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Passive Smoking

Smoking Costs Hong Kong Over $5 Billion Every Year

A collaborative research project between University of Hong Kong and University of Queensland

School of Public Health Department of Community Medicine University of Hong Kong

The first comprehensive assessment of the costs of tobacco in Asia

Why is this topic important?

  • Smoking tobacco affects the health of the smoker and those around the smoker
  • This effect on health creates costs which are shared by several groups
  • Knowing the extent of these costs and who pays for them is essential information for policy decision-making

View the complete presentation here:

Non-smokers the big winners when it comes to smoking bans

Medical Studies/Trials
Published: Thursday, 22-Nov-2007

American scientists have found that heart attacks decreased after a smoking ban was imposed but this only applied to non-smokers.

Their study suggests that the major benefit of the ban on smoking in public places is being seen in nonsmokers.

The researchers from Indiana University say even those with no risk factors for heart disease can still experience heart attacks but after a countywide smoking ban was implemented, hospital admissions for such heart attacks dropped 70 percent for non-smokers, but not for smokers.

The researchers conducted the study in order to investigate whether smoking bans led to any changes in hospital admissions for myocardial infarction (MI).

They did this by comparing hospital admissions for MI in Monroe County, Indiana, which has had a public smoking ban in place since August 2003, with those in Delaware County, also in Indiana, which has much in common with Monroe Country but does not have a smoking ban.

Dong-Chul Seo, lead author and an assistant professor in IU Bloomington’s Department of Applied Health Science, says heart attack admissions for smokers saw no similar decline during the study, so the benefits of the ban appear to come more from the reduced exposure to second-hand smoke among non-smokers than from reduced consumption of tobacco among smokers.

The study is the first to examine the effect of public smoking bans on heart attacks in non-smokers.

Previous studies did not distinguish between non-smokers and smokers when examining the effect of the bans or specifically look at non-smokers who had no risk factors for heart disease, such as high blood pressure, high cholesterol or previous heart surgery.

Experts say exposure to second-hand smoke for just 30 minutes can rapidly increase a person’s risk for heart attack, even if they have no risk factors because the smoke, which contains carbon monoxide, causes blood vessels to constrict and reduces the amount of oxygen that can be transported in the blood.

The researchers say it is of concern that about half of all non-smoking Americans are regularly exposed to second-hand smoke, even though more than 500 municipalities nationwide have adopted some form of a smoking ban in public places.

The study also compared the hospital admissions in Monroe county before and after the smoking ban was adopted and found there was a 70 percent drop in the number of hospital admissions for AMI among non-smoking patients with no history of heart disease.

The study is published in the latest issue of the Journal of Drug Education.

Cigar Show Air Quality

Published in the New York Times November 22, 2007

At a Cigar Show, an Air-Quality Scientist Under Deep, Smoky Cover


The agitators met a few blocks from the target at a secret location, so as not to call attention to the devices in their bags.

They synchronized their watches. They reviewed the well-rehearsed game plan: If their bags were searched, the first operative, known as “Researcher 1 (female),” would say the device was for an asthma condition. If she was not allowed into the event with the device, she would activate Plan B: go to the ladies’ room and strap it to her body.

The man behind the subterfuge (Researcher 2, male) was Ryan David Kennedy, 34, a scrappy Canadian graduate student with crooked glasses who is studying the impact of tobacco on air quality.

He crossed the border at Buffalo on Monday morning and on Tuesday crashed the giant cigar party and trade show sponsored by the publisher of Cigar Aficionado magazine at the Marriott Marquis in Times Square.

A nonsmoking vegetarian posing as a cigar lover, Mr. Kennedy was nervous. Canadians are, for the most part, known to be earnest, demure and very law-abiding.

“I think I’m being watched,” he said before the event, known as the Big Smoke, which drew hundreds of cigar lovers and peddlers into a ballroom on the hotel’s sixth floor. He said he strongly believed his room at the Marriott had been searched.

