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Smoking in Public Places
A Consultation on Reducing Exposure to Second Hand Smoke
Evidence Report
EXECUTIVE SUMMARY
This evidence report draws together the findings from different strands of research and evidence gathering, and consultation activity. These were conducted as part of the Scottish Executive's public consultation on smoking in public places, which aimed to access the range and depth of views amongst members of the public. The findings from these different strands have been used by the Executive to inform future policy to minimise the harm caused by second hand smoke.
The Scottish Executive is committed to improving smoke-free provision as a consequence of the increasing awareness of the health risks of passive smoking that have been demonstrated by scientific research.
The consultative process involved four key elements:
A programme of awareness raising activity carried out by NHS Health Scotland
Research and evidence gathering
Public consultation
Assessment and conclusions drawn together in a evidence report.
Two principal types of evidence have been the outcome: scientific findings derived from the reviews of evidence, and public and professional opinions derived from the consultation activity.
The public consultation had an unprecedented number of responses with 53,474 members of the public, professionals and organisations contributing their views.
The principal issues that have emerged throughout the research and consultation exercises are discussed thematically and cover the following:
Health risks
1
There is robust scientific evidence to show that passive smoking increases the risk of lung cancer and coronary heart disease (CHD), also referred as ischaemic heart disease (IHD)
2. There is also weaker evidence of an effect in relation to stroke and respiratory diseases.
Exposure to environmental tobacco smoke (ETS) in pregnancy can lead to low birth-weight babies and poor gestational growth.
Death rates
The estimated number of deaths per year from exposure to ETS among adults in Scotland caused by lung cancer, IHD, stroke and respiratory disease is 865.
If other diseases known to be related to smoking are included, up to 1,000 deaths per year might be attributed to passive smoking among life-long non-smokers. Including estimates for deaths amongst ex-smokers, some 1,500 to 2,000 deaths could be related to ETS exposure among non-smokers (both life-long and ex).
Impact of introducing legislation
Researchers modelling the impact of the introduction of legislation banning smoking in enclosed public places in Scotland estimated that
219 deaths per annum from lung cancer and IHD would be averted, with a further possible additional reduction in deaths from stroke and respiratory diseases of 187. The full benefit may take between 15 and 30 years to be realised, although some benefits may accrue more rapidly. These estimates are based on the number of adults reporting exposure to ETS only in public places. There will be some additional benefit to people who are exposed to ETS both in public places and at home.
Other benefits to health would be a reduction in exposure to ETS, a reduction in smoking prevalence, and an increase in successful quit attempts.
Public awareness of health impacts of ETS
Whilst the hazards of active smoking were largely acknowledged by the population, there was a lack of awareness about the health risks of passive smoking and doubt that it was responsible for illness and death.
Ventilation was widely assumed to reduce the harm caused by ETS but international research evidence highlights that there is no safe level of exposure to ETS.
Economic impacts
There were concerns about the negative impact of new legislation on the businesses in the licensed trade and hospitality sector. However, evidence to date from countries where legislation has already been introduced suggested that this is unlikely to be a problem.
Studies of the impact of smoking restrictions on the hospitality sector failed to find any statistically significant effect.
The annual effect on the hospitality sector in Scotland is estimated to lie in the range of -104m to +299m with a central estimate of +97m. The net effect in Scotland would be less than this as any change in spending will be redistributed to or from other sectors of the economy.
The total economic effect of eliminating ETS exposure is estimated at +335m (central estimate) which is equivalent to +124m when discounted to take account of the timing of effects, with a net present value over 30 years of +4,620m.
The importance of a level playing field was emphasised so that the same economic conditions apply equally to all businesses.
Workplace issues
The data on employee smoking policies in the workplace revealed that there are currently inequalities between industries, meaning that employees in certain sectors rather than others can be subjected to ETS. Even where policies exist, there was some evidence that there were violations.
Comments from respondents in certain strands of the consultation indicated that the construction and transport sectors are least likely to have employee smoking policies in place. Employees working in pubs, clubs and restaurants are extremely likely to be exposed to passive smoke by being required to work in areas where the public can smoke.
In some strands of the consultation there were assumptions that employees in the licensed trade and hospitality sector can be classified differently from other employees because of the nature of their work. Comments suggested that pubs, clubs and restaurants were not perceived as work places by some respondents.
Across the consultation there was discussion over certain types of workplaces that are also a home such as hospitals, care homes and prisons. Some respondents felt that it could be inappropriate to introduce a smoking ban as these are private homes. However, the concern to protect workers from ETS was also important.
There did not seem to be a strong sense amongst employees nor employers that employers should be responsible for their workers' health in respect of their smoking habits.
