Passive smoking

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Passive smoking

• Gérard Dubois, MD, MPH French Alliance Against
  Tobacco

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Discomfort caused by passive smoking

• French Health Barometer 2000
• 72 of non smokers are complaining
• 53 of smokers are also complaining
• The National Committee against Smoking was
  created in 1868 with Louis Pasteur and Alexandre
  Dumas (son) among the members !

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Discomfort from passive smoking in Europe
Sources Europe against cancer, 1993 and WHO
Europe, 1992.
smokers
discomfort
80
70
60
50
40
30
20
10
0
Ireland
Germany
Spain
Portugal
Belgium
Luxemburg
Denmark
Italy
Greece
Netherlands
UK
France
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Discomfort from passive smoking to smokersFrench
Health Barometer 2000
100
9
9,4
11,7
11,9
16,4
26,6
80
25,7
32,5
40,9
42,7
44,2
60
40,2
40
65,3
58,1
47,5
45,4
39,4
20
33,2
0
lt1 cig/day
1 to 5
6 to 10
11 to 15
16 to 20
gt 20
cig/day
cig/day
cig/day
cig/day
cig/day
Not at all
Yes, a lot
Yes, a little
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The four main hazards of passive smoking in
children
Otitis media Risk increased 21-38-48 when the
father, the mother or both are smokers.
Sudden infant death Risk x 2
Bronchitis Risk increased by 72 if the mother
is a smoker and 29 if another family member is
a smoker.
Asthma attacks Risk increased by 14, 38 et 48
when the father, the mother or both are smokers.
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Passive smoking and children2001 campaign
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The 2 main risks of passive smoking in adults
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Coronary heart disease Risk increased by 25
Lung cancer Risk increased by 26
Breast cancer Risk increased by 25
discomfort 80 for non smokers, 53 for
smokers.
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Health effect of passive smoking

• 1992 US EPA
• 1997 French Medical Academy
• 1998 European report (Sascot A., Dubois G.)
• 2001 French ministerial report
• 2002 IARC ETS carcinogenic for humans
• 2005 California EPA
• 2005 French Medical Academy
• 2005 Royal College of Physicians
• 2006 Smokefree Europe report
• 2006 Surgeon General report
• 2007 WHO WNTD report

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Tobacco industry and passive smoking

• ...what the smoker does to the non smoker this
  we see as the most dangerous development yet to
  the viability of the tobacco industry that has
  yet occurred
• the Roper Organization for the Tobacco industry
  1978

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to keep the controversy alive
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35,351
This is tobacco money
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Tobacco Control 2002,11,251
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Number of workers exposed to respiratory
carcinogens in France
177949
Wood dust
Formaldehyde
307025
Strong inorganic acid mist (sulfuric acid)
375461
410499
diesel exhaust smoke
523971
Radon
Tobacco smoke pollution (gt75 of the time)
1162464
0
200000
400000
600000
800000
1000000
1200000
1400000
CAREX European data base
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Non smoker protection (World)

• European Parliament 1997
• WHO 1999 children
• ILO 2002
• ICOH 2002
• European Commissioners 2002, 2004-2005
• WHO Framework Convention for Tobacco Control 2005

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Framework Convention on Tobacco Control

•  Parties recognize that scientific evidence
  has unequivocally established that exposure to
  tobacco smoke causes death, disease and
  disability. 
• Article 8 signed by 168 countries, entered
  into force on 27 February 2005 for the 149
  Parties (ratification before 09/2007),
  prioritized in COP meeting, Bangkok (2007)

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Non smoker protection (France)

• 1991 Evins law all covered and enclosed places
  are non smoking except
• Labor ministry (opposing strategy)
• National Education Ministry (10 years to write
  the circulaire dapplication)
• French Medical Academy 1997

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Passive smokingPoll of the French Alliance
against Tobacco

• 1008 persons 15
• 5 and 6 October 2004
• Financed by the Ministry of Health

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Q2 Personnally,are you in favor of a total
smoking ban in
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Q2 Personnally, are you in favor of a total
smoking ban in
In favor Cafés Non smokers 76 smokers
33 total 64
Restaurants 82 44 72
Discos 70 32 60
Workplaces 81 54 74
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Q3 If the following places were smokefree,would
you attend them
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• Tobacco smoke is a nuisance

• 2/3 to 3/4 of the French population is in favor
  of a total ban of smoking in cafés, restaurants,
  night clubs and work places

• Under no circumstance a lower attendance can be
  expected.

