Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Banning smoking in outside public spaces may shift smoking back into the home
- Joseph Y Ting, South Brisbane, 4101 Australia (14 December 2008)
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The home as last sanctuary for smokers banned from public outdoor venues
- Joseph Y Ting, South Brisbane, 4101 Australia (15 December 2008)
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A Dangerous Argument
- Michael Siegel (15 December 2008)
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Target companies not those addicted individuals
- Phoebe R Fletcher (15 December 2008)
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This is appalling
- Dave C Atherton (15 December 2008)
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Banning smoking or not is not only about evidence
- Johan M Melse (15 December 2008)
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reduce smoking to reduce exposure
- Becky Freeman (16 December 2008)
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Societal norms need to change in line with the evidence
- J Lennert Veerman (16 December 2008)
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Evidence indicates that smokefree laws can reduce smoking in homes: Response to Ting
- George Thomson, Nick Wilson, Richard Edwards, Alistair Woodward (17 December 2008)
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Addictive drug use in front of children does raise ethical concerns: Response to Siegel
- George Thomson, Nick Wilson, Richard Edwards, Alistair Woodward (17 December 2008)
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‘Out of sight, out of mind’ applies to smoking as well as tobacco products: Response to Fletcher
- George Thomson, Nick Wilson, Richard Edwards, Alistair Woodward (17 December 2008)
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Highlighting the theme of ‘Children see, children do’ is dangerous? : Response to Freeman
- George Thomson (18 December 2008)
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Adolescents follow adults
- Philip K. Pattemore (18 December 2008)
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WHO 1998 report into passive smoking, lets be honest
- Dave C Atherton (23 December 2008)
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Re: WHO 1998 report into passive smoking, lets be honest
- Aviva Sheb'a (29 December 2008)
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Joseph Y Ting, Senior Staff Specialist Mater Public Hospitals, South Brisbane, 4101 Australia
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In advocating banning smoking in outside public spaces, Thomson et al 1 have failed to consider the potential for strongly addicted smokers transferring the smoking habit back into the relative sanctuary, privacy and legal protection of their own homes. If smoking venue shift occurs due to public space bans, household members will experience worsening chronic proximate passive cigarette smoke exposure, with children having intensified contact with a smoking adult at home being subjected to greater risk of modeling them. For this reason alone, I agree with Professor Simon Chapman’s plea 2 for a less reactionary, more evidence- based approach in the debate surrounding the adoption of banning smoking in outside public spaces. 1. Thomson G, Wilson N, Edwards R, Woodward A. Should smoking in outside public spaces be banned? Yes. BMJ 2008; 337: a2806 2. Chapman S. Should smoking in outside public spaces be banned? No. BMJ 2008; 337: a2804 Competing interests: None declared |
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Joseph Y Ting, Senior Staff Specialist Mater Public Hospitals, South Brisbane, 4101 Australia
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In supporting the proposal to ban smoking in open public areas, Thomson et al1 cite several examples where community-wide outdoor smoking restrictions have been implemented. However the extent to which such bans reduce tobacco consumption, smoking prevalence, exposure to secondhand smoke and health outcomes in the area affected by the ban remains contentious, being the subject of a Cochrane proposal. 2 As banning smoking in outdoor public areas has a pervasive, substantial and highly negative lifestyle impact on the adult smoking community on which this ban is imposed, such policies require evidence of effectiveness before implementation, including such outcomes as reduced smoking uptake by children attributable to modeling (as has already been claimed by Thomson et al1) and clinically relevant sporadic passive smoking exposure in non- smokers in proximity. 3 Secker-Walker at al 4 found community-wide interventions to not reduce smoking prevalence in adults. Interestingly, another Cochrane proposal to examine interventions for preventing tobacco smoking in public places has been withdrawn as of 14 May 2008.5 In advocating banning smoking in outdoor recreational public spaces, Thomson et al 1 have failed to consider the potential for strongly addicted smokers transferring the smoking habit back into the last sanctuary of their own homes, with its privacy, comfort and protection from legal censure. If smoking venue shift occurs due to public outdoor space bans, household members will experience worsening chronic proximate passive cigarette smoke exposure, with children having intensified contact with a smoking adult at home being subjected to greater risk of modeling such adults. This will exacerbate the already high rates of second hand exposure at home and in cars among children and teenagers. 