Facts of Life: Issue Briefings for Health Reporters - from the Center for the Advancement of Health

The Issue:

In the debate over smoking restrictions, advocates for clean indoor air laws carefully explain that their fight is an effort to protect nonsmokers' rights and health - not an anti-smoking campaign. But health officials sidestep that political tug-of-war and readily admit their ultimate goal is to reduce smoking in the whole population. Smoking bans serve both objectives: reducing smokers' tobacco consumption 1 and decreasing nonsmokers' exposure to environmental tobacco smoke.2

Second-hand Smoke

Environmental tobacco smoke is a combination of mainstream smoke exhaled by a smoker and sidestream smoke, which drifts directly into the air from burning tobacco. When nonsmokers are exposed to this "second-hand smoke" they temporarily become involuntary, or "passive" smokers.

In 1992 the Environmental Protection Agency first classified second-hand smoke as a carcinogen - a known cancer-causing substance.3 That year, the agency also reported that environmental tobacco smoke is responsible for 3,000 lung cancer deaths each year in U.S. nonsmokers.

What We Know Now

More than a decade later, health officials are still learning more about second-hand smoke. In April 2004, the Centers for Disease Control and Prevention issued a new advisory warning people with heart problems to avoid second-hand smoke.

The advisory was based on a study4 that found that short-term exposure to second-hand smoke - lasting as little as 30 minutes - may pose serious heart attack risks. That report revealed that the risk of second-hand smoke is greater than scientists initially thought, according the U.S. Office on Smoking and Health.

The Facts:

Establishing a smoke-free environment is the most effective strategy to reduce second-hand smoke exposure among nonsmokers, according to a task force appointed by the Centers for Disease Control and Prevention.2

Smoking bans and restrictions reduce some smokers' cigarette consumption and may help others quit smoking, a 2001 review of studies found.1

Nonsmokers' second-hand exposure decreased about 70 percent in the United States according to data from 1999-2002 compared to data from 1988-1991 - based on measurements of the environmental tobacco smoke biomarker cotinine.5

Protection from second-hand smoke increased between 1999 and 2004 through the new and tighter state laws regulating smoking in private-sector work sites, restaurants or bars, according to a 2005 CDC report.6

At the end of 2004, 16 states had no state-level smoking restriction for private-sector workplaces, restaurants and bars - three sites considered major sources of second-hand smoke for adult nonsmokers. 6

Smoking ordinances do not adversely affect tourism or businesses (including bars and restaurants), based on a 2001 review of studies.1

A 2003 review of 97 studies included several which found that smoke-free regulations adversely impact the hospitality industry, but the review deemed those studies methodologically weaker than others and much more likely to be funded by the tobacco industry.7

Simply posting "No Smoking" signs does not seem to prevent people from smoking in public places, according to a 2001 systematic review.8

Separating smokers and nonsmokers within the same space reduces - but does not eliminate - nonsmokers' second-hand smoke exposure, a 1986 U.S. Surgeon General's report said.9
A 1997 National Cancer Institute study found fewer than half of indoor workers had a smoke-free policy in their workplace. By 1999, nearly seven of every 10 U.S. workers reported having a smoke-free policy. 10 11

White-collar workers are more likely to be protected by a smoke-free policy than service and blue-collar workers, according to a 1997 NCI study.10

Second-hand smoke contains at least 60 cancer-causing substances, according to a 2005 report on carcinogens.12

Exposure to second-hand smoke causes about 35,000 heart disease deaths and 3,000 lung cancer deaths in U.S. nonsmokers, according to the CDC.13

Localities Lead Smoking-Ban Advocacy

Public health officials say most smoking policy successes begin with local communities whose example often lead to statewide smoke-free regulations.

" Local environments are the innovators. That's always been true since the 1970s," said Terry Pechacek, associate director of the Office on Smoking and Health at the Centers for Disease Control and Prevention.

The federal health-promotion initiative Healthy People 2010 calls for a reduction in nonsmokers' exposure to environmental tobacco smoke to 45 percent from 65 percent. It also seeks to establish smoke-free laws in all 50 states and the District of Columbia to prohibit or restrict smoking in public places and worksites.

Pechacek said the CDC's role is to disseminate the science and provide "technical assistance" to help communities choose programs that best match local needs.

" Policy changes as people become aware of the science," he said.

Today, California law bans smoking in virtually all indoor public spaces and worksites. But those state rules were enacted only after a string of localities came together to change how Californians think about smoking - and where it is acceptable, said Frances Stillman, co-director of the Institute for Global Tobacco Control at the Johns Hopkins Bloomberg School of Public Health.

Local control lays the foundation for statewide smoke-free policies, Stillman said. "It's easier to educate officials at the local level," she said, "and at the local level people have more influence."

