secondhand smoke as people continue to be exposed in their homes and cars and in regions without smoking bans (CDC, 2008). That was a sharp decrease from the 1988–1994 NHANES data, in which the estimate was 84%, and supported an overall downward trend in secondhand-smoke exposure in the United States.

GLOBAL TOBACCO POLICIES

In addition to the United States, many countries (or portions of countries) around the world have implemented smoking restrictions and bans. They include Canada, Italy, and Scotland, where some of the key surveillance studies reviewed by this committee were conducted.

The growing global support for reducing tobacco use and secondhand-smoke exposure is evident from the World Health Organization Framework Convention on Tobacco Control (WHO, 2005). First proposed by the World Health Organization (WHO) in 1999, the treaty was adopted by the World Health Assembly in 2003. It commits ratifying nations to “protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke by providing a framework for tobacco control measures to be implemented by the Parties at the national, regional and international levels in order to reduce continually and substantially the prevalence of tobacco use and exposure to tobacco smoke” (WHO, 2005). Article 8 of the treaty commits parties “to protect all persons from exposure to tobacco smoke.” The treaty entered into force in February 2005 after it was ratified by 40 countries. As of July 30, 2009, 168 of the 192 WHO member states are signatories, and 166 WHO member states had ratified the treaty and become parties, covering 86.24% of the world population (WHO, 2009). The 2007 WHO report Protection from Exposure to Second-hand Tobacco Smoke (WHO, 2007) recommends that member states enact, implement, and enforce laws requiring workplaces and public places to be 100% smoke-free and pursue educational programs and activities to reduce secondhand-smoke exposure in homes.

The data in Figure 5-1, from the WHO Report on the Global Tobacco Epidemic, 2008—The MPOWER Package, however, show that “only 5% of the world’s population is covered by comprehensive smoke-free laws” as defined by WHO (2008), so much work remains. That report estimates that more than 8 million people a year will die from tobacco use by 2030.

ISSUES SURROUNDING SMOKING BANS

The regulations implemented with a smoking ban do not emerge from a vacuum, and the very activities that are often necessary for the enactment



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