Socialising, leisure and recreation
Smoking is closely associated with drinking, socialising and relaxation. It is for this reason that pubs and other licensed premises were often considered to be places that should be exempt from legislation banning smoking. This view came through as strongest amongst younger people (16-24 year olds).
However, some organisations (especially health organisations) responding to the public consultation held the view that there should not be exemptions to the law in order to protect the health of the public adequately in all public places.
In many other enclosed public places, the smoking restrictions and bans that already exist are largely accepted by the majority of people. This would suggest that public opinion may follow established norms. Some respondents expected that it would not take long for the general public to adapt to new smoking restrictions.
There was greater support for a ban in restaurants than in pubs, as there is increasing intolerance towards smoking in places where food is served. Although some pubs serve food, they continue to be viewed in a different way from restaurants by some respondents.
Rights and choices
There was evidence of a concern to balance the rights of both smokers and non-smokers. There was also a sense amongst some respondents that this type of legislation would be excessive government interference. In different strands of consultation activity some respondents felt that people should be able to make their own decisions about where they can smoke. Likewise, businesses responding to the public consultation argued that they have the right to make their own decisions about going smoke-free. This view was also expressed by some representatives of the licensed trade and hospitality sector in certain strands of consultation activity.
On the other hand, there was a view that the public have the right to smoke-free environments and nobody should have to breathe in second hand smoke involuntarily.
Children and babies were most likely to be recognised by respondents as a group requiring protection because they lack the same choices as adults.
Level of support for taking further action
Levels of support have been derived predominantly from the following strands:
The public consultation in which 53,474 individuals and organisations responded. The scale of response indicated that smoking in public places is an issue that people feel strongly about, motivating them to respond to the public consultation. Whilst these results do not represent the Scottish population as a whole, they reflect the breadth and depth of views from those people who chose to respond to the consultation.
The omnibus survey based on 1,026 interviews with a representative sample of the population.
There was broad support for some sort of further action to reduce exposure to second hand smoke. The analysis of responses to the consultation showed that a large majority (82%) of respondents to the public consultation supported the view that further action is needed to reduce exposure to second hand smoke. A smaller majority (53%) offered the same view in the omnibus survey.
While there was support for some form of further action, there were differing views as to what form that should take.
Level of support for legislation to make public places smoke-free
In the analysis of responses to the public consultation a large majority of respondents (80%) said that they
would support a law to make enclosed public places smoke-free.
In the omnibus survey, making all enclosed public places smoke-free was supported by just over half (54%) of respondents. It is notable that around a third of current smokers indicated that they would support a ban.
In other strands of the consultation there were mixed views about legislation. Whilst some respondents supported it, others expressed concern that it was indicative of excessive state interference or removed freedom of choice.
Should there be any exemptions to the legislation?
In the analysis of consultation responses just over a third (35%) of the respondents thought that some public places should be exempt from the law, whilst over half (56%) thought that there should be no exemptions. Of those supporting legislation for a complete ban on smoking in enclosed public places,
only 24% said that there should be exemptions.
Of those who expressed support for exemptions in the public consultation some respondents said that pubs and bars should be exempt or that designated or separated areas should be provided for smokers.
In the omnibus survey, amongst those expressing support for a ban, a high percentage (66%) also believed there should be some exemptions.
In the omnibus survey it was felt that exemptions should apply predominantly to pubs. Just under 6 in 10 (57%) of those in support of legislation spontaneously mentioned pubs when asked which public places should be exempt. The desire for pubs to be exempt was backed up in other strands of the consultation exercise including the focus groups and the youth consultation conducted by Young Scot.
Reasons for the different views
Across the research and public consultation activities a number of reasons were given in favour of and against legislation to make enclosed public places smoke-free.
Reasons for:
Benefit to public health
Help reduce smoking prevalence
Help smokers to give up
De-normalise smoking
Improve social environments
Protect workers
Protect the rights of the general public to a smoke-free environment
Benefit the economy
Save NHS resources
Difficulty of enforcing partial measures
Benefit the image of the Scottish Executive.
Reasons against:
Other things are bad for health not just ETS
Negative economic consequences for licensed trades
Infringement on human rights and choices
Excessive state interference
Difficultly of enforcing and fears of violation
Government driven by fear of litigation in future not public health
Negative impact on community fabric
Enough already being done through voluntary measures to reduce ETS.
Alternatives to a complete ban on smoking
A number of possible alternatives to a complete ban were suggested in different parts of the consultation. These included:
Ventilation
Designated or separated areas
A staged approach to introducing legislation
Voluntary action/ let pubs decide for themselves
Smoking licenses for pubs
Incentives to pubs and other public venues to go smoke-free
Introduction of smoke-free in specific areas, for example around children or where food is served
Increased education about the dangers of passive smoking
Increased smoking cessation support
Providing local authorities with powers to act.
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