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December, 2007:

Protection From Exposure To Second-Hand Tobacco Smoke

Protection from exposure to second-hand tobacco smoke. Policy recommendations.

Scientific evidence has firmly established that there is no safe level of exposure to secondhand tobacco smoke (SHS), a pollutant that causes serious illnesses in adults and children. There is also indisputable evidence that implementing 100% smoke-free environments is the only effective way to protect the population from the harmful effects of exposure to SHS.

Moreover, several countries and hundreds of subnational and local jurisdictions have successfully implemented laws requiring indoor workplaces and public places to be 100% smoke-free without encountering significant challenges in enforcement. The evidence from these jurisdictions consistently demonstrates not only that smoke-free environments are enforceable, but that they are popular and become more so following implementation.

These laws have no negative impact – and often have a positive one – on businesses in the hospitality sector and elsewhere. Their outcomes – an immediate reduction in heart attacks and respiratory problems – also have a positive impact on health.

These experiences offer numerous, consistent lessons learnt, which policy-makers should consider to ensure the successful implementation
of public policies that effectively protect the population from SHS exposure. These lessons include the following:

  1. Legislation that mandates smoke-free environments – not voluntary policies – is necessary to protect public health;
  2. Legislation should be simple, clear and enforceable, and comprehensive;
  3. Anticipating and responding to the tobacco industry’s opposition, often mobilized through third parties, is crucial;
  4. Involving civil society is central to achieving effective legislation;
  5. Education and consultation are necessary to ensure smooth implementation;
  6. An implementation and enforcement plan as well as an infrastructure for enforcement are essential; and
  7. Implementation of smoke-free environments must be monitored and, ideally, their impact measured and experiences documented.

In light of the above experience, the World Health Organization (WHO) makes the following recommendations to protect workers and the public from exposure to SHS:

  1. Remove the pollutant – tobacco smoke – by implementing 100% smoke-free environments. This is the only effective strategy to reduce exposure to tobacco smoke to safe levels in indoor environments and to provide an acceptable level of protection from the dangers of SHS exposure. Ventilation and smoking areas, whether separately ventilated from non-smoking areas or not, do not reduce exposure to a safe level of risk and are not recommended;
  2. Enact legislation requiring all indoor workplaces and public places to be 100% smokefree environments. Laws should ensure universal and equal protection for all. Voluntary policies are not an acceptable response to protection. Under some circumstances, the principle of universal, effective protection may require specific quasi-outdoor and outdoor workplaces to be smoke-free;
  3. Implement and enforce the law. Passing smokefree legislation is not enough. Its proper implementation and adequate enforcement require relatively small but critical efforts and means.
  4. Implement educational strategies to reduce SHS exposure in the home, recognizing that smoke-free workplace legislation increases the likelihood that people (both smokers and non-smokers) will voluntarily make their homes smoke-free.

WHO encourages Member States to follow these recommendations and apply lessons learnt to advance the goals of public health through legislated implementation of 100% smoke-free environments in workplaces and public places.

Download the entire document on Protection From Exposure To Second-Hand Tobacco Smoke here.

Banning smoking in cars carrying children

Banning smoking in cars carrying children: an analytical history of a public health advocacy campaign

Objective: Framing public health policy reform in ways that attract public and political support is a core skill of advocacy. In this paper we summarise the 12- year Australian history of advocacy for banning smoking in cars carrying children, culminating in the governments of the
Australian States of South Australia and Tasmania enacting legislation.

Method: ‘Smoking in cars’ was searched on the print news media database, with returns limited to Australian newspapers published before 1 June 2007.

Results: The issue of smoking in cars received extensive and emotive media coverage, primarily in support of legislating a ban. Invoking the protection of vulnerable children in the debate about smoking in cars was a powerful and persuasive theme. Unlike all other advocacy for smoke-free areas, this debate was not contested by the tobacco industry or other commercial interest groups.

Conclusions: Even in the absence of a co-ordinated advocacy campaign, public opinion studies on support for such legislation have been consistently strong. Communities view the protection of children as paramount and non-negotiable.

Implications: Smoke-free cars legislation can and should be fast tracked in order to capitalise on this community support.

See the full document on  Banning smoking in cars carrying children here.

Hong Kong Smoking Ban

What do you think about the smoking ban after a year?

Published in the SCMP – Updated on Dec 31, 2007

We should look ahead at how to make the prohibition of smoking in restaurants and other places in Hong Kong more effective in 2008 and beyond.

The ban has resulted in smoke-free shops, hotel lobbies and some (but not all) bars and restaurants. Dining out in a smoke-free atmosphere makes for a great improvement but too many bars-cum-restaurants have exemptions, making the visitor obliged to inhale smoke emitted by others.

