Running head: PUBLIC SMOKING BAN

Public Smoking Ban

Maureen A. Hammond, Sarah McNair, Andrea Montgomery, and Alice Rhodes

Ferris State University

Public Smoking 2

Abstract

Second-hand smoke (SHS) is an important health concern in today’s society. Annually, 38,000

non-smokers die from exposure to SHS, and many of the exposed are children or non-smoking

bar and restaurant patrons. To protect their citizens, many countries around the world have

adopted bans on smoking in public areas. In the United States, Michigan is one of only fifteen

states that have not adopted such a bill, although legislation has been in the works since 2000.

While those opposing such a smoking ban do have some valid arguments, we as public health

nurses believe such a ban would be a positive change, helping to protect the health of Michigan’s

citizens now and in the future.

 Public Smoking Ban

Most people agree that one of the government’s most important duties is to protect it’s

constituents. Because smoking in public places harms everyone, we as a group believe smoking

in public places should be banned. This policy position paper examines what the professional

literature says about secondhand smoke (SHS) and the consequences if a public smoking ban in

Michigan is not adopted.

Hazards of Smoking

According to The American Cancer Society, each year about 443, 000 people in the

United States die from illnesses related to cigarette smoking. Smoking tobacco causes more

deaths each year in the United States than any other preventable cause of disease and death, and

kills more people each year than alcohol, AIDS, car crashes, illegal drugs, murders and suicides

combined (Wilson, Duncan, Nicholson, 2004). The American Cancer Society also reported in

1982 that “cigarette smoking is the major single cause of cancer mortality in the United States”

and unfortunately, this statement still stands true today. However, there is reason to be hopeful:

in 2007 the number of smokers was down 1% from the previous year, and “adult tobacco user

prevalence is now under 20% for the first time since tobacco use rates began to fall during the

mid 1960s” (American Cancer Society 2008).

Hazards of Second Hand Smoke

The year 1986 was a turning point in the understanding of the hazards of SHS. The

National Research Council and the Surgeon General issued reports outlining the detrimental

health effects of SHS (Eriksen, LeMaistre, & Newell, 1998). The Annual Review of Public
Public Smoking 4

Health defines SHS as a combination of the “sidestream smoke that is emitted from the burning

tip of a cigarette and mainstream smoke which is the inhaled, filtered, and exhaled by the

smoker” (Eriksen et al., p. 48). According to the Centers for Disease Control (2006), SHS

contains about 3800 chemicals, of which 250 are toxic and 50 are known carcinogens. SHS

contains high concentrations of ammonia, formaldehyde, benzene, carbon monoxide and nicotine

(Eriksen et al., p. 48). Tobacco has been estimated to have caused the deaths of over 14 million

people since 1964. Giovino (2007) notes that annually among smokers there are approximately

3,000 deaths due to lung cancer and 35,000 deaths due to cardiovascular disease.

In 1992, the California Environmental Protection Agency issued a report regarding the

exposure to SHS and those who were most at risk. This report was first published in the Journal

of American Medicine in 1993, and then again in 1998. This report outlined specifically who

was at risk from SHS and which diseases presented most prominently within those populations.

Their final caveat within this report stated that there was “no evidence of a threshold of exposure

below which exposure is safe” (Davis, 1998, p. 1947). Children exposed to SHS often present

with higher incidences of asthma, pneumonia, allergies, bronchitis, and middle ear disease.

These diseases are thought to present in children exposed to SHS possibly due to the immaturity

of children’s respiratory systems. The California EPA also estimated that between 1,900 and

2,700 children died annually of sudden infant death syndrome due to exposure of SHS (Davis,

1998). Long term, it has also been found that children run a 50% increased cancer risk in homes

where the father smoked (Eriksen et al., 1998).

Smoking Bans
 As reported in a study by Johnsson, Tuomi, Rituttala, Hyvarinen, Rothberg, & Reijula

(2007), it was “estimated that 617 employed people in the UK die owing to passive smoking

each year, including 54 worker deaths in the hospitality industry each year.” Because of the

dangers of secondhand smoke, many countries throughout the world have passed bans on public

smoking, including Ireland, Italy, New Zealand, Iran, South Africa and Finland. Attempts to ban

smoking in the United States have been left up to the individual states and counties, making a

ban on smoking a very patchwork concept. Maurer and Smith, (p. 418, 2005) discuss national

policy and health promotion, stating:

Health promotion is a social project, not solely a medical enterprise. Societies have a

political responsibility to strengthen the link between health and social well-being. An

integration of government, major interest groups, and community forces is needed to

establish and maintain public policy and community action that promotes the health of

individuals, families, and communities in society.