6 I therefore wholeheartedly support Professor Simon Chapman’s plea 3 for a less reactionary, more evidence-based approach in the debate surrounding the adoption of banning smoking in outdoor public spaces. References 1. Thomson G, Wilson N, Edwards R, Woodward A. Should smoking in outside public spaces be banned? Yes. BMJ 2008; 337: a2806 2. Callinan JE, Clarke A, Doherty K, Kelleher C. Smoking bans for reducing smoking prevalence and tobacco consumption. (Protocol) Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD005992. DOI: 10.1002/14651858.CD005992. 3. Chapman S. Should smoking in outside public spaces be banned? No. BMJ 2008; 337: a2804 4. Secker-Walker R, Gnich W, Platt S, Lancaster T. Community interventions for reducing smoking among adults. Cochrane Database of Systematic Reviews 2002, Issue 2. Art. No.: CD001745. DOI: 10.1002/14651858.CD001745. 5. http://www.cochrane.org/reviews/en/info_161299071913364809.html [accessed 14th Dec 2008] 6. Gillespie J, Milne K, Wilson N. Secondhand smoke in New Zealand homes and cars: exposure, attitudes, and behaviours in 2004. N Z Med J 2005; 118: U1782 Competing interests: None declared |
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Michael Siegel, Professor Boston University School of Public Health, Boston, MA 02118
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The argument presented in this commentary is not compelling. The article argues that government should interfere with the right of adults to engage in lawful, unhealthy behavior that may be observed by children. But this represents an extreme - and an unwarranted - intrusion into individual liberty and autonomy. The same reasoning being used to support outdoor smoking bans would also support banning the consumption of alcohol in front of children. It would support banning adults from eating junk food or soda in front of children. It would support banning adults from playing hockey or engaging in any similar high-risk activities in front of children. Auto racing would certainly have to be banned in cases when any children were present. So would boxing. So would most movies, including those that are currently rated PG and PG-13. The only compelling justification for government to restrict public behaviors from the sight of children is if those behaviors are viewed as morally reprehensible. For example, we protect children from seeing public nudity, public drunkenness, and public sex because there is a violation of public morals that we attribute to these behaviors. By putting smoking in the same category, anti-smoking advocates are basically arguing that smoking is an immoral behavior that needs to be regulated in the same way. I find this to be quite unfortunate, as public health practitioners should not be ascribing moral value to lawful, unhealthy behaviors. I actually see this justification for outdoor smoking bans to be a dangerous one. Because once we start ascribing moral value to legal choices that people make which are truly not ethical decisions, we are in trouble. I certainly would hope that we won't start to view obesity this way, for example. But the same argument being advanced by these anti- smoking researchers would support interventions to ban fat people from the view of children in public. Competing interests: None declared |
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Phoebe R Fletcher, Lecturer University of Auckland 1142
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The case for banning smoking in public spaces is looking at the symptom rather than the cause and is about as effective as banning eating junk food in public spaces when people are exposed to a barrage of advertisements encouraging them to indulge. These initiatives should be targeted at the companies who make millions of dollars off providing incentives for dairies and shops to position cigarettes in public spaces, not the people who have been socialised to think this is acceptable. The more illicit you make smoking, the cooler it will become for young children. At the moment the advertisements on not smoking inside in New Zealand have been very effective in changing people's perception on smoking. Banning it outside as well will add to its allure. Competing interests: None declared |
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Dave C Atherton, Salesman EC3A
