Rationale-
The rationale for smoking bans posits that smoking is optional, whereas breathing is not. Therefore, proponents say, smoking bans are enforced to protect people from the effects of second-hand smoke, which include an increased risk of heart disease,cancer, emphysema, and other diseases. Laws implementing bans on indoor smoking have been introduced by many countries in various forms over the years, with some legislators citing scientific evidence that shows tobacco smoking is harmful to the smokers themselves and to those inhaling second-hand smoke.
In addition such laws may reduce health care costs, improve work productivity, and lower the overall cost of labour in the community thus protected, making that workforce more attractive for employers. In the US state of Indiana, the economic development agency included in its 2006 plan for acceleration of economic growth encouragement for cities and towns to adopt local smoking bans as a means of promoting job growth in communities.
Additional rationales for smoking restrictions include reduced risk of fire in areas with explosive hazards; cleanliness in places where food, pharmaceuticals, semiconductors, or precision instruments and machinery are produced; decreased legal liability; potentially reduced energy use via decreased ventilation needs; reduced quantities of litter; healthier environments; and giving smokers incentive to quit.
The World Health Organization considers smoking bans to have an influence to reduce demand for tobacco by creating an environment where smoking becomes increasingly more difficult and to help shift social norms away from the acceptance of smoking in everyday life. Along with tax measures, cessation measures, and education, smoking bans are viewed by public health experts as an important element in reducing smoking rates and promoting positive health outcomes. When effectively implemented they are seen as an important element of policy to support behaviour change in favour of a healthy lifestyle.
Banning smoking in public places has helped to cut premature births by 10 percent, according to new research from the United States and Europe.
Passive Smoking-
Research has generated evidence that second-hand smoke causes the same problems as direct smoking, including lung cancer, cardiovascular disease, and lung ailments such as emphysema, bronchitis, and asthma. Specifically, meta-analyses show that lifelong non-smokers with partners who smoke in the home have a 20–30% greater risk of lung cancer than non-smokers who live with non-smokers. Non-smokers exposed to cigarette smoke in the workplace have an increased lung cancer risk of 16–19%.
A study issued in 2002 by the International Agency for Research on Cancer of the World Health Organization concluded that non-smokers are exposed to the same carcinogens on account of tobacco smoke as active smokers. Sidestream smoke contains 69 known carcinogens, particularly benzopyrene and other polynuclear aromatic hydrocarbons, and radioactive decay products, such as polonium 210. Several well-established carcinogens have been shown by the tobacco companies' own research to be present at higher concentrations in second-hand smoke than in mainstream smoke.
Scientific organisations confirming the effects of second-hand smoke include the U.S. National Cancer Institute the U.S.Centers for Disease Control and Prevention (CDC), the U.S. National Institutes of Health, the Surgeon General of the United States, and the World Health Organization.
Epidemiological studies show that non-smokers exposed to second-hand smoke are at risk for many of the health problems associated with direct smoking. Most of the research has come from studies of nonsmokers who are married to a smoker. Those conclusions are also backed up by further studies of workplace exposure to smoke.
In 1992, a review estimated that second-hand smoke exposure was responsible for 35,000 to 40,000 deaths per year in the United States in the early 1980s. Theabsolute risk increase of heart disease due to ETS was 2.2%, while the attributable risk percent was 23%. A 1997 meta-analysis found that second-hand smoke exposure increased the risk of heart disease by a quarter,and two 1999 meta-analyses reached similar conclusions.
Evidence shows that inhaled sidestream smoke, the main component of second-hand smoke, is about four times more toxic than mainstream smoke. This fact has been known to the tobacco industry since the 1980s, though it kept its findings secret. Some scientists believe that the risk of passive smoking, in particular the risk of developing coronary heart diseases, may have been substantially underestimated.
In 1997, a meta-analysis on the relationship between secondhand smoke exposure and lung cancer concluded that such exposure caused lung cancer. The increase in risk was estimated to be 24 percent among non-smokers who lived with a smoker In 2006, Takagi et al. reanalyzed the data from this meta-analysis to account for publication bias and estimated that the relative risk of lung cancer among those exposed to secondhand smoke was 1.19, slightly lower than the original estimate. A 2000 meta-analysis found a relative risk of 1.48 for lung cancer among men exposed to secondhand smoke, and a relative risk of 1.16 among those exposed to it at work.Another meta-analysis confirmed the finding of an increased risk of lung cancer among women with spousal exposure to secondhand smoke the following year. It found a relative risk of lung cancer of 1.29 for women exposed to secondhand smoke from their spouses.A 2014 meta-analysis noted that "the association between exposure to secondhand smoke and lung cancer risk is well established."