Mr. Kennedy, who holds a master’s degree in environmental science from the University of Waterloo in Ontario and is working on a doctorate in psychology there, soon found himself in the belly of decadence. The ballroom was swarming with stogies — Bolivar, Ashton, Don Tomas and a dozen other brands — whiskey, tequila and exotic dancers.

Mr. Kennedy, who has also researched the level of particulate matter produced by smoking tobacco on outdoor patios, and Kerri Ryan (Researcher 1), a friend from college who lives in New York, sneaked their devices in the door. (Mr. Kennedy’s professor used a discretionary fund to cover the costs of the event tickets — $400 each — and other expenses.)

A tiny white plastic tube protruding from each of their bags like a hidden microphone took in the air, which was then measured for particles by the device, known as a Sidepak. The device can log 516 minutes of air sampling before the battery runs out, and is a well-established method for detecting dust and smoke.

Mr. Kennedy measured the particles in the air on Monday to obtain a baseline before the cigar smokers descended. Then on Tuesday he tested the air inside the ballroom and in various places outside the cigar party — at the elevators, in guest rooms and in the lobby. To log enough data on the air, he would need to stand in one place for 5 or 10 minutes and look busy.

If Mr. Kennedy and Ms. Ryan were lurking in one place for too long, perhaps seeming suspicious to security guards, they would say loudly, “We’re waiting for Sally.”

It was easy for Mr. Kennedy to prove his thesis: that plumes of cigar smoke lead to high levels of particulate matter in the air.

Marriott Hotels announced in July that it was making all of its hotels 100 percent smoke-free, but it has made an exception for the Big Smoke.

Opponents of smoking working with Mr. Kennedy said the exception was a glaring violation of the hotel’s own policy.

“The event is really a flagrant contradiction to their commitment to their guests and employees,” said Louise Vetter, president of the American Lung Association of the City of New York and a spokeswoman for the New York City Coalition for a Smoke-Free City. “The dangers of secondhand smoke are indisputable, and in New York City it is law to protect workers from secondhand smoke. We applauded Marriott, but to have this event in New York City and to create an exception — there’s no exception for public health.”

Under the state law, smoking is banned in most indoor places, including the Marriott ballroom (though there is no legal ban on smoking in guest rooms). But the law allows an exception for tobacco promotional events “where the public is invited for the primary purpose of promoting and sampling tobacco products.”

Cigar bars that were open in the city before Dec. 31, 2002, and can prove that they generated at least 10 percent of their gross income from the sale of tobacco products are also exempt; they can extend their registration each year if they continue to meet those criteria and do not expand or change location.

Kathleen Duffy, a spokeswoman for Marriott Hotels, said the company was honoring a longstanding contract with the publisher of Cigar Aficionado, Marvin R. Shanken, and had been the host of the Big Smoke at the Marriott Marquis for at least 10 years.

“We are not going out and booking smoking events at any of our hotels,” she said. “We did announce we would be smoke-free, but with this client we had an obligation.”

She said “we tripled our efforts” to keep the smoke contained, banning smoking outside the ballroom and increasing the filtration in the room, so that the smoke was funneled outside the hotel through air vents.

Under Environmental Protection Agency guidelines, air with fewer than 15 micrograms per cubic meter is considered good quality; air with more than 251 micrograms per cubic meter is hazardous.

Mr. Kennedy’s preliminary findings showed that the average level of particulate matter in the hotel the day before the event was 8 micrograms per cubic meter, 40 micrograms where he was waiting to get in line for the event and 1,193 micrograms inside the ballroom.

About 10 p.m., after one last measurement — “Elevators, 9:44!” Mr. Kennedy said to his assistant — he was bloodshot and stinky, but he declared the experiment a success.

Second hand smoke – what is the risk to your health?