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As a 7 year old (in 1967) I sat in assembly at school listening to the radio and the news confirmed that smoking was a major contributor to lung cancer. I was a bit upset because my dad smoked. There must be not one person on the planet who is not aware of active smoking health effects. Just because us smokers refuse to bend at the knee to your constant nannying, and now bullying we have even more restrictions or not to look to. The law of unintended consequences means many of us who smoked in the privacy of our bars and pubs are now fully on display in the street, park or hanging outside a bar. When I could smoke I usually waited until I sat down in the bar, but use the dead time in my journey to light up. If you think you are going to ban me smoking in the street etc, I think in the UK you will find extensive disobedience. There is increasing resentment at the draconian indoor laws with people smoking/drinking at home or going to "smoke-easies" which are now common place. Most importantly do not insult mine and others intelligence on passive smoking. I am sure you are aware of the BMJ peer reviewed 39 year Enstrom/Kabat report which stated that when exposed to SHS/ETS smoke "evidence of increased mortality is sparse." And don't give me all that rubbish "its for the children." The only peer reviewed paper I have been able to find about children inhaling SHS/ETS is from the National Cancer Institute 1991 which gave an RR of 0.78-0.92. Theorectically proctective. Hitler was the first dictator in modern times to ban smoking and civil liberties seem to be the first casuality of the smoking ban. Competing interests: Smoker, member of Freedom2Choose and supporter of Forest, both pro choice smoking organisations |
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Johan M Melse, Conceptual research and support RIVM - Netherlands Institute for Public Health and the Environment, PO Box 1, 3720 BA Bilthoven, NL
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What often strikes me in anti-smoking discussions as the above, is what is left out. Focussing on evidence or feasibility relegates the discussion to the realm of means, obscuring possible differences in goals, in values. Even the argument of infringing personal freedom has a somewhat similar effect, in that it is ‘negative’, about something being in danger. All this obscures that there is more to life than health. Most people - smokers and non-smokers alike- value besides health, also pleasure, social relations, justice etc. Evidence that active or passive smoking is bad for health is of course important input for public health discussions and decisions. But unless we want a scientocratic society, such evidence must be weighed against many other arguments dealing with what is important in life, for different people in different places. This also compels us, health professionals, to reflect on our own values behind the evidence we choose to emphasize. Competing interests: None declared |
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Becky Freeman, Researcher and PhD Candidate University of Sydney
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The "protecting children" argument seems to be used whenever someone wants to try and diffuse a controversial or unclear issue, it's like "if you disagree with me you hate children, you don't hate children do you?" Whereas if people were more honest about it, they really want smoking banned outdoors because they just don't like it. Of course, there is also genuine desire to do anything to help people to quit. Many smokefree homes campaigns have been built on the message if you can't quit, "take the smoke outside" - a harm reduction approach that shows you are being a good parent - what happens to this message when we then tell parents not to take the smoke outside either? What are they meant to do? A real danger of using the role modelling argument is that it suggests that smokers are somehow unfit parents and carers. Smoking is but one aspect of total behaviour, it's not as simple as smoking=bad, not smoking=good. Building public health policy around things we "just don't like" doesn't sound like a fair and just way to advance public health. But that said, many municipal bylaws do exist for this very reason - for example, I'm glad my local council requires that people clean-up after their dogs, I hate stepping in nasty surprises when out for a run. I also love that my favourite beach is smokefree - it can often be cheek-to-cheek on a hot day and sitting next to a group of smokers who leave all their butts in the white sand would spoil such a gorgeous spot. However, the best way to reduce smoking in front of children, inside or out, is to reduce total smoking prevalence and consumption. There are many policies left in the tobacco control bank that we know will achieve this goal - display bans, plain packaging, tax increases (especially on roll your own)etc. etc. Disclaimer: Simon Chapman is my PhD supervisor, my opinions are my own. Competing interests: None declared |
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J Lennert Veerman, Research Fellow The University of Queensland, School of Population Health, Herston Road, Herston QLD 4006, Australia
