Within15yearsfollowingthegeneralbanontobaccoadvertisingthathasexistedin Norwaysince1975,therewasadeclineinthenumberofadolescentsmokersof5–10,
dependingonagegroupandsex,withtotalsmokingprevalencereductionsof10among 16–24-year-oldmenand20amongwomenofthesameage
[96,97] .Smokingpreva-
lencealsofellamongolderpeoplewithin15years,withiguresof35formenand32 forwomenbeingreportedin1995
[98] .Overall,per-capitatobaccoconsumptionfellfrom
2,100to1,553gduringtheperiodfrom1975to1996Fig. 13.9
[99]
. InFinland,thebanwasimplementedintwophasesin1977and1994:inthesecond
considerablymorestringentphase,cigaretteadvertisementswerealsoprohibitedinfor- eignmagazines,whichareextremelypopularinFinland.Thegreatestdeclineinsmoking
prevalence was recorded among men [100]
. During the period 1978–1996, per-capita tobaccoconsumptionfellfrom2,134to1,350gFig.
13.9
[99,101] .
TheadvertisingbanintroducedinNewZealandin1990resultedinareductioninper- capitatobaccoconsumptionfrom1,957to1,553g1990vs.1996.Overthesameperiod,
thenumberofadolescentsmokersfellby1.9 [99]
. InFrance,abanontobaccoadvertisinghasbeeninplacesince1993.Within4years,
per-capitatobaccoconsumptionfellfrom2,970to1,834g;despitethisfall,noreduction insmokinghasbeenreportedamong12–18-yearoldsTable
13.3
[99] .
Country Introductionof
advertisingban Referenceyear
forevaluation Reductioninconsumptionamong
adolescentsby1996;inGermany by1993
Norway 1.7.1975
1975 −15.8boys;−15.4girls
Finland 1.3.1978
19781979 −12boys;−14girls
NewZealand 17.12.1990
1990 −2.1
France 1.1.1993
1992 Germany
– 1993
−5.4
Table 13.3
ReductioninpercentageofadolescentswhosmokedailyinivecountriesinGermany, thereferenceindexshownisthepercentageofadolescentswhosmokeregularly
[35]
Fig. 13.9
Meanper-capita consumptionoftobaccoin
eightdifferentcountries Canada,USA,Norway,
Finland,Sweden,Austria, France,Germany[D]during
theperiod1964–1990 adaptedfrom
[114]
13.8 Smoking Bans in Public Buildings and Public Spaces
Therangeofpreventivemeasuresshouldincludegovernmentregulationsenforcingsmoking bansinpublicbuildings,suchashealthcentres,workplaces,schools,academicinstitutions,
waiting rooms, restaurants, businesses and on public transport. Alongside general bans, partialbansmayalsobeannouncedusingappropriatesignage.Peoplewishingtosmokecan
bereferredtospecialareas,apartialsolutionthathasbeenemployedintheUSA,forexam- ple.Thesenon-smokingpoliciescanbesupportedbyhealtheducationcampaigns
[102, 103]
.Comparableregulationsdifferverymarkedlyfromcountrytocountry.IntheUSA, AustraliaandthecountriesofNorthernEurope,changeshavetakenplaceasaresultof
legislationandgeneralattitudestowardssmoking.Inothercountries,theregulationsare considerablymoremoderate
[104–107] .
Themosteffectivemeansofachievingasmokingbaninpublicbuildingsistoissuean absolutedecisiononthematter,accompaniedbyeducationalprogrammes,dissemination
ofinformation,managertrainingandprovisiontohelpsmokersachievesmokingcessation [102,103]
.TwostudiesinBaltimorehospitalshaveconvincinglyconirmedtheeficacy ofthisapproach.Thesemodelshavebeensuccessfullycontinuedinvarioushealthinstitu-
tionsintheUSA [108]
,andinstructionsforsimilarcampaignsarenowavailableonthe Internet
[108] .Inprojectsofthisnature,itiscrucialthattheorganisation’smanagement
takesresponsibilityandtalkswiththoseaffectedbythebantoprovideeducationandinfor- mation.Ithasalsobeenfoundthatonlycomprehensivemeasuresaresuccessfulinthe
workplace [60,109]
.Standsdisplaying“Nosmoking”signsinpublicareasareminimally successful.Similarly,discussionswithsmokersabouttheharmfuleffectsoftobaccouse
onhealthwerelesssuccessfulthanface-to-facedialoguesessionsbetweensmokersand non-smokers. According to some studies, successful “No smoking” campaigns in the
workplacehaveactuallypersuadedsmokerstoquit [110,111]
.Inthiscontext,itisevi- dentlyimportant,particularlyinGermany,toissueappealstothemedicalprofessionto
ensurethatthereisirstareductioninthehighproportionofdoctorswhosmokeapproxi- mately20.Onepossibilityistoestablish“smoke-free”hospitals,anapproachthatis
nowalsobeingattemptedinGermanye.g.the“BerlinHeartCentre”. Theimplementationof“Nosmoking”lawsisonlyusefulifsuchlegislationissup-
portedbydetailedregulationsonenforcement [104,106]
.InFrance,forexample,theban onsmokinginrestaurantsandotherpublicbuildingsislargelyignored.