“Public health officials have concluded that secondhand smoke from cigarettes causes disease, including lung cancer and heart disease, in non-smoking adults, as well as causes conditions in children such as asthma, respiratory infections, cough, wheeze, otitis media (middle ear infection) and Sudden Infant Death Syndrome. In addition, public health officials have concluded that secondhand smoke can exacerbate adult asthma and cause eye, throat and nasal irritation.”

Source: Philip Morris International website

Water Margin OSA Air Quality

The following letter was sent to the Food and Environmental Hygiene Department over concerns of contamination due to smoking in the outdoor areas of restaurants in Discovery Bay’s Water Margin complex. 

Dear Sir

We are informed the Water Margin OSA is continuing to be used daily by the restaurants since our initial complaint.

Neither have we received any update from you as promised in the letter.

We reiterate our objection under OSA guidelines for licences to be granted for OSA to these existing premises if smoking is allowed under our previously stated reasons copied below.

As regards an application for OSA – Outside Seating Accommodation guidelines :

“The operation of OSA should not create any environmental nuisance (such as water pollution, air quality nuisanceand noise nuisance).”

It is quite clear that allowing smoking in partially enclosed and covered outdoor areas like this constitutes an environmental nuisance as regards air quality nuisance to workers , passers by using the walkway who are frequently also children and non smoking patrons alike.

Accordingly Clear the Air objects to any current use of the OSA whilst smoking is permitted by the licensees in the OSA area and to any subsequent application by them to include the OSA in their licences under these legal ‘air quality nuisance’ grounds.

In addition, food is carried through and deposited in the OSA to be served to customers :
4. Adequate measures should be taken to protect food from risk of contamination during conveyance to the OSA.

The micron sized particles of cancerous environmental cigarette smoke will pass through any type of food service cover and will also contaminate the food when placed on the tables of the OSA for consumption. None of these premises other than McSoreleys has a smoking deferral approval in place.

7. The licensee should comply with the provisions of the laws of Hong Kong

The podium has numerous parasols which constitute a cover or roof under Cap 371. As such under Hong Kong laws the employers have a legal duty to protect their workers from unsafe work environments; the lethal dangers of passive cigarette smoke are documented and proven beyond contest, even acknowledged on the major tobacco company websites. ” An employer who fails to maintain the workplace in a condition that is, so far as reasonably practicable, safe and without risks to health – intentionally, knowingly or recklessly – commits an offence and is liable on conviction to a fine of $200,000 and to imprisonment for 6 months.”   Chapter: 509 Title: OCCUPATIONAL SAFETY AND HEALTH ORDINANCE Gazette Number: L.N. 230 of 1998 Section: 6 Heading: Employers to ensure safety and health of employees Version Date: 01/06/1998

Allowing smoking in  partially covered area workplaces is definitely not a condition that is ‘safe and without risks to health.’

kind regards
James Middleton
Clear the Air

Cafe Duvet Smoking Experience

This letter was sent to Lewis Ho of Hong Kong Resorts International Ltd in regards to smoking concerns at Cafe Duvet in Discovery Bay’s Water Margin complex by one of Clear The Air’s members, Nigel Bruce. 

Dear Mr. Ho,

I was informed by a neighbour that the new Cafe Duvet has opened on the raised podium in the Plaza.

He told me he had to leave shortly after sitting down, as the cafe was full of people smoking. I was not surprised, as this was sadly to be expected, given your response to my earlier email (see below).

You said in that email: “we, as the landlord, are not entitled during the tenancy period to unilaterally impose extra conditions on the own use of the leased premises by the tenants”. But this is a new lease, and surely Management now had the opportunity to attempt to carry out a policy to protect residents’ health?

 I find it disappointing in the extreme that you are again failing to take an opportunity to pursue such a policy.

Also, when you say: “Having said that, however, we would encourage the individual restaurants to allocate non-smoking areas within their leased premises on a voluntary basis so that both the smoking and non-smoking population can enjoy the superb Water Margin outdoor experience”, does this mean that you have not actually entered into any discussions with your tenant restaurants about their smoking policies?


