Defend Smokefree

Introduction
On July 1st 2007 smoking in England's enclosed workplaces - including pubs and restaurants became illegal. Ministers at the time promised to review the law after three years. ASH has been commissioning YouGov surveys to track public attitudes to the law. In this report we analyse 5 waves of surveys. The first wave was conducted in April 2007, almost three months before the legislation came into force and the most recent wave was conducted in March 2010.1

Campaign to bring smoke back into pubs
A small number of MPs have signed an Early Day Motion (a kind of petition for MPs) to bring back smoking into England's pubs. Click here to visit the parliament website and see which MPs have signed so you can write to them and tell them what you think.

People like the smokefree law

England's smokefree law was passed at a time when public attitudes to tobacco smoke were changing fast. In March 2004 Ireland became the first country to introduce a comprehensive law for smokefree workplaces.

A month after Ireland went smokefree, a MORI poll for ASH 3 showed that there was overwhelming support for the proposition that "All employees should have the right to work in a smoke-free environment" and more than half of adults strongly supported a law similar to that brought in Ireland. When asked specifically about laws banning smoking in shopping malls, restaurants and cafes the great majority continued to support the legislation but when asked specifically about a ban on smoking in pubs and bars the margin narrowed with 49%, or just under a half, supporting the law and 38% opposing it. Opposition was strongest among smokers, younger people and those from lower socioeconomic groups.

By December 2005 support for a smokefree law had increased so much that when asked specifically if they would support a ban in pubs and bars, 66% agreed. 4 Following a vote in Parliament to make the legislation apply to almost all enclosed workplaces, support continued to grow and has grown ever since. Less than three months before the legislation was to come into force across England support had risen to 76% and in our most recent survey 80%.

More and more smokers back smokefree

Support Smokefree law by smoking status graph

Some of the greatest changes have taken place in the attitudes of smokers. Half of all smokers now support the smokefree law including almost one in four (23%) who strongly support it. Opposition among smokers (now just 38%) appears to be ebbing away with only one smoker in 6 (17%) strongly opposing the law.

This change appears to be underpinned by a deep seated shift in smokers' attitudes. Smokers are increasingly aware of the harm from secondhand smoke with 75% believing it is harmful to children's health and 70% believing it is harmful to the health of adults.

Daily smokers represent about three quarters of smokers and tend to have stronger views on tobacco policy than those who smoke but not every day but even there, significant changes are occurring. 70% of daily smokers and 85% of non-daily smokers see the law as good for the health of most workers. Importantly, increasingly they see themselves as having benefitted from the law. Half of all daily smokers and almost three quarters of non daily smokers (72%) regard the law as having been good for their own health.

Perhaps surprisingly, there is substantial support among smokers for further restrictions on smoking, 49% support a ban on smoking in children's play areas (30% oppose) and 61% support a ban on smoking in cars with children (22% oppose), In the general population 73% support a ban on smoking in children's play areas and 77% support a ban on smoking in cars carrying children.

Some exposure at work continues

Smokefree law is good for the health of most workers graph

Despite the legislation, one non smoker in eight continues to be exposed to tobacco smoke at work (12% exposed at work, 11% at home and 3% at home and at work). This is not because the existing law is being disregarded but largely because of exposure that occurs within the law. For example, almost two thirds (64%) of these workers report being exposed at the entrances to buildings and in outdoor areas where smoking is permitted. The other most common environments where secondhand smoke exposure occurs are outdoor areas where smoking is prohibited but not illegal (18%) indoor environments where smoking is allowed - such as a client's home - (15%) and private vehicles (11%). Fewer than one in ten of those exposed at work report exposure in work vehicles and other indoor areas covered by the law (9% for vehicles and 8% for indoor areas). Previous surveys have shown that most of those who continue to be exposed to secondhand smoke at work rate themselves as being much less exposed than before the legislation.

The impact on the hospitality industry

Alcohol licences issued in England and Wales

Contrary to industry predictions, there is no objective evidence that the hospitality industry overall suffered as a result of smokefree regulations. The total number of licenses issued by Local Authorities for premises to serve alcohol increased by around 5%. 5 The nature of those premises is likely to have changed with a greater concentration of bars in town centres but this is unrelated to the legislation. By contrast, the restaurant trade may have benefited substantially.

