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Rapid Responses: Rapid Responses published:
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No cause for concern
- Dylan M Wilson (14 September 2007)
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Call for a long term public health vision - a smoke-free planet
- Per Lytsy (14 September 2007)
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Smoking and legislation for young people
- Bhaskar Punukollu, Thivya Sekar (14 September 2007)
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Effects of the smoking ban on alcohol related admissions in Ayrshire, Scotland
- Sujoy Ghosh, James Rose, Jyotirmoy Pal, Andrew Collier (16 September 2007)
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Infringe?
- Andrew Privett (26 September 2007)
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Dylan M Wilson, Paediatric Registrar Gold Coast Health Service District, Australia
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Professor Chapman need not be concerned about parents smoking in the house around their children and exposing them to second-hand smoke. I can only refer to my own personally conducted research, but as a paediatrician who sees acute asthmatics on a daily basis, the most frequent response to the question of whether anyone smokes in the household is usually "Yes, but outside, not in front of the kids". In fact I am struggling to remember seeing a parent who has stated (or more accurately perhaps, admitted) that they did. I want to believe them, and often have idealistic visions of said parents, stood on the porch, braving the elements ten to twenty times a day for the sake of their children's health. However my cynicism wins over, accept that they are lying and I usually nod politely in agreement before coming up with a way of explaining that smoking regardless of location is detrimental to their child's health, often referring to how smoke drifts, and the residual smoke on clothes can be harmful. I find this common response encouraging in a way, as at least they have the insight to realise they are being "naughty" and perhaps their is a genuine group of parents out there that really DO smoke outside. I am also aware that parents' smoking is frequently overlooked in the discharge plan for asthmatics which tend to focus on ensuring the correct delivery and frequency of bronchodilators and steroids. Linking in smoking parents to cessation services should perhaps be a compulsory part of discharging children with respiratory disease. Competing interests: None declared |
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Per Lytsy, M.D, doctoral student University, 75185, SwedenDepartment of Public Health and Caring Sciences, Uppsala
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Professor Chapman asks the question if is it is possible to ban smoking in private homes. An even more fundamental question would be if it is possible to ban it from earth. The growing knowledge of the negative consequences from tobacco smoking must be discussed form a global perspective. According to the World Health Organisation, chronic pulmonary diseases are increasing and will by the year of 2020 be the cause of every third death. A major part of this disease impact is avoidable. Banning smoking would be the start. Such an action would call for a global initiative with a clear goal to have the planet smoke-free by a half century or so. Respect the individuals that smoke today and help the ones that want to quit, but make it gradually even more costly to start smoking in the first place. Introduce a small global tax that is annually increased. With such a strategy smoking will more or less disappear a within a century, when cigarettes simply are to costly. It will by that time be lacked by few, if any. It is impossible to do this, will people say, and refer to human and individual rights as well as taxing difficulties and arising illegal markets. They may be correct that a world wide smoking ban is troublesome and hard to maintain and control. But spare me the right to have a global long term public health vision that includes a smoke-free planet. Tobacco smoking is the only legal product, that used as intended, will shorten your life. Less dangerous products have been banned for health reasons. So what are we waiting for? Competing interests: None declared |
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Bhaskar Punukollu, SpR in Substance Misuse Soho Alcohol and Drug Treatment Service, 1A Frith Street, Soho, London, W1D 3HZ, Thivya Sekar
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Smoking is well known in the UK as a major cause of morbidity associated with heart disease and lung cancer as well as chronic bronchitis and other respiratory disorders. In his article, Simon Chapman praises the work done so far internationally in reducing smoking in public places through legislation (1). A survey conducted recently by restaurant guide Zagat showed that 93% of London diners (of more than 5000 questioned) were in favour of the smoking ban introduced throughout the UK on 1st July 2007. This fits with Chapman's article which states that contrary to what the tobacco industry would have us believe, the vast majority of people appreciate smoke free public spaces. However he also highlights the importance of need for greater public health campaigns and health