Smoking Bans: Benefits, Challenges, and Recommendations - Research Paper Example

 Smoking Bans: Benefits, Challenges, and Recommendations Abstract Why should smoking be banned and how can a comprehensive smoking ban be effective in changing smoking behaviors? These questions are significant to the health and welfare of society and the productivity and marketing of organizations. Direct and secondhand smoke produces various health problems, such as heart attack, stroke, lung cancer, throat cancer, acute myocardial infarction (AMI), and emphysema, among others. The paper reports research findings on the benefits and challenges of smoking bans. It also presents recommendations for designing and implementing a successful comprehensive smoking ban. Organizations that comprehensively ban smoking can attain the benefits of less hospital admissions for its employees, lower fire hazards, and better air quality, because smoking rooms and areas are futile in protecting non-smokers from secondhand smoke. These effects can impact employee morale, productivity, and performance. In addition, a comprehensive smoking ban can be more effective, if it includes research, education, and advertising components. It can also become a differentiation strategy. Smoking Bans: Benefits, Challenges, and Recommendations for Implementation Smoking causes an estimate of 6 million deaths every year because it is responsible for numerous health problems, such as heart attack, stroke, lung cancer, throat cancer, acute myocardial infarction (AMI), and emphysema, among others (Buonanno and Ranzani 192). Secondhand smoke further causes adverse health effects, such as asthma and respiratory infections in children, and cancer, coronary heart disease, and stroke in adults (Herman and Walsh 491). Even low doses of secondhand smoke can increase the risks of respiratory infections and coronary heart diseases (Juster et al. 2035). The accumulation of scientific evidence that prove that smoking can cause illnesses and death has forced many international organizations and countries to implement smoking control policies, including comprehensive smoking bans and smoking bans in public places (Buonanno and Ranzani 192). Public smoking bans, however, have not always resulted to widespread changes in smoking attitudes and behaviors (Buonanno and Ranzani 192). Why should smoking be banned and how can a comprehensive smoking ban be effective in changing smoking behaviors? These questions are important to the health and welfare of society and the productivity and marketing of organizations. Organizations that comprehensively ban smoking can experience the benefits of less hospital admissions for its employees, lower fire hazards, and better air quality for all users of its buildings, because smoking rooms and areas are ineffective in protecting non-smokers from secondhand smoke. However, a comprehensive smoking ban can be more effective, if it includes research, education, and advertising components. Including the smoking ban as part of the differentiation strategy for employees, customers, and the government can also improve the success of comprehensive smoking bans. Organizations that apply a comprehensive smoking ban can reap the benefits of better health for its employees, which results to higher productivity, performance, and cost-savings. A comprehensive smoking ban means that the organization applies a smoke-free law in all its premises, and even around it, without exceptions (Centers for Disease Control and Prevention (CDC)). This means that comprehensive smoking bans do away with smoking places or smoking rooms. A comprehensive smoking ban has a direct effect on the health of employees and building users, both for smokers and secondhand smokers. Harlan R. Juster et al. of the New York State Department of Health determined if the comprehensive smoking ban in New York, which was implemented in 2003, decreased hospital admissions for acute myocardial infarction and stroke. The controlled the effects for moderate, local, and statewide smoking restrictions and secular trends. They also analyzed monthly hospital admissions at county levels for AMI and stroke from 1995 to 2004. They learned that, in 2004, hospital admissions dropped by 3,813 instances for AMI and that the state saved $56 million due to lower hospital admissions (Juster et al., 2037). Stroke admissions did not show significant reduction, however (Juster et al., 2037). The study concluded that comprehensive smoking bans have direct health and financial benefits for the people and the government. The strength of the study from Juster et al. is its control of mediating factors, while its weaknesses are lack of individual-level data and not being able to capture smoking prevalence rates. This study considered that other social and individual variables may account for lower hospital admissions. Their control measures increased the validity of their findings. The study’s weaknesses, however, are not being able to consider individual-level data that can provide alternative causal explanations and not determining smoking prevalence rates because they can also provide additional proof that the smoking ban in itself directly controlled smoking behaviors (Juster et al., 2037). Another study examined the effects of smoking bans on population health for more smoking-related health problems. Doctors Patricia M. Herman