History-
One of the world's earliest smoking bans was a 1575 Roman Catholic church regulation which forbade the use of tobacco in any church in Mexico. In 1604, King James I of England published an anti-smoking treatise, A Counterblaste to Tobacco, that had the effect of raising taxes on tobacco. The Ottoman Sultan Murad IV prohibited smoking in his empire in 1633 and had smokers executed.Pope Urban VII also prohibited smoking in the Church in 1590followed by Urban VIII in 1624.Pope Urban VII in particular threatened to excommunicate anyone who "took tobacco in the porchway of or inside a church, whether it be by chewing it, smoking it with a pipe or sniffing it in powdered form through the nose". The earliest citywide European smoking bans were enacted shortly thereafter. Such bans were enacted in Bavaria, Kursachsen, and certain parts of Austria in the late 17th century. Smoking was banned in Berlin in 1723, in Königsberg in 1742, and in Stettin in 1744. These bans were repealed in the revolutions of 1848. The first building in the world to ban smoking was the Old Government Building in Wellington, New Zealand in 1876. This was over concerns about the threat of fire, as it is the second largest wooden building in the world.
The first modern attempt at restricting smoking was imposed by the then German government in every university, post office, military hospital, and Nazi Party office, under the auspices of Karl Astel's Institute for Tobacco Hazards Research, created in 1941 under orders from Adolf Hitler. Major anti-tobacco campaigns were widely broadcast by the Nazis until the demise of the regime in 1945.
In the latter part of the 20th century, as research on the risks of second-hand tobacco smoke became public, the tobacco industry launched "courtesy awareness" campaigns. Fearing reduced sales, the industry created a media and legislative programme that focused upon "accommodation". Tolerance and courtesy were encouraged as a way to ease heightened tensions between smokers and those around them, while avoiding smoking bans. In the USA, states were encouraged to pass laws providing separate smoking sections.
In 1975, the US state of Minnesota enacted the Minnesota Clean Indoor Air Act, making it the first state to restrict smoking in most public spaces. At first, restaurants were required to have No Smoking sections, and bars were exempt from the Act.As of 1 October 2007, Minnesota enacted a ban on smoking in all restaurants and bars statewide, called the Freedom to Breathe Act of 2007.
The resort town of Aspen, Colorado, became the first city in the US to restrict smoking in restaurants, in 1985, though it allowed smoking in areas that were separately ventilated.
On 3 April 1987, the City of Beverly Hills, California, initiated an ordinance to restrict smoking in most restaurants, in retail stores and at public meetings. It exempted restaurants in hotels – City Council members reasoned that hotel restaurants catered to large numbers of visitors from abroad, where smoking is more acceptable than in the United States.
In 1990, the city of San Luis Obispo, California, became the first city in the world to restrict indoor smoking in bars as well as restaurants.However, the ban did not include workplaces but covered all other indoor public spaces and its enforcement was somewhat limited.
In America, California's 1998 smoking ban encouraged other states such as New York to implement similar regulations. California's ban included a controversial restriction upon smoking in bars, extending the statewide ban enacted in 1994. As of April 2009 there were 37 states with some form of smoking ban. Some areas in California began banning smoking across whole cities, including every place except residential homes. More than 20 cities in California enacted park and beach smoking restrictions.
Since December 1993, in Peru, it is illegal to smoke in any public enclosed places and any public transport vehicles (according to Law 25357 issued on 27 November 1991 and its regulations issued on 25 November 1993 by decree D.S.983-93-PCM). There is also legislation restricting publicity, and it is also illegal (Law 26957 21 May 1998) to sell tobacco to minors or directly advertise tobacco within 500m of schools (Law 26849 9 Jul 1997).
Smoking was first restricted in schools, hospitals, trains, buses and train stations in Turkey in 1996. In 2008, a more comprehensive smoking ban was implemented, covering all public indoor venues.