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I think the authors present a good case. The direct evidence that seeing adults smoke makes children more likely to take up smoking may not be very strong, but the mechanism is plausible in view of what we know about how advertising works. Yes, legislation that further restricts areas where one can legally smoke is paternalistic, but the same can be said of the use of seat belts or helmets for motorbike riders. I think the case for restricting public smoking is stronger than for restricting public nudity, which to my knowledge has not damaged others even indirectly and is not more in conflict with the values that I personally hold. The fact that public nudity is not deemed acceptable and public smoking is, is a mere historical accident. We are simply used to the one and not the other. When people started smoking they had no idea of the health damage it does, nor of the addictive nature. We do know now, and we should change our collective norms to incorporate this knowledge. That takes a lot of time and nagging, I am afraid. Collective norms change slowly and with reluctance, as evidenced by the fact that up the the 1970- ies smoking was allowed in medical faculties even during lessons (personal communication T. Vos). That practice would find few supporters now, I hope. Our norms have changed. Some argue that smoking is a choice, but this is only partly so: tobacco is addictive. Free-choice advocates should logically also be in favour of the legalisation of marihuana and heroin, the use of which is less noxious to the users’ environment than tobacco smoking (provided the users clean up after them, which neither heroin users nor smokers seem to be particularly good at). That said, I would be in favour of regarding smokers as similar to heroin addicts: unfortunate persons who fell into a trap and need our compassion and help to change their ways, if possible. Further restrictions on smoking can help to prevent children from falling victim and for that I’ll accept a great deal of paternalism. Competing interests: I am father to 3 children and therefore no stranger to paternalism. |
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George Thomson, Senior Research fellow University of Otago, Wellington, Nick Wilson, Richard Edwards, Alistair Woodward
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Dr Ting in a response speculates that smokefree policies may result in increased smoking inside homes. But evidence from Scotland indicates that such concerns were incorrect, with the result of smokefree legislation being to reduce second-hand smoke (SHS) exposure in homes.1 In New Zealand, there was similar speculation, but in reality, after a smokefree bars law, the long-term trend for declining SHS exposure in homes continued unabated.2 In Ireland, the proportion of homes with smoking bans increased after the recent smokefree law.3 We suggest that it is likely that reduced opportunities to smoke in public outdoor places will lead to a consequent greater population awareness of the dangers of SHS and of the dangers of modelling, and will result in less smoking inside homes, rather than more. Dr Ting also believes that ‘banning smoking in outdoor public areas has a pervasive, substantial and highly negative lifestyle impact on the adult smoking community’ and thus ‘such policies require evidence of effectiveness before implementation’. We suggest that the findings that most smokers want to give up smoking, regret starting, don’t want their or other children to start smoking, and recognise the role of modelling in uptake, indicates that many smokers will support such measures. Evidence for this comes from surveys of smokers’ attitudes which have found considerable support for smokefree policies in outdoor places where there are children.4-6 Other surveys have shown majority support from smokers for an outdoor stadium smokefree policy,7 and for a smokefree parks policy.8 We also suggest that in some situations of uncertainty, where large negative consequences may occur if action is not taken, interventions are necessary before complete certainty is achieved. As we stated in our article, ‘any assessment of the balance of benefit and harm should put the protection of children first’, before the protection of amenity for adult smokers. References 1. Akhtar PC, Currie DB, Currie CE, et al. 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. 2. Edwards R, Thomson G, Wilson N, et al. After the smoke has cleared: evaluation of the impact of a new national smoke-free law in New Zealand. Tob Control. 2008;17:doi:10.1136/tc.2007.020347. 3. Fong GT, Hyland A, Borland R, et al. Reductions in tobacco smoke pollution and increases in support for smoke-free public places following the implementation of comprehensive smoke-free workplace legislation in the Republic of Ireland: findings from the ITC Ireland/UK Survey. Tob Control. 2006;15 Suppl 3:iii51-8. 4. Alesci NL, Forster JL, Blaine T. Smoking visibility, perceived acceptability, and frequency in various locations among youth and adults. Preventive Medicine. 2003;36:272-81. 5. Klein EG, Forster JL, McFadden B, et al. Minnesota tobacco-free park policies: attitudes of the general public and park officials. Nicotine & Tobacco Research. 2007;9 Suppl 1:S49-55. 6. Quit Victoria. Quit gets behind smokefree playgrounds. Quit Victoria. Melbourne. February 2007. Accessed September 22, 2008. http://www.quit.org.au/media.asp?ContentID=19068 7. Giles-Corti B, Clarkson JP, Donovan RJ, et al. Creating smoke-free environments in recreational settings. Health Education & Behavior. 2001;28:341-51. 8. Stevenson AM, Bradshaw R, Cook J, et al. Majority of smokers and non- smokers in favour of smokefree parks in New Zealand. New Zealand Medical Journal. 2008;121:108-10. Competing interests: All authors have done contract work for health non-governmental organisations, the New Zealand Ministry of Health, or WHO on tobacco control research. |
