Editing Passive smoking (section)

== Smoke-free laws ==
{{See also|Smoking ban|List of smoking bans|Smoking bans in private vehicles}}

As a consequence of the health risks associated with secondhand smoke, many national and local governments have outlawed smoking in indoor public places, including [[restaurant]]s, [[café]]s, and [[nightclub]]s, as well as some outdoor open areas.<ref>[http://gothamist.com/2011/05/18/smokers_just_daring_bloomberg_to_ti.php Smokers Daring Bloomberg To Ticket Them Under Park Ban] {{webarchive|url=https://web.archive.org/web/20131126094031/http://gothamist.com/2011/05/18/smokers_just_daring_bloomberg_to_ti.php |date=2013-11-26 }}</ref> [[Ireland]] was the first country in the world to institute a comprehensive national ban on smoking in all indoor workplaces on 29 March 2004. Since then, many others have followed suit. The countries which have ratified the [[WHO Framework Convention on Tobacco Control]] (FCTC) have a legal obligation to implement ''effective'' legislation "for protection from exposure to tobacco smoke in indoor workplaces, public transport, indoor public places and, as appropriate, other public places." (Article 8 of the FCTC<ref name="framework-treaty">{{cite web |url = http://whqlibdoc.who.int/publications/2003/9241591013.pdf |title = WHO Framework Convention on Tobacco Control |publisher = [[World Health Organization]] |quote = Parties recognize that scientific evidence has unequivocally established that exposure to tobacco causes death, disease and disability |date = 2005-02-27 |access-date = 2009-01-12 }}</ref>) The parties to the FCTC have further adopted ''Guidelines on the Protection from Exposure to secondhand Smoke'' which state that "effective measures to provide protection from exposure to tobacco smoke ... require the total elimination of smoking and tobacco smoke in a particular space or environment in order to create a 100% smoke-free environment."<ref name="fctc-guidelines">{{cite web |title = Guidelines on the Protection from Exposure to Secondhand Smoke |website = [[Framework Convention on Tobacco Control]] |publisher = [[World Health Organization]] |year = 2007 |access-date =2009-01-29 |url =https://www.who.int/fctc/cop/art%208%20guidelines_english.pdf }}</ref>

Opinion polls have shown considerable support for smoke-free laws. In June 2007, a survey of 15 countries found 80% approval for such laws.<ref>[http://www.marketresearchworld.net/index.php?option=content&task=view&id=1619&Itemid= Market Research World]</ref> A survey in France, reputedly a nation of smokers, showed 70% support.<ref name="France to ban smoking"/>

=== Effects ===
Smoking bans by governments result in decreased harm from secondhand smoke, including less admissions for [[acute coronary syndrome]].<ref>{{cite journal |last1=Frazer |first1=Kate |last2=Callinan |first2=Joanne E |last3=McHugh |first3=Jack |last4=van Baarsel |first4=Susan |last5=Clarke |first5=Anna |last6=Doherty |first6=Kirsten |last7=Kelleher |first7=Cecily |title=Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption |journal=Cochrane Database of Systematic Reviews |date=4 February 2016 |volume=2016 |issue=2 |pages=CD005992 |doi=10.1002/14651858.CD005992.pub3 |pmid=26842828 |pmc=6486282 }}</ref> In the first 18 months after the town of [[Pueblo, Colorado]], enacted a smoke-free law in 2003, hospital admissions for heart attacks dropped 27%. Admissions in neighbouring towns without smoke-free laws showed no change, and the decline in heart attacks in Pueblo was attributed to the resulting reduction in secondhand smoke exposure.<ref>{{cite journal |title=Reduced hospitalizations for acute myocardial infarction after implementation of a smoke-free ordinance—City of Pueblo, Colorado, 2002–2006 |journal=MMWR Morb. Mortal. Wkly. Rep. |volume=57 |issue=51 |pages=1373–7 |date=January 2009 |pmid=19116606 |url=https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5751a1.htm |author1= Centers for Disease Control and Prevention (CDC) }}</ref> A 2004 smoking ban instituted in [[Massachusetts]] workplaces decreased workers' secondhand smoke exposure from 8% of workers in 2003 to 5.4% of workers in 2010.<ref name=Fitzsimmons>{{cite web |url = http://blogs.cdc.gov/niosh-science-blog/2013/11/21/ets/ |title = Reducing Worker Exposure to ETS |publisher = National Institute for Occupational Safety and Health (NIOSH) |date = 21 November 2013 |last = Fitzsimmons |first = Kathleen |access-date = 14 January 2015}}</ref> A 2016 review also found that bans and policy changes in specific locations such as hospitals or universities can lead to reduced smoking rates. In prison settings bans might lead to reduced mortality and to lower exposure to secondhand smoke.<ref>{{cite journal |last1=Frazer |first1=Kate |last2=McHugh |first2=Jack |last3=Callinan |first3=Joanne E |last4=Kelleher |first4=Cecily |title=Impact of institutional smoking bans on reducing harms and secondhand smoke exposure |journal=Cochrane Database of Systematic Reviews |date=27 May 2016 |volume=2016 |issue=5 |pages=CD011856 |doi=10.1002/14651858.CD011856.pub2 |pmid=27230795 |pmc=10164285 }}</ref>