That carries with it even greater health risks to the unfortunate staff, who are obliged to breathe in second-hand smoke every day at their workplace. The long-term effects of this will sadly mean illness, even death, for some of them.

The sooner these numerous exemptions are withdrawn, the better.

In public areas where smoking is supposed to be prohibited, smokers are often seen indulging their habit. These include train stations and the Central escalator, for example.

More effective enforcement action is clearly needed in such places.

Many restaurants have set up smoking areas outside their entrances, with an open frontage to the street. Consequently, patrons inside are still subjected to smokers’ fumes, blown in off the street. Clearly, such smoking areas should be out of range of the restaurants.

Office building approaches are now littered with discarded fag ends and when you visit an office block, you often have to pass by people smoking heavily on both sides of the entrance. Firms should make provision for smokers on a rooftop or terrace, and there should also be in-house quitting campaigns.

As the intention of the legislation is to see a general reduction in smoking, the duty-free allowance for cigarettes should be withdrawn.

More sustained campaigns against smoking are clearly needed. But this first year of partial prohibition has generally been accepted and is certainly to be welcomed.

What is now needed is to stiffen the provision of anti-smoking methods, as outlined above, with the intention of better safeguarding the health of us all, smokers and non-smokers alike.

Paul Surtees, Mid-Levels

Federal Trade Commission Cigarette Report For 2004 and 2005

This report is the latest in a series on cigarette sales, advertising, and promotion that the Federal Trade Commission (“the Commission”) has prepared since 1967.

The statistical tables appended to this report provide information on domestic sales and advertising and promotional activity for U.S.-manufactured cigarettes for the years 1963 through 2005. The tables were compiled from raw data contained in special reports submitted to the Commission pursuant to compulsory process by the five major cigarette manufacturers in the United States: Altria Group, Inc. (the ultimate parent of Philip Morris); Houchens Industries, Inc. (the ultimate parent of Commonwealth Brands, Inc.); Loews Corp. (the ultimate parent of Lorillard Tobacco Co.); Reynolds American, Inc. (the ultimate parent of R.J. Reynolds Tobacco Co. and Santa Fe Natural Tobacco Company, Inc. and which acquired Brown & Williamson Tobacco Corp. in 2004); and Vector Group Ltd. (the ultimate parent of Liggett Group, Inc. and Vector Tobacco, Inc.).

View the entire Federal Trade Commission Cigarette Report For 2004 and 2005.

Smoke-Free Policy Legislation Failure

The Editor
South China Morning Post

Dear Sir

Paul Surtees (Talkback 31 Dec) provides an excellent summary of the frank failure of the current smoke-free policy legislation to protect large numbers of people from tobacco smoke. The catering industry ,while not fully supportive of the policy, did ask the government to at least give them a level playing field. They didn’t get it and since then the Department of Health has expended considerable resources trying to deal with manoeuvres to by-pass the legislation.

One way of doing this is simply to change the venue’s name to include the word “bar”. Others pretend they can be non-smoking at certain hours of the day or days of the week when they want to attract different clientele, including families and offer children’s menus. At the same time they defend their exempted status with spurious arguments about the proportion of their revenue from alcohol sales. All this is understandable given the vagaries of the Bill and the unequal constraints placed on their ability to compete for custom.

The government will privately argue that covert deals with vested interests were needed to push through the tobacco control Bill. In doing so they abrogated their duty of care to the workforce and with over 1300 exemptions subjected thousands of workers to irreversible harm to their heart and lung function. The government ignored the overwhelming global evidence that second-hand smoke kills and that comprehensive smoke free policies ultimately benefit the hospitality sector.

Paul Surtees rightly looks to make the policy more effective, but the government is now looking at proposals by The Hon. Tommy Cheung Yu Yan and British American Tobacco to create smoking rooms in catering venues. Nothing could be more
damaging to the industry, workers, patrons and the health care system of Hong Kong.

Anthony Hedley
School of Public Health
University of Hong Kong

France To Introduce Nationwide Smoking Ban

By RIA Novosti (MCT)
Saturday, December 29, 2007 1:56 AM CST

PARIS — France will introduce a nationwide ban on smoking in most public places from January 1, 2008, the French health minister said Friday.

Eleven months after smoking became illegal in offices, schools, hospitals, airports and train stations, Europe’s heaviest smokers, the French will now be banned from smoking in cafes, bars, restaurants, hotels, clubs and casinos.

“The ban has been ready for a year and everyone knows that it is coming into effect. No one can say they were taken by surprise,” said Health Minister Roselyne Bachelot.