Nigel Bruce

Risk of Exposure to Secondhand Tobacco Smoke Outdoors

Stanford University – 2nd May 2007

Study confirms the risk of exposure to secondhand tobacco smoke outdoors

Tens of thousands of Americans die each year from secondhand tobacco smoke, according to a 2006 report by the U.S. Surgeon General. While the health risks associated with indoor secondhand smoke are well documented, little research has been done on exposure to toxic tobacco fumes outdoors.

Now, Stanford University researchers have conducted the first in-depth study on how smoking affects air quality at sidewalk cafés, park benches and other outdoor locations. Writing in the May issue of the Journal of the Air and Waste Management Association (JAWMA), the Stanford team concluded that a non-smoker sitting a few feet downwind from a smoldering cigarette is likely to be exposed to substantial levels of contaminated air for brief periods of time.

“Some folks have expressed the opinion that exposure to outdoor tobacco smoke is insignificant, because it dissipates quickly into the air,” said Neil Klepeis, assistant professor (consulting) of civil and environmental engineering at Stanford and lead author of the study. “But our findings show that a person sitting or standing next to a smoker outdoors can breathe in wisps of smoke that are many times more concentrated than normal background air pollution levels.”

Klepeis pointed to the 2006 Surgeon General’s report, which found that even brief exposures to secondhand smoke may have adverse effects on the heart and respiratory systems and increase the severity of asthma attacks, especially in children.

“We were surprised to discover that being within a few feet of a smoker outdoors may expose you to air pollution levels that are comparable, on average, to indoor levels that we measured in previous studies of homes and taverns,” said Wayne Ott, professor (consulting) of civil and environmental engineering at Stanford and co-author of the JAWMA study. “For example, if you’re at a sidewalk café, and you sit within 18 inches of a person who smokes two cigarettes over the course of an hour, your exposure to secondhand smoke could be the same as if you sat one hour inside a tavern with smokers. Based on our findings, a child in close proximity to adult smokers at a backyard party also could receive substantial exposure to secondhand smoke.”

Unlike indoor tobacco smoke, which can persist for hours, the researchers found that outdoor smoke disappears rapidly when a cigarette is extinguished. “Our data also show that if you move about six feet away from an outdoor smoker, your exposure levels are much lower,” Klepeis added.

The public has become increasingly concerned about the effects of outdoor smoking, Ott noted. More than 700 state and local governments have passed laws restricting outdoor smoking at playgrounds, building entrances and other public areas, according to the American Nonsmokers’ Rights Foundation. Some of the strictest ordinances are in California. The city of Santa Monica, for example, recently banned smoking at parks, beaches, ATM machines, theater lines, open-air restaurants and other outdoor locations.

“Throughout the country, cities and counties are looking at various laws against outdoor smoking, and some of the proposals are pretty drastic,” Ott said. “The problem is that until now, there have been virtually no scientific data to justify such restrictions. In fact, our paper is the first study on outdoor smoking to be published in a peer-reviewed scientific journal.”

Particulate matter

In the study, the researchers used portable electronic monitors to make precise measurements of toxic airborne particles emitted from cigarettes at 10 sites near the Stanford campus. “We wanted to quantify the potential level of exposure to outdoor tobacco smoke that could occur in everyday settings,” Klepeis said. “To do this, we used five different, state-of-the-art instruments to measure secondhand smoke at parks, open-air cafes, sidewalks and outdoor pubs where smokers were present.”

Each instrument was calibrated to measure an airborne pollutant known as particulate matter-2.5 (PM2.5), which consists of thousands of microscopic particles that are less than 2.5 micrometers in width–about 30 times narrower than a human hair.

“PM2.5 is a toxic pollutant produced by cigarettes, wood-burning stoves, diesel engines and other forms of combustion,” Ott explained. “It contains benzo(a)pyrene, a carcinogen, and many other toxic chemicals that can penetrate deep inside the lungs.”

