Smoking ban: has it eliminated the effects of passive smoking?

The sight of people smoking outside the buildings where they work has become commonplace since smoking restrictions were introduced in the UK over the past two years. In the month of the No Smoking Day challenge, which takes place on 12 March, this article looks at a survey which indicates that outdoor smoking areas should be located some distance from the employer’s premises.

The University of Wales, Bangor, introduced smoking restrictions in October 2005, prohibiting smoking in buildings and hired, owned or leased vehicles, in advance of the legislation. People who choose to smoke must do so outside, where facilities to dispose of waste have been provided.

Survey

An online survey was conducted among students and staff during the first three weeks of December 2007. The aim was to provide feedback about the impact of smoking restrictions from people dispersed across several sites. The objectives were:

  • to provide a greater understanding of the effect that smoking restrictions have had on non-smokers
  • to understand the effect of smoking restrictions at work on smoking habits
  • to understand the environmental impact of smoking restrictions.

Non-smokers (distinct from ex-smokers) were defined as people who had not smoked for 12 months, and smokers as those who have frequently smoked manufactured or self-rolled cigarettes, or who have regularly smoked a pipe or cigar in the past 12 months.

The environmental impact considered the presence of smokers standing outside buildings, second-hand smoke entering buildings, and waste from smoking.

Results (see below)

The survey was started by 150 people, and 149 completed responses were received. For ease of reference and analysis, the results were grouped into the data collection table.

Results from the online survey have been separated into three categories that reflect its objectives.

Discussion

Before smoking restrictions were introduced, the effect from other people’s smoke was experienced by more than half of all respondents (53%). Symptoms ranged from sensing the unpleasant smell of tobacco to sore eyes and coughing – the irritant effect of the body defending itself.

While an unpleasant smell is not a good indicator of harm, sore eyes and coughing reflect exposure to respiratory irritants. Reports of nausea and breathing problems indicate that harm is occurring.

Since restrictions were introduced, 9% of respondents still suffer from the effect of other people’s tobacco smoke. The principle reasons for ongoing symptoms among non-smokers is due to their exposure to smoke when they are in the company of people smoking, or from inhalation of other people’s smoke as they enter buildings, or from smoke entering buildings when doors or windows are open.

Although the quantity of inhaled smoke will be less than before the restrictions came into force, health will only be protected when exposure to second-hand smoke is completely eliminated.

While smoking restrictions aimed to protect the health of the non-smoker, they have also had some benefit for smokers. Fourty-six per cent said they are smoking less on university premises, and 37% want help to stop smoking altogether. But this is not a success story.

A large number of smokers (63%) indicate they still wish to smoke, despite the availability of free nicotine replacement prescriptions or other prescribed drugs in Wales. Efforts will continue to assist those who wish to stop smoking.

The environmental impact of people smoking outside the university buildings can present difficulties for people wishing to enter or exit doorways – 60% of respondents’ encountered difficulties caused by the physical obstructions of doorways by smokers. The waste products (cigarette ends, matches, empty packets) are reported to be safely disposed of in the receptacles provided (69%).

Conclusion

This survey has answered the crucial question of whether smoking restrictions have eliminated the exposure of non-smokers to health risks associated with second-hand smoke with a resounding no. Their exposure to second-hand smoke has been reduced, but not eliminated.

The combination of tobacco smoke entering buildings from those smoking outside, plus the presence of people smoking making it difficult to enter or exit buildings has given rise to a general wish, among smokers and non-smokers alike, to ban smoking within five metres of a university building. This could only be achieved when practicable to do so: five metres from some buildings could place smokers in the sea.

Smoking restrictions have not stopped existing smokers from smoking.

Survey results

Question   Yes No   Total
 Are you a smoker?  30 119 149
 Before smoking inside the university buildings was restricted, did you suffer nausea, sore eyes, coughing, unpleasant smell, breathing problems?  82 67 149
If so, do you still suffer from the irritant effect of other people’s smoke?  33 49 82
Does tobacco smoke enter your building from those smoking outside?  79 70 149
If you are a smoker, do you now want help to stop smoking?  11    
If you are a smoker, are you smoking less than before the restrictions?  14    
Does the presence of people smoking outside university buildings make it difficult to enter or exit?  89 60 149
 Are the waste products from smoking – for example, cigarette ends, used packets and matches – disposed of properly in the correct binsprovided by the university?  46 103 149
Would you support a ban on smoking within five metres of a university building (where this is practicable)?  108 41 149

Of the 149 completed responses, 20% came from smokers (n=30) and 80% from non-smokers (n=119).

Evidence base for the impact of smoking on health

While recent legislation aims to protect the health of non-smokers from second-hand smoke, the link between smoking and carcinoma of the lung was first established more than 50 years ago. Since that time, increasing evidence has been provided by longitudinal studies of risks caused by second-hand smoke to the health of non-smokers.

Doll et al (1950) conducted a study showing a 26-fold increase in the risk of lung cancer among smokers of 15 to 24 cigarettes a day.1 According to Jamrozik (2005), there is a 25% increase of lung cancer in adult ‘never smokers’ who are exposed to second-hand smoke.2

In addition to cancers, an update of evidence on the health effects of second-hand smoke has been undertaken by the Department of Health’s Scientific Committee on Tobacco and Health.

The committee informed the department of evidence linking passive smoking with ischemic heart disease, stroke and respiratory health damage (2004). The report concludes that second-hand smoke represents a substantial public health hazard.3

Joe Patton is a specialist nurse practitioner in occupational health at Bangor University

References

  1.  Doll, R and Hill, A B ‘Smoking and carcinoma of the lung’ (1950) BMJ p. ii:739-48

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