite the emphasis put on such qualities by advertisers, they are minor considerations. This is one of the first facts we discovered when we asked several hundred people, from all walks of life, why they liked to smoke cigarettes. Smoking is as much a psychological pleasure as it is a physiological satisfaction. As one of our

respondents explained: "It is not the taste that counts. It's that sense of satisfaction you get from a cigarette that you can't get from anything else."

Smoking is Fun

What is the nature of this psychological pleasure? It can be traced to the universal desire for selfexpression. None of us ever completely outgrows his childhood. We are constantly hunting for the carefree enjoyment we knew as children. As we grew older, we had to subordinate our pleasures to work and to the necessity for unceasing effort. Smoking, for many of us, then, became a substitute for our early habit of following the whims of the moment; it becomes a legitimate excuse for interrupting work and snatching a moment of pleasure. "You sometimes get tired of working intensely," said an accountant whom we interviewed, "and if you sit back for the length of a cigarette, you feel much fresher afterwards. It's a peculiar thing, but I wouldn't think of just sitting back without a cigarette. I guess a cigarette somehow gives me a good excuse."

Smoking is a Reward

Most of us are hungry for rewards. We want to be patted on the back. A cigarette is a reward that we can give ourselves as often as we wish. When we have done anything well, for instance, we can congratulate ourselves with a cigarette, which certifies, in effect, that we have been "good boys." We can promise ourselves: "When I have finished this piece of work, when I have written the last page of my report, I'll deserve a little fun. I'll have a cigarette." The first and last cigarette in the day are especially significant rewards. The first one, smoked right after breakfast, is a sort of anticipated recompense. The smoker has work to do, and he eases himself into the day's activities as pleasantly as possible. He gives himself a little consolation prize in advance, and at the same time manages to postpone the evil hour when he must begin his hard day's work. The last cigarette of the day is like "closing a door." It is something quite definite. One smoker explained: "I nearly always smoke a cigarette before going to bed. That finishes the day. I usually turn the light out after I have smoked the last cigarette, and then turn over to sleep." Smoking is often merely a conditioned reflex. Certain situations, such as coming out of the subway, beginning and ending work, voluntary and involunatary interruptions of work, feelings of hunger, and many others regulate the timetable of smoking. Often a smoker may not even want a cigarette particularly, but he will see someone else take one and then he feels that he must have one, too.

While to many people smoking is fun, and a reward in itself, it more often accompanies other pleasures. At meals, a cigarette is somewhat like another course. In general, smoking introduces a holiday spirit into everyday living. It rounds out other forms of enjoyment and makes them one hundred per cent satisfactory.

Smoking is Oral Pleasure

As we have said, to explain the pleasure derived from smoking as taste experience alone, is not sufficient. For one thing, such an explanation leaves out the powerful erotic sensitivity of the oral zone. Oral pleasure is just as fundamental as sexuality and hunger. It functions with full strength from earliest childhood. There is a direct connection between thumbsucking and smoking. "In school I always used to chew a pencil or a pen," said a journalist, in reply to our questions. "You should have seen the collection I had. They used to be chewed to bits. Whenever I try to stop smoking for a while, I get something to chew on, either a pipe or a menthol cigarette. You just stick it in your mouth and keep on sucking. And I also chew a lot of gum when I want to cut down on smoking...." The satisfied expression on a smoker's face when he inhales the smoke is ample proof of his sensuous thrill. The immense power of the yearning for a cigarette, especially after an enforced abstinence, is acknowledged by habitual smokers. One of our respondents said: "When you don't get a cigarette for a long time and you are kind of on pins, the first drag goes right down to your heels."

The Cigarette -- A Modern Hourglass

Frequently the burning down of a cigarette functions psychologically as a time indicator. A smoker waiting for someone who is late says to himself, "Now I'll smoke one more cigarette, and then I am off." One person explained, "It is much easier to watch a cigarette get smaller and smaller than to keep watching a clock and look at the hands dragging along." In some countries, the farmers report distances in terms of the number of pipes, as, for example, "It's about three pipes from here to Smithtown." A cigarette not only measures time, but also seems to make time pass more rapidly. That is why waiting periods almost autuomatically stimulate the desire to smoke. But a deeper explanation of this function of smoking is based on the fact that smoking is ersatz activity. Impatience is a common feature of our times, but there are many situations which compel us to be patient. When we are in a hurry, and yet have to wait, a cigarette gives us something to do during that trying interval. The experience of wanting to act, but being unable to do so, is very unpleasant and may even, in extreme cases, cause

attacks of nervous anxiety. Cigarettes may then have a psychotherapeutic effect. This helps to explain why soldiers, waiting for the signal to attack, sometimes value a cigarette more than food.

