Wednesday, October 5

No more smoking on terraces and on beaches: socially it makes sense, scientifically not so much


Reduce tobacco consumption by 30% before 2025. That is the goal set by the Ministry of Health after “verifying that the fight against smoking has stalled“To do this, it is about to modify the Tobacco Law and, in view of the draft that has been leaked, the modifications will not be minor. Do they make scientific sense? Will they get us closer to the Government’s objectives?


What does the government plan to do?

The draft Comprehensive Plan for the Prevention and Control of Smoking 2021-2025 seeks expand smoke-free spaces. To the current ones (closed spaces, including hotels, urban transport and playgrounds) will be added outdoor sports facilities (from soccer fields to athletics stadiums), bar and restaurant terraces, beaches and private vehicles if minors or pregnant women travel in them.

In other words, in general terms, the plan includes reducing outdoor spaces where you can smoke, on the one hand. And, on the other, address the issue of the regulation of tobacco consumption in cars (which has been addressed in some communities, but has not yet materialized anywhere in Spain).

This is how Health intensifies the fight against tobacco: it will restrict smoking in the car, terrace and beaches

In addition to that, the Plan also contemplates an in-depth review of the taxation of these products to “achieve an increase […] of the price of all tobacco products and of the heating devices used for their consumption”. It is also proposed to create special taxes to tax “electronic cigarettes”.

Does it make sense to ban smoking in cars?

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Anton Vorobyev

The text foresees ban smoking when traveling with children or pregnant women because of their particular vulnerability. This is one of the most controversial issues in the Ministry’s Plan, and yet it is also where the scientific evidence is clearest. In fact, if carried out, Spain would join many European countries such as France, Italy, the United Kingdom, Ireland, Germany, Austria or Greece that already prohibit smoking in this type of situation.

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And it is that, as I say, In this, lThe scientific evidence is quite solid: Cars are very small spaces and are not well ventilated enough that the effects of smoking inside them are not a problem. In this matter, moreover, we do not have to resort to international data. The TackSHS project of the Institut Català d’Oncología has studied in depth the effect of this type of practice in our country.

Their conclusions indicate that staying inside a car while someone smokes exposes you to 21.4 micrograms of nicotine per cubic meter of air. In other words, one of the environments with the most levels analyzed. 15 times higher than on a semi-enclosed terrace where you are smoking.

“We have studied the burden of disease attributable to exposure to secondhand smoke and it is very high. For example, among the diseases that we know are directly related to exposure to secondhand smoke, 72% of low birth weight births and 13% of respiratory tract infections in children,” explained Dr. Esteve Fernández, director of the Tobacco Control Unit and coordinator of the TackSHS.

What about outdoor spaces?

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Although they have their own particularities, the prohibition of smoking in outdoor sports facilities, beaches and terraces of bars, cafes and restaurants have many elements in common. Among them, the fact that They are not very new measures.

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The case of sports stadiums is paradigmatic. The Basque Country, for example, has already prohibited smoking in open sports spaces since 2016 and there are stadiums (such as the Camp Nou) that already apply it autonomously. FIFA, in 2019, asked the federations to convert their facilities into smoke-free spaces. But beyond all that, the truth is that this prohibition is already active as part of the COVID measures, what Public Health wants now is expand these measures and decouple them from the pandemic to make them permanent.

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The case of the terraces is particular; as was the ban on smoking in bars and restaurants in general at the time. Not so much because of the evidence on its health effect, but because of the economic damage that could be. In fact, some communities also banned smoking in these spaces during the pandemic and have progressively withdrawn these measures at the request of hotel management.

When we go to the available scientific evidence, we see that in this type of prohibition there are more doubts. Not because “second-hand smoke” is not a problem (the AECC observatory estimates that 15% of the adult population is exposed to tobacco on a daily basis), nor because it does not constitute a health hazard (it is estimated that this type of exposure increase the risk of heart disease and chronic respiratory problems by up to 30%); there are more doubts because each space offers different risks.

Meanwhile, according to the AECC, we can find traces of tobacco consumption in more than 95% of the terraces of bars, restaurants and other hospitality establishments. This is more difficult to determine in areas such as beaches or athletic stadiums. In this sense, from Public Health it is alleged that the fundamental criterion is the “agglomeration” of smokers, non-smokers and many minors at interpersonal distances that do not guarantee the safety of the spaces.

However, this general judgment is not sustainable if these measures are not also understood as a way of continuing to hinder tobacco consumption (and, in this way, promoting its abandonment). And it is that (as also often happened with certain pandemic measures) when we discuss the real risk of certain situations and the effectiveness of certain measures, we forget that these plans are not aimed at “managing risks” but at discourage consumption whether or not it harms others.

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Image | Nico Miot

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