ABSTRACT
Abstract .................................................................................................................. 108 7.1 Introduction................................................................................................... 109 7.2 Health Consequences of ETS Exposure ...................................................... 109
7.2.1 U.S. Status Differences in Levels of ETS Exposure ....................... 110 7.2.2 International Differences in Levels of ETS Exposure..................... 110
7.3 ETS-Control Policies in the U.S. ................................................................. 111 7.3.1 Federal Policies................................................................................. 111 7.3.2 State Policies .................................................................................... 111 7.3.3 Local and Workplace Policies .......................................................... 112 7.3.4 Two Difficulties in Enacting Local ETS Policies............................ 114 7.3.5 Enforcement of U.S. Local Policies................................................. 116 7.3.6 U.S. Airport Policies......................................................................... 116 7.3.7 U.S. Hospital and Private Sector Policies........................................ 116
7.4 Effects of U.S. ETS Policies ........................................................................ 117 7.4.1 Effects on Exposure to ETS............................................................. 117 7.4.2 Effects on Smoking .......................................................................... 118
7.5 Tobacco-Control Policies around the Globe ................................................ 118 7.6 International ETS-Control Policies .............................................................. 119
7.6.1 Countries with Nationwide ETS Policies ........................................ 119 7.6.2 The Canadian Example .................................................................... 119 7.6.3 Countries with Policies that Have Regional/State Exceptions ........ 119 7.6.4 Countries Considering Nationwide ETS Policies............................ 120 7.6.5 International Airline ETS Policies ................................................... 120
7.7 Future Directions for ETS-Control Policies ................................................ 120 7.7.1 Improving and Enforcing Policies ................................................... 120 7.7.2 Achieving Equality in Policies......................................................... 121 7.7.3 Protecting Children from ETS ......................................................... 121
7.7.3.1 Public Education................................................................ 122 7.7.3.2 Encouraging Adult Smokers to Quit ................................. 122 7.7.3.3 Litigation............................................................................ 122
7.7.4 ETS Litigation as an Alternative to Policy ...................................... 123 7.7.5 WHO’s Recommendations for Future ETS Policies ....................... 123 7.7.6 One Policy Strategy: ETS Warnings on Tobacco Packages ............ 124
Acknowledgments.................................................................................................. 125 References.............................................................................................................. 125
Many countries have implemented some form of tobacco-control policy. These typically require health warnings on packages of tobacco, increase tobacco surtaxes, and prohibit tobacco sales to youth, but do little to control involuntary exposure to environmental tobacco smoke (ETS). Only 12 countries in the world have nationwide ETS policies (i.e., with no regional exceptions), and these tend to restrict smoking to a confined area (rather ban it) within enclosed spaces. Even in the U.S. where tobacco-control policies are somewhat tougher than in much of the world, only 5 states have statewide ETS policies, and only 259 (of thousands of) cities have citywide policies. Furthermore, U.S. policies tend to protect Whites, adults, and white-collar workers, leaving their Black, Latino, young, and blue-collar cohorts still exposed to high levels of ETS. Children (
≤
5 years of age) are particularly vulnerable to the deleterious effects of ETS, and their exposure is widespread and involuntary. Half of all children
≤
5 years of age in the U.S. and in the world — 700 million children — live with at least one adult smoker and are exposed to ETS each year. Hence, The World Health Organization (WHO) recently suggested adding warnings to tobacco packs regarding the dangers of exposing others (children in particular) to ETS. Given the paucity of ETS policies in the world, the inability to legislate people’s behavior in their homes, and the widespread acceptance of health warnings on packs of tobacco, we reiterate WHO’s suggestion. Adding warnings about the dangers of ETS to existing warnings on packages of tobacco is an inexpensive strategy for reducing adult and child ETS exposure in developed and developing nations alike, insofar as this strategy may circumvent the tobacco industry’s efforts to block implementation of ETS policies that curtail smoking in public places. We add to WHO’s suggestion that such future, potential ETS warning labels should be strong and rotated (like current health warnings on cigarette packs in Canada and Thailand) and should occupy at least 20% of the package (like current health warnings on cigarette packs in Poland and South Africa). Finally, efforts must be made in the U.S. to overcome ethnic, racial, and social class inequality in ETS exposure.