According to the Environmental Protection Agency, exposure to PM2.5 can lead to serious health problems, including asthma attacks, chronic bronchitis, irregular heartbeat, nonfatal heart attacks and even premature death in people with heart or lung disease. The current EPA ambient air standard for PM2.5 is 35 micrograms per cubic meter of air averaged over 24 hours. Levels that exceed 35 micrograms are considered unhealthy “However, since tobacco smoke contains many toxic components, including carcinogens, it may be even less healthy than typical ambient air pollution,” Klepeis noted.

Test results

To measure PM2.5 levels in secondhand smoke, the researchers placed the instruments near actual smokers in different open-air environments. “We also performed controlled experiments with burning cigarettes, which allowed us to make precise measurements of PM2.5 levels at different distances,” Klepeis said.

The results were clear: The closer you are to an outdoor smoker, the higher your risk of exposure.

“A typical cigarette lasts about 10 minutes,” Klepeis said. “We found that if you’re within two feet downwind of a smoker, you may be exposed to pollutant concentrations that exceed 500 micrograms of PM2.5 over that 10-minute period. If you’re exposed multiple times to multiple cigarettes over several hours in an outdoor pub, it would be possible to get a daily average of 35 micrograms or more, which exceeds the current EPA outdoor standard.”

Outdoor tobacco smoke consists of brief plumes that sometimes exceed 1,000 micrograms, Klepeis added. “On the other hand, clean air typically contains less than 20 micrograms of PM2.5,” he said. “Therefore, a person near an outdoor smoker might inhale a breath with 50 times more toxic material than in the surrounding unpolluted air.”

However, the researchers found that air quality improved as they moved away from the smoker. “These results show what common sense would suggest–when you’re within a few feet downwind of a smoker, you get exposed,” Ott explained. “But likewise, when you go a little distance or stay upwind, the exposure goes way down. If there’s just one smoker, and you can sit six feet away, you would have little problem. At the same time, if there are a lot of smokers nearby, you may be exposed to very high levels of secondhand smoke. So this thing that critics have been dismissing as trivial is not.”

Added Klepeis: “If people realize that being near outdoor smokers can result in potentially large exposures to toxic air pollution, they may decide they do not wish to be exposed in a variety of outdoor settings. This realization may lead to an increased number of smoking bans in public locations.”

Passive Smoking Risks in Catering Industry

Published by Oxford University Press on behalf of the Society of Toxicology on the 20th of January 2006: 

Risks for Heart Disease and Lung Cancer from Passive Smoking by Workers in the Catering Industry

Workers in the catering industry are at greater risk of exposure to secondhand smoke (SHS) when smoke free workplace policies are not in force. We determined the exposure of catering workers to SHS in Hong Kong and their risk of mortality from heart disease and lung cancer. Non-smoking catering workers were provided with screening at their workplaces and at a central clinic. Participants reported workplace, home and leisure time exposure to SHS. Urinary cotinine was estimated by enzyme immunoassay. Catering facilities were classified into three types: non-smoking, partially restricted smoking (with non-smoking areas) and unrestricted smoking. Mean urinary cotinine levels ranged from 3.3 ng/ml in a control group of 16 university staff, through 6.4 ng/ml (non smoking), 6.1 ng/ml (partially restricted) and 15.9 ng/ml (unrestricted smoking) in 104 workers who had no out of work exposures. Workers in non-smoking facilities had exposures to other smoking staff. We modeled workers’ mortality risks using average cotinine levels, estimates of workplace respirable particulates, risk data for cancer and heart disease from cohort studies, and national (US) and regional (Hong Kong) mortality for heart disease and lung cancer. We estimated that deaths in the Hong Kong catering workforce of 200,000 occur at the rate of 150 per year for a forty year working life time exposure to SHS. When compared with the current outdoor air quality standards for particulates in Hong Kong, 71% of workers exceeded the 24 hour and 98% exceeded the annual air quality objectives due to workplace SHS exposures.