"With a Cigarette I Am Not Alone"

Frequently, our respondents remarked that smoking cigaretees is like being with a friend. Said one, "When I lean back and light my cigarette and see the glow in the dark, I am not alone any more...." In one sense, a cigarette seems to be something alive. When it is lighted it appears to be awakened, brought to life. In a French moving picture (Daybreak) the hunted criminal, played by Jean Gabin, holds out as long as he has his cigarettes. He barricades himself against the police and stands siege courageously for some time -- until his last cigarette is gone. Then he gives up. The companionable character of cigarettes is also reflected in the fact that they help us make friends. In many ways, smoking has the same effect drinking has. It helps to break down social barriers. Two smokers out on a date light up a cigarette as soon as they get into their car. "It's just the right start for an evening," they say. Immediately they feel at ease, for they have found an interest they both share. We could report many true anecdotes to illustrate how cigarettes bring people together. One such story was related by a middle-aged lady: "A long time ago, on a steamer, there was a boy I was quite eager to meet... but there was no one to introduce us.... The second day out, he was siting at a table right next to me, and I was puffing away at my cigarette. The ashes on my cigarette were getting longer and longer, and I had no ash tray. Suddenly he jumped up and brought me one. That's how the whole thing started. We are still happily married."

"I Like to Watch the Smoke"

In mythology and religion, smoke is full of meaning. Its floating intangibility and unreal character have made it possible for imaginative man to see therein mystery and magic. Even for us moderns, smoke has a strong fascination. To the cigarette smoker, the clouds he puffs out seem to represent a part of himself. Just as most people like to watch their own breath on cold winter days, so they like to watch cigarette smoke, which similarly makes one's breath visible. This explains the emotional attitudes of many toward smoke. "Smoke is fascinating," said one of the people we interviewed. "I like to watch the smoke. On a rainy day, I sort of lie in a haze in the middle of the room and let my thoughts wander while I smoke and wonder where the smoke goes." The desire to make things is deep-rooted -- and smoke is manufactured by the smoker himself. Smoking provides satisfaction because it is a playful, creative activity. This fact was well stated by one

cigarette devotee as follows: "It's a fascinating thing to watch the smoke take shape. The smoke, like clouds, can form different shapes.... You like to sit back and blow rings and then blow another rings through the first ones. You are perfectly relaxed."

Around 5.4 million deaths a year are caused by tobacco. * Smoking is set to kill 6.5 million people in 2015 and 8.3 million humans in 2030, with the biggest rise in low-and middle-income countries. * Every 6.5 seconds a current or former smoker dies, according to the World Health Organization (WHO). * An estimated 1.3 billion people are smokers worldwide (WHO). Over 443,000 Americans (over 18 percent of all deaths) die because of smoking each year. Secondhand smoke kills about 50,000 of them. 1.2 million people in China die because of smoking each year. That's 2,000 people a day. Tobacco use will kill 1 billion people in the 21st century if current smoking trends continue. 33 percent to 50 percent of all smokers are killed by their habit. * Smokers die on average 15 years sooner than nonsmokers.

Smoking is one of the most difficult addictions to break. Scientists estimate that cigarettes are more addictive than cocaine, heroin, or alcohol. According to the World Health Organization, smoking kills more people than any disease in the world. With all this information readily available, why do people continue to smoke? Most people who smoke do so because they can't stop. Nicotine is a highly addictive substance that makes people feel energized and alert. Smokers get a rush after a cigarette, and giving up produces withdrawal symptoms that include difficulty sleeping and cravings. Seventy percent of people who quit smoking eventually start again. Tobacco advertising also has a big influence on why people smoke. For years, the industry has focused on making smoking glamorous through advertising in movies, television, and billboards. While cigarette advertising is now controlled, its influence can still be felt in the form of free samples, smoking cartoons, and the promise of cool merchandise that can be obtained in exchange for coupons printed on cigarette packs. Many people claim that smoking keeps them thin, but the truth is that smoking reduces the sense of taste, so many people who smoke simply eat less because they don't enjoy food as mu

