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Smoking in Public Places
A Consultation on Reducing Exposure to Second Hand Smoke
Evidence Report

CHAPTER 1 - BACKGROUND AND INTRODUCTION

BACKGROUND

1.1 The detrimental effects of smoking have been a major public health concern since 1962 when the Royal College of Physicians published "Smoking and Health". This groundbreaking report clearly evidenced a direct link between smoking and life threatening diseases such as lung cancer and coronary heart disease, and called for urgent government intervention recommending actions such as a public education programme, increased taxation, restrictions on tobacco advertising, greater steps to restrict the sale of tobacco to children and restrictions on smoking in public places.

1.2 Since then, progress has been made to reduce levels of smoking, and establish smoke-free zones through a variety of measures and policies. However, there is still a long way to go. Smoking is a habit that is deep rooted within Scottish society, particularly within deprived communities ³. Recent figures show that 31% of adult males and 31% of adult females are smokers ⁴. The habit remains the biggest single cause of preventable illness and premature death in Scotland, placing considerable strain on the National Health Service. Smoking is estimated to cost the NHS between 1.4bn and 1.7bn annually in the UK ⁵ whilst the NHS in Scotland spends an estimated 200 million per annum (at present day prices) on hospital treatment for diseases caused by tobacco use ⁶.

1.3 The issue of passive smoking has recently been brought to the fore, in the light of research evidence to indicate that second hand smoke increases the risk of a number of life threatening illnesses and other conditions ⁷. Passive smoking is consequentially now a matter of major public health concern.

1.4 The Scottish Executive is tackling the problem of smoking in Scotland as part of a wider policy to improve the health of the nation, increase life expectancy across the whole population and narrow the gap between deprived communities and the better off ⁸. The first ever action plan on tobacco control for Scotland, " A Breath of Fresh Air for Scotland" ⁹, was published in January 2004. This document builds on the work of NHS Scotland and ASH Scotland ¹⁰, and outlines action in a range of areas including prevention and education, the provision of smoking cessation services, and protection and controls to reduce the attractiveness and availability of cigarettes. One of the key elements of the plan is to minimise the harm caused by second hand smoke.

1.5 It is recognised that policies of persuasion are very often more likely to be successful than those of coercion. Indeed, voluntary approaches to reducing smoking in public places have had some degree of success in the past and restrictions on smoking have been introduced into many work places in recent years ¹¹. However, it is estimated that a quarter of employees are still exposed to tobacco smoke in the workplace, particularly those working in leisure areas such as restaurants, bars and pubs ¹². Whilst there has been progress through the Voluntary Charter on Smoking in Public Places to improve smoke-free provision in such venues, its impact is limited and there is recognition that more needs to be done ¹³.

1.6 The Tobacco Control Action Plan announced the Executive's decision to consult the people of Scotland on the issue of passive smoking, targeting individuals, businesses, representative groups and other organisations, and enabling them to contribute to the policy process. Alternative approaches to minimising the harm caused by second hand smoke were suggested in the consultation materials. These were:

• Enhancing the current voluntary approach

• Introducing a ban on smoking in public places Scotland-wide, either complete or targeted at specific places

• Giving powers to local authorities to regulate smoking in public places

• A combination of targeted statutory controls and voluntary action.

1.7 Any action to restrict or prohibit smoking in public places through legislation is a highly controversial issue. Many individuals consider smoking to be a matter of personal choice and a basic right. Moreover, general public awareness of the health implications of second hand smoking is still limited, and the justification for such legislation may not be widely understood. In this context, the Scottish Executive realises the importance of a public debate and consultation, both to generate awareness of the health risks of second hand smoke as well as providing opportunities for various interested parties to express their opinions on the issue.

1.8 The Tobacco Control Action Plan published in January 2004 announced the Scottish Executive's decision to consult the people of Scotland. This led to the launch of the public consultation, 'Smoking in Public Places' in June 2004. ¹⁴

1.9 The consultative process was broad-ranging and encompassed a number of different activities. In addition to a number of different consultation activities, a series of research and evidence gathering activities were conducted. The aim was:

• To capture the breadth of view points from individuals and organisations who may be affected by smoking in public places and or have a particular interest in the issue

• and

• To obtain sound information on the implications of change for Scotland based on robust scientific research.