worker involvement in helping parents to stop smoking when their children are at home. Children may easily become addicted to cigarettes if they start smoking. They are more likely to start smoking if they have a parent, sibling or friend who smokes. Some of the main reasons why children smoke are- to be sociable, gain a sense of independence or maturity, perceive themselves as attractive and a feeling of being at one with other friends who smoke. In the UK it is illegal for retailers to sell tobacco to children under 16 years old under the Young Persons Act 1991. Shopkeepers who break the law can be fined up to £2500. However, many young children still manage to obtain cigarettes through older friends or from retailers not properly checking their age through use of ID cards. The UK has not yet implemented a clear system for shopkeepers to check a child’s age such as a national identity card or a young person’s card. A survey by the National Centre for Social Research and the Information Centre for Health and Social Care in 2006 revealed that two fifths (39 per cent) of pupils reported having tried smoking at least once in their life. Whilst the proportion of pupils who have never smoked rose progressively to 61 per cent in 2004, it has remained at a similar level since. Nine per cent were regular smokers (smoked at least once a week), a proportion which has remained unchanged since 2003. One fifth (20%) of 15 year olds said they smoked at least once a week, compared with only 1% of 11 year olds. About two thirds (65 per cent) of pupils who smoked identified shops as one of their usual sources of cigarettes. All the pupils in the survey were under the legal age of 16 for smoking in the UK (2). There are many potential interventions to reduce smoking and passive smoking among children. As Chapman stated in his article, one of these is for GPs and other health workers to work with parents to help them stop smoking. Singapore is an example of one of the first countries in the world to have banned smoking in public places. Efforts to promote a smoke- free lifestyle in Singapore started in the 1970s with the introduction of laws restricting smoking in public places and prohibition of tobacco advertisements. In 1986, the National Smoking Control Programme, a comprehensive long-term programme for smoking control spearheaded by the Ministry of Health, was launched with the theme "Towards a Nation of Non- Smokers". The programme uses a multidimensional approach to promote non- smoking using public education, legislation, tobacco taxation, partnerships with schools and the health care industry as well as provision of smoking cessation services. Since the start of the programme in 1986, there has been an overall decrease in smoking prevalence from 20% (37% males and 3% females) in 1984 to 12.6% (21.9% males and 3.4% females) in 2004. Smoking prevalence among Singaporean men and women are among the lowest in the world when compared with countries such as Canada, Australia, United States, Hong Kong, Republic of Korea, Japan, Thailand, Italy, Germany, Switzerland and the UK (3). A different approach may be required in the UK but given the ongoing high rates of smoking in the UK and in children under 16, it may well be time for the government to introduce further legislation to effectively prevent children acquiring cigarettes from shops as well as integrating school education, smoking cessation programmes, GPs and health workers to further reduce the prevalence of this problem. References: 1. Chapman S. The future of smoke-free legislation. BMJ 2007;335:521 -522 (15 September). 2. Fuller E, Bates B, Blenkinsop S, Clemens S, Deverill C, Hills A, et al. Smoking drinking and drug use among young people in England in 2006. The information centre for health and social care and The National Centre for Social Research. 3. National Smoking Control Programme. www.hpb.gov.sg Singapore Government Health Promotion Board. Competing interests: None declared |
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Sujoy Ghosh, Clinical Teaching & Clinical Research Fellow The Ayr Hospital, Ayrshire, KA6 6DX, Scotland, James Rose, Jyotirmoy Pal, Andrew Collier
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Effects of the smoking ban on alcohol related admissions in Ayrshire, Scotland Sujoy Ghosh, James Rose, Jyotirmoy Pal, Andrew Collier The Ayr Hospital, Ayrshire, Scotland, UK We have read with interest the original research articles and the accompanying editorial on the effects of smoking ban in public places in Scotland. [1-4] Bans on smoking in public bars and restaurants came into effect on 26th March 2006 in Scotland. [5] This change is not isolated to Scotland and in the last few years North American cities, Ireland, Norway and Sweden have also banned smoking.