Cost of tobacco-related diseases


Cost of tobacco-related diseases, including passive smoking, in Hong Kong

S M McGhee1, L M Ho1, H M Lapsley2, J Chau1, W L Cheung1, S Y Ho1, M Pow1, T H Lam1, A J Hedley1

1 Department of Community Medicine, University of Hong Kong, Hong Kong SAR, China
2 Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland, Brisbane, Queensland, Australia

Correspondence to:

Professor Anthony J Hedley
Department of Community Medicine, University of Hong Kong, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong SAR, China; Background: Costs of tobacco-related disease can be useful evidence to support tobacco control. In Hong Kong we now have locally derived data on the risks of smoking, including passive smoking.

Aim: To estimate the health-related costs of tobacco from both active and passive smoking.

Methods: Using local data, we estimated active and passive smoking-attributable mortality, hospital admissions, outpatient, emergency and general practitioner visits for adults and children, use of nursing homes and domestic help, time lost from work due to illness and premature mortality in the productive years. Morbidity risk data were used where possible but otherwise estimates based on mortality risks were used. Utilisation was valued at unit costs or from survey data. Work time lost was valued at the median wage and an additional costing included a value of US$1.3 million for a life lost.

Results: In the Hong Kong population of 6.5 million in 1998, the annual value of direct medical costs, long term care and productivity loss was US$532 million for active smoking and US$156 million for passive smoking; passive smoking accounted for 23% of the total costs. Adding the value of attributable lives lost brought the annual cost to US$9.4 billion.

Conclusion: The health costs of tobacco use are high and represent a net loss to society. Passive smoking increases these costs by at least a quarter. This quantification of the costs of tobacco provides strong motivation for legislative action on smoke-free areas in the Asia Pacific Region and elsewhere.


Abbreviations: COPD, chronic obstructive pulmonary disease; IHD, ischaemic heart disease; LIMOR, University of Hong Kong Lifestyle and Mortality Study; OR, odds ratio; PAF, population attributable fraction; SAF, smoking-attributable fraction

Comprehensive Smokefree Policies

Response to Consultation on the Smokefree Elements of the Health Improvement and Protection Bill

5th August 2005 The Royal College of Physicians UK
Background to response

The Royal College of Physicians (RCP) has long recognised that tobacco smoking is a powerfully addictive and major health hazard. The RCP considers smoking to be an addiction typically established during experimentation with and short term use of smoked tobacco in teenage years, typically resulting in a longterm dependence on cigarettes and sustained smoking for many years. Half of all regular smokers die prematurely as a consequence of smoking.

This burden of entirely avoidable mortality, which currently accounts for over 100,000 deaths per year in the UK 1, falls disproportionately on the poor and disadvantaged in society and contributes more to social inequalities in health than any other known avoidable cause.

Preventing smoking is therefore the most important public health priority in the UK, and the RCP is committed to the promotion of all strategies likely to reduce the prevalence of smoking.

The RCP recognises that passive smoking (exposure to environmental tobacco smoke or secondhand smoke) is a significant public health hazard in its own right, but also that smokefree policies in public and workplaces have a further important health effect through their impact on the incidence and prevalence of smoking. Smokefree policies are therefore an effective means of both health protection and health promotion.

In July 2005 the RCP published a comprehensive report on passive smoking, which recommended the implementation of comprehensive smokefree legislation in all public and workplaces, without exception, throughout the UK 2. The key conclusions and recommendations of that report were:

1. Passive smoking currently kills about 12,000 people in the UK every year. These deaths are entirely preventable.

2. Most of the deaths are caused by passive smoking at home, but about 500 each year are due to exposure at work. Exposure is particularly high for some workers in the hospitality industry, such as bar workers.

3. There is an unanswerable moral case to protect all people from passive smoking at work. All employees have a right to work in a safe environment, and all employers have a duty to ensure that they do.

