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Smoking in Public Places
A Consultation on Reducing Exposure to Second Hand Smoke
Key Findings of Responses to a Public Consultation

CHAPTER 4: WHETHER FURTHER ACTION NEEDS TO BE TAKEN

4.1 The first question posed on the public consultation paper was "Having considered the health risks associated with passive smoking, do you think that further action needs to be taken to reduce people's exposure to second-hand smoke?" Respondents were given the option of three responses; 'yes', 'no' or 'don't know'. They were then given the opportunity to add any further comments.

4.2 As shown in the following chart, the majority (82%) of those responding to the consultation felt that further action needs to be taken to reduce people's exposure to second-hand smoke; only 13% stated that no further action is required.

Whether further action is needed to reduce exposure
Base: All respondents (53,474)

(Source: Q1)

4.3 When we examine sub-groups within the responses, there is little difference between the views of males and females, the age group of the respondents, or indeed the type of response, be that personal (82%) or on behalf of a group or organisation (79%).

4.4 However, there were some differences in terms of the method used to submit a response to the consultation. Of those using the web to respond, 94% felt that more needed to be done, whereas 79% of those replying via a hard copy of the consultation paper felt that further action needed to be taken to reduce people's exposure to second-hand smoke.

4.5 Not surprisingly, there were also differences according to smoking status, with 94% of those who do not smoke claiming that further action is needed, in comparison to only 43% of respondents who smoke. There were also some differences in response from organisations. Within the companies and organisations responding to the consultation, those in the hospitality sector, especially bars and pubs, were less inclined to agree that further action is needed to reduce exposure to second-hand smoke than any other type of organisation. Table 4.1 below shows the profile of those responding according to various sub-group characteristics.

Whether further action is needed to reduce exposure

4.6 The organisations submitting lengthier responses also showed some difference in the answers given. The majority of health organisations, local authorities and voluntary organisations responded positively to this first question. However, these views were not universally held and it should also be noted that a number of health organisations and local authorities, did not state whether further action needs to be taken.

4.7 Of those businesses not giving either a "yes" or "no" response to this question, the majority of responses were from organisations involved in providing ventilation services, companies who provide vending machines, breweries or trade organisations.

4.8 After stating whether action needs to be taken to reduce exposure to second hand smoke, respondents were invited to make further comments regarding this specific issue. The majority of respondents chose not to provide any further comments in support of their initial response. Where further comments were provided, some reccurring themes were identified each of which will be dealt with in turn. The types of responses that were given by organisations submitting lengthier replies to the consultation were very much in line with these, therefore only key points or differences arising from these replies have been highlighted.

The Health Risks of Smoking and Passive Smoking

4.9 In general, the associated health risks of smoking and passive smoking were commented on by a large number of those who felt that further action is required to reduce people's exposure to second hand smoke. In terms of sub-groups, greater proportions of non-smokers referred to health risks than did smokers. Across these individuals, there was specific reference to passive smoking being a health risk or something that can cause or exacerbate illness. Some respondents mentioned specific illnesses and others the protection that a ban would afford children. Nevertheless there were also respondents (mainly smokers) - both those who support further action and those who do not - who felt that there needs to be more research into the health risks of tobacco smoke.

4.10 There was also reference made by many who support further action to the need for non-smokers to be protected from the effects of second-hand smoke. Other health related comments include the view that smoking related illnesses use up NHS resources and that banning smoking in enclosed public places will lead to an improvement in health for everybody.

4.11 The responses from organisations also referred to the health risks of both smoking and passive smoking. Not surprisingly, those responding on behalf of health organisations gave much more detailed information about the specific diseases that are caused or aggravated by exposure to environmental tobacco smoke, as did many local authorities. The following quotes from two health organisations include some of the diseases and health risks most commonly cited.

