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Smoking in Public Places
A Consultation on Reducing Exposure to Second Hand Smoke
Key Findings from Focus Group Research
CHAPTER FIVE: HEALTH ISSUES
5.1 This chapter illustrates the level of awareness amongst respondents of the health implications of both active and passive smoking. It also outlines how significantly fears for health affect individual choices concerning both active smoking and exposure to second hand smoke. The chapter also discusses views on ventilation and smoking around children.
AWARENESS OF HEALTH RISKS
5.2 There are varied levels of awareness of the health risks associated with smoking both in terms of the severity of risk and the range of risks that have now been identified. Most respondents are aware that active smoking poses a threat to their personal health. However, the level of understanding about the range and types of diseases that are caused by smoking is quite variable.
5.3 Many respondents are aware that medical research has established a connection between lung cancer and smoking. The connection between smoking and cardio-vascular disease is also quite well known with respondents aware of the impact of smoking on the arteries and the heart. Less well known is the impact of smoking on gastro intestinal ailments. Neither are respondents as aware of the additional types of diseases and cancers attacking other organs in the body that have been more recently identified as being linked to smoking.
5.4 The impact of
passive smoking on health is comparatively less well known and is less accepted by some respondents. There is a sense that passive smoking has a far less significant impact on health, and that it is far less risky to non-smokers.
"I probably didn't think it was as
bad as smoking, to be honest."
(Edinburgh, young people)
5.5 There is also some questioning of the evidence linking passive smoking and ill health, especially by smokers. Some respondents would, therefore, question whether or not passive smoking is really a sufficiently serious concern to justify the proposed controls.
"I am still struggling with the passive thing believing it sometimes. I think it's over the top."
(Oban, manufacturing, engineering, construction, transport)
5.6 A few respondents who are smokers deny that smoking either actively or passively has a negative impact on health. They are prepared to disregard any of the health information based on scientific medical research including that which we gave them in the focus groups.
"They haven't quite established a link between smoking and lung cancer, have they? Where is the proof? Where's the evidence? There's no proof for it."
(Ayr, smoker, NHS)
Other respondents appear to believe that cancer is caused by a gene or a virus.
5.7 Similarly, another respondent points out the difficulties of believing the link between passive smoking and lung disease:
I don't know how they can single it (smoking)
out?... Irrespective of whether or not you smoke or you don't smoke, you're
breathing all the time and you're being exposed to different things. For example, if you lived all your life by a busy road could you contract lung cancer because of the …pollution from the passing cars, or could that be attributed to going to the pub three times a week and breathing in second hand smoke?
(Aberdeen, manufacturing, engineering, construction and transport)
5.8 Respondents are unsure of the different levels of harm. As the above quote also demonstrates, it is not clear to some respondents which activity is more harmful to their health: passive smoking or breathing in car fumes.
5.9 Even among respondents who acknowledge that passive smoking can impact negatively on health, there is relatively little awareness of the precise damage that secondary smoke can cause. At best, respondents tend to assume that the side effects from passive smoking are similar to those of direct smoking, but to a lesser extent. For example, there is a lack of understanding about which aspects of cigarette fumes are harmful to health, with some people assuming that the carbon dioxide and carbon monoxide produced by a cigarette are the main cause for concern.
5.10 Some of the respondents who are smokers acknowledge the risks but rationalise their choice to continue smoking by pointing out that there are many risks to health in life as well as smoking. Being killed crossing the road is frequently referred to. The dangers posed by chemicals that are added to food, and the fumes from cars that pollute the air we breathe are also common reasons given.
5.11 Other respondents add that the government is frequently issuing health warnings concerning the use or consumption of many different products, often food products, and if each one of these was respected, life would be difficult to lead. In line with this rationale is the belief that is held by some of the respondents that life involves taking a few risks. Smoking is merely another one of these.
5.12 Some respondents also argue that not everyone who smokes will suffer health problems. In the focus group many respondents knew someone who has smoked heavily all their lives and lived to a ripe old age. Indeed, the classic quote came out in a number of groups:
"I've got an Uncle who's 96 years old and he's smoked Capstan full strength all his days until they stopped making them, and he's still going yet, and he's hardly got a cough."