Itremainstobeestablishedwhethersmokingbansinpublicbuildingswillbringabout behaviouralchangeattheindividuallevel.Charitableorganisationsandanti-smokingassocia-
tionsmustcertainlystrivetoachievegradualbehaviouralchangeacrossthewholeofsociety, andtheenforcementofexistingregulationsisanimportantchallengethatmustbesolved.
Areductioninsmokingamongadolescentswasreportedfollowingaconcertedcam- paigncombiningrestrictionsonsmokingathomewithstrictbansinpublicplacesandat
school.Thestudy,whichwasconductedamong17,287studentsfrom200schoolsover30 days,concludedthatteenagesmokingwasreducedchielythroughrestrictionsonsmoking
athomeandinpublicplaces,andtoalesserextent,inschools,andthenonlyifthebanwas stronglyenforcedTable
13.4
[112] .
13.9 Concluding Remarks
A survey of the facts and data presented by the tobacco industry and necessarily
•
supplementedbygovernmentagenciestoensureatruepicturerevealsthatthenumber ofadolescentsmokerscanbereducedonlybytoughinternationallegislation
[113] to
regulateavarietyofissues:manufacture,tradeincludingcigarettesmuggling,adver- tisinganddistributionoftobaccoproductsandpromotionalitems,especiallytoyoung
people. Inparticular,theinternationalcommunityanditspoliticiansmustensurethateconomi-
•
callyweakcountriesdonotbecomeatargetfortheactivitiesofthetobaccoindustry. Everysingleday,3,000adolescentsintheUSAarerecruitedtotheranksofsmokers.If
•
thenumberofsmokersisnotreducedintheyearsahead,thelamentablefactisthat10 millionpeopleannuallywilldiefromtobacco-attributablecausesworldwidebythe
year2025. Themedicalprofessionandpoliticiansmustnotstandidlyandwatchthistrendunfold.
•
References
1.YachD,BettcherD2000Globalisationoftobaccoindustryinluenceandnewglobalresponses. TobControl92:206–216
2.PhilipMorris1997,Aug23TabakherstellersprichtvondenGefahrendesRauchens.Frankf AllgZ[195],1.1997
3.Anonym1999BittekaufenSieunserProduktnichtWelt 4.HausteinKO1999Smoking:healthcareandpoliticsinlux.Rauchen:Gesundheitswesen
undPolitikimWechselspiel.ZArztlFortbildQualitatssich93:355–361 5.MacKayJ,CroftonJ1996Tobaccoandthedevelopingworld.In:DollR,CroftonJeds
Tobaccoandhealth.RoyalSocietyofMedicine,London,pp206–221 6.MurrayC,LopezA1996Theglobalburdenofdisease:acomprehensiveassessmentofmor-
talityanddisabilityfromdisease,injuries,andriskfactorsin1990andprojectedto2020. HarvardUniversity,Boston
Table 13.4
Logistic regression analysis for association of restrictions with 30-day smoking prevalence
[112] Oddsratio95CI
pvalue Publicrestrictions
0.910.83–0.99 0.03
Totalhomeban 0.790.67–0.91
0.001 Somehomerestrictions
0.850.74–0.95 0.01
Schoolban 0.990.85–1.13
0.86 Enforcedschoolban
0.860.77–0.94 0.001
2logL=16271.0,df=16,intraclustercorrelation=0.038,clustervariance=0.131,p0.0001.Odds ratiosareadjustedforschoolgrade,sex,race,adultsmokersinhomeandsiblingsmokers;n=14746