In 2001, a systematic review for the Guide to Community Preventive Services acknowledged strong evidence of the effectiveness of smoke-free policies and restrictions in reducing expose to secondhand smoke. A follow-up to this review, identified the evidence on which the effectiveness of smoking bans reduced the prevalence of tobacco use. Articles published until 2005, were examined to further support this evidence. The examined studies provided sufficient evidence that smoke-free policies reduce tobacco use among workers when implemented in worksites or by communities.<ref>{{cite journal | vauthors = Hopkins DP, Razi S, Leeks KD, Priya Kalra G, Chattopadhyay SK, Soler RE | year = 2010 | title = Smokefree policies to reduce tobacco use. A systematic review | journal = Am J Prev Med | volume = 38 | issue = 2 Suppl | pages = S275–89 | doi = 10.1016/j.amepre.2009.10.029 | pmid = 20117612| author7 = Task Force on Community Preventive Services }}</ref>

While a number of studies funded by the tobacco industry have claimed a negative economic impact from smoke-free laws, no independently funded research has shown any such impact. A 2003 review reported that independently funded, methodologically sound research consistently found either no economic impact or a positive impact from smoke-free laws.<ref>{{cite journal |vauthors=Scollo M, Lal A, Hyland A, Glantz S |title=Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry |journal=Tobacco Control |date=Mar 2003 |pmid=12612356 |pmc=1759095 |volume=12 |issue=1 |pages=13–20 |doi=10.1136/tc.12.1.13}}</ref>

Air nicotine levels were measured in Guatemalan bars and restaurants before and after an implemented smoke-free law in 2009. Nicotine concentrations significantly decreased in both the bars and restaurants measured. Also, the employees' support for a smoke-free workplace substantially increased in the post-implementation survey compared to pre-implementation survey.<ref>{{cite journal |vauthors=Barnoya J, Arvizu M, Jones MR, Hernandez JC, Breysse PN, Navas-Acien A |title=Secondhand smoke exposure in bars and restaurants in Guatemala City: before and after smoking ban evaluation |journal=Cancer Causes Control |volume=22 |issue=1 |pages=151–6 |date=November 2010 |pmid=21046446 |doi=10.1007/s10552-010-9673-8 |s2cid=673901 }}</ref>

=== Public opinion ===
Recent surveys taken by the [[Society for Research on Nicotine and Tobacco]] demonstrate supportive attitudes of the public towards smoke-free policies in outdoor areas. A vast majority of the public supports restricting smoking in various outdoor settings. The respondents' support for the policies were for varying reasons such as litter control, establishing positive smoke-free role models for youth, reducing youth opportunities to smoke, and avoiding exposure to secondhand smoke.<ref>{{cite journal |last1=Thomson |first1=George |last2=Wilson |first2=Nick |last3=Edwards |first3=Richard |title=At the frontier of tobacco control: A brief review of public attitudes toward smoke-free outdoor places |journal=Nicotine & Tobacco Research |date=June 2009 |volume=11 |issue=6 |pages=584–590 |doi=10.1093/ntr/ntp046 |pmid=19359392 |doi-access=free }}</ref>

