Smoke Free Laws and Advocacy
- Exposure to passive smoking may have declined in those countries where regulations have been introduced to protect the non- and ex-smokers from environmental tobacco smoke.1 It is desirable that this become commonplace all over Europe and India
- Only around 7% of the world’s population lives in areas with comprehensive smoke-free laws, and the enforcement of such laws are often lacking. However, in places with strong enforcement of smoke-free laws, research has found an overall reduction of exposure to secondhand smoke by 60% and as high as 90% in places like bars and restaurants.2
- Protection of children and women from second-hand smoke (SHS) in many regions needs to include complementary educational strategies to reduce exposure to second-hand smoke at home. Voluntary smoke-free home policies reduce exposure of children and adult non-smokers to second-hand smoke, reduce smoking in adults, and seem to reduce smoking in youths. 2
- Reductions in exposure to SHS have been shown to attenuate the risk of CVD. The implementation of a comprehensive smoking ban in New York State in 2003 was associated with an 8% (3813 fewer) reduction hospital admissions for heart attacks than would have been expected in the absence of the comprehensive smoking ban. Direct health care cost savings of $56 million were realized the very next year (2004). Comprehensive smoking bans constitute a simple, effective intervention to substantially improve the public’s health.3
- A strong tobacco control program is not only associated with reduced smoking, but also with reductions in health care. California invested $1.8 billion in a statewide tobacco control program funded by a portion of the cigarette excise tax revenue. This resulted in $86 billion personal health-care expenditures during the first 15 years (1989-2004).4 This translates to a return of investment of nearly $50 for every $1 spent on tobacco control programs in California. The CDC recommends states to invest $9-18 per capita on comprehensive tobacco control programs.
- Cigarette excise tax increase has been consistently shown to reduce tobacco use and initiation. A 10% increase in the price of cigarettes can reduce consumption by 4% in adults and can have even greater effects in children and other price-sensitive groups.5, 6
- Tobacco companies, however, are spending enormous amounts of money to reduce the price of cigarettes at point of sale (to offset the excise tax). For example, cigarette companies spent $12.5 billion on marketing and promotional expenditure in 2006, of which 74% was spent to offset tax increase.
- The average combined excise tax for cigarettes is $2.35 for a pack of 20 cigarettes. If cigarette tax is increased by another $1.00 an estimated $9.1 billion additional revenue will be generated each year in the US. Besides, 1 million smoking-caused deaths would be prevented and 2.3 million children would not initiate smoking. (Campaign for tobacco-free kids. Tobacco taxes: a win-win-win for cash strapped states).
- In 2004 Ireland became the first country to pass a national smoking ban in working places. Scotland, Norway, Sweden and Italy now have laws prohibiting smoking in work places. At present 5 European nations, New Zealand, 11 states in the US, and 9 Canadian provinces prohibit smoking in work places. Creation of smoke-free workplaces has an additional advantage of doubling the quit rates among active smokers.7
- The tobacco control policy between 1991 and 2006 in Thailand decreased smoking rates by 25%.8 Banning smoking in public places is associated with 17% reduction in heart attacks, an effect greater for young and non-smokers.10
- The various measures to reduce and eliminate tobacco use are:9
- Increase in government taxes
- Comprehensive restriction on smoking in the workplace and in public
- Ban on advertising and sponsorship by tobacco companies
- Comprehensive and enforced restrictions on sales of tobacco to minors
- Limiting and eliminating tobacco crop subsidies to farmers
- Government support for conversion of tobacco crops to other crops
- Financial support to anti-tobacco advertisements
- Enhanced community education programs
- Divestment of tobacco-company stocks by public institutions and universities
- Support for personal injury litigation against tobacco industry
- Physician supervised counseling on smoking cessation
- Arranging support by spouse and family
- Nicotine substitutes and other pharmacologic interventions in refractory cases.
1. Mancia G, De Backer G, Dominiczak A, et al. 2007 Guidelines for the Management of Arterial Hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. Jun 2007;25(6):1105-1187.
2. Oberg M, Jaakkola MS, Woodward A, Peruga A, Pruss-Ustun A. Worldwide burden of disease from exposure to second-hand smoke: a retrospective analysis of data from 192 countries. Lancet. Nov 25 2010.
3. Juster HR, Loomis BR, Hinman TM, et al. Declines in hospital admissions for acute myocardial infarction in New York state after implementation of a comprehensive smoking ban. Am J Public Health. Nov 2007;97(11):2035-2039.
4. Lightwood JM, Dinno A, Glantz SA. Effect of the California tobacco control program on personal health care expenditures. PLoS Med. Aug 26 2008;5(8):e178.
5. Chaloupka FJ. Macro-social influences: the effects of prices and tobacco-control policies on the demand for tobacco products. Nicotine Tob Res. 1999;1 Suppl 1:S105-109.
6. Tauras JA. Public policy and smoking cessation among young adults in the United States. Health Policy. Jun 2004;68(3):321-332.
7. Bauer JE, Hyland A, Li Q, Steger C, Cummings KM. A longitudinal assessment of the impact of smoke-free worksite policies on tobacco use. Am J Public Health. Jun 2005;95(6):1024-1029.
8. Sangthong R, Wichaidit W, Ketchoo C. Current situation and future challenges of tobacco control policy in Thailand. Tob Control. Jul 26 2011.
9. Gupta R. Prevention of Coronary Artery Disease in India Guidelines Jaipur: Cardiological Soceity of India;2000.