On World NO Tobacco Day the ESC urges governments to spread smoking bans & tax tobacco

A month after Spain implemented its smoking ban in January 2006, tobacco companies dropped their prices in an attempt to keep their customers smoking. The result was that Spaniards were able purchase a packet of cigarettes for just 1.85 euros, 26 percent less than before the smoking ban. It was the lowest price in years and led to debates about whether the ban was useful.

In fact, while there is always controversy before a ban is implemented; time has shown that they are extremely effective in curbing smoking, as illustrated by the tobacco companies' battle to retain their customers.

On World No Tobacco Day, the European Society of Cardiology would like to urge government officials to protect their citizens by implementing comprehensive smoking bans and imposing high taxes on tobacco products.

"One of the objectives of the ESC is to decrease the number of smokers in Europe, which will reduce the burden of cardiovascular disease," said ESC President Michal Tendera. "To accomplish this we need the cooperation of politicians who can implement legislation that protects those who do not smoke from passive smoking, and that imposes high tax on cigarettes. Smoking bans and tobacco taxes, introduced in several European countries, have proven to be extremely effective in reducing the number of smokers."

Opponents of smoking bans base their arguments on economics and personal freedom. But these arguments ignore some basic facts: Smoking is one of the most significant contributors to cardiovascular disease (CVD) and CVD costs the European Union 169 billion annually -- 230 for every man, woman and child in the EU. It took up 12 percent of all the healthcare expenditure, accounted for 126 million hospital bed days, 268.5 million working days lost and it severely hampered the daily activities of 4.4 million people one in every 100 EU citizens.

And, while smoking bans may inhibit those who smoke, they provide freedom for those who do not. Each year, thousands of people die from inhaling second-hand smoke.

Smoking bans significantly decrease exposure to smoke in the workplace. In addition, bans deter people from taking up the habit, which ultimately saves lives.

"Second-hand smoke has serious deleterious effects on health; some of these are almost immediate and can precipitate acute manifestations in cardiac patients," said Professor Guy DeBacker, chairman of the Joint European Societies Cardiovascular Prevention Committee. "It is important therefore to consider ways to minimize exposure and one very effective way is a comprehensive smoking ban. Banning smoking in the work environment -- including in the hospitality sector -- lessens exposure to second-hand smoke and ultimately saves lives."

An increase in tobacco taxes has also proven successful in stopping people from taking up the habit. When cigarette prices increase by 10 percent, smoking decreases by 4 percent. A 10 percent increase in tax also leads to a 3.4 percent increase in smoking cessation attempts among young adult smokers and can decrease the probability of smoking initiation between 3 and 10 percent.

"Smoking is an addiction disease, from which only a minority of the patients can be cured. Life expectancy for the incurable is reduced by 10 years," said ESC prevention spokesperson professor Freek Verheugt, from Radboud University Medical Centre in Nijmegen, Netherlands. "Fortunately, there are ways to minimize the number of people who begin smoking and thus decrease the number killed each year. Regular increases in tobacco tax have proven to be exceedingly successful in curbing smoking. Increasing the price of cigarettes leads to a decrease in the number of smokers. Additionally, fewer young people take up the habit. If we can stop the addiction before it begins, we can save lives."

Within 10 months of Italy's decision to ban smoking in public places, including restaurants and bars, the Italian Centre for Disease Control and Prevention reported that half a million Italians had quit and that cigarette sales had dropped by 5.7 percent. In addition, 83 percent of Italians said they continued to frequent bars and restaurants as often as before and nearly 10 percent said the smoke-free environment led them to dine out more. Half of the smokers in Ireland said the ban was more likely to help them stop smoking and 1.5 percent of smokers did quit within the first year of the ban. Ninety-three percent (including 80 percent of smokers) said they thought the ban was a good idea.

"Smoking is the biggest totally avoidable cause of death and disability known to mankind. Any support for the growth, distribution or sale of tobacco is indefensible on public health grounds," said Ian Graham, chairperson of the European Association for Cardiovascular Prevention and Rehabilitation. "The Irish experience has shown that a total ban on smoking in public places is readily achievable. It may be seen as a symbol of a culture that progressively regards any exposure to tobacco whatsoever as unacceptable and supports its citizens in avoiding or stopping smoking."

According to a soon to be released study, evidence suggests that patients with manifest coronary heart disease have a relative risk reduction of approximately 35 percent compared with continued cigarette smokers. The report, Working Group for the Tobacco Control Handbook: Reversal of Risk on Quitting Smoking, assembled by the International Agency for Research on Smoking also found that individuals without diagnosed coronary heart disease had similar relative risk reduction following smoking cessation.

In other words, it is never too late to stop smoking and prevent CVD. Save lives; spread the ban across Europe.

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Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
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