Smoking has been restricted at a French beach – the Plage Lumière in La Ciotat, France, became the first beach in Europeto restrict smoking, from August 2011, in an effort to encourage more tourists to visit the beach.
In 2012, smoking in Costa Rica became subject to some of the most restrictive regulations in the world, being banned from many outdoor recreational and educational areas as well as public buildings and vehicles.
Total Tobacco Ban-
Bhutan is the only country in the world to completely outlaw the cultivation, harvesting, production, and sale of tobacco and tobacco products under the 'Tobacco Control Act of Bhutan 2010'. However, small allowances for personal possession are permitted as long as the possessor can prove that they have paid import duties. The Pitcairn Islands had previously banned the sale of cigarettes; however, it now permits sales from a government run store. The Pacific island of Niue hopes to become the next country to prohibit the sale of tobacco. Iceland is also proposing banning tobacco sales from shops, making it prescription only and therefore dispensable only in pharmacies on doctor's orders.New Zealand hopes to achieve being tobacco free by 2025 and Finland by 2040. In 2012, anti-smoking groups proposed a 'smoking licence' – if a smoker managed to quit and hand back their licence, they would get back any money they paid for it. Singapore and the Australian state of Tasmania have proposed a 'tobacco free millennium generation initiative' by banning the sale of all tobacco products to anyone born in and after the year 2000.
In March 2012, Brazil became the world's first country to ban all flavored tobacco, including menthols. It also banned the majority of the estimated 600 additives used, permitting only eight. This regulation applies to domestic and internationally imported cigarettes. Tobacco manufacturers have 18 months to remove the non-compliant cigarettes, 24 months to remove the other forms of non-compliant tobacco.
The concept of multi-pronged and therefore 'comprehensive' tobacco control arose through academic advances (e.g. the dedicated Tobacco Control journal), not-for-profit advocacy groups such as Action on Smoking and Health and government policy initiatives. Progress was initially notable at a state or national level, particularly the pioneering smoke-free public places legislation introduced in New York City in 2002 and the Republic of Ireland in 2004, and the UK efforts to encapsulate the crucial elements of tobacco control activity in the 2004 'six-strand approach' (to deliver upon the joined-up approach set out in the white paper 'Smoking Kills' ) and its local equivalent, the 'seven hexagons of tobacco control'. This broadly organised set of health research and policy development bodies then formed the Framework Convention Alliance to negotiate and support the first international public health treaty, the World Health Organization Framework Convention on Tobacco Control, or FCTC for short.
The FCTC compels signatories to advance activity on the full range of tobacco control fronts, including limiting interactions between legislators and the tobacco industry, imposing taxes upon tobacco products and carrying out demand reduction, protecting people from exposure to second-hand smoke in indoor workplaces and public places through smoking bans, regulating and disclosing the contents and emissions of tobacco products, posting highly visible health warnings upon tobacco packaging, removing deceptive labelling (e.g. 'light' or 'mild'), improving public awareness of the consequences of smoking, prohibiting all tobacco advertising, provision of cessation programmes, effective counter-measures to smuggling of tobacco products, restriction of sales to minors and relevant research and information-sharing among the signatories.
WHO subsequently produced an internationally-applicable and now widely recognised summary of the essential elements of tobacco control strategy, publicised as the mnemonic MPOWER tobacco control strategy.
Effects upon health-
Several studies have documented health and economic benefits related to smoking bans. A 2009 report by the Institute of Medicine concluded that smoking bans reduced the risk of coronary heart disease and heart attacks, but the report's authors were unable to identify the magnitude of this reduction. Also in 2009, a systematic review and meta-analysis found that bans on smoking in public places were associated with a significant reduction of incidence of heart attacks. The lead author of this meta-analysis, David Meyers, said that this review suggested that a nationwide ban on smoking in public places could prevent between 100,000 and 225,000 heart attacks in the United States each year.
Legislating on smoking of tobacco in public places has reduced the cause of heart disease among adults. Such legislations include banning smoking in restaurants, buses, hotels and workplaces. Institute of Medicine (IOM) convened by the Center for Disease Control (CDC) found out that there are cardiovascular effects from exposure to secondhand smoke. An epidemiology report says that the risk of coronary heart disease is increased to around 25-30% when one is exposed to secondhand smoke. The data shows that even at low levels of the smoke, there is the risk and the risks increases with more exposures.
