Bans on smoking in public become more commonplace

BMJ 1998; 316 doi: (Published 07 March 1998) Cite this as: BMJ 1998;316:723

The following four page report shows that there is a growing international trend in restricting smoking in public, writes Simon Chapman. However, bans are not always strictly enforced, and compliance depends largely on public awareness of the harmful effects of passive smoking

The term passive smoking first appeared in the research literature in 1974, when Walter Holland's group at St Thomas's Hospital in London reported in the Lancet that exposure to ambient tobacco smoke in homes was associated with increased respiratory disease in children. Four years later the Roper market research group advised its client, the US Tobacco Institute: “This we see as the most dangerous development to the viability of the tobacco industry that has yet occurred.” How prescient this advice was to prove.

The emerging evidence on passive smoking has redefined the very foundations of the ethical basis for public health action against smoking. If smoking not only is a risk to an individual's own health but also poses an avoidable risk to others, then smoking can no longer be sidelined as a private matter, where regulatory policies would offend John Stuart Mill's principle that “the only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others.”

Although passive smoking has engendered some plainly overreactive policies—such as the attempt by the mayor of Friendship Heights in Maryland to ban smoking even in parks and on footpaths—it is driving an international revolution about where smoking can take place.

As the following review shows, a typical smoker in many countries today cannot smoke during the hours spent commuting to and from work on public transport, during most of the hours spent inside the workplace, and while attending indoor entertainment. Increasingly, they may not be able to smoke when visiting others' houses—for example, 48% of Australians do not allow smoking in their homes—when dining in restaurants, or when sitting cheek by jowl with others in outdoor sports stadiums.

The bottom line of all of this for an apoplectic tobacco industry is that internationally, billions of cigarettes are not being smoked that otherwise would be. For public health, this reduction in smoking—estimated at about 20% from studies that have followed cohorts of smokers after bans have been introduced in the workplace—may well lead to a reduction in illness caused by tobacco. Moreover, the cultural redefinition of smoking as appropriate to groups of consenting adults, may well see a retreat in smoking in much the same way that public spitting moved from cafe floors and footpaths into bathrooms.

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Evidence for the dangers of passive smoking is growing


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