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December 11th, 2008:

Should The Full Smoking Ban be Delayed?

11 Dec 2008 – SCMP

It beggars belief that anyone who claims to be concerned about air quality (P. A. Crush) should campaign for clean outdoor air while actively dismissing the impact of tobacco smoking on indoor air pollution (Talkback, December 6).

Both aspects of air pollution were highlighted and debated throughout the recent Clinton Global Initiative in Hong Kong and participants agreed that both were important and required attention in this region.

Dr Judith Mackay, director, Asian Consultancy on Tobacco Control

Should The Full Smoking Ban be Delayed?

SCMP – Updated on Dec 11, 2008

There has been much debate about whether or not the current exemptions that permit smoking in many bars should be extended.

The fact is, however, that many of these establishments are really restaurants, which also serve drinks.

They have somehow managed to get around the laws banning smoking in restaurants – the sooner that anomaly stops, the better.

There is little point in prohibiting smoking in restaurants if this simply results in groups of smokers lighting up on the street immediately by the open frontage of a restaurant. Their noxious fumes permeate the restaurant even though they may be technically outside. Regulations need to be introduced here, as they have been in other jurisdictions, banning smoking in the close vicinity of bars and restaurants.

Passers-by on the street are now subject to the smoke emitted by groups of smokers loitering outside almost every restaurant in town.

As you approach offices these days, those shirking work for a cigarette pollute the entrances and, incidentally, give an unfortunate first impression of the company that employs them.

Perhaps a way needs to be found for those determined to hurt themselves by smoking to be able to do so without subjecting passers-by to the known health dangers of passive smoking.

It is surely an absurdity for cigarettes to be sold tax-free at our frontier checkpoints, which not only deprives the government of that lost tax income but can be seen as offering encouragement to smokers who travel. The government loses twice over, because smokers are likely to cost the health services a lot when the deadly effects of their habit hit home in later years.

Let us be clear about the matter. Other dangerous drugs (Ice, heroin) are banned. That’s because taking them kills people. But for historical reasons, taking the almost equally dangerous tobacco products is still regarded by many as acceptable.

But smoking also kills people, thousands a day worldwide. While one person may choose to risk his health by smoking, he does not have the right to risk the health of others – passive smokers, that is – whose comfort and health he selfishly ignores.

It is high time more stringent measures were introduced to help limit the number of Hong Kong people who will die from smoking-induced illnesses.

Paul Surtees, Mid-Levels

Tougher Laws On Way for Smokers, Says Health Chief

Anita Lam, SCMP – Dec 11, 2008

The smoking ban will be expanded in the second half of next year to include covered public transport interchanges, along with a fixed penalty system for smokers who flout rules.

Open-air interchanges would be the next target, the health minister said yesterday.

But bus drivers said there was nothing they could do to enforce the rules apart from advising passengers, who are often seen smoking in enclosed interchanges, where smoking is already banned.

Speaking in the Legislative Council, health minister York Chow Yat-ngok said his ultimate goal was to establish a smoke-free city, and he would also consider raising the import tax on tobacco.

He said government statistics showed that the number of smokers aged between 15 and 19 had fallen from 3.5 per cent in 2005 to 2.4 per cent recently.

At the same time, however, the number of cigarettes sold that incurred duty jumped 9.1 per cent, from 3.44 billion cigarettes between October 2006 and September last year to 3.76 billion a year later.

Dr Chow said this could be due to an earlier change in policy that cut the number of cigarettes that incoming visitors could bring from six packs to three.

“Another reason may be that the hard work of the Customs Department in tackling smuggled cigarettes is working so people need to make the purchase via normal channels.”

A fixed penalty of HK$1,500 for a smoking offence is expected to come into effect in the latter half of next year, as the Department of Health is taking the final steps in formulating an administrative and information system to implement the law.

“We hope the new penalty system can come out at the same time when public transport interchanges are designated no-smoking areas,” Dr Chow said.

Kowloon Motor Bus said it would advise drivers to warn commuters if they received complaints, but a spokeswoman did not say if it would encourage drivers to report cases to the Tobacco Control Office.

A Post employee saw a woman smoking openly inside the Lam Tin bus interchange – which is already classified a smoke-free area as it is largely indoors – without being challenged.

Chung Chung-fai, staff union chairman at New World First Bus, said giving warnings was probably the best option as few drivers wanted trouble.

Even if they informed the Tobacco Control office, “by the time they get through, the commuters will have long gone”.