Smoking also produces psychological dependency. Many people smoke because it helps them relax and cope with difficult situations, or because it gives them confidence. Others smoke when they feel bored. Smoking produces a feeling of satisfaction that's difficult to give up. Finally, people who smoke are usually in denial they know that smoking is bad, but they convince themselves it's simply "not as terrible as they make it sound." Smoking is a social activity as well. Many people who smoke do so as a way to start conversations and interact at parties or in crowded places. This is known as "social smoking," and it usually involves alcohol as a complement. Many teenagers start smoking due to peer pressure. They may also smoke to feel more mature or as a form of rebellion against parental authority. It has been proved that children are also more likely to smoke if their parents do.
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Have you ever come home with the stench of smoke clinging to your clothes? Or inhaled a cloud of smoke as a group of smokers passed, causing you to cough and choke? Neither experience is pleasant, and this is why smoking should be banned in public areas. Smoking can be dangerous not only for the smoker, but also for those around the smoker. Secondhand smoke is the third leading cause of preventable death (after active smoking and alcohol), according to the Manitoba Medical Association. They also say that the smoke contains over 4,000 chemicals, 50 of which are known to be cancer-related. Secondhand smoke has been linked to heart and respiratory disease; lung, breast, cervical, and nasal sinus cancers; strokes and miscarriages. In children, dangers include sudden infant death syndrome, fetal growth impairment, bronchitis, pneumonia, asthma and middle-ear disease. People who smoke subject themselves to deadly diseases, as well as long- and shortterm health problems. Non-smokers should not have to live with the consequences of smokers' actions. Not permitting smoking in public areas may help people refrain from smoking. Some argue that there would be a significant decline in the clientele in bars and clubs, but non-smokers actually outnumber smokers three to one. A ban could actually increase people going out because nonsmokers would be more comfortable. There may also be a sudden realization of the dangers of smoking. With the state government taking a stand, it may cause people to take another look at the deadly factors of "cancer sticks." After a recent incident from the widely known Target Market program, people are beginning to feel that

anti-tobacco efforts are losing their focus. At a local event a couple years ago, a punk band hired by the anti-drug campaign played songs that included positive images of cigarettes and other drugs in their lyrics. This is not the most efficient way to use money set aside for anti-drug programs. Instead, this money could be used to enforce the laws that should be passed to ban smoking in public places. Sometimes those you think would be against the idea of making smoking illegal actually agree with it. Patrick Reynolds, heir to the tobacco empire, rejected becoming president of his family's tobacco company because it was proven to have caused both his father's and his older brother's deaths. Now, he runs a campaign to stop people from smoking. In his presentation, he states that a smoker will spend about $1,400 a year for one pack a day. Reynolds also says that the more secondhand smoke you inhale, the more susceptible you are to health problems. People working in casinos, for example, are up to eight times as likely to be in danger of the effects of secondhand smoke. Banning smoking in public places can prevent death and illness. Some say that no matter what, nothing will reduce or stop cigarette smoking altogether. The laws banning smoking might convince some to quit and create a safer environment for everyone else. Also, some argue that there isn't money to carry this out. The money that goes into programs such as Target Market and Big Tobacco will be cut and the difference will go toward law enforcement. Smoking is a dangerous habit that not only affects the smoker, but those around him or her. Banning the smoking in public will keep non-smokers safer. People who smoke subject themselves to deadly diseases by choice. Why should non-smokers be forced to be around it?

Smoking, ban in public places (JUNIOR) print this page Debatabase Junior Topic Discuss topic Summary: Should smoking be banned in public places?

Introduction

Author:George Molyneaux ( United Kingdom ) George Molyneaux (UK) studied History at the University of Oxford. He reached the semi-finals of the World Schools Debating Championships twice (representing Scotland), the octo-finals of the World Universities Debating Championships and the semi-finals of the European Universities Debating Championships. He is currenlty the Coach of the Scotland Schools Debating Team.

Created: Saturday, September 02, 2006 Last Modified: Friday, August 27, 2010

Context

For many years, governments have tried to reduce smoking by taxing tobacco, running advertising campaigns and putting warnings on packets. Recently, several countries have also restricted the areas in which people may smoke. Most bans apply only to enclosed places (meaning inside buildings, e.g. shops, restaurants, bars, offices, theatres, trains, bus shelters etc). Smoking is banned in all or most enclosed public places in South Africa, New Zealand, Italy and the Republic of Ireland. There are similar bans in the American states of California and New York. Smoking in enclosed public places was recently banned in Scotland. It will become illegal in the rest of the UK in 2007. In England and Wales, pubs that do not serve food can continue to choose to allow smoking. Bans on smoking in public places in the open air (e.g. parks, streets) are less common. Smoking is banned in some streets in Tokyo (Japan). Smoking near the entrances of buildings is banned in some parts of Australia, Canada and the USA. The proposition must define this motion clearly. They must state whether they would ban smoking in all public places, or only in enclosed public places. They must also make it clear if there would be any major exceptions to the ban (e.g. pubs that do not serve food, private clubs open only to members). However, this debate often works best if the proposition do not introduce lots of exceptions.

Arguments

Pros Cons

Scientists agree that smoking is dangerous. Tobacco smoke can cause cancer, strokes and heart disease. Smoking does not just harm the smoker it also harms people nearby, who breathe in the smoke (this is called passive smoking). Smokers choose to smoke, but people nearby do not choose to smoke passively. People should only be exposed to harm if they understand the risks and choose to accept them. A complete ban on smoking in public is needed to protect people from passive smoking.

