Are there health benefits associated with comprehensive smoke-free laws
In the past few years, comprehensive smoke-free laws that prohibit smoking in all workplaces have been introduced in many jurisdictions in the US, Canada, and Europe. In this paper, we review published studies to ascertain if there is any evidence of health benefits resulting from the implementation of these laws.
All papers relating to smoke-free legislation published in or after 2004 were considered for inclusion in this review. We used Pubmed, Google scholar, and Web of Science as the main search tools. The primary focus of the paper is on health outcomes, and thus many papers that only report exposure data are not included.
Studies using subjective measures of respiratory health based on questionnaire data alone consistently reported that workers experience fewer respiratory and irritant symptoms following the introduction of smoke-free laws. Some studies also found measured improvements in the lung function of workers. However, the most dramatic health outcome associated with smoke-free laws has been the reduction in myocardial infarction in the general population. This outcome has been observed in the US, Canada, and Europe, with studies reporting reductions of between 6 and 40%, post-legislation, the larger reductions being mostly from studies with smaller population groups. The evidence as to whether these smoke-free laws have helped smokers to stop smoking or to reduce tobacco consumption is less clear.
There is now significant body of published literature that demonstrates that smoke-free laws can lead to improvements in the health of both workers who are occupationally exposed and of the general population. There is no longer any reason why non-smokers should be exposed to SHS in any workplace. We recommend that all countries adopt national smoke-free laws that are in line with article 8 of the WHO Framework Convention on Tobacco Control that sets out recommendations for the development, implementation, and enforcement of national, comprehensive smoke-free laws.
KeywordsSmoking policies Smoke-free laws Tobacco consumption
- Ayres JG, Semple S, MacCalman L, Dempsey S, Hilton S, Hurley JF, Miller BG, Naji A, Petticrew M (2009) Bar workers’ health and environmental tobacco smoke exposure (BHSHSE): symptomatic improvement in bar staff following smoke-free legislation in Scotland. Occup Environ Med 66:339–346CrossRefPubMedGoogle Scholar
- Centers for Disease Control (2007) Reduced secondhand smoke exposure after implementation of a comprehensive statewide smoke-free laws—New York, June 26, 2003–June 30, 2004. Morb Mortal Wkly Rep 56:705–708Google Scholar
- Clancy L, Manning PJ, Holohan J, Keogan S, Goodman PG, Kabir Z (2008) Smoking and bronchitis symptoms among Irish school children: an ISAAC protocol study, 1995-2007. Eur Resp J 32 (Supp 52)Google Scholar
- Committee on the medical effects of air pollutants (1995) Health effects of non-biological particles. Department of Health. HMSO, LondonGoogle Scholar
- Fernández E, Fu M, Pascual JA, López MJ, Pérez-Ríos M, Schiaffino A, Martínez-Sánchez JM, Ariza C, Saltó E, Nebot M, the Spanish Smoking Law Evaluation Group (2009) Impact of the Spanish smoking law on exposure to second-hand smoke and respiratory health in hospitality workers: a cohort study. PLoS ONE 4:e4244CrossRefPubMedGoogle Scholar
- Fong GT, Hyland A, Borland R, Hammond D, Hastings G, McNeill A et al (2006) 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 15(Suppl 3):iii51–iii58CrossRefPubMedGoogle Scholar
- Gasparrini A, Gorini G, Barchielli A (2009) On the relationship between smoking bans and incidence of acute myocardial infarction. Eur J Epidemiol (on line 1 August 2009)Google Scholar
- Gorini G, Moshammer H, Sbrogiò L, Gasparrini A, Nebot M, Neuberger M, Tamang E, Lopez MJ, Galeone D, Serrahima E, Italy & Austria Before and After Study Working Group (2008) Italy and Austria before and after study: second-hand smoke exposure in hospitality premises before and after 2 years from the introduction of the Italian smoke-free laws. Indoor Air 18:328–334CrossRefPubMedGoogle Scholar
- Raupach T, Schafer K, Konstantinides S, Andreas S (2006) Secondhand smoke as an acute threat for the cardiovascular system: a change in paradigm. Eur Heart J 27:382–383Google Scholar
- Stranges S, Bonner MR, Fucci F, Cummings KM, Freudenheim JL, Dorn JM, Muti P, Giovino GA, Hyland A, Trevisan M (2006) Lifetime cumulative exposure to secondhand smoke and risk of myocardial infarction in never smokers: results from the Western New York health study, 1995–2001. Arch Intern Med 166:1961–1967CrossRefPubMedGoogle Scholar
- US Surgeon General (2006) The health consequences of involuntary exposure to tobacco smoke: a report of the US Surgeon General. Department of Health and Human Services. CDC Office on Smoking and HealthGoogle Scholar