1.10 There were four key elements to the consultative process:

• A programme of awareness raising activity, carried out by NHS Health Scotland.

• Research and evidence gathering: Three pieces of research were commissioned by NHS Health Scotland, on behalf of the Scottish Executive. These research activities aimed to analyse the implications of legislative change for Scotland, taking into account the specific conditions of the Scottish context.

  • A study of smoking policies in small, medium sized and large enterprises

  • An international review of the health and economic impact of action to control passive smoking

  • A morbidity and mortality analysis of the impact of passive smoking in Scotland.

• Public consultation:

  • Publication of consultation materials, including a written consultation document, were made widely available to organisations, businesses and members of the public. Responses could be made by hard copy, e-mail or on-line

  • A series of focus groups with targeted sections of the population

  • A number of regional public seminars throughout Scotland

  • Activities conducted with young people by the Young Scot organisation

  • An opinion survey of a representative sample of the Scottish population

  • A national conference held on 9 September 2004.

The consultation is an important aspect of the policy making process. The information gathered has been used to inform the policy decision about whether or not further action is needed and if so, what that action might be, but it has not in itself determined the policy process. That decision lies with policy makers.

• Assessment and conclusions from this work feeding into a final evidence report.

1.11 A report has been produced for each strand of research and evidence gathering and consultation activity. These are published on the Scottish Executive website at www.scotland.gov.uk/library5/health/smipp-00.asp. Readers are advised to consult the full reports for details about each strand of the research and evidence gathering activities and the consultation exercises.

The Evidence Report

1.12 This document constitutes the evidence report. The report aims to provide an accurate and comprehensive overview of the key findings which have emerged in the different strands of research and evidence gathering and public consultation activities listed earlier. As many of the same themes and issues have emerged in different parts of the exercise, there is inevitably some degree of repetition in this report.

1.13 The publication of this report aims to contribute to a transparent process of evidence gathering, consultation and policy making. The aim of the report is to demonstrate the full range of evidence that has fed into the policy process and to present the findings of the consultation in a format that is accessible to a broad audience including members of the general public.

1.14 The evidence report does not draw overall conclusions or make recommendations. It simply presents the key findings of the various strands of the work. The information is presented for each separate strand and thematically, looking across the strands.

1.15 The individual evidence reports that have formed the basis of the final evidence report are listed in the table below.

1.16 In addition to the activities listed above, feedback was also obtained through a discussion forum on the Scottish Executive's website. Relevant findings from this have been incorporated into the discussions in chapter four.

Different forms of evidence

1.17 The research and evidence gathering and the public consultation activities described above have generated different types of data and information. These constitute different forms of evidence. We would like to clarify the use of the term "evidence" at the outset to avoid any confusion given that the term is often used to refer to findings that are scientifically robust. In this report the term covers each of the different types of data that have been obtained. This includes:

• Reviews of robust scientific evidence and development of models to illustrate the health risks of passive smoking and the implications of legislative change for Scotland. These are found in two of the NHS research reports: The International Review of the Health and Economic Impact of the Regulation of Smoking in Public Places and Passive Smoking and Associated Causes of Death in Adults in Scotland (see Table 1.1 for further details).

• Quantitative data. This is obtained from the quantitative survey from the smoking policies in the workplace study, the opinion survey, the analysis of responses to the consultation and the youth survey conducted by Young Scot. The quantitative data provide a measure of the level and distribution of support.

• Qualitative data. This is obtained from responses to the public consultation, the focus group research, the interviews conducted within the smoking policies in the workplace study, the regional public seminars, discussions and debates at the national conference and the youth consultation conducted by Young Scot. The qualitative data provides the range of views and issues and the depth of detail emerging in each of the consultation activities.

Report Structure

1.18 The main body of the report is structured as follows.

• Chapter two provides summaries of the three reports from the NHS commissioned research.

• Chapter three contains summaries of the reports from the different strands of consultation activity.

• Chapter four pulls together the key findings and issues from each of the evidence strands, analysing them thematically. These broadly cover: passive smoking and health, economic concerns, workplace issues, socialising, leisure and relaxation, and rights and choices issues.

• Chapter five discusses the level of support for introducing legislation.

• Chapter six analyses the perceptions about the implications of introducing legislation and the reasons for the different viewpoints, followed by alternative courses of action that have been suggested across the consultation activity.

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