(Ayr, smoker, NHS workers)
5.13 Similarly, smokers also point out that some non-smokers get cancer.
5.14 Amongst some respondents it was evident that the knowledge of the potential dangers is often not sufficient to stop some people from smoking. Smokers admit that because they cannot see the damage that smoking could be doing to them, some are not aware that they are doing long term damage to themselves. They also assume or hope that they will not be afflicted. Some ex-smokers note that it was only after giving up smoking that they started to feel healthier and realised how adversely smoking had affected them.
"You assume it won't happen to me."
(Inverness, licensed trade and hospitality sector)
5.15 Moreover, whilst some ex-smokers mention their health as a key motivating reason for stopping, others admit that their primary reason for quitting was to save money, with health being a secondary consideration.
5.16 Likewise, awareness of the health risks of second hand smoking is also not sufficient to discourage many non / ex-smokers from entering smoky environments, if they wish to socialise with their friends.
5.17 Some respondents are also aggrieved by the tendency of GPs and medical practitioners to attribute the majority of the health conditions or ailments to smoking.
"Everything that is wrong with you is put down to smoking. The minute you say, 'Smoker', 'Oh, you'll have to stop smoking."
(Ayr, smoker, NHS)
SMOKING AND VENTILATION
5.18 Many respondents assume that ventilation is an adequate solution to the problem of second hand smoke. Some respondents consider greater use of ventilation systems to be an alternative to banning smoking in enclosed public places. Only one or two respondents participating in the focus groups are aware of the fact that ventilation makes the atmosphere more comfortable by removing the smokiness, but does not remove the carcinogens from the air. As such, a number of individuals assume that improved ventilation systems in all smoky atmospheres will counteract the negative impact of tobacco smoke.
SMOKING AND CHILDREN
5.19 Most respondents, regardless of the level to which they understand the harmful effects of smoking and passive smoking, will try to avoid smoking in the presence of their own children, particularly in enclosed environments. This behaviour suggests that there is an acknowledgement amongst some participants that passive smoking is harmful - at least to some degree. For many respondents, there is a connection between childhood asthma and exposure to tobacco smoke. Most women attending focus groups had stopped smoking for the duration of any pregnancies due to fears that exposure to cigarette smoke could harm the unborn child.
5.20 However, the extent to which smoking parents are successful in protecting their children from passive smoke varies. Some parents admit that, despite their best intentions to avoid smoking in front of their children at home and in public places, they may end up doing it nonetheless due to their strong desire to smoke and the inconvenience of going outside and some participants were subjecting their children to cigarette smoke on a regular basis.
5.21 The main reasons for avoiding smoking in front of children are the following:
To discourage their children from smoking
To protect their children from second hand smoke and allied to health concerns
To set a good example for their children.
5.22 There is also a strong sense amongst the respondents participating in the focus group research that young children and babies have very limited or no choice over whether or not they are exposed to environmental tobacco smoke in many contexts in which they find themselves. Whilst an adult can remove themselves from a smoky atmosphere or request a smoker to stop smoking in their presence, a child usually does not have the independence to move away or choose their own environment, nor the authority to make such a request. Children must endure the conditions that a parent chooses for them, and if this is a smoky environment, they have no way of avoiding it. For many smokers, this is a strong motivation for specific avoidance behaviour in front of their children.
5.23 By the same token, parents also avoid taking their children to smoky environments in the public arena and will choose specific restaurants or cafes with non-smoking children's areas.
5.24 Many parents participating in the focus groups note that their children are receiving a significant degree of health education at school which is successfully warning them of the dangers of smoking, and passive smoking. Some parents mention that their children have badgered them to stop smoking and in some cases this has been successful in encouraging a parent to quit.
"If you lit up a cigarette anywhere near my son, he would say, 'Oh, you're blackening my young lungs."
(Ayr, NHS)
5.25 The educational approach is regarded by many as an extremely important route to reducing smoking throughout the population as a whole. By encouraging children to be aware of the dangers of passive smoking, a health message is being spread. There is also acknowledgement from some parents that "nagging" from their children had been instrumental in giving up smoking.
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