and Michele E. Walsh, who both work for the Evaluation, Research and Development Unit, Department of Psychology at University of Arizona, Tucson, studied the effect of Arizona’s May 2007 comprehensive statewide smoking ban on hospital admissions for those diagnosed with AMI, angina, stroke, and asthma. They compared monthly hospital admissions from January 2004 to May 2008 for the mentioned main secondhand smoke (SHS) diagnoses and four diagnoses that are not related to SHS, which are appendicitis, kidney stones, acute cholecystitis, and ulcers, for Arizona counties with smoking bans and no smoking bans. Herman and Walsh also estimated the smoking ban’s effect on cost savings. Their sampling included 87 hospitals. Their findings showed that smoking bans caused a marked decrease in hospital admissions for AMI, angina, stroke, and asthma compared to counties with smoking bans and that the estimated cost savings is $16.8 million (Herman and Walsh 494). The control factor of non-SHS diagnoses showed no difference in hospital admissions, which showed that the smoking ban directly affected SHS-related illnesses (Herman and Walsh 494). The study from Herman and Walsh has the strength of a well-designed causality model. They used Hill’s causality guidelines to measure the causal relationship between the smoking ban and hospital admissions. These guidelines are the following: (1) there was a decrease in admissions after the comprehensive smoking ban (temporality), (2) the reduction showed significant statistical effect (strength), (3) the drop in admissions in the counties with no past smoking bans in place was bigger when compared to counties with former smoking bans (dose–response), and (4) the decrease in health conditions was applied to SHS exposure and provided adequate or suggestive proof of causal relationship (Herman and Walsh 492). These guidelines can provide valid evidence that the smoking ban itself, and not any other factors, caused lower hospital admissions. The weaknesses of the study are its observational nature and external validity. The study did not conduct a scientific way of measuring the physiological effects of lower exposure to smoking due to smoking bans. It also did not have individual-level measures of sicknesses that were reduced, due to lower smoking prevalence in communities. It relied on hospital admissions and diagnoses to understand a causative relationship between smoking bans and SHS-based diseases. In addition, the study focused on Arizona alone. The setting may have other particular characteristics that mediate the effects on lower hospital admissions for AMI, angina, stroke, and asthma. These studies, though observational, show that a comprehensive smoking ban can cause lower hospital admissions and this effect can cause positive changes on productivity and performance, as well as cost savings for companies too. If people are not getting sick and hospitalized due to direct smoking or SHS, they are more capable of working. Absences and late attendance from smoking-related diseases will be reduced. At the same time, a comprehensive smoking ban has shown positive effects on employee wellbeing (Holm and Davis). Employees appreciate that they are working in a safe and healthy work environments (Holm and Davis). In addition, cost savings are real benefits for the company. They are also spending on their employees if they get hospitalized through lost revenues and other financial effects of these negative health effects. Comprehensive smoking bans yield positive effects on performance, productivity, and cost savings. Aside from these connections between a comprehensive smoking ban and several organizational benefits, a smoking ban can also reduce fire hazards. One of the reasons why the aviation industry advocated for smoking ban inside airlines is because of the fire in an airliner bathroom waste bin that resulted to an airplane crash, which killed 124 people (Holm and Davis i31). The safety of employees, customers, and visitors are at stake when smoking continues in and around buildings. Smoking increases fire hazards because not all smokers properly dispose their cigarette butts. Smoking can burn buildings and kill and injure employees and other building users. These fires will not only cost the company potential litigations because of charges of carelessness, but more importantly, loss of precious human lives and properties. Apart from the reduction of fire hazards, a comprehensive smoking ban will result to better air quality for all users of its buildings, because indoor smoking rooms and smoking areas are ineffective in protecting non-smokers from secondhand smoke. The history of the aviation industry’s advocacy against smoking in airlines depicts the importance of total smoking ban on human health and comfort. Holm and Davis, who work for the Center for Health Promotion and Disease Prevention in Detroit, Michigan, narrated the events that took place, before smoking is fully banned in many airlines and during flights. They noted that, during the late 1960s and early 1970s, when consumers and airline employees were actively advocating for a smoking ban, the Federal Aviation Administration (FAA) did not favorably respond to them. When advocates went to the Civil Aeronautics Board (CAB), CAB issued a rule in providing smoking sections for smokers and separate non-smoking sections for non-smokers (Holm and Davis i31). The advocates complained that smoking sections leaked smoke into non-smoking sections, which made the whole ruling meaningless (Holm and Davis i31). Having separate smoking rooms did not separate smoking and non-smoking air, precisely because air diffuses easily across these areas (Holm and Davis i31). Other studies proved that smoking rooms, especially indoors ones, are ineffective in stopping the toxic substances of smoke from reaching non-smokers (Lee et al.; Pion and Givel). Lee et al. evaluated air quality inside and outside a total of four smoking rooms in a regional commercial airport. They measured particulate matter, assessed the operation of ventilating systems for these smoking rooms, and counted people and smokers. Their findings showed that, though few smokers smoke at several instances inside these smoking rooms, average particulate matter less than 2.5-mm (PM2.5) concentrations were higher in these settings than the National Ambient Air Quality Standard for 24 hours (35 mg/3) (Lee et al. 667). See Table 1. Table 1 shows that the ranges of PM2.5 are still high outside these rooms: the toxic substances in smoke continue to harm nonsmokers. At the same time, these fine particles from secondhand smoke leaked outside, despite properly working ventilation systems (Lee et al. 667). The strengths of the study are its empirical data-collection method for measuring particulate matter from smoking and consideration of spillover of SHS, while its weakness are that it did not measure the impact of these particulate matter on the hospital admission of smokers and non-smokers and small sampling. This study, nonetheless, empirically measured the reality that smoking areas are ineffective in containing toxic substances. Source: Lee et al. (666) Another study proved that SHS contaminated air outside smoking rooms. Pion and Givel from the Department of Political Science of the University of Oklahoma studied SHS contamination of outside air of several smoking rooms in Lambert Airport from 1997 to 1998 and again in 2002. They also compared the results to a relatively smoke-free Seattle-Tacoma International Airport (Sea-Tac Airport). They monitored nicotine levels in particular for their study. Findings showed that nicotine vapor migrated outside smoking rooms because its levels were much higher outside than in non-smoking airports. The strengths of the study are its comparison with a control group that increases the validity of its results and longitudinal study, while the weaknesses are its small sampling and lack of measurement of direct health effects for secondhand smokers in the concerned airport. Though these studies have weaknesses, they do not deny the common-sense understanding that smoking rooms do not work. Non-smokers know that separate smoking rooms/areas are not working because they can smell tobacco smoke seeping out from these rooms/areas, not to mention, the smell of smoke that come from smokers exiting these rooms. Both Pion and Givel and Lee et al. recommended a comprehensive smoking ban in airports because it is the only effective way of ensuring the eradication of SHS’s negative health effects. A comprehensive smoking ban more than public smoking ban can expand the effects on smokers and reduce effects on revenues. Paolo Buonanno and Marco Ranzani from the Department of Economics of the University of Bergamo at Bergamo, Italy studied individual reaction to a public smoking ban in Italy. They conducted a survey that involved 50,474 households and 128,040 individuals. Findings showed that the propensity of being a smoker dropped by 1.3%, while daily cigarette consumption dropped by 0.3 cigarettes each day, which is equal to 8% of their consumption (Buonanno and Ranzani 198). If public smoking ban can reduce cigarette consumption by 8%, a comprehensive smoking ban may yield higher results. A comprehensive smoking ban can make it easier to stop smoking, since it is not allowed anywhere. A total smoking ban, in particular, will not result to smokers preferring places which allow smoking, such as what Gregory T. Bradley and Cherylynn Becker learned from their study. They determined that when a voluntary smoking ban is applied to a single casino resort while other resorts continue to promote smoking, some smokers will transfer to these smoking casinos. A comprehensive smoking ban across the state, or at the minimum, across a specific industry, will reduce smoking customer flight. Besides understanding the advantages of comprehensive smoking ban compared to public smoking ban, a comprehensive smoking ban can be more effective if it includes an educational and advertising component. Education and reminders are important to an effective smoking ban. Doctor Kari Jo Harris and peers from the School of Public and Community Health Sciences of the College of Health Professions and Biomedical Sciences at the University of Montana, Missoula, Montana studied the effects of a smoking ban enforcement package on compliance. They used 39 observers to measure compliance. The enforcement package included the following: (1)…moving cigarette receptacles outside the 25-foot smoke-free zone, (2) specifying the smoke-free zone with prominent ground markings, (3) adding signs about the outdoor smoking ban, and (4) distributing positive reinforcement cards to compliant smokers and reminder cards to noncompliant smokers. (Harris et al. 122). The positive reinforcement cards thank smokers for compliance and offer free drinks at the student union building (Harris et al. 122). The reminder cards informed smokers of the smoking ban and students’ support for the policy (Harris et al. 122). They learned that compliance was highest during the intervention week at 74% but dropped at 54% during the follow-up session. 