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Here a non smoker already smoked 19540 cigarettes
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Here a non smoker already smoked 27600 cigarettes
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Non smoker protection (France)

• Court of Appeal Rennes 16 March 2004
• French Alliance Against Tobacco report February
  2005
• Supreme Court (Cour de Cassation) June 2005
• French Medical Academy June 2005
• Yves Bur (Vice Chairman of the French Assembly)
  makes a proposal of law 2 November 2005
• The Health minister announces an initiative for
  soon January 2006
• 22 February NGOs meet the Health minister for
  breakfast
• 6 March appointment with the Health minister.

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Poll IFOP 24 February 2006

• 78 of the French population in favor of a total
  ban of smoking in enclosed public places
• Retired 89 15-24 ans 66
• Workplaces 78 Restaurants 74 cafés 57

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Non smoker protection (France)

• 12 April the Prime minister attempts to sweep
  away the issue, strong media reaction
• June/July Parliamentary mission on passive
  smoking
• 9 October appointment with the Prime minister we
  take note of the political decision to make a
  decree instead of a law
• Writing of the new decree

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Decree 15 November 2006

• It is forbidden to smoke
• in all collective places and workplaces,
• in public transports,
• in open places within schools and colleges and
  all buildings used for minors.

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Decree 15 November 2006

• The smoking ban does not apply in places
  dedicated to smokers
• No smoking rooms in all teaching places, places
  for sport activities, health buildings and
  governmental buildings

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Decree 15 November 2006

• Smoking rooms are
• fully enclosed,
• only dedicated to smoking,
• with no services,
• with separate ventilation (10 vol/h),
• with negative pressure,
• with an automatic closing door
• not a pathway
• lt 35 m2 or 20
• with a health warning
• forbidden to lt 16

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Decree 15 November 2006

• Smoker 68 fine
• Owner 135 fine
• implemented 1st February 2007
• 1st January 2008 for cafés, hotels, restaurants,
  discos, casinos.

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Results 21st March 2007

• Unions keep silent
• Out of medias 3rd February
• Quit line calls 69
• Smoking clinics 24
• Cessation treatments 127
• Patches 141, gums 76, Zyban 19
• Cigarette market in February 1,2

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Results 21st April 2007

• Fully nonsmoking places January 41, February
  71, March 80
• 91 in schools, 84 in hospitals
• CHRD January 25, March 44
• 34 fines occupational inspection
• 6 fines DDAS

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Results 21st April 2007

• Cessation treatments January 126, February
  38 ( 61 1st trimester)
• Cigarettes 1,2 in February, -1,5 in March
• Roll yourself tobacco 11 in March

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Personnally, are you in favor of a total smoking
ban in
INPES 4 September 2007
French Alliance 4 October 2007
In favor Cafés Non smokers 76 smokers
33 total 64
Restaurants 82 44 72
Discos 70 32 60
80
83
77
72
53
48
71
79
67
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Personnally, are you in favor of a total smoking
ban in
INPES 4 September 2007
French Alliance 4 October 2007
In favor Cafés Non smokers 76 smokers
33 total 64 increase 10 15-24
70
Restaurants 82 44 72 7 81
Discos 70 32 60 7 66
80
83
77
72
53
48
71
79
67
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Do you want to be in the active or the passive
smoking section?
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• In France, there is change in the air

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Merci
Thank you