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Passive Smoking: Is it fair to share?

First Published in Le News on 6 March 2015

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Two decades ago when California first introduced a public smoking ban, it set in motion a tidal wave of social change. Since then half the US States and over a hundred countries have introduced similar anti-smoking measures. In Switzerland, the issue has now moved from the public to the private domain, as we begin to debate whether tenants have the right to smoke in their own apartments.

The communal areas of most apartment buildings were declared smoke-free about five years ago, so the present debate is about the inconvenient 'neighbourhood effects' of cigarette smoke from those who puff away on thier balconies or at an open window.

Public smoking bans have generally received immense popular support, and smoking restrictions have been truly respected - not just from time to time like the speed limit! And while obedience is not the foremost Italian trait, Italy (where smoking was once symbolic of la dolce vita) was the first European country, and Ticino was the first Swiss canton, to uphold a public smoking ban.

There are two major reasons for this seizmic shift in social emphasis. Firsty, smoke-free initiatives have widespread support because of growing health concerns. After decades of misinformation, we've learned how the toxic mix of chemicals in cigarette smoke (roughly 4,000 chemicals, including more than 200 toxins and about 70 carcinogens) annually contributes to over half a million preventable deaths worldwide. In Switzerland where it claims 25 lives a day, the social and economic burden is too heavy to ignore. Smoking kills!

Secondly, there's a growing social intolerance towards 'passive smoking' (i.e. being forced to share another person's cigarette smoke) because in addition to the health risks, it's really unpleasant for bystanders to breathe the harsh and noxious smell of second-hand tobacco smoke. Smoking stinks!

The rationale behind smoke-free legislation is that smoking is optional, whereas breathing is not. Legislation has helped improve the air quality in public places, workplaces, bars and restaurants.

Research indicates that bans have had significant public health benefits. In one such study, researchers at the Mayo Clinic analysed the effects of smoke-free laws in Olmstead County, Minnesota. By comparing data for the 18-months before the restaurant ban to the same period afterwards, they found a 33% per-capita drop of in the number of heart attacks in the county, and a 17% drop in the number of sudden cardiac deaths. They concluded that “All people should avoid secondhand smoke to the extent possible, and people with coronary heart disease should have no exposure to secondhand smoke”.

The authors of the Mayo Clinic report are amongst many specialists who believe that their data should support the continued expansion of smoke-free laws, such as to certain beaches in California, Hong Kong, Australia and France which have been designated as smoke-free areas.

Yet the counter-argument is that there should be limits to regulatory intervention, and at a given point a clear-cut health initiative can turn into a thorny debate over personal freedom. Whether tenants may smoke in their apartments appears to intrude too far into their personal sphere.

The organisation Addiction Monitoring in Switzerland has shown that a quarter of the population smokes, of which 7.4% claim to only smoke occasionally (an average of 1.3 cigarettes per day). More interesting statistics relate to the age at which most individuals begin to smoke. It turns out that 80% of male smokers are recruited before they are 16. The details reveal that fewer than 1% of boys or girls aged 11 admit to smoking , however this rises to 19.4% of boys and 15.2% of girls by the age 15.

The great political dream is that policy initiatives, including graphic warnings on cigarette packaging and advertising shock tactics will get smokers to modify their behaviour. This is indeed a dream.

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The majority of smokers would prefer not to smoke

Most smokers over 35 have already made three or four concerted quit attempts, yet sadly around 95% of all quit attemtps end in failure within 6 months. So, contrary to popular belief, individuals do not choose to smoke. In fact a Gallup poll revealed that as many as 74% would prefer not to. Equally, these 'trapped smokers' cannot be held fully responsible for their inability to break an addiction to nicotine - which has been compared to that of cocaine or heroin.

At a personal level, it's easy to empathise with the predicament of the individual smoker, faced with low odds of kicking the habit, and increasing social hostility. They must have made few teenage decisions that commited them to such an unfortunate destiny.

On the other hand, it's just as easy to sypathise with a family who are forced to endure a neighbour's toxic smoke whenever it permeates into their homes. This is even more of an issue in older homes with less effective insulation. Economists call this kind of spillover a 'negative externality' since the actions of one person inflict negative consequences on an unrelated third party.

Textbook solutions to negative externalities include lawsuits to compensate the affected party for the negative consequences; and mediation, to agree on an acceptable level of inconvenience.

A study at the University of Fribourg estimated that a single case of lung cancer has a social cost in the region of half a million francs. So it's unlikely that either a lawsuit or mediation could provide adequate financial compensation for exposure to passive smoking. Indeed, smokers are writing cheques they cannot afford to cash!

Over the past few years, a practical solution has emerged to resolve this intractible policy quagmire. Electronic cigarettes deliver the nicotine that smokers depend on, while avoiding the harmful chemicals found in tobacco smoke. And they generates negligible second hand effects.

Instead of smoke, they produce a rich vapour which resembles cigarette smoke, and gives a taste experience and throat hit that is comporable to that of a conventional cigarette. And since there is no smell or second-hand smoke, it leaves former smokers free to enjoy their pleasures without disturbing those around them - especially those who live right next door.

Despite the growing body of evidence in favour of electronic cigarettes as a fresh alternative, many regulators and medical practitioners remain circumspect. They want to see the results of long-term studies into the effects of 'vaping' before they will endorse them. Critics have likened this stance to ‘sticking with a sinking ship because the lifeboats have not been tested’.

Advocating ecig use in apartments changes the regulatory game from one of banning the use of cigarettes to one of limiting the harm inflicted on others. And while it's theoretically possible to find an acceptable trade-off for when and where your neighbours smoke, it's probably easier to encourage them to switch to ecigs and enjoy their nicotine pleasures without disturbing others - notably you and your loved ones!

And that win-win solution is truly a breath of fresh air!

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James Cullinan is the author of the new book "Flitting - A Beautiful Choice". Flitting is the latest freedom plan for smokers who want to reduce the harm of tobacco without having to break with cigarettes: It allows them to 'Keep the best and vape the rest'!

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