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George Thomson, Senior Research Fellow University of Otago, Wellington, NZ, Nick Wilson, Richard Edwards, Alistair Woodward
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Professor Siegel suggests that such a change is ‘an extreme - and an unwarranted - intrusion into individual liberty and autonomy.’ We suggest that it is not extreme, and it is readily justified (see response to Dr Ting). Professor Siegel further suggests that only ‘morally reprehensible’ behaviour in front of children should be banned. We suggest that normalising addictive drug use in front of children is an ethical concern – especially since nicotine is so addictive and tobacco use is such a serious health hazard. Our view is compatible with societal concern about other role modelling of equally additive and dangerous behaviours to children, such as portrayals of drug use in films and TV programmes likely to be viewed by children. There is always a question of where to draw the line. Such decisions will hinge on factors such as the degree of hazard and the likelihood of children being influenced from the modelled behaviour, and the degree of loss of amenity/autonomy to those engaging in the behaviour. We believe that in the case of smoking, the balance is clearly tilted towards restricting smoking in public places frequented by children. In contrast, the situation with junk food is very different, as such food is not addictive and is not as unequivocally hazardous as tobacco is (ie, everyone needs some calories). Competing interests: All authors have done contract work for health non-governmental organisations, the New Zealand Ministry of Health, or WHO on tobacco control research. |
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George Thomson, Senior Research Fellow University of Otago, Wellington, NZ, Nick Wilson, Richard Edwards, Alistair Woodward
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We agree with Ms Fletcher that tobacco companies are a priority target for policy, and have advocated this, eg,1-8. However, we disagree with her speculation that smokefree policies for outdoor public places where there are children make smoking ‘cooler’. We would be interested to see peer-reviewed evidence of this effect, and the extent that it over- rides the ‘out of sight, out of mind’ effect that has been documented for controls of tobacco advertising, such as bans on tobacco displays in shops.3 References 1. Quedley M, Ng B, Sapre N, et al. In sight, in mind: Retailer compliance with legislation on limiting retail tobacco displays. Nicotine Tob Res. 2008;10:1347-54. 2. Wilson N, Thomson G, Edwards R. Use of four major tobacco control interventions in New Zealand: a review. NZ Med J. 2008;121:71-86. 3. Thomson G, Hoek J, Edwards R, et al. Evidence and arguments on tobacco retail displays: marketing an addictive drug to children? NZ Med J. 2008;121:87-98. 4. Thomson G, Wilson N. The tobacco industry in New Zealand: A case study of the behaviour of multinational companies. Department of Public Health, Wellington School of Medicine, University of Otago. Wellington. 2002. http://www.wnmeds.ac.nz/academic/dph/Publicationsreports/TobaccoMonograph.pdf 5. Thomson G, Wilson N. Directly eroding tobacco industry power as a tobacco control strategy. NZ Med J. 2005;118:U1683. http://www.nzma.org.nz/journal/118-1223/1683/. 6. Thomson G, Wilson N. Implementation failures in the use of two New Zealand laws to control the tobacco industry: 1989-2005. Aust New Zealand Health Policy. 2005;2:32. 7. Thomson G, Wilson N, The Tobacco Industry, in International encyclopedia of Public Health, Kris Heggenhougen and Stella Quah, Editors. 2008, Elsevier: Amsterdam. 8. Thomson G, Wilson N, Crane J. Rethinking the regulatory framework for tobacco control in New Zealand. NZ Med J. 2005;118:1213:U1405. Competing interests: All authors have done contract work for health non-governmental organisations, the New Zealand Ministry of Health, or WHO on tobacco control research. |
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George Thomson, Senior Research Fellow University of Otago, Wellington, NZ
