Intended for healthcare professionals


Smoking in public places

BMJ 1996; 312 doi: (Published 27 April 1996) Cite this as: BMJ 1996;312:1051
  1. Simon Chapman
  1. Associate professor of public health and community medicine University of Sydney, Sydney 2006, Australia

    Self regulation of businesses is not working

    Britain's environment minister, James Clappison, has released results of a National Opinion Poll study of provision of smoke free indoor environments by businesses that deal with the public.1 Attempting to put a flattering spin on the findings, his press release claims “a substantial increase in the number of establishments covered by a smoking policy (between 1992 and 1995). In the travel sector, the percentage has doubled.” But reading the report itself, only those content with bleak expectations bound to the incrementalist gains of self regulation could share the minister's enthusiasm. Only 38% of businesses in the travel sector were described as having effective policies. Just 36% of restaurants qualified and, most damning, even health establishments (at 71%) failed to reach the government white paper's modest target of 80%.2

    Workplaces and restaurants are the public venues that expose the greatest number of people to environmental tobacco smoke. Because of their prolonged exposure,3 4 staff in bars and dining rooms are most at risk; the 50% increase in lung cancer risk among food service workers may be in part attributable to workplace exposure to tobacco smoke.5 Levels of environmental tobacco smoke in restaurants have been found to be double those in offices and 1.5 times higher than in homes with at least one smoker.5 Levels in bars can be more than six times those in offices that allow smoking.5 In Australia, concern about litigation from staff is now driving workplaces to become smoke free faster than is nominal concern for workers' health and amenity (National Heart Foundation of Australia, personal communication).

    While public preference for smoke free dining is growing, restaurateurs often grossly underestimate the potential demand. An Australian study surveyed restaurateurs and their patrons to determine whether restaurateurs' perceptions and policies matched customers' preferences.6 While less than 2% of restaurants were totally smoke free and 22% provided some smoke free areas, 47% of patrons dining in those restaurants stated that they believed restaurants should be totally smoke free, with a further 42% supporting smoke free areas. Only a third of restaurateurs who thought they should provide smoke free areas actually provided them.

    In the report of the National Opinion Poll, 76% of restaurateurs believed that a policy to ban or restrict smoking would harm their business.1 Californian laws require smoking areas to be separate and ventilated, and New York City bans smoking in restaurant dining areas with more than 35 seats. About 11000 of some 15000 restaurants are affected. Analysis of American restaurant sales tax data shows no evidence that banning smoking in restaurants depresses patronage. A three year survey from the Centers for Disease Control of eight restaurants in a suburb of Austin, Texas, found a slight increase in restaurant sales after a local ordinance requiring restaurants to be smoke free took effect.7 In Massachussets, more upmarket establishments may have actually increased takings.8 The largest of the studies found no significant differences in restaurant sales between 34 communities that banned restaurant smoking and 102 communities that had not.9

    A former president of the Beverly Hills [California] Restaurant Association, formed by the tobacco industry to oppose the 1988 legislation, later testified before the New York City Council. He said, “The tobacco industry repeatedly claimed that Beverly Hills restaurants suffered a decline in revenues. Sales tax data, however, showed an increase. I regret my participation.”10

    Arbitrary “magic line” divisions between smoking and non-smoking sections in restaurants are popular concessions to “progress.” But a non-smoking section in a restaurant is about as meaningful as a non-urinating section in a swimming pool. While such sections have reduced levels of environmental tobacco smoke, they do not eliminate it. A study of seven restaurants that restricted smoking to one third of the seating area found mean concentrations of respirable suspended particles and nicotine were 40% and 65% lower, respectively, in the non-smoking than in the smoking sections.11

    British industry's self regulatory dawdle toward smoke free restaurants and workplaces is evident in the National Opinion Poll report.1 The sawdust commonly found on cafe floors of the last century, placed—along with spittoons in more genteel establishments—to soak up spittle, are things of the past thanks to concerns about public health.12 The same cannot be said of smoke filled rooms, where lack of political will is making a mockery of Britain's national smoke free target.


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