In fact, the total number of people visiting pubs has actually increased since the legislation. An Office for National Statistics survey on attitudes to smoking found that more people are going to pubs. 6 The survey, which asked "how often did you visit pubs before the smoking restrictions," found that 17% of people reported that before smokefree legislation they used to go to the pub less often than they do nowadays, while 14% reported that they used to go more frequently. In other words, the survey indicates a net increase of 3% of people going to pubs since smoking restrictions were imposed. The increase is consistent across all age groups and for both men and women.

So how do the pro-tobacco lobby come frequently to cite figures that as many as 52 pubs are closing every week. 7 A detailed exploration of the potentially misleading use of these figures for the BBC concludes shows that the change is largely a product of how the survey classifies pub. When more food is served the pub will often be de-classified as a pub and re-classified as a restaurant so although it stays open under the same management the survey may show it as having closed as a pub. The report concludes, "Pubs aren't closing, they are evolving". 8

The impact on heart attacks
Two reports published in June 2010 reported some of the measureable benefits from England's smokefree legislation. The first, published in the British Medical Journal concluded that - even allowing for a long-term trend in reduced heart attacks - the law resulted in a 2.4% drop in heart attacks in its first year. The authors calculate that this represents 1,200 fewer emergency admissions. 9 The study builds on a growing body of evidence linking the introduction of smokefree legislation with a reduction in hospital admissions for acute coronary events. It finds a smaller reduction in admissions than studies in other countries, and the authors propose two reasons for this. First, levels of exposure to other people's smoke in England were already quite low before the legislation was introduced and thus the potential for health benefits following the legislation will be lower. Second, the analysis helped eliminate other reasons for a decline in admissions including accounting for the fact that admissions for heart attacks have been reducing anyway.

The second estimates that £8.4 million has been saved in emergency hospital care for heart attacks in the same period. The estimates in the Heartsavers report by the London Health Observatory account only for reductions achieved through the immediate impact of the legislation. They do not include savings from the long term effects of reduced second hand smoking. The savings are the result of the 2.4% reduction in emergency admissions for heart attack. 10 The report shows approximate savings across England vary from around £0.4 million in the north east region to £1.4m in the south east. LHO Director, Dr Bobbie Jacobson, said "The introduction of the smoke-free legislation in England has resulted in almost 10,000 fewer bed days for emergency admissions due to heart attack. This is a fantastic outcome and is just the tip of the iceberg in terms of long term health improvements since the introduction of the smoke-free legislation in England."

1. Surveys conducted by YouGov Plc.
Wave 1: Fieldwork was undertaken between 17th and 22nd April 2007. Total sample size was 1562 adults.
Wave 2: Fieldwork was undertaken between 22nd and 28th August 2007. Total sample size was 1532 adults.
Wave 3: Fieldwork was undertaken between 20th and 25th February 2008. Total sample size was 1056 adults.
Wave 4: Fieldwork was undertaken between 25th and 30th March 2009. Total sample size was 10895 adults.
Wave 5: Fieldwork was undertaken between 17th and 22nd March 2010. Total sample size was 10276 adults.
The surveys were carried out online. The figures have been weighted and are representative of all England adults (aged 18+).

2. Neither support or oppose: 6% Tend to oppose: 8% Strongly oppose: 5% Don't know: 1%

3. Interviews conducted by MORI interviewed between 15th and 19th April, 29th April - 4th May 2004. Sample size: 4060 Adults

4. Interviews conducted by YouGov using an internet panel survey with residents in England aged 18 years and over. Fieldwork conducted 2-7 December 2005. Sample sizes: England 1,995

5. DCMS Statistical Bulletin, Alcohol, Entertainment and Late Night Refreshment Licensing, England and Wales, April 2007 - March 2008 (pdf file).

6. Smoking related behaviours and attitudes 2008/9, Department of Health, 2009

7. British Beer & Pub Association 2009

8. Mark Easton, 31 July 2009, Pubs aren't dying - they are evolving, BBC News

9. Sims M, Maxwell R, Bauld L, Gilmore A. Short term impact of smoke-free legislation in England: retrospective analysis of hospital admissions for myocardial infarction. BMJ.2010 Jun 8;340:c2161. doi: 10.1136/bmj.c2161.

10. London Public Health Observatory, June 10. 2010, Heartsavers (pdf file)