Should Smoking In Outside Public Spaces Be Banned? Yes

BMJ – Published 11 December 2008, doi:10.1136/bmj.a2806

George Thomson, senior research fellow1, Nick Wilson, senior lecturer1, Richard Edwards, associate professor1, Alistair Woodward, professor2

1 University of Otago, Wellington, Box 7343, Wellington, New Zealand, 2 University of Auckland, Private Bag 92019, Auckland, New Zealand – Correspondence to: G Thompson

After success in stopping smoking in public buildings, campaigns are turning outdoors. George Thomson and colleagues argue that a ban will help to stop children becoming smokers but Simon Chapman (doi:10.1136/bmj.a2804) believes that it infringes personal freedom Legislation to ban smoking indoors in public places is now commonplace, driven mainly by the need to protect non-smokers from exposure to secondhand smoke. A new domain for tobacco control policy is outdoor settings, where secondhand smoke is usually less of a problem. However, the ethical justification for outdoor smoking bans is compelling and is supported by international law. The central argument is that outdoor bans will reduce smoking being modelled to children as normal behaviour and thus cut the uptake of smoking. Outdoor smoke-free policies may in some circumstances (such as crowded locations like sports stadiums) reduce the health effects of secondhand smoke1; will reduce fires and litter2; and are likely to help smokers’ attempts at quitting.

Need to reduce modelling

There is no simple answer to the question of what causes children to take up smoking.3 4 We know, however, that children tend to copy what they observe and are influenced by the normality and extent of smoking around them.5 6 7 Many smokers recognise that their smoking affects children’s behaviour.8 The primary strategy for tobacco control is reducing the prevalence of smoking, and such reduction will in itself mean that smoking is less visible in society. But the modelling of smoking can also be reduced by policies to restrict smoking in the presence of children. The entrenched nature of tobacco use in most societies, and its highly addictive qualities, require that such policies are far reaching. Smoking bans in many outdoor public areas are therefore an important additional approach to tobacco control. The need for outdoor smoking restrictions is increasingly recognised. Finland, five Canadian provinces, two US states, and New Zealand use law to require smoke-free school grounds. Other jurisdictions (such as Australian states) use administrative policies. California has banned smoking within 25 feet (7.6 metres) of outdoor playgrounds. United Kingdom, Scottish, Australian, and New Zealand authorities have been explicit about the need to reduce the modelling of smoking to children as a justification for this type of outdoor smoking restrictions.9 10 11 12 Policies encouraging or requiring other outdoor smoke-free areas have been introduced in the past 10 years in North America, Australasia, Hong Kong, Singapore, and elsewhere.13 Reducing the modelling of smoking to children has often been given as a justification for introducing these restrictions.

Are outdoor smoke-free policies practical?

How best to reduce the visibility of smoking? Media campaigns can promote not smoking in the presence of children as a social norm.14 Legislation and other uses of law can expand smoke-free policies to ensure the inclusion of all public areas where children predominate. These areas include schools, parks and playgrounds, swimming pool complexes, sports grounds, and parts of beaches. The success of outdoor bans depends on the size of the areas covered, the ways the policy is communicated (for example, signage), and the extent of public support.15 Reports from Britain, New Zealand, and parts of Australia and the United States indicate majority support for restricting or banning smoking in outdoor areas where there are children.15 16 17 18 19 20 We are aware of no evidence that outdoor smoke-free policies have resulted in a public backlash against other advances in tobacco control.

Ethical and international treaty considerations

Children are a highly vulnerable population, susceptible to the influences of adult behaviours. Protection from addiction can be considered to enhance overall freedom, given that most smokers regret ever starting.21 We may not yet be certain that outdoor smoke-free areas reduce smoking uptake; the necessary studies have not been carried out. However, where there is uncertainty in policy making, any assessment of the balance of benefit and harm should put the protection of children first.22 This is because of the extent and severity of the hazard that taking up smoking poses to children and the theoretical and empirical evidence for a role modelling effect on smoking uptake. The principle of giving primacy to the protection of children is also underpinned by international treaty obligations. The United Nations Convention on the Rights of the Child requires that in making policy, children’s rights must be put first, and governments “shall undertake all appropriate legislative, administrative, and other measures for the implementation of the rights.”23 Adverse effects from outdoor smoke-free areas are largely restricted to the possible loss of amenities for some smokers. We argue that society has an ethical duty to minimise the risk of children becoming nicotine dependent smokers. A reasonable step is banning smoking in selected outdoor areas frequented by children. Children need smoke-free outdoor places now, to help normalise a smoke-free society. Cite this as: BMJ 2008;337:a2806

Competing interests: All authors have done contract work for health non-governmental organisations, the New Zealand Ministry of Health, or WHO on tobacco control research.