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It is unfortunate that in the response of Freeman (and others) that there is an assumption that the individual smoker is the object of our article. Rather, we have endeavoured to take a population approach, and focus on the policies of governments and local authorities. So, for instance, Becky Freeman states that raising the issue of role modelling ‘suggests that smokers are somehow unfit parents and carers.’ In writing the article, we rather were pointing out that governments and local authorities need to better help societies and communities to make smoking less normal, and better provide the environment for smokers to quit. As we wrote: ‘The primary strategy for tobacco control is reducing the prevalence of smoking, and such reduction will in itself mean that smoking is less visible in society. But the modelling of smoking can also be reduced by policies to restrict smoking in the presence of children.’ Because, as she says: ‘There are many policies left in the tobacco control bank that we know will achieve this goal [of reducing smoking prevalence] - display bans, plain packaging, tax increases (especially on roll your own) etc’ does not mean that all avenues for tobacco denormalisation are not important. To respond to some of the other issues Ms Freeman raises: 1) It is unclear whether she is implying that we were trying to diffuse the issue of smoking uptake by arguing for the protection of children, and were doing so because of other motivations. If so, we appear to be in company of the Canadian government, with their ‘Children see, children do’ graphic pack warnings. 2) Ms Freeman questions ‘what happens to [the ‘take it outside’] message when we then tell parents not to take the smoke outside either?’ In fact, we focused on public places, and what we suggested was that ‘selected outdoor areas frequented by children’ be smokefree, not everywhere. Competing interests: I have done contract work for health non-governmental organisations, and the New Zealand Ministry of Health. |
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Philip K. Pattemore, Associate Professor of Paediatrics University of Otago, Christchurch, New Zealand 8042
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I am astounded at the tone of the negative responses to the article by Thomson et al. You can critique the strategy and suggest an alternative strategy to achieve the same ends, or you can criticise the ends to be achieved. These responses read uncannily like the authors are not convinced of the end to be achieved - reducing and eliminating disease and death due to tobacco smoke. Personal choice and freedoms, are unfortunately the words that have been used to cast doubt and delay action over tobacco policy ever since Sir Richard Doll made some observations about lung cancer. The literature suggests that targeting smoking uptake in children and adolescents is a difficult and often unsuccessful task. A likely reason for this is that while adults continue to smoke, such targeted efforts can reinforce the portrayal of smoking as an adult behaviour, and make it more desirable for adolescents. It is unlikely that we will stop children and adolescents from smoking uptake until it ceases to be a visible badge of adulthood. The steps to making this happen are to encourage widespread smoking cessation, and to reduce exposure to adults smoking, both at home in public. Media and health professionals are reinforcing and should continue to advocate for a smokefree home and car environment. The message has been well heard, given that most smoking parents will vociferously deny that they smoke inside the home (even if the reality is short of their claims). Smokefree offices, bars and restaurants legislation have been accompanied by continued decline in smoking rates. The message that smoking is bad not only for you but for Jo Public is getting out even to the most hardened addicts. Legislation to ban smoking in other public places is highly unlikely to suddenly produce a reversal in these trends. Wakefield et al (1) documented an association (albeit weak), of public place restrictions with reduced likelihood of smoking and smoking uptake in teenagers. Tobacco smoking is not just a personal freedom. It is soon to become, if not already, the biggest single cause of death worldwide. A huge amount of childhood morbidity and mortality is attributable to tobacco smoking by parents. The smoking parent was an adolescent smoker not long ago, and a nonsmoking child observing smoking adults not long before that. This is a vicious cycle. The stakes are very high, far higher than most stakes that people believe demand legislation which would restrict some freedoms. Let's not get weak at the knees at a crucial point in the history of this lethal habit. 1. Wakefield et al. Effect of restrictions on smoking at home, at school, and in public places on teenage smoking: cross sectional study. BMJ (2000) vol. 321 (7257) pp. 333-7 Competing interests: None declared |
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Dave C Atherton, Salesman, computer services EC3A 5AG
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George Thomson et al, the whole of your argument is based around the assumption that SHS is harmful. In 1998 that august body the WHO produced a report into SHS and the spin was that it was a killer. Alas the facts got in the way of a good story and here are the conclusions: “RESULTS: ETS exposure during childhood was not associated with an increased risk of lung cancer (odds ratio [OR] for ever exposure = 0.78; 95% confidence interval [CI] = 0.64- 0.96).” That is exposure during childhood exposure is protective, and: “Ever exposure to ETS from other sources was not associated with lung cancer risk. Risks from combined exposure to spousal and workplace ETS were higher for squamous cell carcinoma and small-cell carcinoma than