The International Agency for Research on Cancer (IARC) has announced
that the implementation of smoke-free policies in many Western
countries has reduced the prevalence of smoking and had subsequent
health benefits [1]. Furthermore, such smoking bans have not had
adverse financial effects on the bar and restaurant industry, it
says.

Dr John Pierce (University of California, San Diego) and Dr Maria
Leon (IARC, Lyon, France) have prepared a special report on the
subject, published in the July 2008 issue of Lancet Oncology. Leon
told heartwire that the latest handbook from IARC is currently being
prepared and is the first one to focus on assessing the effects of
smoke-free policies; previous handbooks have concentrated on tobacco
control.

"We show that comprehensive smoke-free laws significantly reduce
exposure to secondhand smoke, which has been associated with
undesirable health outcomes," she said. Studies of the effects of
smoke-free policies consistently show that passive smoking is
reduced by 80% to 90% in high-exposure settings. In turn, this has
had health benefits in terms of a reduction in heart-disease
morbidity, a reduction in respiratory symptoms, and an expected
decline in lung cancer, she noted.

Handbook to be Published in February 2009

Leon said the handbook being prepared will be published in February
2009 and will consist of nine chapters dedicated to specific
subjects, seven of which will present results from scientific
studies "and, based on that evidence, certain conclusions have been
made."

The chapters will focus on: the effects of smoking bans on smoking
behavior; exposure to secondhand smoke; effects of smoking bans on
business; effects of voluntary implementation of smoke-free homes;
and the health outcomes of these changes, among other things.

"Studies suggest that smoke-free workplace policies are followed by
a 10% to 20% decrease in hospital admissions for acute coronary
events in the first year after implementation [of a smoking ban],"
say Pierce and Leon. "There is strong evidence suggesting that the
introduction of a smoke-free legislation decreases heart-disease
morbidity," they add.

Smoking bans also benefit employees in the hospitality industry,
with "sufficient evidence that the introduction of smoke-free
policies decreases respiratory symptoms in workers,' they note.

And although cancer cases are expected to drop also, it will take
some time for this to register, say the scientists.

"In view of the long lag time between secondhand smoke exposure and
the development of lung cancer, data are not yet available regarding
the expected decline in lung cancer after implementation of smoke-
free policies," they note.

Tobacco Industry Tries to Impede Smoke-Free Policies

Leon told heartwire that one chapter in the book is also dedicated
to the role of the tobacco industry in trying to impede the
introduction of smoke-free policies. "They have done this by, for
example, casting doubts on the adverse health effects associated
with exposure to secondhand smoke," she explained.

Also, cigarette firms will often try to promote alternatives to
total smoking bans, she notes, suggesting environments that allow
both smoking and smoke-free areas or encouraging other solutions to
smoking, such as ventilation, rather than outright bans.

The researchers conclude that most of the research to date has been
done in high-resource countries, but the challenge now is to expand
smoke-free policies to low-resource and medium-resource nations.

Leon believes the tide is starting to turn: "Around 150 countries
worldwide have signed the WHO's Framework on Tobacco, which makes
reference to smoke-free legislation. Now there is a momentum, and
countries want to emulate the good that is happening in our places,"
she concludes.

Pierce JP and Leon ME, on behalf of the IARC Handbook Volume 13
Working Group and IARC Secretariat. Special report: policy.
Effectiveness of smoke-free policies. Lancet Oncol 2008; 9:614-615.