However, the minister said the ban will be enforced gradually and police will be in no hurry to impose fines for those caught smoking on the first few days after New Year.

Meanwhile, French cafe owners fear that they will lose clients and their profits could plunge. Owners of France’s 800 shisha bars are particularly concerned by the new law fearing it will lead to mass closures. (Shisha is flavored tobacco smoked through a water pipe — also known as hookah.)

Psychologists also warned that the country with 15-million smokers could face a shock.

France is the latest of the EU member states to ban smoking in public places.

In 2004, Ireland became the first European country to introduce a comprehensive ban, prohibiting smoking in pubs, restaurants and other enclosed workplaces. Ireland’s anti-smoking measures were followed by Italy, Norway, Sweden, the U.K, Denmark and Portugal.

Tobacco Taxes Versus Needless Deaths

Prabhat Jha Updated on Dec 29, 2007 – SCMP

A global killer is ripping through the world’s poorer countries largely unchecked. Within 25 years, it will cause 10 million deaths a year – far more than malaria, maternal deaths, childhood infections and diarrhoea combined. At least half of the dead will be aged 30 to 69, losing about 25 years of life expectancy. The culprit? Smoking tobacco. The same addiction that became the top preventable cause of death in western countries has made big inroads in developing nations. Given current trends, smoking will kill about 1 billion people in the 21st century, mostly in developing countries. In India, smoking cigarettes triples the risk of death from tuberculosis in men and from respiratory disease among women.

We know now that quitting works: even those who stop smoking in their forties lower their risk of death remarkably, and those who quit in their thirties have death risks close to those of lifelong non-smokers.

So cessation by the 1.1 billion current smokers would lower tobacco deaths over the next few decades. Tobacco tax increases, the dissemination of information about the health risks of smoking, smoking bans in public spaces and workplaces, prohibition of advertising and promotion, and cessation therapies help smokers to quit and prevent youngsters from starting. Of these, tobacco taxes are as close to a silver bullet as exists in public health. Indeed, they are probably the single most cost-effective intervention for adult health in the world. A tripling of the excise tax would roughly double the price of cigarettes, preventing about 3 million deaths per year by 2030.

Most developed countries began to take tobacco control seriously in the past two decades, reducing male tobacco-related deaths. But effective tobacco control measures are not under way in developing countries. Taxes are about 80 per cent of the street price of cigarettes in Toronto, but less than 30 per cent in Beijing or New Delhi. And knowledge of the health risks from smoking is low: 61 per cent of Chinese smokers in 1996 thought tobacco did them “little or no harm”.

Spurious economic arguments against tobacco control, debunked in the west, are still commonly repeated in the finance ministries of developing countries.

Money not spent on tobacco can be spent on other goods and services. Tax increases lower consumption and raise revenue: a 10 per cent higher tax means about 7 per cent higher revenue over the medium term. These funds can be a precious resource in fighting poverty.

In China, a 10 per cent higher price would reduce consumption by 5 per cent, and raise enough revenue to pay for a basic health package for 33 million poor rural Chinese.

One common argument against tobacco control – that if people are not harming others, governments should not interfere – is at odds with both common sense and the evidence. In countries with good information about tobacco risks, by the time child smokers become adults, more than 80 per cent wish they had never started.

The agenda is clear. Governments must take tobacco seriously as a leading killer of adults worldwide. International poverty goals must include tobacco control. There are hopeful signs: more than 160 countries have signed the World Health Organisation’s global tobacco control treaty, and the Bloomberg and Gates Foundations are stepping up funding for its implementation.

If the proportion of adults in developing countries who quit smoking increases from below 5 per cent today to 30 to 40 per cent by 2020, then 150 million to 180 million tobacco deaths would be avoided before 2050 – half of these in productive middle age.

Benjamin Franklin once said, “In this world, nothing can be said to be certain, except death and taxes.” Yet we have a tax that could prevent hundreds of millions of premature deaths. It is time to use it.

Prabhat Jha is research chair of health and development at the University of Toronto

Experts Aim To Stub Out Tobacco Smuggling

Dec 29 2007 by Marie Levy, Evening Gazette

TEESSIDERS who buy cut-price cigarettes could be smoking mud, dirt and even animal excrement.

The shocking revelation was made as experts in the region joined forces to try to stub out tobacco smuggling in the area.

Hosted by Fresh Smoke Free North East, the 200-strong delegation heard from organisations including the Department of Health and Her Majesty’s Revenue and Customs on the extent of the problem and its serious impact on public health.

The summit revealed:

Up to one in five cigarettes and half of all loose tobacco in the North is sold at knockdown prices.

Smokers often think they are smoking genuine “duty free” products, but increasingly are being sold fake and counterfeit products.