Even though smoking ban legislation has been in the works since 2000, Michigan is one

of only fifteen states currently without a smoking ban (Chase, 2009). On December 19, 2008,

Michigan’s proposed smoking ban, which included a ban in bars and other public establishments,

was struck down. Another proposed ban is already in the works. The current house bill, bill

number 4099, was introduced January 22, 2009. Section 12606 of this bill state that the

employer must adopt, implement, publish, maintain, and modify practices to reflect any changes

in a written non-smoking policy, and after three weeks of implementation the policy must be

disseminated to all current employees and new employees. The bill also states that health

department will be in to inspect the establishments and those who do not abide by the law will be

fined. Although this is only one bill, two bans would actually be needed due to Michigan’s health
Public Smoking 6

code, which categorizes bars and restaurants as having distinctive safety regulations from other

work places (Michigan Smoking Bans Information, 2006). Given Michigan’s poor economy and

the fear of losing revenue brought in by tobacco sales, legislators are doubtful as to whether the

current bill will pass or not. There is a possibility that a smoking ban may be listed as a proposal

on the 2010 ballot.

Legislative obligation

Article 4, section 5 of the Constitution of Michigan, adopted in 1963, states, “The public

health and general welfare of the people of the state are hereby declared to be matters of primary

concern. The legislature shall pass suitable laws for the protection and promotion of the public

health” (Legislative Council, State of Michigan, 2008). This portion of the state constitution

reiterates the state government’s responsibility to enact laws which benefit the health of the

people of Michigan.

Our text, (Maurer & Smith, p.421, 2005) also discusses the importance of nurses’

utilization of the health-belief model which promotes health protecting behaviors, defined as

“those that protect people from problems that jeopardize their health and well-being.” Within the

Healthy People 2010 objectives, established by the United States Department of Health and

Human Services (USDHHS), seventeen pertain to reducing illness, disability, and death due to

tobacco use (Eriksen & Chaloupka, 2007). Five of these seventeen objectives address SHS

directly.

Consequences of Inaction

What would be the consequences of keeping the status quo in Michigan in regards to

SHS? In 2005, the Society of Actuaries analyzed the annual nationwide cost of exposure to SHS,
and reported “increases in morbidity in direct medical costs to be around $5 billion, with $5

billion in indirect costs” (Eriksen & Chaloupka, 2007, p. 372). The United States Department of

Health and Human Services estimates that use of tobacco has caused more than 14 million

premature deaths since 1964 (Giovino, 2007, p. S318). Given our aging population in Michigan,

the astronomical rise in health care costs over the last twenty-five years, can we afford not to

implement a public ban on smoking?

Opposition

Of course, not everyone believes a smoking ban in Michigan would be a positive thing.

Those opposing the ban believe smokers do have the right to smoke and the smoking restrictions

currently in place are more than adequate. Smokers already are made to sit in designated

smoking areas in most public facilities, and those bothered by the smoke have the choice to

either sit in the non-smoking section or not frequent the establishment. Most outdoor smoking

areas are also out of the way enough to not bother those wishing to avoid second-hand smoke

and do little to infringe on the rights of the non-smoker. Furthermore, it could be argued that

workers may be less productive if not allowed to smoke on their breaks. Cigarettes are often used

to help de-stress, and denying an individual of his right to smoke may lead to a more stressed and

unproductive workforce. Employers should allow employees to smoke on breaks in a designated

smoking area, just as non-smokers are able to do what they please on their breaks from work

(Bradley, 2007).

Banning smoking in public areas may also deal a fatal blow to Michigan’s already

hurting economy. In their free time, many people choose to congregate at restaurants and bars. If
Public Smoking 8

patrons are not allowed to smoke at these restaurants and bars, they may choose to eat or drink at

home, which would further hurt the economy. It should be up to the patrons and restaurant

owners to decide if smoking is acceptable to them or not. As Thomas Lambart (2006) argues, “If

he [the owner] permits overly dirty indoor air, he’ll tend to lose business unless he somehow

compensates aggrieved patrons with lower prices and/or more attractive products.” If customers

are satisfied with the way things are, why do we need to change them? And if someone is

bothered by the secondhand smoke in a restaurant or bar, they always have the choice of not

eating or drinking there.

Proponents of the smoking ban also argue that second hand smoke affects the health of

public workers. However, according to Lambart (2006), “A vast body of empirical evidence

demonstrates that employers must routinely pay [a] sort of risk/inconvenience premium to their

workers.” And again, the workers, many of whom may be smokers themselves, choose to work

in an environment that exposes them to secondhand smoke. If they were bothered by it, they

could find a job that does not expose them to the risks SHS entails.

Finally, the ban on smoking in public places may have “the perverse effect of enticing

young people to smoke” (Lambart, 2006). If smoking is further restricted, it may become that

much more rebellious- and therefore that much more “cool”- to take up the habit. However, even

if a young person does decide to smoke, it should be his decision entirely. One of the great things

about America is that we have the freedom to choose what we think is best for us. A smoking

ban in Michigan would restrict the rights of smokers and could potentially hurt our already

suffering economy.
Public Health Nurses’ View

As future Public Health Nurses, we favor a ban on smoking in public places. Nurses are

in strategic positions to influence community health awareness of health risks involved with

second hand smoke (SHS). The aggregates in our target population would be our clients or

patients at risk for exposure to SHS. As public health nurses, our strategy would be to provide

people with information about the hazards of SHS and assist them with modifying the origins of

the problem. Health education and promotion will be our primary intervention to pass this policy.