for adenocarcinoma, but the differences were not statistically significant. CONCLUSIONS: Our results indicate no association between childhood exposure to ETS and lung cancer risk. We did find weak evidence of a dose- response relationship between risk of lung cancer and exposure to spousal and workplace ETS. There was no detectable risk after cessation of exposure.” As scientists surely you are aware epidemiologically that an RR of 16% is statistically insignificant. (1) Tobacco smoke has often been associated with aggravating asthma and atopy. In January of this year a report was published in New Zealand and I quote “"Smoking linked to reduced allergic sensitization By David Holmes, 21 January 2008 J Allergy Clin Immunol 2008; 121: 38-42 MedWire News: Parental smoking during childhood and personal cigarette smoking in teenage and early adult life lowers the risk for allergic sensitization in those with a family history of atopy, according to the results of a study from New Zealand. Writing in the Journal of Allergy and Clinical Immunology, Robert Hancox (University of Otago, Dunedin) and colleagues explain that "the findings are consistent with the hypothesis that the immune-suppressant effects of cigarette smoke protect against atopy." The authors write: "We found that children who were exposed to parental smoking and those who took up cigarette smoking themselves had a lower incidence of atopy to a range of common inhaled allergens.”These associations were found only in those with a parental history of asthma or hay fever." They conclude: "The harmful effects of cigarette smoke are well known, and there are many reasons to avoid it.”Our findings suggest that preventing allergic sensitization is not one of them." (2) What has been the net effect of banning smoking in bars in the UK? More smokers on display to children, it is “cool” to smoke and smoking a year after the ban has actually risen, especially among younger smokers. In England female adult smoking has remained static at 21% but male smoking has risen from 23 to 24% and people are smoking 1.5 cigarettes a day too. Youth smoking in Scotland has risen from 25% in 2004 to 31% after the ban in 2007. (3) (4) Many people may ask why all this public money is spent on smoking reduction when it appears to have no effect. We in the awkward squad who spend our free time investigating the many claims of the anti smokers can barely disguise our contempt for the way the world’s public have been misled over the claims of SHS/ETS, when it is a smokescreen (pun intended) for a policy that has seen its course run. Active smoking has decreased significantly due to (yes I am being honest) to the efforts of the WHO and national governments. It is most effective when educational and instructive rather than nannying and bullying. Can I suggest to the WHO we meet you half way. On private property with the consent of the owner and the majority of patrons, we smokers are left alone to enjoy our pastime, and on ETS/SHS an honest debate takes place. I am then quite happy for you inform the rest of the world on active smoking without let or hindrance, and wish you well to reduce the incidence of tobacco consumption. The right not to smoke is equal as a right to smoke. 1. http://jnci.oxfordjournals.org/cgi/content/abstract/90/19/1440 2. http://www.medwire- news.md/48/72330/Respiratory/Smoking_linked_to_reduced_allergic_sensitization_.html 3. http://news.bbc.co.uk/1/hi/scotland/7791012.stm 4. http://www.ic.nhs.uk/statistics-and-data-collections/health-and- lifestyles-related-surveys/health-survey-for-england/health-survey-for- england-2007:-healthly-lifestyles:-knowledge-attitudes-and-behaviour- %5Bns%5D Competing interests: See previous, although can I confirm I recieve no remuneration directly or indirectly for my time. |
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Aviva Sheb'a, Writer/performer, freelance Kiama, New South Wales Australia 2533
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Having read all the Rapid Responses to date, it seems an important aspect has been left out, though mentioned ever so briefly by Dave C Atherton: "The right not to smoke is equal as a right to smoke".
For me, the right to breathe equals the right to not smoke. I'm a severe asthmatic who grew up in a house with heavy smokers. My worst trigger is tobacco smoke, which compromises my life-style repeatedly. I live in a town that's nearly all beach and hills (yes, lucky aren't I), yet rarely can I go to for a healthy swim without being exposed to other people's smoke. I'm often so affected by it I have to leave, thus being bullied away by smokers -- sometimes in their early teens.
Entering or exiting shopping centres here in New South Wales is also precarious, due to people smoking at entrances.
Smoking may or may not be a choice but everybody has to breathe. I'm not arguing about people's right to smoke: I'm arguing for people's right to not inhale other people's smoke. The sooner we get tobacco smoke out of all public spaces the better. I can hardly wait to be able to live more fully with as much right to breathe as smokers have.
Competing interests: None declared |
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