15.1 Why implement smokefree environments?

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 secondhand smoke (SHS) together with growing public dislike of cigarette smoke and concern about legal liability—particularly under occupational health and safety laws—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.1-3 Certainly one of the most compelling arguments for banning smoking in workplaces has been the protection of employees from the hazards of chronic exposure.4–6 The threat of litigation arising from knowledge of these health risks and employers' duty of care to staff and customers and patrons has been a significant factor influencing the introduction of smokefree policies in organisations across both the public and private sectors (see Chapter 16, Section 16.3).

Protecting the health of the public, particularly children,7,8 has also been a significant factor driving the introduction of smoking bans in a variety of public places such as shopping centres and restaurants. Children are at particular risk from exposure to SHS due to their immature respiratory systems.2,9

As knowledge of the health risks associated with SHS has increased over time, the public has become increasingly concerned about being exposed to SHS and support for smokefree legislation has grown. Prior to the widespread introduction of smokefree policies in public places, many Australians were frequently exposed to tobacco smoke in the course of their everyday lives. A South Australian survey in 2004 for instance reported that most people in that state (74%) were concerned about personal exposures to SHS. 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 al fresco (13%), and in private homes or cars (33%). Thirty-seven per cent were also exposed to SHS in the street or at outdoor entertainment venues.10

Evidence of the benefits for introducing comprehensive smokefree legislation that covers all indoor public places and workplaces is now overwhelming.11 As spelled out in detail in Chapter 15, Section 15.8, bans have been well accepted in the community, compliance has been high, and substantial improvements in air quality have been documented. Chapter 15, Section 15.9 outlines some of the major benefits of such policies in terms of reduced exposure to secondhand smoke, declines in amounts smoked and numbers of people smoking. The benefits in terms of reduced disease and deaths are described in Chapter 15, Section 15.10.

Smokefree laws have fast become a global priority for public health as governments around the world move to implement the WHO Framework Convention on Tobacco Control.12

Relevant news and research

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1. National Health and Medical Research Council. The health effects of passive smoking: a scientific information paper. Canberra: Australian Government Publishing Service, 1997.

2. US Department of Health and Human Services. The health consequences of involuntary smoking: a report of the Surgeon General. Rockville, Maryland: US Department of Health and Human Services, Public Health Service, Centers for Disease Control, Center for Health Promotion and Education, Office on Smoking and Health, 1986. Available from: http://www.cdc.gov/tobacco/data_statistics/sgr/pre_1994/index.htm

3. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Tobacco smoke and involuntary smoking. IARC monographs on the evaluation of carcinogenic risks to humans, Vol. 83. Lyon, France: International Agency for Research on Cancer, 2004. Available from: http://monographs.iarc.fr/ENG/Monographs/PDFs/index.php

4. Goodman P, Agnew M, McCaffrey M, Paul G and Clancy L. Effects of the Irish smoking ban on respiratory health of bar workers and air quality in Dublin pubs. American Journal of Respiratory and Critical Care 2007;175(8):840–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17204724

5. Holm AL and Davis RM. Clearing the airways: advocacy and regulation for smoke-free airlines. Tobacco Control 2004;13(suppl. 1):i30–6. Available from: http://tobaccocontrol.bmj.com/content/13/suppl_1/i30.abstract

6. Wakefield M, Trotter L, Cameron M, Woodward A, Inglis G and Hill D. Association between exposure to workplace secondhand smoke and reported respiratory and sensory symptoms: cross-sectional study. Journal of Occupational and Environmental Medicine 2003;45(6):622–7. Available from: http://journals.lww.com/joem/Abstract/2003/06000/Association_Between_Exposure_to_Workplace.7.aspx

7. Sweda E, Gottlieb M and Porfiri R. Protecting children from exposure to environmental tobacco smoke. Tobacco Control 1998;7:1–2. Available from: http://tobaccocontrol.bmj.com/cgi/content/full/7/1/1

8. Ferrence R. Passive smoking and children. British Medical Journal 2010;340:c1680. Available from: http://www.bmj.com/cgi/content/full/340/mar24_1/c1680?view=long&pmid=20335342

9. Tobacco Advisory Group. Passive smoking and children. London: Royal College of Physicians, 2010. Available from: http://bookshop.rcplondon.ac.uk/details.aspx?e=305

10. Hickling J and Miller C. Progress in tobacco control in South Australia: summary of key findings from the 2004 Health Omnibus Survey. Adelaide: Tobacco Control Research and Evaluation Program, 2005.

11. International Agency for Research on Cancer. Evaluating the effectiveness of smoke-free policies. Handbooks of cancer prevention, tobacco control, Vol 13. Lyon, France: IARC, 2009. Available from: http://com.iarc.fr/en/publications/pdfs-online/prev/handbook13/

12. WHO Framework Convention on Tobacco Control. Geneva: World Health Organization, 2003. Available from: http://www.who.int/tobacco/framework/WHO_FCTC_english.pdf