4. Comprehensive smoke-free legislation, making all public places and workplaces completely smoke-free, without exception, is the only effective means of achieving this.

5. A clear majority of the public supports smoke-free legislation. Where enacted in other countries, smoke-free policies have proved to be extremely popular and attract high levels of compliance.

6. Comprehensive smoke-free policies also improve public health by helping existing smokers to quit, and discouraging young people from starting to smoke. As a consequence, smoke-free legislation will also generate longterm health improvements and reductions in social inequalities in health.

7. Preventing passive smoking at home, particularly for children, is a public health priority. Home exposure is prevented only by encouraging parents and carers to quit smoking completely, and/or by making homes completely smoke-free.

8. By helping smokers to quit smoking, and by changing usual patterns of smoking behaviour, smoke-free policies in public and workplaces increase the number of smoke-free homes. Strong and sustained health promotion campaigns are required to enhance this process. These and other population and individual-level interventions to encourage smoking cessation are the most effective means of reducing ETS [Environmental Tobacco Smoke] exposure at home.

9. Making the UK smoke-free would benefit the economy by about £4 billion each year.

10. We recommend that the UK Government enact comprehensive legislation to make all workplaces and other enclosed public places smoke-free at the earliest possible opportunity.

The RCP thus takes the view that radical and comprehensive smokefree policy is a crucial public health and health protection priority. The RCP therefore welcomes and fully supports the proposal to introduce smokefree legislation in the Health and Health Protection Bill, but disagrees in particular with some of the proposed exemptions.

The RCP responses to the questions posed in the current consultation are as follow. Where appropriate, to provide a source for a review and summary of the evidence supporting our responses, we cite the relevant chapters in our recent report 2 , provided as an appendix to this document in pdf format.

1. Definition of smoke or smoking

Although the evidence on smoking and passive smoking effects relates predominantly to tobacco smoke, many of the major constituents of the tar and vapour produced by burning non-tobacco products are similar to those in tobacco smoke, and are consequently likely to be similarly harmful. The RCP would therefore support the adoption of a definition which includes all products used with intent to inhale smoke.

2. Definition of ‘enclosed’

In view of the additional value of smokefree policies as a means of ‘denormalising’ smoking and consequently both reducing smoking prevalence and increasing the numbers of smokefree homes [see Chapters 3 and 7], the RCP proposes that the legislation should apply to all public and work places irrespective of whether they are enclosed.

3. Proposal to include some other non-enclosed public places

The RCP would support the inclusion of all public places that are part of or in a built environment. Exemptions, if any, should be restricted to outdoor areas in open countryside.

4. Proposal to delay implementation of smokefree policies in licensed premises

The RCP sees no justification behind this proposal. Experience in Ireland and New York demonstrates that implementation of comprehensive policies in all premises is effective and achieves high compliance [see Chapter 15]. There is no clear advantage in delaying the implementation in licensed premises, but there is disadvantage arising from the health effects of continued exposure of staff and customers to passive smoke. Licensed premises should become smokefree at the same time as all other work and public places.

5. Proposed exceptions to permit continued smoking in licensed premises that do not serve food

The RCP sees no logic or justification for this exemption. All licensed premises are workplaces, and people working there are entitled to the same protection from the health effects of passive smoke as in any other environment. Exposure to passive smoke is especially high in licensed premises [see Chapter 3] so the need for protection of workers in these environments is a particular priority.

6. Exemptions for residential premises

The RCP considers that the only exemption should be the private home of the smoker. Residential accommodation (such as hotels, nursing homes, halls of residence) that is also a workplace, and/or includes non-smoking residents, should be smokefree. There are however some special cases, such as prisons or psychiatric institutions, where smokers are detained against their will and are thus deprived of the option of smoking in their own private home [see Chapter 14]. In these cases exemptions should made, but in a context of provision of maximal cessation support for the smoker to quit if he or she chooses, and of preventing exposure of other residents or staff to tobacco smoke. From a moral and ethical perspective, the human rights of the smoker in all of these circumstances are outweighed by the rights of others to a clean and safe environment [see Chapter 10].

