Smoke-free legislation in the UK has been a success. Making enclosed public places smoke-free has proved highly popular, achieved widespread compliance, improved indoor air quality, and reduced passive smoke exposure. Most businesses, including those in the hospitality trade, have adapted successfully to the legislation. The health benefits, particularly in terms of reductions in acute cardiovascular disease, have proved substantial. With a few exceptions, of which the tobacco industry is one, smoke-free legislation has been good for just about everyone.
Smoking in vehicles is an area in which the legislation has been less successful, and where grounds for further protection of vehicle users are strong, given the high levels of exposure in vehicles containing smokers. Currently, vehicles that meet the definition of workplaces are required to be smoke-free. Enforcement of the smoke-free regulations in work vehicles by external agencies is difficult, not least because it is not always clear whether a vehicle is a workplace or not. These difficulties could easily be resolved by extending smoke-free legislation to all vehicles. External policing would then be practically feasible.
There is also scope to extend the legislation to include other outside areas where smoking is still commonplace and some degree of passive smoke exposure still occurs, such as beaches, children’s playgrounds, parks and other public areas. Extensions of smoke-free legislation into areas such as these has been pursued in other countries, and demonstrate that, with public support, smoke-free policies can be applied much more widely than is currently the case in the UK. The 2006 Health Act provides for regulations to designate additional places smoke-free which are not necessarily enclosed or substantially enclosed, but where there is significant risk that people present would be exposed to significant quantities of smoke. We suggest that this provision should be used to extend substantially the range of smoke-free outdoor public areas to prevent any passive exposure to smoke that might occur, but also, and perhaps more importantly, to prevent exposure of children and young people to smoking behaviour.
Health effects of passive smoking in children
The UK smoke-free legislation was not drafted or intended directly to protect children. However, the trends in cotinine levels described in Chapter 2 indicate that smoke-free legislation, in common with other successful tobacco control policy in the UK over recent years, has almost certainly contributed to a sustained secular decline in levels of passive exposure of children to tobacco smoke. They also demonstrate that children, particularly those who live with smokers, and those in relatively disadvantaged households, continue to experience substantial levels of exposure. Most of that exposure occurs in the home. Exposure is highest in children whose mothers smoke.
- About 2 million children currently live in a household where they are
exposed to cigarette smoke; more are exposed outside the home.
- Governments and individuals have a duty to protect children from
exposure to smoke and to smoking.
- Smoke-free legislation has been successful but should be extended much
more widely, to include public places frequented by children and young
- Smoking in cars and other vehicles should also be prohibited.
- The most effective means of protecting children from passive smoking is to
reduce the prevalence of smoking in adults, and particularly young adults.
- This will require sustained increases in the real price of tobacco, further
investment in mass media campaigns targeting smoking in younger adults,
more effective health warnings, prohibition of point of sale display,
mandatory generic standardised packaging, provision of tailored cessation
services, and a range of other policies.
- Specific measures to prevent uptake of smoking, by reducing the number
and accessibility of tobacco retailers, imposing strict penalties on those who
sell to children, and promoting peer-led and other school-based
interventions, are also required.
- It is also important to promote smoke-free homes, through mass media
campaigns, behavioural interventions and to explore new approaches such
as short-term nicotine substitution.
- There is public support for wider smoke-free policy, and a strong ethical
justification for these measures.
- Further investment in these and other comprehensive conventional tobacco
control strategies will yield significant future financial savings and health
benefits to society through prevention of passive smoking in children.