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Smoking bans effective, but should they go further?

Extending the smoking ban outside bars could help curb “social smoking” because this goes hand in hand with drinking, according to a small qualitative study published online in Tobacco Control.1

The international evidence suggests that while the prevalence of smoking per se has decreased, social smoking – smoking intermittently or only in given situations – has increased among young adults, say the authors. 
They carried out in-depth interviews in 2011 with 13 “social smokers,” aged between 19 and 25, who were recruited through the online social network Facebook and via posters in cafes, supermarkets, and on community noticeboards.

Analysis of the transcripts showed that social smokers often had conflicted identities. They found it very difficult to reconcile their stated identity as non-smokers, who smoke.
They managed this conflict by limiting where and when they smoked and by sharply differentiating themselves from “addicted” smokers to whom, by and large, they felt superior, using several strategies.

These included claiming never to smoke alone; asserting that they controlled when, where, and how much they smoked; and defining their smoking as “a temporary phase”.

They also rationalised their behaviour by saying that it only occurred when they had been drinking, describing smoking and drinking as going “hand in hand.”  Alcohol enabled them to absolve themselves of any responsibility for their actions, which they inevitably subsequently regretted, say the authors.

One respondent commented: “Some nights I can smoke 14/15 ciggies or a pack while I’m drinking but I can never do that without alcohol.” 

When asked for their views on mandating smoke free areas outside bars, which could help decouple smoking and drinking, all but one participant strongly backed this proposal, and indicated that it would help them cut down or stop smoking.

“Introducing smoke-free outdoors bars could reduce social smoking by removing cues that stimulate this behaviour and changing the environment that facilitates it,” suggest the authors.

“Such a policy would eliminate the current intersection between smoke-free and smoking spaces and create a physical barrier that, for some, would make accessing the smoking zone too difficult,” they conclude.

Public bans also reduce home smoking habit…

Additionally, smoking bans in public/workplaces lead to less smoking at home, not more, according to a study2 of four European countries with smoke free legislation also published recently in Tobacco Control.

The authors base their findings on two waves of the International Tobacco Control Policy Evaluation Project (ITC Project) Europe Surveys.

These were carried out before and after legislation banning smoking in public places had come into force in Ireland, France, Germany and the Netherlands, and in the UK, excluding Scotland, before legislation was enacted.

The surveys, which were conducted between 2003/4 and 2008/9, depending on when bans took effect, involved 4,634 smokers in the four countries with smoke free legislation and 1,080 smokers in the UK, which served as comparison country at a time when no public/workplace smoking ban had come into force.

Before a ban came into force, most smokers had at least partial restrictions on smoking at home, although the proportions varied significantly among all four countries, with the highest levels of restrictions in Germany and France.

The presence of a young child in the household and supporting a smoking ban in bars were key factors associated with choosing to restrict smoking at home.

After legislation was enacted, the percentage of smokers who banned smoking at home increased significantly in all countries, rising by 25% in Ireland, 17% in France, 38% in Germany and 28% in the Netherlands by the time of the second survey.

This increase was irrespective of whether the public/workplace smoking ban was comprehensive or allowed for some exceptions.

Home smoking bans were more likely to be adopted when the smoker planned to quit smoking, when there was a birth of a child, and among those smokers who supported a smoking ban in bars.

In the UK, the percentage of smokers who implemented a home smoking ban also rose 22% between the two surveys, the second of which was carried out just a few months before the smoking ban came into force.

After taking account of several demographic and smoking history variables, the percentage of continuing smokers banning smoking at home increased significantly in all four countries, but did not significantly increase in the UK.

Current thinking suggests that the consequences of banning smoking in public end up either boosting the amount of smoking at home as smokers try to compensate, or encouraging smokers to apply the same restrictions at home, say the authors.

“Opponents of workplace or public smoking bans have argued that smoke-free policies—albeit intended to protect non-smokers from tobacco smoke—could lead to displacement of smoking into the home and hence even increase the second hand smoke exposure of non-smoking family members and, most importantly, children,” they continue.

In fact, the findings support the “social diffusion hypothesis”—that banning smoking in public places “may stimulate smokers to establish total smoking bans in their homes,”

they conclude.

References

1. Hoek J, Maubach N, Stevenson R, Gendall P, Edwards R. Social smokers’ management of conflicted identities. Tob Control. doi:10.1136/tobaccocontrol-2011-050176

2. Matt GE, Fortmann AL, Quintana PJE, et al. Towards smoke-free rental cars: an evaluation of voluntary smoking restrictions in California. Tob Control. doi:10.1136/tobaccocontrol-2011-050231

Published on: March 9, 2012

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