15.1 Why implement smokefree environments?

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While the earliest smoking bans in cinemas and public transport were driven primarily by concerns about fire risk, the growing recognition of the health effects of SHS together with growing public dislike of cigarette smoke have been the factors facilitating the adoption of smokefree policies and legislation in more recent times.

Scientific research is unequivocal about the serious health effects of exposure to SHS.4, 5 Certainly one of the most compelling arguments for banning smoking in workplaces has been the protection of employees from the hazards of chronic exposure.6–8 Protecting the health of the public, particularly children,9 has also influenced policy-makers to strengthen smoking bans.

People are concerned about being exposed to SHS. A South Australian survey reported that most people in that state (74%) were concerned about personal exposures to second-hand smoke. The highest rates of exposure to SHS in enclosed or restricted places occurred in hotels and bars (36%). Many people reported being exposed to SHS while dining alfresco (13%), and in private homes or cars (33%). Thirty-seven percent were also exposed to SHS in the street or at outdoor entertainment venues.10

Comprehensive smoking bans significantly reduce non-smokers' exposure to SHS.11 A number of studies in several different jurisdictions show reduced levels of salivary cotinine (a marker of SHS exposure) among non-smoking staff and patrons after the implementation of smoking bans in pubs and clubs.6, 12–15 Bar workers also experience a decrease in respiratory illness symptoms following the implementation of smokefree laws.6, 16, 17 A Scottish study, the largest evaluation of the effect of smokefree legislation on air quality inside pubs, found substantial improvement in air quality in pubs.18 Post smoking ban, many pubs had air particulate levels similar to those found in the ambient outside air. Children who reside in smokefree homes also have significantly lower levels of cotinine in their saliva.19 Smokefree environments are effective in reducing non-smokers exposure to SHS.

Smoking bans are also beneficial to the health of smokers. Bans have been shown to be helpful to smokers who are trying to quit by both encouraging more quit attempts20 and increasing the chances of a successful quit attempt.21–23 A 1999 study of Australian smokefree workplaces legislation found that a smoking ban was responsible for an annual reduction in consumption of some 602 million cigarettes, or 1.8% of all cigarettes that might otherwise be consumed and that if workplaces were universally smokefree, the number of cigarettes forgone annually would increase to 1.14 billion (3.4%).24 In a 2002 review of 26 studies on the effects of smokefree workplaces in the United States, Australia, Canada, and Germany, totally smokefree workplaces were associated with reductions in prevalence of smoking of 3.8% and 3.1 fewer cigarettes smoked per day per continuing smoker.25 Additionally, younger smokers who are 'socially cued' to smoke in places such as bars, are more likely to give up smoking when comprehensive bans are introduced.26 p 300

Smoking bans may also reduce hospital admissions for smoking-related diseases. A study conducted in Helena, Montana, found that the number of monthly admissions for acute myocardial infarction fell significantly during the six months a smokefree law was in effect.27 Another US study found that hospital admissions for coronary heart disease reduced by 47% after three years following the implementation of a city ordinance banning smoking in public places and workplaces.28

The SHS issue can be considered a "Trojan horse to its less discussed effects: the reduced morbidity and mortality likely to result in smokers from the significant reductions in smoking frequency that occur with the proliferation of smoking restrictions introduced in the name of concern for the health of non-smokers."29 p 417