Society accepts that adults can decide to harm themselves to some extent, so long as they do not harm others. This is why the proposition is not arguing that people should be banned from smoking in private. Passive smokers do choose to breathe in other peoples smoke. If they do not want to smoke passively, they do not need to go to places where smoking is allowed. There is therefore no reason to ban smoking in public.

The opposition is wrong to say that people choose to smoke passively. In many places, there are no non-smoking bars or restaurants. Unless people refuse to go out with friends, they cannot avoid passive smoking. People who work in smoky workplaces (e.g. bars) often do not freely choose this sometimes no other jobs are available. In most countries, safety standards do not allow workers to be exposed to unnecessary danger, even if they agree. Workers should not be exposed to other peoples smoke, since they may not have made a free choice to do so.

If enough people want to go to non-smoking bars, companies will set up non-smoking bars. If there are no non-smoking bars, this suggests that very few people want them. Some people are quite happy to work in smoky places. In any case, workers should be allowed to choose to work in dangerous conditions. This is accepted for jobs like mining, fishing and the armed forces. Individuals decide that they are better doing this work than not having a job at all. A complete ban is not necessary to protect workers anyway ventilation fans can remove most smoke.

A ban would encourage smokers to smoke less or give up. If smoking was banned in public places, it would no longer be a social activity. Instead, smokers would have to leave their friends inside and go outside to smoke. This would be particularly unpleasant when it is cold/wet. One third of smokers in Scotland said the ban was helping them to cut down. If smoking was a less social activity, fewer people would start smoking. In many countries, governments pay all or some of the cost of treating smoking-related diseases. This means that governments should have a right to discourage smoking.

It is legal to smoke tobacco, so governments have no right to try to make people stop. It is therefore wrong to argue that a ban on public smoking should be introduced to encourage people to give up. Smokers fund their own healthcare through the high taxes they pay on tobacco. In any case, heavy smokers are unlikely to give up since they are addicted to nicotine.

People will not smoke more at home. Smokers need to maintain a certain level of nicotine in their blood to remain content. A ban on smoking in public would force them to smoke less while at work. Over time, this would lower the level of nicotine they need to feel content. This would reduce how often they need to smoke. They would therefore smoke less at home, as well as less at work.

Banning smoking in public will encourage people to smoke more at home. This will harm other people in their house, particularly children. This is important, since children are not old enough to choose freely to smoke passively. Also, people smoking at home may drink more alcohol than they would if they went to a bar. This is because they can buy it more cheaply at a supermarket or off-licence. Drinking more alcohol may lead to other health problems.

It is more important to protect peoples health than to protect businesses. Pubs and clubs should adapt, for example by trying to earn more money from selling food. After a ban was introduced in New South Wales (Australia), only 9% of restaurants reported a drop in trade.

A ban on smoking in public places would drive many bars, pubs and clubs out of business. Smokers would not go to these places. These businesses would also earn less money from selling tobacco. In many places, pubs and Working Mens Clubs are important social places for communities. They also provide jobs for people with few skills in places with little other work. It is therefore important that they survive.

There have been few problems with bans where they have been introduced. Heavy fines put off companies from allowing people to smoke. A survey for the Scottish Executive found that 99.4% of premises were observing the ban three months after it was introduced.

It would be impossible to police this ban in many public places. Small workplaces will often ignore the ban and are unlikely to be caught. Staff who do not smoke are unlikely to report smokers, in case their colleagues work out who told the authorities.

Motions

This House would ban smoking in all public places without exception This House would ban smoking in public places This House would ban smoking in enclosed public places This House would stub out smoking in public places That smoking should be made illegal in enclosed public spaces

Useful Sites Action on Smoking and Health - very accessible basic information under Fact sheets. More challenging fact sheets and a guide to smoking legislation are also available American Heart Association - quite accessible BBC article on smoking bans very accessible BBC list of places where smoking is banned in public very accessible, but not comprehensive list FOREST - quite accessible information from a group that campaigns for smokers rights. The

Key issues menu is especially useful Scientific facts on Tobacco: Active and Passive Smoking very accessible information under Summary, with more complex information under Details. Available in English, French, German and Spanish Wikipedia list of countries in which smoking in public is banned accessible, but note that anyone can update this site so it may not be reliable World Health Organization Tobacco Free Initiative more demanding, but contains lots of useful links, especially under Information resources. Available in several languages

Useful Books Smoking, At Issue series By: Mary Williams (ed.) Know About Smoking By: Margaret Hyde Smoking By: Lauri Friedman Clearing the Haze: A Teens Guide to Smoking-Related Health Issues By: Joan Esherick Smoking 101: An Overview for Teens By: Margaret Hyde Tobacco and Smoking, Opposing Viewpoints series By: Karen Balkin