Now that strategy is being tested in tobacco-producing states - like Kentucky - where opposition to smoke-free laws is fierce, said Bronson Frick, associate director of Americans for Nonsmokers' Rights.

" When it's a local debate the public is more involved in the process. It's harder for tobacco lobbyists to show up at a local council meeting," he said.

Smoking-ban opponents often argue that restrictions will hurt local businesses. Most peer-reviewed studies find no economic loss from smoking restrictions, but a March 2005 analysis from the national smokers' rights group The Smokers' Club says "long before state bans go into effect, many local governments have passed bans that affect business, and long before local governments pass bans many restaurants voluntarily ban smoking."

Lexington, Ky., survived a state Supreme Court battle and its smoking ban went into effect in April 2004. Georgetown, Ky., followed and this October became the state's second city with a smoke-free ordinance.

Frick said he is convinced local clean indoor air laws will continue to snowball into statewide smoking restrictions. "We expect a record number of legislatures to consider statewide smoke-free policies in the next legislative session," he said.

Recent moking-ban battles have focused on "pre-emption," Stillman said. Pre-emptive legislation prevents local bodies from enacting ordinances that are more stringent or different from the state law.

Preemptive laws have been a stumbling block for smoking-ban advocates and an effective tool for opponents.

" Tobacco companies would rather fight a big fight at the statehouse than a lot of brushfires all over the state," Frick said.

Expert Sources:

Frances Stillman, Ed. D.
Institute for Global Tobacco Control
Johns Hopkins Bloomberg School of Public Health

Terry Pechacek, Ph.D.
Associate Director
CDC Office on Smoking and Health
To request an interview contact Joel London
770-488-5493 or jlondon@cdc.gov

David Levy, Ph.D.
Senior Research Scientist
Pacific Institute for Research and Evaluation
To request an interview contact Jim Gogek
301-755-2445 or jgogek@pire.org

Bronson Frick
Americans for Nonsmokers' Rights


1. Reviews of Evidence Regarding Interventions to Reduce Tobacco Use and Exposure to Environmental Tobacco Smoke. American Journal of Preventive Medicine, 2001; 20(2S):1-87.

2. Task Force on Community Preventive Services. Guide to community preventive services: tobacco use prevention and control. American Journal of Preventive Medicine, 2001; 20(2S):1-87.

3. Respiratory Health Effects of Passive Smoking (Also Known as Exposure to Secondhand Smoke or Environmental Tobacco Smoke ETS). U.S. Environmental Protection Agency, EPA/600/6-90/006F, 1992.

4. R.P. Sargent et al. Reduced incidence of admissions for myocardial infarction associated with public smoking ban: before and after study, 2004. British Medical Journal, 328 (7446), pgs. 977-980.

5. Third National Report on Human Exposure to Environmental Chemicals. National Center for Environmental Health. NCEH Pub. No. 05-0725.

6. State Smoking Restrictions for Private-Sector Worksites, Restaurants, and Bars - United States, 1998-2004. MMWR 2005, Vol. 54, No. 26.

7. M. Scollo et al. Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry. Tobacco Control, 2003:12:12-20.

8. C. Serra et al. Interventions for preventing tobacco smoking in public places. (Review) Cochrane Database of Systematic Reviews, Issue 3, 2001.

9. The Health Consequences of Involuntary Smoking. U.S. Surgeon General, 1986.

10. K.K. Gerlach et al. Workplace Smoking Policies in the United States: Results of a National Survey of More than 100,000 workers. Tobacco Control, 1997; 6:199-206.

11. Cancer Progress Report 2003. Public Health Service, National Cancer Institute.

12. 11th Report on Carcinogens. U.S. DHHS. National Toxicology Program, 2005.

13. Annual smoking-attributable mortality, years of potential life lost, and productivity losses - United States, 1997-2001. CDC. MMWR 2005; 54:625-8


? Copyright 2006, Center for the Advancement of Health

The Center for the Advancement of Health is an independent nonprofit organization that promotes greater recognition of how psychological, social, behavioral, economic and environmental factors influence health and illness. The Center advocates the highest quality research and communicates it to the medical community and the public. The fundamental aim of the Center is to translate into policy and practice the growing body of evidence that can lead to the improvement and maintenance of the health of individuals and the public. The Center was founded by the John D. and Catherine T. MacArthur Foundation and the Nathan Cummings Foundation, which continue to provide core funding. Funding for this series was provided by the Robert Wood Johnson Foundation.

For Information Contact:
Lisa Esposito, Editor, Health Behavior News Service
Center for the Advancement of Health
2000 Florida Ave., NW, Suite 210, Washington, DC 20009
p. 202.387.2829 / f. 202.387-2857?  press@cfah.org


Facts of Life: Issue Briefings for Health Reporters
The Center for the Advancement of Health
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