A new article published in The Lancet Oncology claims that the recent smoke-free policy initiatives have resulted in numerous public health gains. The special report from the International Agency for Cancer Research (IARC) reveals that the policies have been instrumental in reducing heart disease related to smoke exposure, diminishing the number of adults who smoke, and curbing second-hand smoke exposure to adults and children. In addition, the report finds – to the benefit of the main critics of the policies – that there is no noticeable decrease in restaurant and bar business activity due to these policies. It is too early to say whether or not the policies have led to a reduction in lung cancer, but the study believes it to be a likely outcome after they process the required data.
The lead writers of the report, Dr John Pierce (University of California, San Diego, CA, USA) and Dr María León (IARC’s Tobacco and Cancer Team), collaborated with a Working Group of world scientists and researchers from the IARC secretariat to prepare the Special Report. The group analyzed smoke-free policies in several jurisdictions and then placed into three categories 11 causal statements about the policies. The three classifications were:
- Sufficient evidence – the association was judged to be causal
- Strong evidence – the association is consistent but there is not enough evidence to mark as causal
- Insufficient data – the researchers lacked the necessary data to come to a conclusion
Placement into these three categories was guided by a comprehensive assessment of peer-reviewed published work as well as governmental reports on the effects of smoke-free policies.
The following statements were classified as having sufficient evidence to make a causal statement:
- Smoke-free policies decrease second-hand smoke exposure
- Smoke-free workplaces decrease the number of cigarettes that existing smokers consume
- Smoke-free policies do not harm the business activity of the restaurant and bar industry
- Smoke-free policies decrease respiratory problems in workers
- Voluntary smoke-free policies in the home reduce children’s second hand smoke-exposure
- Smoke-free home policies decrease adult smoking
The following statements were classified as having strong evidence:
- Smoke-free workplaces decrease the number of adults who smoke
- Smoke-free policies decrease youth tobacco consumption
- Smoke-free legislation decreases death due to heart disease
- Smoke-free policies in the home reduce smoking in youths
Since it takes 20 years or more to diagnose lung cancer after carcinogenic exposure, the researchers maintain that, “Data are not yet available regarding the expected decline in lung cancer after implementation of smoke-free policies.”
The authors argue that the evidence found in this and other studies suggests that governments should implement smoke-free policies that are in line with the WHO Framework Convention on Tobacco Control (FCTC). They conclude: “Implementation of such policies can have a broader population effect of increasing smoke-free environments. Not only do these policies achieve their aim of protecting the health of non-smokers by decreasing exposure to second-hand smoke, they also have many effects on smoking behaviour, which compound the expected health benefits. These benefits will be greater if these policies are enacted as part of a comprehensive tobacco-control strategy that implements all of the provisions called for by the WHO-FCTC.” The researchers also call for policy assessments to be conducted in low- and medium-resource countries, not just high-resource countries.
Effectiveness of smoke-free policies
John P Pierce and María E León, on behalf of the International Agency for Cancer Research (IARC) Handbook
The Lancet Oncology (2008). 9(7): pp. 614-615.
DOI:10.1016/S1470-2045(08)70167-0
Written by: Peter M Crosta