54% was still higher, nevertheless, compared to the 33% baseline compliance (Harris et al. 124). This study showed that education and incentives promote compliance with smoking bans. Other scholars noted that education about health effects increases compliance. Valentina Mele and Amelia Compagni studied the success of Italy’s smoking ban. They learned that it came from emphasizing the positive effects of not smoking on secondhand smokers and smokers and the organization of implementation factors. Ryan Phelps investigated the empirical effects of a smoking ban and learned that having an education component is essential to its success. Smoking ban policies must be accompanied by convincing education components and reminders to help change smoking behaviors (Harris et al.; Mele and Compagni; Phelps). Finally, organizations can also note that including the smoking ban as part of the differentiation strategy for employees, customers, and the government can improve the success of smoking bans. Bradley and Becker discussed the role of a smoking ban as a differentiation strategy for companies who are in industries where they have customers and employees as smokers. Organizations can differentiate their companies if they focus on the health and cost savings of smoking bans. They should also be able to handle resistance from smokers, since they also have smokers’ organizations, which represent the belief that smokers have a right to smoking (Holm and Davis i33). Organizations must empathize with smokers who are already addicted to smoking and who firmly believe that smoking does not harm them and non-smokers. Harris et al. showed that smoking bans must have educational and monitoring components to help change smoking habits. Smokers do not even have to be punished because this can increase resistance. Instead, emotional and logical appeals to their sentiments can improve smoking ban compliance. If cigarette advertising is effective in increasing or inducing smoking (Braverman and Aarø), smoking-ban advertisement and education can have a similar behavioral effect. Organizations only have to study the motivations of smokers to offer incentives that can help them appreciate smoking bans and, ultimately, in the long run, change smoking attitudes and practices. They can tap government health agencies in conducting research that will examine smoking motivations and determine proper intervention programs with compliance monitoring measures. A comprehensive smoking ban may seem impossible, especially in public areas where smokers frequently smoke. However, the paper proves that it must be implemented because of its health, morale, safety, and financial benefits, and that it must be comprehensively applied to ensure greater coverage and compliance. A comprehensive smoking ban can also be a differentiation strategy to promote its concern for their employees’ and customers’ welfare. Moreover, resistance to smoking bans and low compliance can be handled through proper education, advertisement, and research components. A comprehensive smoking ban saves lives and money and organizations should implement and advocate for them across industries and states. Works Cited Bradley, Gregory T., and Cherylynn Becker. “Consumer Attitudes and Visit Intentions Relative to a Voluntary Smoking Ban in a Single Casino Resort with a Dense Competitive Set.” Academy of Health Care Management Journal 7.2 (2011): 41-56. Print. Braverman, Marc T., and Leif Edvard Aarø. “Adolescent Smoking and Exposure to Tobacco Marketing Under a Tobacco Advertising Ban: Findings from 2 Norwegian National Sample.” American Journal of Public Health 94.7 (2004): 1230-1238. Print. Buonanno, Paolo, and Marco Ranzani. “Thank You for Not Smoking: Evidence from the Italian Smoking Ban.” Health Policy 109.2 (2013): 192-199. DOI: 10.1016/j.healthpol.2012.10.009. Print. Centers for Disease Control and Prevention. (CDC). “Comprehensive Smoke-Free Laws — 50 Largest U.S. Cities, 2000 and 2012.” Morbidity and Mortality Weekly Report (MMWR) 61.45 (16 Nov. 2012): 914-917. Web. 29 Apr. 2015. Harris, Kari Jo, Stearns, Julee N., Kovach, Rachel G., and Solomon W. Harrar. “Enforcing an Outdoor Smoking Ban on a College Campus: Effects of a Multicomponent Approach.” Journal of American College Health 58.2 (2009): 121-126. Print. Herman, Patricia M., and Michele E. Walsh. “Hospital Admissions for Acute Myocardial Infarction, Angina, Stroke, and Asthma after Implementation of Arizona's Comprehensive Statewide Smoking Ban.” American Journal of Public Health 101.3 (2011): 491-496. DOI: 10.2105/AJPH.2009.179572. Print. Holm, A.L., and R. M. Davis. “Clearing the Airways: Advocacy and Regulation for Smokefree Airlines.” Tobacco Control 13.1 (2004): i30–i36. DOI: 10.1136/tc.2003.005686. Web. 29 Apr. 2015. 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Pion, M., and M.S. Givel. “Airport Smoking Rooms Don’t Work.” Tobacco Control 13.1 (2004): i37–i40. DOI: 10.1136/tc.2003.005447. Web. 29 Apr. 2015. Read More