- Wherever they wanted, whenever they wanted
- No matter who was in the room
- On airplanes, in restaurants and hospitals and in the workplace

- Home
- Work-place

Evidence accumulated that secondhand smoke causes disease and premature death

- Smoking bans in the workplace exist in 11 US states
- → 11 states where respiratory health is being improved
- Chronic diseases are being prevented & people have the chance to live longer because they're not exposed to secondhand smoke

- Initially focused on pregnant women, their fetuses & children
- Early concerns: premature birth & death, lung cancer & increased risk of coronary heart disease
- Public health focus geared toward information campaigns tapping into parents’ concerns for the health of their children
- California was 1st US state to take issue into workplace, State provided a study lab for health outcomes of preventive health legislation
- In 1998 a research group found the California smoking ban reduced secondhand smoke exposure among bartenders
- They found that with reduced exposure to smoke, bartenders experienced decreased nasal eye and throat irritations, decreased coughing, wheezing & shortness of breath, & improvements in their pulmonary function tests
- Eight years later, similar findings were confirmed among Scottish bar workers following Scotland's prohibition of smoking in confined spaces
- March 2006, these findings coincided with lower levels of the chemical cotinine, a biological marker present in the blood after exposure to secondhand smoke
- Other studies in New York City, Ireland, Norway and New Zealand confirmed

- Indoor pollutants had long been suspected as causative agents in these adults whose acute wheezing and air constriction occurred rapidly, and at times with deadly result
- After smoking ban went into effect in Scotland, asthmatic bartenders showed even greater improvement in lung function than their non-asthmatic co-workers
- For those who had already had chronic airway disease, the ban was doubly important

- Between 1988 and 2002 as a result of changes in personal & public spaces, degree of exposure to secondhand smoke as measured by serum cotinine levels in those aged 4 and older declined by 70% in non-smokers
- Yet, 43% of our population still experiences some level of continued exposure
- For children in African-Americans the numbers are even higher

- Stress a smoke-free continuum from home to work-place to home
- Strong ongoing public health campaigns that tap into multi-generational health responsibilities
- Zero tolerance especially when it comes to bars, taverns and casinos where workers are exposed to 4 to 6 times more secondhand smoke than workers in standard settings
- Clear up some common misconceptions and old arguments that continue to slow corrective legislation
• Claim that laws restricting workplace smoking don't work is not true. Adherence levels range from 76% to 99%
•  It's been said that the general public won't support legislation to mandate smoke-free bars and restaurants. That's not true either. In fact in the US and beyond, patrons support legislation, and this support increases over time
•  It's inaccurate to think that these regulated establishments will collapse financially. Studies including bars, restaurants, and hotels show no loss of income
•  Many say smoking bans are unfair to smokers or are inconvenience or experienced no real benefit. The reality is smoking bans in the workplace result in higher rates of smoking cessation in workers who smoke, and lower cigarette consumption among those who continue to smoke. After the ban in Ireland 15% of the smokers quit immediately

- It takes time to build a body of compelling evidence and you have to keep at it
- It's useful to have confirmatory studies arising from different people & nations around the globe
- Restrictive legislation offers a unique opportunity to document health improvements & reinforce continual expansion of positive health policy
- We should keep our eyes open for surprising outcomes at the intersection of discrete populations as was the case here with adult asthmatics
- We must reinforce that positive health demands a healthy behavior continuum from home to work place to home. Such a continuum requires excellent compelling information on the one hand, & courageous and determined legislative action on the other

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