[6] A smoking ban is soon to be introduced in England and Wales. Obviously the rationale for this change has been ‘effects on the health of others’. The original articles show that the benefit of the smoking ban has been significant in non-smokers from non-smoking households. Non-smokers living in smoking households continue to have high levels of exposure to second hand smoke. [1] Smoking, drinking and gambling tend to go together. [7] The editorial states the concerns raised in some quarters, that following smoking ban in public places there would a possible rise in alcohol consumption and that smokers drinking at home would lead to increase in domestic violence. We therefore investigated the possible impact of smoking ban on hospital admissions due to alcohol overdose or withdrawal, which we used as a crude maker of alcohol consumption. We would like to share a small audit which we undertook with relationship to smoking ban and alcohol consumption. METHOD: We looked at the number of alcohol related admissions to The Ayr Hospital, South Ayrshire prior to the ban (April to July 2005) and compared it with that after imposition of ban (April to July 2006). We also categorised the admissions on whether they were related to alcohol overdose or withdrawal. RESULTS: The results are summarised as follows: Period (April- July) 2005 2006 Total no. of admissions 54 58 Total no. of overdoses 39 46 Total no. of withdrawals 15 12 Known Smokers 17 20 DISCUSSION: There is no one correct method of trying to analyse alcohol consumption. Some people would say that the best way to do that would be to monitor the sale of alcohol. Others would opt for a questionnaire based analysis of alcohol intake in individuals. We looked at the number of patients who were admitted to the hospital due to either alcohol overdose or alcohol withdrawal. The smoking status was not well documented in all the patients. It was therefore difficult to be certain to conclude how many of the patients was ex- smokers or non-smokers. The small number of patients also made sub- group, analysis difficult. To ban smoking in bars or other drinking places potentially has number of effects on smoking and drinking among those who are regular smokers and bar drinkers. Some would probably stay inside the drinking- place and would thereby probably cut down their total number of cigarettes smoked. Some customers would be forced to go outside the bar and smoke, which at least in some circumstances may cut down their drinking (due to local climate/season). Some of the smokers would stay away from the drinking- place. This may affect their drinking habits, depending on whether and how much they drink instead elsewhere. Among non-smokers, some potential customers who previously stayed away from smoking areas may now come there.[8] We wondered whether the smoking ban would lead to increased drinking at home. However this small audit failed to show any significant difference between the rates of admission due to either alcohol overdose or alcohol withdrawal. From this audit we would conclude that the smoking ban had no major impact on hospital admissions and that the fear of increase in alcohol consumption is perhaps unwarranted. [1] Haw S J, Gruer L.Changes in exposure of adult non-smokers to secondhand smoke after implementation of smoke-free legislation in Scotland: national cross sectional survey. BMJ 2007;335:549-552 [2] Phillips R, Amos A, Ritchie D, Cunningham-Burley S, Martin C. Smoking in the home after the smoke-free legislation in Scotland: qualitative study. BMJ 2007;335:553-557 [3] Akhtar P C, Currie D B, Currie C E, Haw S J. Changes in child exposure to environmental tobacco smoke (CHETS) study after implementation of smoke-free legislation in Scotland: national cross sectional survey. BMJ 2007;335:545-549 [4] Chapman S. The future of smoke-free legislation. Will cars and homes follow bans on smoking in public spaces. BMJ 2007;335:521-522. [5] The Smoking, Health and Social Care (Scotland) Act 2005 (Prohibition of Smoking In Certain Premises) Regulations 2005 (web reference: http://www.scotland.gov.uk/Publications/2005/03/20827/54289) Last accessed on 16th September 2007. [6] Room R. Banning smoking in taverns and restaurants- a research opportunity as well as a gain for public health. Addiction. 2005; 100: 888 -90. [7] Room R. Smoking and drinking as complementary behaviours. Biomedicine & Pharmacotherapy (2004); 58: 111-115. [8] Kabat. G. Effect of public smoking ban in Helena. Montana (2004); British Medical Journal 328: 1379 Competing interests: None declared |
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Andrew Privett, CIvil Servant - Health and Social Services CF10 3NQ Welsh Assembly Government
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There is a clear-cut, logical case for a global ban on tobacco. There is also a clear-cut, logical case for a global ban on alcohol. You must ask yourself a few questions:
The answers are irrelevant. Alcohol kills more people than crack/heroin/cocaine/cannabis/LSD/amphetamines. Again irrelevant. Alcohol is moderated and sold 'responsibly'. Is there a good reason why alcohol should remain available when tobacco should not? I would be very interested to hear one. Some smokers will have a cigarette on a Sunday evening although 20-a-day is assumed to be 'normal' use. This assumption assists the argument but has no factual basis. In light of all of this 'evidence', the fact remains that you cannot ban tobacco. It's a natural growing substance. Nobody on this earth has the right to remove something else from it. Who would give you permission? This point is often dismissed and no doubt will be dismissed again. The notion of a global ban when we have ignored the rest of the globe for so long is deeply insulting. You have the right to remove smoking from public places, however you do not have the right to remove other people's rights. Competing interests: None declared |
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