"Passive smoking is detrimental to health. The World Health Organisation and the US Environmental Protection Agency have classified environmental tobacco smoke (ETS) as a human carcinogen, the risk of coronary heart disease can increase by as much as 60% and exposure to ETS during pregnancy is associated with premature birth and low birth weight. As health professionals, we have a duty to support measures which improve the health of individual as well as communities."

"There is a need to provide facilities for smokers. Children should always be protected from second hand smoke."

4.12 As demonstrated in the last quote, there was also much concern, from all types of organisations, that the health of children in particular needs to be protected. Even some organisations that were not in support of a total ban felt that more needed to be done to protect children. Of those who supported the call for further action to reduce people's exposure to second hand smoke, many believed that the only way to reduce the health risks is by the introduction of legislation, as illustrated by one health organisation.

"We believe that the introduction of legislation to prevent smoking in public places would be the most significant single action that could be taken to improve the nation's health in Scotland."

4.13 Among respondents who claimed that further action is not required, there tended to be a focus on non smoking issues and individuals commented that other things (such as exhaust fumes, alcohol and drug abuse and fatty foods) are more hazardous or are a greater cause for concern than (passive) smoking.

4.14 For those who did not comment either positively or negatively about support for further action and indeed for some respondents who felt no further action was necessary, the key comment referred to there not being enough evidence about the dangers of passive smoking, or that they did not believe the evidence. This view was also reflected by one of the organisations.

"The body of scientific and epidemiological evidence on ETS does not prove that ETS causes disease in non-smokers and does not provide justification for a public policy prohibiting smoking in work and other places. In those few epidemiological studies that have reported an association that satisfies conventional statistical tests, the level of relative risk is extremely low; could easily be accounted for by inadequate adjustments for errors and flaws arising from study design, methodology, bias or confounding; and, in any event, does not equate to any meaningful increase in risk for any individual person."

Support for a Ban in Public Places

4.15 A significant proportion of respondents who agreed that further action is required stated that they support a ban that would prevent smoking in all public places, with a smaller number suggesting that legislation is necessary as voluntary measures have not worked. However, some respondents were in favour of compromise measures, with suggestions that there should be a ban that prevents smoking in specified public places, such as in restaurants, cafes or other eating-places, or in places where children are present. There were also some comments suggesting that smoking should be banned in additional areas, including the entrances of buildings, anywhere outside and even that smoking should be prohibited in the home.

4.16 Whilst on the whole those responding on behalf of an organisation expressed the need for further action to be taken - many of whom suggested measures similar to those already stated - there was one difference between these responses and those responses from the general public. There was more widespread support for smoking to be banned in all public places expressed by organisations, especially by many health organisations, local authorities, and voluntary organisations. Indeed there was also a call for a complete ban from some businesses, including one who said:

"As far as [we] are concerned, our position is that we would like to ban it completely. We are currently in the process of consulting with one or two of our … [businesses] to ban it now on a trial basis."

4.17 While there was very little comment from the majority of respondents in relation to the workplace specifically, a few organisations did focus on this and a small number of respondents referred to the need for a workplace ban specifically. There were also some comments that any ban has to be enforced by law to work effectively and that voluntary bans do not work. However, a small number did suggest that further action be taken using these voluntary measures.

4.18 Even among replies from respondents expressing the view that further action is not required, there was a small proportion that went on to refer to some form of action being needed. Indeed there were a small number who stated that 'people should not be exposed to second hand smoke in public places that they can't avoid using'. However, there were concerns about the introduction of legislation and worries about the extent of the ban. Where respondents did not state whether they felt further action is required, some stated that smoking in specified public places should be banned.

4.19 Not all respondents were supportive of a ban. Regardless of whether they supported further action or not, a small proportion said that they did not support a total ban. Furthermore, of those who said further action was not required, a small proportion felt that enough is already being done. Of those against taking further action, some turned the choice onto non-smokers and commented that non-smokers can avoid smoking areas if they are concerned about exposure to smoke.