=== Alternative forms ===
Alternatives to smoke-free laws have also been proposed as a means of [[harm reduction]], particularly in bars and restaurants. For example, critics of smoke-free laws cite studies suggesting ventilation as a means of reducing tobacco smoke pollutants and improving air quality.<ref>{{cite news |title=No ifs or butts |url=https://www.building.co.uk/no-ifs-or-butts/3047478.article |work=Building |date=7 March 2005 }}</ref> Ventilation has also been heavily promoted by the tobacco industry as an alternative to outright bans, via a network of ostensibly independent experts with often undisclosed ties to the industry.<ref>{{cite journal |vauthors=Drope J, Bialous SA, Glantz SA |title=Tobacco industry efforts to present ventilation as an alternative to smoke-free environments in North America |journal=Tob Control |volume=13 |issue=Suppl 1 |pages=i41–7 |date=March 2004 |pmid=14985616 |pmc=1766145 |doi= 10.1136/tc.2003.004101|quote = The industry developed a network of ventilation 'experts' to promote its position that smoke-free environments were not necessary, often without disclosing the financial relationship between these experts and the industry. }}</ref> However, not all critics have connections to the industry.

The [[American Society of Heating, Refrigerating and Air-Conditioning Engineers]] (ASHRAE) officially concluded in 2005 that while completely isolated smoking rooms do eliminate the risk to nearby non-smoking areas, smoking bans are the only means of eliminating health risks associated with indoor exposure.  They further concluded that no system of dilution or cleaning was effective at eliminating risk.<ref name="ASHRAE">{{cite web |title=ASHRAE Position Document on Environmental Tobacco Smoke |url=https://www.ashrae.org/file%20library/about/position%20documents/pd_environmental-tobacco-smoke-2020-07-1.pdf |publisher=[[American Society of Heating, Refrigerating and Air-Conditioning Engineers]] |date=July 2020 }}</ref> The [[U.S. Surgeon General]] and the [[European Commission Joint Research Centre]] have reached similar conclusions.<ref name="sg-exec-summary">{{cite web |title = The Health Consequences of Involuntary Exposure to Tobacco Smoke |publisher = [[Surgeon General of the United States]] |website = Executive Summary |year = 2006 |access-date =2009-01-28 |url = http://www.surgeongeneral.gov/library/secondhandsmoke/report/executivesummary.pdf }}</ref><ref name="ecjrc">{{cite web|publisher=[[European Commission]] [[Joint Research Centre]] |title=Institute for Health and Consumer Protection Activity Report 2003 |year=2003 |url=http://ihcp.jrc.ec.europa.eu/docs/IHCP_annual_report/ihcp03.pdf |access-date=2009-01-28 |url-status=dead |archive-url=https://web.archive.org/web/20090327101821/http://ihcp.jrc.ec.europa.eu/docs/IHCP_annual_report/ihcp03.pdf |archive-date=March 27, 2009 }}</ref> The implementation guidelines for the [[WHO Framework Convention on Tobacco Control]] states that engineering approaches, such as ventilation, are ineffective and do not protect against secondhand smoke exposure.<ref name="fctc-guidelines" /> However, this does not necessarily mean that such measures are useless in reducing harm, only that they fall short of the goal of reducing exposure completely to zero.

Others have suggested a system of tradable smoking pollution permits, similar to the [[emissions trading|cap-and-trade]] pollution permits systems used by the [[United States Environmental Protection Agency]] in recent decades to curb other types of pollution.<ref>{{cite news |title = Let Bars Buy, Sell Smoking Permits |url = http://www.madison.com/archives/read.php?ref=/madison.com/html/archive_files/wsj/2005/09/25/0509240280.php |first = Robert |last = Haveman |author2 = John Mullahy |work = [[Wisconsin State Journal]] |date = September 25, 2005 |access-date = 2009-01-28 |page = B2 |url-status = dead |archive-url = https://web.archive.org/web/20090104145317/http://www.madison.com/archives/read.php?ref=%2Fmadison.com%2Fhtml%2Farchive_files%2Fwsj%2F2005%2F09%2F25%2F0509240280.php |archive-date = January 4, 2009 }}</ref> This would guarantee that a portion of bars/restaurants in a jurisdiction will be smoke-free, while leaving the decision to the market.