The publics’ knowledge of the risks of SHS needs to be improved, as many people do not realize

the hazards of SHS. If a professional health care provider does not alert the general public of the

risk associated with smoking and SHS then many people will fail to understand the dangers

involved. I once had a patient that thought it was perfectly fine that he smoked. He stated, “My

doctor knows I smoke and he doesn’t say anything about it, so I know it’s OK”. It is simply our

duty as public health nurses to educate our community.

In the past, the ban on smoking has not passed. As nurses’ we must heighten the

community’s awareness of the hazards of SHS so that it does pass in the future. Despite

popular support and incontrovertible benefits, the legislature has not acted on the bills for the

past nine years, with the reasons being voter apathy and industry lobbying. (Michigan Smoking

Bans Information. 2006). As public health nurses’ we need to form partnerships and establish

support from local businesses, health networks, schools, hospitals, news media and politicians.

By forming these partnerships, we can develop, adopt, and identify funding sources for public-

education campaigns. As public health nurses we need to identify and publicize possible

incentives for businesses to become involved. We must teach not only the general public but
Public Smoking 10

our politicians that SHS creates toxins and carcinogens which put employees, children, and the

general public at risk for preventable health problems. As community health nurses’ we must

advocate and promote legislation that provides the funding and resources needed to ban

smoking in public places. Prevention is the key to this epidemic and as public health nurses we

need to educate and promote a ban on SHS.

Conclusion

In conclusion, we favor the proposed ban on smoking in Michigan. Although the

opposition does have some valid concerns, we believe the benefits of the ban would far

outweigh any potential negatives. As nurses, we feel we have a responsibility to promote the

health of our citizens. Because SHS affects everyone, including those who choose not to smoke,

we feel a ban would be beneficial for every Michigan citizen.

References
American Cancer Society. (2008). Retrieved February 20, 2009, from

http://www.cancer.org/docroot/NWS/content/NWS_1_1x_Smoking_Rate_Declines_For_

the......
Bradley, C. (2007, April 4). Why ban smoking in public? Arguments against. Associated

Content. Retrieved from http://www.associatedcontent.com/article/189344/

why_ban_smoking_in_public_arguments.html? cat=9

CDC, (2006). Smoking & Tobacco Use [Fact sheet]. Retrieved from

http://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke.

Chase, B. S. (2009, January 6, 2009). Smoking Ban Faces Further Delay. Michigan Daily.

Retrieved from http://www.michigandaily.com/content/2009-01-07/smoking-ban-faces-

further-delay.

Davis, R. M. (1998). Exposure to Environmental Tobacco Smoke: Identifying and Protecting

Those at Risk. Journal of the American Medical Association, 280(22), 1947-1949.

doi:10.1001/jama.280.22.1947.

Eriksen, M. P., LeMaistre, C. A., & Newell, G. R. (1998). Health hazards of Passive Smoking.

Annual Review of Public health, 9 47-70. doi: 0163-7525/88/0510-0047.

Eriksen, M., & Chaloupka, F. (2007). The Economic Impact of Clean Indoor Air Laws. CA; A

Cancer Journal for Clinicians, 57 367-378. doi:doi:10.3322/CA.57.6.367.

Giovino, G. A. (2007). The Tobacco Epidemic in the United States. American Journal of

Preventative Medicine, 33 S318-S326. Retrieved February 8, 2009

doi:10.1016/j.amepre.2007.09.008.
Public Smoking 12

Johnsson, T., Tuomi, T., Riuttala, H., Hyvarinen, M., Rothberg, M., & Reijula, K. (2006).

Environmental tobacco smoke in Finnish restaurants and bars before and after smoking

restrictions were introduced. [Electronic Version]. Oxford University Press 15, 331-341.

Lambert, T.A. (2006, October 23). Against Restaurant Smoking Bans. The Washington Post.

Retrieved from http://www.washingtonpost.com/wp-dyn/content/article/2006/10/19/

AR2006101901275.html

Legislative Council, State of Michigan (2008). State Constitution of Michigan of1963. Retrieved

2/10/2009, from www.legilature.mi.gov.

Maurer, F. A., & Smith, C. M. (2005). Community Public Health Nursing Practice: Health for

Families and Populations (3rd ed.). St. Louis, Mo.: Elsevier Saunders.

Michigan Smoking Bans Information. (2006). Lansing Journal (April 11, 2006). Retrieved from

http;//www.somacon.com/p441.php.

Wilson, R., Duncan, D., Nicholson, T. (2004). Public attitudes toward smoking bans in tobacco-

producing county. [Electronic Version]. Southern Medical Journal. 97, 645-650