The majority of smuggled tobacco is brought in from Russia and Eastern Europe where packets of 20 cigarettes cost as little as £1 but can be sold on in the UK for about £3.

Counterfeit tobacco – where copies of the bigger known brands are made – are even worse for smokers’ health. All cigarettes contain arsenic and heavy metals, but counterfeit cigarettes sometimes contain even higher levels of these poisonous substances, along with floor sweepings – including animal excrement, mud and dirt.

The North-east has become a hub for the illegal trade in contraband tobacco with unprecedented quantities entering the country via Tees Port as well as the region’s airports. Large hauls of tobacco have been found behind panels on vessels, within loads of logs, flowers, and even concrete blocks.

John Kinghorn, HMRC’s head of detection for the North of England, said: “Many smokers think they are getting a good deal but these cigarettes are usually cheap because they are not the genuine article.

“Counterfeit cigarettes are even worse for health than normal cigarettes and it is not easy to tell the difference.”

Ailsa Rutter, director of Fresh Smoke Free North East, added: “We look forward to working with a number of organisations as we develop an action plan to tackle this problem in the North-east.”

Wisconsin Increases Tobacco Tax for 2008

Posted: 4:37 PM Dec 29, 2007 Last Updated: 4:37 PM Dec 29, 2007 Reporter: Amy Pflugshaupt
Email Address:

One of the most common New Year’s Resolutions People make is to quit smoking and this just might be the year that many tobacco users in Wisconsin keep their resolutions.

On January 1st, Wisconsin will raise the tax on all tobacco sales. The US dollar-per-pack increase means Wisconsin smokers will now pay US$1.77 in taxes on every pack of cigarettes. It’s the 12th highest tobacco tax in the nation and it has many tobacco users saying enough is enough.

Local stores are saying many people are coming in and buying several cartons before the increase takes effect.

The campaign for Tobacco-Free Kids predicts the higher tax will stop nearly 66,000 Wisconsin children from starting smoking, and it will help more than 33,000 smokers quit. The campaign estimates the state will save about US$ 1.5 billion in long-term smoking-related health care expenses.

Wisconsin Provide Quit Smoking Starter Kits

Free stop-smoking medications available in new year

New Richmond News Published Friday, December 28, 2007

At a recent news conference in Milwaukee, the Wisconsin Department of Health and Family Services and the University of Wisconsin Center for Tobacco Research and Intervention announced an expansion of Quit Line services for Wisconsin tobacco users who want to quit.

This includes free medication for those who participate in Quit Line coaching, and a new interactive Web coaching service that provides personal tracking tools and discussion forums for those trying to quit.

These enhancements to the tried-and-true Wisconsin Tobacco Quit Line (1-800-QUIT-NOW) come at a critical time for the 800,000 tobacco users in the state.

New Year’s is a traditional time that smokers think about quitting.

Additionally, the excise tax on cigarettes in Wisconsin will increase by $1 per pack on Jan. 1. The expanded Quit Line services are designed to assist the great majority of Wisconsin smokers who want to quit and may try in response to the tax increase and the New Year.

Starting on Jan. 1, Wisconsin residents who call the Quit Line for coaching can obtain a free two-week starter kit of quit-smoking medications that will be mailed directly to their homes, either nicotine patches, gum or lozenges.

Study after study has shown that providing medications in addition to Quit Line coaching is a cost-effective way to get large numbers of smokers to make a quit attempt.

“This is an unprecedented moment for Wisconsin,” said Dr. Michael Fiore, director of UW-CTRI. “We are capitalizing on that moment. The New Year, the tax increase, Quit Line coaching and the free medication represent a combined triumph over an addictive product that kills half of the people who use it. We now have the potential to spare thousands of Wisconsin families from the pain of losing loved ones to tobacco-related disease. I’m so pleased that Gov. Jim Doyle and the Legislature provided the leadership that enables us to offer this assistance to tobacco users and their families.”

St. Croix County healthcare providers have also used the Quit Line with their patients over the years and welcome the enhancements.

“We recently added the ability to fax a patient’s Quit Line request to their staff”, notes Dr. Paul McGinnis, a Western Wisconsin Medical Associates family physician in Hudson. “The patient fills out a brief form, signs it and the Quit Line will call them at a time the patient chooses. The Quit Line, and now medications, are great free benefits for those attempting to overcome tobacco addiction.” Other St. Croix County cessation opportunities can be found by visiting

The Quit Line is available from 7 a.m. to 11 p.m. seven days a week. At other times, callers can leave a message for a return call. Coaches fluent in many languages are available to callers. The Wisconsin Department of Health and Family Services contracts with UW-CTRI to provide services through the Quit Line.