Smoking Bans

Smoking Bans



Smoking Bans

Smoking has over the years emerged as a considerable public health concern. Policy makers however, continue to struggle to come up with policies that are effective and permanent solutions to the problem. One of the main approaches adopted by policy makers has been that of bans on public smoking. Such an approach has however, met significant opposition from opponents who question its effectiveness when it comes to improving health outcomes. In recent years, most localities and states have enacted laws that forbid smoking in public places, arguing that such bans help protect the rights of non smokers, as well as improve public welfare and health. Despite the ongoing debate, and numerous justifications offered by the proponents of public smoking bans, there is considerable doubt that smoking bans have a positive impact on health outcomes.

Enstrom, J., & Kabat, G. (2003) Environmental tobacco smoke and tobacco related mortality ina Prospective Study of Californians, 1960-98. British Journal of Medicine 326, 1057.

Enstrom and Kabat (2003) provide sound evidence or lack thereof of the relationship between tobacco smoke and the development of either lung cancer or coronary heart disease. This study is quite important, as it provides essential scientific evidence for or against potential health impact of smoking bans. The study entailed a 39 year cohort, in which non-smoking spouses to non smokers were followed for 39 years to establish whether their exposure to tobacco smoke had any statistically significant health impact. The control study included non-smoking participants married to non-smokers, in order to provide a baseline for comparison. The findings were that the adjusted risk for those married to ever smokers compared to those married to never smokers was 0.75 for lung cancer, 0.94 for coronary heart disease and 1.27 for COPD (chronic obstructive pulmonary disease). These findings according to the researchers did not support the existence of a causal relationship between tobacco smoke and mortality or illness, although they do raise the possibility of the existence of a much weaker relationship than originally thought. The lack of a relationship between tobacco smoke and disease for secondary smokers raises considerable questions over the need for smoking bans, let alone the existence of any meaningful impact on health.

Lambert, T. (2006). The Case Against Smoking Bans. Retrieved from

Lambert (2006) provides alternative arguments to what he claims are the three main arguments used by smoking ban advocates. He outlines that smoking ban advocates argue that they rectify a market failure, act to discourage future smoking by shaping individual preferences, as well as reduce the health risk otherwise associated with environmental tobacco smoke (ETS). He however disagrees with the negative externality argument, averring that instead, individuals, or patrons who are forced to bear the costs of smoking pollution, have already been compensated for the potential pollution taking place within their establishment. According to Lambert, outdoor air is common property, while indoor air on the other hand, is private. When it comes to the question of shaping individual preferences regarding smoking, Lambert posits that the argument is fallacious, because despite having the requisite knowledge of the negative effects smoking, individuals still continue to take up smoking every day. It is therefore, highly unlikely that such individuals are going to change their preferences simply because they are not allowed to smoke in public, more so when a threat to their very wellbeing could not. Lastly and perhaps most importantly, Lambert cites the disgraced EPA study of 1992, which was found to have been fictitious by a congressional inquiry, as one of the main reasons for the enactment of legislation imposing sweeping smoking bans. He therefore, argues that the exact effect of ETS is still not quite clear, and the imposition of smoking bans are an overreaction. Further weight is added to Lambert’s claims, by his citation of the cohort study by James Enstrom and Geoffrey Kabat above, whose findings were that there was no increased risk of cancer amongst non smoking spouses to smokers.

Shetty, K., DeLeire, T., White, C., & Bhattacharya, J. (2009). Changes in U.S Hospitalizationand Mortality Rates Following Smoking Bans.

Shetty et al (2009) carry out a nationwide assessment of the effects that recent smoking bans have had on the rates of hospitalization and mortality in the United States. The assessment is done by reviewing nationally representative databases in order to compare the existence of any short-term changes in the hospitalization and mortality rates within the areas in which smoking restrictions were enforced. The findings indicated no statistically significant short term declines in the hospital admissions and mortality rates, especially for myocardial infarction (MI). In fact, an analysis by the researchers, which entailed a simulation involving subsamples, indicated that the significant short term increases in MI following bans within the work place, were as common as the large decreases in incidences reported in some published media, implying selective sampling in studies indicating otherwise. The authors conclude that whereas smoking bans may not really have any significant health effects, publication bias has led to the misleading notion that they do.

Ong, M., & Glantz, S., (2004). Cardiovascular Health and Economic Effects of Smoke-FreeWorkplaces. American Journal of Medicine 117(1), 32-38.

Ong and Glantz (2004) in an attempt to highlight the health and economic effects that having a smoke-free workplace national policy could have on indoor workers, attempted to simulate based on previous findings using a Monte-Carlo simulation as a form of sensitivity analysis. The findings were projections that the first year effect of such a policy would be the production of 1.3 million new quitters, the prevention of approximately 350 strokes and 1500 myocardial infarctions. When in a steady state, the estimations climbed to a whooping 1270 strokes and 6250 myocardial infarctions, with the reductions in passive smoking accounting for a significant 60% of these results. In conclusion, the simulation by Ong and Glantz, implied that smoking bans would be of great benefit health-wise to the general population.

Metzger, K., Mostashari, F., & Kerker, B. (2005). Use of pharmacy data to evaluate smokingregulations’ impact on sales of nicotine replacement therapies in New York City.American Journal of Public Health 95(6), 1050-1055.

The authors through their exploration of the effect that increments in taxes could have on the smoking population, hence reducing smoking, provide a window into the potential effects that regulations have on smoking behavior. The authors found that indeed increments in taxes led to an increase in the purchase of NRTs (nicotine replacement therapy). This led to the conclusion that it was possible to affect smoking behavior through regulations. Such a finding portends well for the potential effect of smoking bans on smoking behavior, and by extension on health. However, the finding that the behavior change was only observed in low income areas however dents such hopes, as it exposes the possibility of smokers modifying their behavior in order to cope with the bans, hence rendering them immaterial. For instance, the smokers could simply establish private lounges for smokers.

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