Smoking in public should be restricted

BMJ 1998; 316 doi: (Published 21 March 1998) Cite this as: BMJ 1998;316:881
  1. Caroline White
  1. London

    Smoking in public places should be restricted on the grounds of public health, concludes the report of the Scientific Committee on Tobacco and Health—a group of independent scientific experts.

    The government committee states categorically that passive smoking does cause lung cancer and ischaemic heart disease. Long term exposure to environmental tobacco smoke increases the risk of dying from the disease by 20-30% in non-smokers, accounting for several hundred extra deaths from lung cancer in the UK every year, says the report. Passive smoking, it says, also damages children's health and is an important cause of childhood respiratory infections and chronic lung disease. The report is the first government report on the effects of active and passive smoking on health to be published for 10 years. Its recommendations will form the basis of the government's white paper on tobacco and health to be published later this year.

    Data from the Health Education Authority show that smoking killed 120000 people in the UK in 1995. Preliminary figures from the 1996 general household survey, published at the end of last year, show that the fall in the prevalence of smoking has levelled off, with even a slight increase to 1992 levels. If current smoking patterns continue, it is estimated that tobacco will account for 10 million deaths worldwide by the late 2020s.

    Babies whose mothers smoke are twice as likely to die of the sudden infant death syndrome, says the report; and the risk of developing asthma, cough, and wheeze is increased by up to 60% in school age children if both parents smoke. Other respiratory illnesses are also more common among the children of smokers, finds the report, especially when it is the mother who smokes. The report calls for public education about the effects of smoking in the home on children.

    “Increasing exposure equals increasing risk,” says Dr Derek Cook of the department of public health medicine, St George's Hospital, London, and member of the Scientific Committee on Tobacco and Health. “This is not due to chance or bias: parental smoking, especially by the mother, damages the health of children.” The data on the sudden infant death syndrome, he says, are independent of social class and sleeping position.

    “It is very important to base evidence on passive smoking from data derived from living with a current smoker,” comments Professor Nicholas Wald of the Institute of Preventive Medicine, St Bartholomew's Hospital, London, and also a member of the scientific committee. “The tobacco industry has reported data from people living with an ex-smoker.” The committee had received submissions from the Tobacco Manufacturers' Association outlining the influence of other confounding variables and denying that passive smoking causes lung cancer or that it genuinely increasesthe risk.

    The report also urges the wider availability of nicotine replacement therapy through NHS prescriptions and pharmacies. Use of nicotine replacement therapy, it says, roughly doubles a smoker's chances of giving up and is particularly useful when combined with advice on how to give up smoking from doctors. It calls for further research into other pharmacological agents and the use of nicotine replacement therapy during pregnancy.

    The report recommends that smoking in public places should be restricted on the grounds of public health and that in public service buildings and on public transport it should be allowed only in designated areas. Wherever possible, smoking should not be permitted in the workplace, it says. It also calls for a complete ban on all forms of tobacco advertising, promotion, and identifiable sponsorship.

    Meanwhile, an internal memo has come to light showing that cigarette manufacturers possessed evidence nearly 30 years ago that smoking damages health—something the industry continues to deny. An internal memo, written in April 1970, by the general research manager for Gallaher, the company that makes Benson and Hedges, and Silk Cut cigarettes, revealed that research on beagles proved that smoking caused lung cancer. It said that research “proves beyond all reasonable doubt the causation of lung cancer by smoke.”

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    Passive smoking can cause childhood respiratory infections


    Tobacco industry tries to discredit data on passive smoking

    The World Health Organisation was accused last week by the tobacco industry of suppressing a study allegedly refuting the link between passive smoking and lung cancer.

    The European, multicentre case-control study on the effects of environmental tobacco smoke on the risk of lung cancer in Europe, was conducted under the aegis of the WHO's cancer research organisation, the International Agency for Research on Cancer. The report was submitted for publication to a leading American scientific journal last month, which is why it has not been made available to the public.

    An abstract published in the wake of the allegations showed that although the findings did not show an increased risk of lung cancer among adults who had been exposed to passive smoking as children, they did show that the risk of lung cancer increased by 16% among the non-smoking partners of smokers; the estimated increase for workplace exposure was 17% (see p 945 and our website