  1. Repace J. Benefits of smoke-free regulations in outdoor settings : beaches, golf courses, parks, patios, and in motor vehicles. William Mitchell Law 2008;34:1621-38.
  2. Mackay J, Erikson M, Shafet O. The tobacco atlas. Atlanta: American Cancer Society, 2006.
  3. Milton B, Cook PA, Dugdill L, Porcellato L, Springett J, Woods SE. Why do primary school children smoke? A longitudinal analysis of predictors of smoking uptake during pre-adolescence. Public Health 2004;118:247-55.[CrossRef][ISI][Medline]
  4. Stewart-Knox BJ, Sittlington J, Rugkasa J, Harrisson S, Treacy M, Abaunza PS. Smoking and peer groups: results from a longitudinal qualitative study of young people in Northern Ireland. Br J Soc Psychol 2005;44:397-414.[CrossRef][ISI][Medline]
  5. Kobus K. Peers and adolescent smoking. Addiction 2003;98(suppl 1):37-55.[CrossRef][ISI][Medline]
  6. Tyas SL, Pederson LL. Psychosocial factors related to adolescent smoking: a critical review of the literature. Tob Control 1998;7:409-20.[Abstract/Free Full Text]
  7. Wakefield M, Chaloupka F, Kaufman N, Orleans C, Barker D, Ruel E. Effect of restrictions on smoking at home, at school, and in public places on teenage smoking: cross sectional study. BMJ 2000;321:333-7.[Abstract/Free Full Text]
  8. McCaul KD, Hockemeyer JR, Johnson RJ, Zetocha K, Quinlan K, Glasgow RE. Motivation to quit using cigarettes: a review. Addict Behav 2006;31:42-56.[Medline]
  9. Department for Education. Drug prevention and schools: annex 8—sample smoking policies in schools. London: Department for Children, Schools and Families, 1995.
  10. Griffiths J. Smoke-free Scotland: guidance on smoking policies for the NHS, local authorities and care service providers. Edinburgh: Scottish Executive and Convention of Scottish Local Authorities, 2005.
  11. National Childcare Accreditation Council. Smoke free environment policy. Sydney: NCAC, 2006.
  12. Smoke-free environments amendment act. Wellington: New Zealand Government, 2003.
  13. Wilson N, Thomson G, Edwards R. Lessons from Hong Kong and other countries for outdoor smokefree areas in New Zealand? N Z Med J 2007;120:U2624.[Medline]
  14. Levy DT, Romano E, Mumford EA. Recent trends in home and work smoking bans. Tob Control 2004;13:258-63.[Abstract/Free Full Text]
  15. Klein EG, Forster JL, McFadden B, Outley CW. Minnesota tobacco-free park policies: attitudes of the general public and park officials. Nicotine Tob Res 2007;9(suppl 1):S49-55.
  16. Alesci NL, Forster JL, Blaine T. Smoking visibility, perceived acceptability, and frequency in various locations among youth and adults. Prev Med 2003;36:272-81.[CrossRef][ISI][Medline]
  17. Gilpin EA, Lee L, Pierce JP, Tang H, Lloyd J. Support for protection from secondhand smoke: California 2002. Tob Control 2004;13:96.[Medline]
  18. Health Sponsorship Council. Acceptability of smoking in outdoor public places. Wellington: Health Sponsorship Council, 2008.
  19. Populus. BBC Daily Politics Show poll [smoking related questions]. London: BBC, 2007.
  20. Quit Victoria. Quit gets behind smokefree playgrounds. Melbourne: Quit Victoria, 2007.
  21. Fong GT, Hammond D, Laux FL, Zanna MP, Cummings KM, Borland R, et al. The near-universal experience of regret among smokers in four countries: findings from the International Tobacco Control policy evaluation survey. Nicotine Tob Res 2004;6 (suppl 3):S341-51.
  22. Nuffield Council on Bioethics. Public health: ethical issues. London: NCB, 2007.
  23. United Nations Office of the High Commissioner of Human Rights. Convention on the rights of the child. Geneva: UN, 1990.