7. Membership clubs

See comments on licensed premises above.

8. Practical implications in the workplace

Experience from the many parts of the world where smokefree policies have been implemented demonstrates clearly that smokefree policies are effective and successful, in almost all circumstances [see Chapters 9 and 15]. It is however crucial in implementing smokefree policies to ensure that as far as possible, smokers are provided with cessation support to encourage and promote quit attempts.

9. Signage

Signage is clearly important for public information but only especially so if there is likely to be confusion over where smoking is and is not permitted. The RCP proposes that non-smoking should be the default in any public or workplace, and that signage should be required to reinforce that message.

10.-12. Penalties, Defences and Enforcement

These are crucially important areas and we would advise the adoption of policies that have proved successful in other countries, and particularly the Irish experience. In Ireland the general approach is similar to that outlined in the consultation but fines are substantially higher. Responding rapidly to episodes of non-compliance in the early days of the smokefree legislation was also crucially important, and appropriate resources need to be made available for this. The experience in Ireland suggests that the need for these resources falls rapidly over time [see Chapter 15].

13. Proposal to restrict smoking at the bar

Smoking in an enclosed place is harmful to everyone. Exposure of staff in pubs and bars is especially high [see Chapter 3]. Making the bar area smokefree does not protect staff from exposure, because smoke drifts. Partial policies such as this, or the use of ventilation, can sometimes improve subjective air quality but does not prevent exposure to harm [see Chapter 5]. This proposal is therefore ineffective and also potentially counterproductive, since it implies that non smoking areas within rooms where people smoker are somehow safer. They are not. The RCP opposes this policy.

14. Timetable

The RCP considers that the optimum time of year to introduce comprehensive smokefree legislation is the spring (in Ireland the date was late March) and that the sooner the legislation is introduced, the better. To give time to prepare the public (and to allow the further increase in public support for the legislation that follows the announcement of legislation, see Chapter 9) the announcement of intent should be made as soon as possible, and the date no later than March 2007.

15. Effects on binge drinking

This concern arises from the proposal to allow exemptions for pubs that do not serve food. The RCP opposes those exemptions. If all pubs are required to become smokefree, this concern is redundant.

16. Effect on health inequalities

The prevalence of smoking is highest, and the potential benefits of preventing smoking greatest, in the poorest communities 3 . Exposure to passive smoking is also highest in these communities [see Chapter 3]. It is therefore self-evident and particularly important that comprehensive smokefree policies apply in all communities, so that all can reap the maximum public health benefit. The proposal to exclude pubs that do not serve food will in the long run exacerbate health inequalities, since these pubs tend to be located in poorer areas.

17. Comments on Partial Regulatory Impact Assessment

The RCP supports Option 2. We are persuaded by the experience of New York and particularly Ireland that concerns that the policy would not gain public support and may be difficult to enforce are entirely unfounded. We estimate the cost benefits to society of Option 2 at about £4 billion per year [see Chapter 11]. Our analysis is that any adverse effect on the hospitality trade is likely to be extremely small [see Chapter 12].


The RCP supports this legislation but believes strongly that it does not, as proposed, go far enough. We urge the government to learn from the experience of other countries and implement comprehensive smokefree policies in all public and workplaces, without exception, as soon as possible.


1. Twigg L, Moon G, Walker S. The smoking epidemic in England. London: Health Development Agency; 2004.
2. Royal College of Physicians. Going smoke-free: the medical case for clean air in the home, at work and in public places. A report on passive smoking by the Tobacco Advisory Group of the Royal College of Physicians. London: RCP; 2005.
3. Royal College of Physicians. Nicotine Addiction in Britain. A report of the Tobacco Advisory Group of the Royal College of Physicians. London: Royal College of Physicians of London; 2000.

Please download the full report here :