Evaluating Smoke-Free Policies: Andrew Hyland, PhD

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© 2007 Johns Hopkins Bloomberg School of Public Health

Evaluating Smoke-Free Policies

Andrew Hyland, PhDRoswell Park Cancer Institute

© 2007 Johns Hopkins Bloomberg School of Public Health

Section A

General Overview

Evaluating Smoke-Free Policies: Andrew Hyland, PhD

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Images source: Hyland, A.

Why Have Smoke-Free Rules?

Clean up the air

Help smokers quit

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Source: California Environmental Protection Agency. (2005).

Effects Causally Associated with SHS Exposure

Developmental effects− Fetal growth

Low birth weight, sudden infant death syndrome (SIDS),and preterm delivery

Respiratory effects− Acute lower respiratory tract infections, asthma induction,

chronic respiratory syndromes in children, eye and nasalirritation, and middle ear infections in children

Evaluating Smoke-Free Policies: Andrew Hyland, PhD

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5© 2007 Johns Hopkins Bloomberg School of Public Health

Effects Causally Associated with SHS Exposure

Carcinogenic effects− Lung cancer, nasal sinus cancer, and breast cancer

Cardiovascular and hematological effects− Heart disease, acute and chronic coronary heart disease

morbidity, and altered vascular properties

Source: California Environmental Protection Agency. (2005).

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“Each Party shall adopt and implement in areas ofexisting national jurisdiction as determined bynational law and actively promote at otherjurisdictional levels the adoption and implementationof effective legislative, executive, administrativeand/or other measures, providing for protection fromexposure to tobacco smoke in indoor workplaces,public transport, indoor public places and, asappropriate, other public places”

— World Health Organization

Source: World Health Organization. (2005).

Protection from Exposure to Tobacco Smoke

The Framework Convention on Tobacco Control (FCTC), ArticleEight: Protection from Exposure to Tobacco Smoke

Evaluating Smoke-Free Policies: Andrew Hyland, PhD

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Nations and States Are Going Smoke-Free

Ireland went smoke-free inMarch, 2004

Norway went smoke-free inJune, 2004

Scotland went smoke-free inMarch, 2006

Uruguay

Uganda

Image source: Tobacco Scam. (2003).

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Nations and States Are Going Smoke-Free

England went smoke-freeJuly, 2007

Australia (de facto)

Smoke-free Olympics, 2008

Others

Image source: Tobacco Scam. (2003).

Evaluating Smoke-Free Policies: Andrew Hyland, PhD

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What Happened in Other Places that went Smoke-Free?

Today, many places are going 100% smoke-free

Arguments against smoke-free places− SHS not harmful− Bad for business− Choice

Case studies− New York− Ireland

International Agency for Research on Cancer (IARC): Methods forEvaluating Tobacco Control Policies (see chapter in readings)

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General Overview: When Places Go Smoke-Free

Evaluation questions− Does SHS exposure decrease and health improve?− Do people comply with the rules?− Does the hospitality economy suffer?− Unintended consequences

Are smokers more likely to seek treatment services andstop smoking?

Smoke more at home?

Evaluating Smoke-Free Policies: Andrew Hyland, PhD

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Does SHS Exposure Decrease and Health Improve?

Yes− An approximate 90% reduction in SHS exposure− Reduced nicotine levels− Improved lung function− Reduced adverse symptoms in bartenders

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Do People Comply With the Rules?

Yes− Adjustment period that can take from days to months− Compliance generally high and increases over time− Lowest compliance in bars and pubs

Evaluating Smoke-Free Policies: Andrew Hyland, PhD

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Does the Hospitality Economy Suffer?

No− Twenty-one best-designed studies: zero claimed lost business

due to smoke-free laws− Fewer studies in pubs, but evidence points to the same

conclusion− Results consistent across Western countries

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Unintended Consequences

Are smokers more likely to seek treatment services and stopsmoking? smoke more at home?− Yes and no, depending on the issue

Smoke-free worksites promote cessation and a largedemand for free nicotine replacement therapy (NRT)

Pharmacy NRT sales and quit hotline calls may increase abit

No increase in smoking or drinking in the home Effect likely enhanced with greater access to services

and media promotion