4.20 One health organisation questioned the purpose of the legislation, whether it was to discourage smoking in general or protect customers and employees in public places. Their view was that if the purpose is the former, then smoking should not be allowed in places of public entertainment. In addition there should not be provision of designated smoker's rooms, smokers congregating outside building should not be tolerated and consideration must be given to smoking at home, as this is where passive smoking can be most harmful, particularly to children.

Support for partial measures

4.21 Not all respondents and organisations who felt that further action is required supported a ban on smoking in enclosed public places. However some individual respondents, and to a lesser extent organisations, did feel that there should be partial measures. The most common theme among these suggestions was ventilation, including the improvement of ventilation systems, financial assistance to improve ventilation and the introduction of mandatory standards for ventilation systems.

4.22 Other actions suggested include the provision of completely separate smoking rooms, signs clearly indicating the smoking status of the premises or area, and publications of the health-risk ratings of establishments. Those responding from prisons suggested segregation of smoking and non-smoking areas (for both inmates and staff), including cells, cell blocks and wings. Where respondents did not state whether they felt further action is required, similar suggestions for partial measures were given, whilst others felt that the segregated areas already in place were sufficient.

4.23 In contrast to this, there were comments regarding the ineffectiveness of these measures. Some suggested that where segregated areas are provided, the smoke drifts into non-smoking areas, whilst some wrote that ventilation systems are ineffective in eliminating the effects of passive smoking. Another view from a voluntary organisation was that whilst some may consider alternatives such as "smoke free areas or ventilation systems. However, scientific research has shown that neither of these measures is effective".

Individual Choice

4.24 Regardless of whether or not they felt further action was needed to reduce people's exposure to second hand smoke, some respondents commented on the rights of individuals. Many of those who felt that further action is required were concerned about the freedom of choice for all. When further broken down, this includes respondents who were concerned that smokers can choose to smoke, whilst passive smokers have no choice in the matter; those who felt that people have the right to choose whether or not to smoke and where; and those who felt that people can choose whether or not to enter premises that allow smoking. Indeed others commented that the licensed trade should decide for itself about smoking policies. Despite the strong support for freedom of choice, other respondents commented that reducing exposure to second-hand smoke should be given priority over smoker's freedom of choice .

4.25 Similarly many of those who felt further action was not required said that individuals should have the right to choose, with a small number claiming that banning smoking amounts to dictatorship. Of those who did not commit to whether further action was required, some mentioned that individuals should be allowed to choose, stating that a ban would be against smoker's rights.

4.26 Where responses received from organisations mentioned freedom of choice, generally it was in relation to non-smokers, expressing the view that "no one should be involuntarily exposed to second-hand smoke".

Other Views Expressed by Organisations and Respondents

4.27 In addition to these themes there were a number of other issues that came out of the responses from organisations. This includes those who felt that more needs to be done to protect the health of workers, as the following quote from a local authority illustrates.

"Given the evidence of the Scientific Committee on Tobacco and Health, it is untenable that we continue to allow exposure of individuals to second hand smoke causing detriment to health and avoidable drain on resources. Employers and businesses have a duty of care to protect their staff and customers. Existing policies do not protect people sufficiently from exposure to second hand smoke- this reinforces the need for further action."

4.28 In addition to this some organisations expressed the view that while they were in favour of further action they felt this must be supported by help and advice for smokers, and that it is vital that people's life circumstances are taken into consideration.

4.29 There were also some comments from organisations and respondents that there needs to be some form of education for individuals about the dangers of passive smoking in order to raise public awareness about this specific issue.

4.30 In addition there were further comments made by a small number of respondents. These included:

• Positive aspects of legislation, including the view that it will encourage smokers to smoke less.

• Suggestions that the Government should "take the lead in this matter."

• A call for further support for assisting smokers to give up.

4.31 Overall the largest proportion of respondents agreed that there should be further action taken to reduce people's exposure to second-hand smoke. However preferences for the type of action required varied enormously and a wide range of suggestions were made from imposition of a ban on smoking in public places to compromise measures such as designated smoking areas, exemptions or improved ventilation systems.

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