A 2010 Cochrane review found that smoking bans led to decreases in exposure to second-hand smoke, and that "there is some evidence of an improvement in health outcomes" following the enactment of such bans. A 2012 meta-analysis found that smoke-free legislation was associated with a lower rate of hospitalizations for cardiac, cerebrovascular, and respiratory diseases, and that "More comprehensive laws were associated with larger changes in risk." The senior author of this meta-analysis, Stanton Glantz, told USA Today that, with respect to exemptions for certain facilities from smoking bans, "The politicians who put those exemptions in are condemning people to be put into the emergency room." A 2013 review found that smoking bans were associated with "significant reduction in acute risk".
A 2014 systematic review and meta-analysis found that smoke-free legislation was associated with approximately 10% reductions in preterm births and hospital attendance for asthma, but not with a decrease in low birth weight.
Smoking restrictions may make it easier for smokers to quit. A survey suggests 22% of UK smokers may have considered quitting in response to that nation's smoking ban.
Restaurant smoking restrictions may help to stop young people from becoming habitual smokers. A study of Massachusetts youths, found that those in towns with smoking bans were 35 percent less likely to be habitual smokers.
Pathophysiology-
A 2004 study by the International Agency for Research on Cancer of the World Health Organization concluded that non-smokers are exposed to the same carcinogens as active smokers. Sidestream smoke contains more than 4,000 chemicals, including 69 known carcinogens. Of special concern are polynuclear aromatic hydrocarbons, tobacco-specific N-nitrosamines, and aromatic amines, such as 4-aminobiphenyl, all known to be highly carcinogenic. Mainstream smoke, sidestream smoke, and second-hand smoke contain largely the same components, however the concentration varies depending on type of smoke. Several well-established carcinogens have been shown by the tobacco companies' own research to be present at higher concentrations in sidestream smoke than in mainstream smoke.
Second-hand smoke has been shown to produce more particulate-matter (PM) pollution than an idling low-emission diesel engine. In an experiment conducted by the Italian National Cancer Institute, three cigarettes were left smoldering, one after the other, in a 60 m³ garage with a limited air exchange. The cigarettes produced PM pollution exceeding outdoor limits, as well as PM concentrations up to 10-fold that of the idling engine.
Second-hand tobacco smoke exposure has immediate and substantial effects on blood and blood vessels in a way that increases the risk of a heart attack, particularly in people already at risk. Exposure to tobacco smoke for 30 minutes significantly reduces coronary flow velocity reserve in healthy nonsmokers. Second-hand smoke exposure also affectsplatelet function, vascular endothelium, and myocardial exercise tolerance at levels commonly found in the workplace.
Pulmonary emphysema can be induced in rats through acute exposure to sidestream tobacco smoke (30 cigarettes per day) over a period of 45 days. Degranulation of mast cells contributing to lung damage has also been observed.
The term "third-hand smoke" was recently coined to identify the residual tobacco smoke contamination that remains after the cigarette is extinguished and second-hand smoke has cleared from the air. Preliminary research suggests that by-products of third-hand smoke may pose a health risk, though the magnitude of risk, if any, remains unknown. In October 2011, it was reported that Christus St. Frances Cabrini Hospital in Alexandria, Louisiana would seek to eliminate third-hand smoke beginning in July 2012, and that employees whose clothing smelled of smoke would not be allowed to work. This prohibition was enacted because third-hand smoke poses a special danger for the developing brains of infants and small children.
In 2008, there were more than 161,000 deaths attributed to lung cancer in the United States. Of these deaths, an estimated 10% to 15% were caused by factors other than first-hand smoking; equivalent to 16,000 to 24,000 deaths annually. Slightly more than half of the lung cancer deaths caused by factors other than first-hand smoking were found in nonsmokers. Lung cancer in non-smokers may well be considered one of the most common cancer mortalities in the United States. Clinical epidemiology of lung cancer has linked the primary factors closely tied to lung cancer in non-smokers as exposure to second-hand tobacco smoke, carcinogens including radon, and other indoor air pollutants.
