Do bans make people smoke less?

 

As Spain introduces some of Europe’s most stringent anti-smoking measures, Irish publicans and campaigners weigh in on the pros and cons of restricting tobacco use, writes RÓISÍN INGLE

WHEN, LAST YEAR, it became clear to Spanish publicans that they were going to be dragged wheezing and spluttering into a continent congested by smoke-free zones they called on their Irish counterparts for advice. This meant a day trip to Madrid for some members of the Vintners’ Federation of Ireland, including its president, Gerald Mellett. “They were looking for information about our experience . . . but all we could really tell them was that there’s not an awful lot you can do about it,” he says.

The Spanish measures, which are the country’s second attempt at a ban, are far more stringent than those introduced here in 2004, when Ireland became the first EU country to implement the policy. Since last Sunday, smoking in Spain – the fourth largest tobacco manufacturer in the EU – is outlawed not only in places such as restaurants, bars and airports but also outside schools, hospitals and in children’s playgrounds. The fines for breaking the ban range from €60 to €600,000. It remains to be seen whether the fuming Spaniards will flout the new laws, but both Irish experience and recent research suggest the extreme nature of the ban makes compliance even more likely.

A new study from the science research journal PLoS ONEhas confirmed that the greater the restrictions in a country, the lower the consumption and passive exposure to smoke. It showed that in countries such as Ireland, the UK, Malta and Sweden, where there are stricter smoking controls, the consumption was “relatively low” – as was exposure to smoke in the home and workplace.

But can the Spaniards actually expect a reduction in the number of smokers in the wake of the ban?

IRISH FIGURES VARY from survey to survey, and it’s almost impossible to work out whether we are smoking more or less than we were before the policy was introduced.

The smoking-prevalence figure mentioned in the Dáil just before Christmas and cited by organisations such as the Irish Cancer Society is from a four-year-old Slán – or Survey of Lifestyle, Attitudes and Nutrition – study. It indicated that 29 per cent of people smoke, compared with 27 per cent in the pre-ban era – which would indicate a considerable increase since the ban.

Minister of State for Health Áine Brady said this 2 per cent increase was despite measures such as the ban, the abolition of packs of fewer than 20 cigarettes, the ending of in-store displays and advertising and the cost of cigarettes – which, at €8.55 a pack, is among the highest in the world.

Even more damning are the latest Eurostat figures, which put our smoking rate at 31 per cent, a mere four percentage points away from a place in the world’s top 10 smoking nations.

Yet the Office of Tobacco Control’s figures from June 2010 – using information gathered by phone, in contrast to Slán’s face-to-face interviews – indicate that smoking is at an all-time low in this country, at just under 24 per cent.

Dr Brian Maurer of the anti-smoking organisation Ash Ireland maintains the 25 per cent smoking-prevalence figure is more accurate. “I believe that around 10 per cent of those who say they smoke do so only occasionally.”

He says he has “enormous sympathy” for smokers. “I still remember the difficulty I had giving up, 40 years ago. It was probably one of the hardest things I ever did in my life . . . I have a lot of patients and family members who smoke and can’t give up, but most of them try at least once a year. I see them as the victims of a pretty vicious addiction which has been inflicted on them by tobacco companies.”

He also says that when the smoking ban came into force here the science behind the health risks of passive smoking was “not strong” – an argument that tobacco lobbyists would have made at the time.

“There is fairly conclusive evidence now, though,” he says, pointing to a World Health Organisation study released late last year – the first study to assess the global impact of passive smoking – which stated that passive smoking kills about 600,000 people around the world each year, or about 1 per cent of all deaths. Almost a third of these were among children.

For Dr Maurer the Irish experience has been a success, not least in terms of the health benefits. “The smoking ban here resulted in a fall in the number of respiratory admissions within six months, and that increased further in the first year,” he says. “Those reduced levels have been maintained, and, in the longer term, you would expect a very significant fall in death rates from cancer and heart disease. This will take much longer to manifest, but we already know that heart attacks have halved in this country in the last 25 years, during which period the number of smokers went from 50 per cent to around 25-30 per cent.”

Dr Maurer would support even more stringent tobacco controls, mirroring those in Spain, because he believes such moves would reduce the numbers of smokers. “Anything that makes the public aware of the dangers and undesirability of smoking will encourage more people to give up.”

FROM THE PUBLICAN’S perspective, the ban has, along with the increase in availability of cheap alcohol and tougher drink-driving laws, contributed to the 1,300-strong reduction in the number of pubs around the country. The Vintners’ Federation of Ireland continues to campaign for “smoking rooms”, the kind seen in countries such as France and Holland, with little success.

“Smoking is bad – you have to put your hands up and say that. We are not looking for a change in the law,” says Mellett, formerly an 80-a-day man. “I was in a pub in Amsterdam recently, and they had an all-glass cubicle for smokers. It was a comfortable place, and we feel the way forward to implement the ban in a safe way, taking into account consequences to the hospitality business, is to have properly ventilated, comfortable smoking rooms. It’s common sense, but the vintners have had meetings with the Department of Health on this, and there isn’t a lot of appetite for the introduction of such a facility.”

He says the ban has affected pubs – “of course it has” – and has driven people back to their homes to drink cheap alcohol and smoke in their sitting rooms, “often in front of their children, something they wouldn’t be doing if their local pub provided a smoking area that protected them from the elements”.

“When you take the weather into account it’s a very different situation, certainly, to southern Spain, where people smoke outdoors anyway because of the climate. The recent snow and ice here meant there were other health-and-safety issues facing people going outside to smoke,” says Mellett.

What the Spanish can definitely expect, if the Irish experience is anything to go by, is that the smoking lobby will continue to rail against the measures long after they are introduced. John Mallon of the smoker’s-rights group Forest Éireann says the way the ban was put together was “very sneaky” and based on what he suspects is flimsy scientific evidence. He also believes the way smoking areas are assessed by the HSE needs to be scrutinised more closely. He is planning to make a documentary about the contrasts in construction found in legal smoking areas by comparing facilities in pubs across the regions.

Like the vintners, his group is pushing for “comfortable smoking rooms” where, he says, risks to staff health would be allayed by a rule that says cleaning staff cannot go into the room for an hour after the smoking has ceased. The smoking-room idea has not been incorporated into the strict Spanish measures.

“The fact is the Spanish are not going to be hit as hard as us Irish, because for the most part the climate is warm and temperate enough to sit outside and smoke,” he says. “I would like to see lovely, comfortable rooms in Irish pubs which, like the ones I’ve seen in France, would be done up in celebration of smoking and provide choice for those who wish to smoke.”