Five years of the smoking ban

FOR MANY, it seems like a distant memory, a bygone age when smokers and non-smokers sat side-by-side enjoying a drink in a Scottish pub. Now, smokers are left out in the cold – some would say in more ways than one.

The ban on smoking in public places in Scotland, now approaching its fifth anniversary, was hailed as a major step forward in the battle to improve public health. Those exposed to second-hand smoke would see their health improve, while smokers would be encouraged to kick the habit rather than find themselves out in the rain while their friends enjoyed a pint inside in the warmth.

But from the very start, fears were raised about the ban's impact on the pub industry, as well as the civil liberties of smokers themselves, who point out that tobacco is still a legal substance for which they pay billions in taxation to the government.

Five years on from its implementation on 26 March, 2006, the success or otherwise of the ban very much depends on who you ask. Research in Glasgow has suggested almost immediate health benefits. One study in 2007 concluded heart attacks among non-smokers had fallen by a fifth since the ban came in.

And last year more research found that the rate of hospitalisations for children with asthmatic symptoms had dropped by more than 18 per cent year-on-year since the ban, the assumption being smoker parents are also cutting down at home.

Jill Pell, professor of public health at Glasgow University, who was involved in the research, said: "We have seen improvements in many aspects of health, including reductions in heart disease and respiratory disease. The legislation has not only reduced exposure to tobacco smoke in public places, such as pubs, but has also resulted in an increase in voluntary restrictions in people's homes.

"As a result exposure has fallen among children too young to frequent pubs.

"Hospital admissions for asthma in children have already fallen and further benefits will be realised as children grow older and fewer develop heart disease and cancer than would otherwise have done so."

But not everyone is willing to accept such research at face value. Simon Clark, from smokers' lobby group Forest, said: "It's far too soon to draw definitive conclusions. That will take a generation at least. To suggest reduced exposure to secondhand smoke is the reason for a reduction in the number of hospital admissions for heart attacks is ridiculous.

"The number of emergency heart attack admissions had been falling for several years, even before the smoke-free legislation, so what we are seeing is part of a trend that has nothing to do with the smoking ban."

Setting aside the health debate, the smoking ban has prompted a raft of social and business changes.

Hundreds of millions of pounds have been spent renovating outdoor areas to protect smokers from the elements. Sales of patio heaters have doubled, prompting complaints from environmentalists who said they are unecological.

The smoking ban has also changed the way people socialise. Many report that they have lost count of the number of times that an interesting discussion has been curtailed because smokers disappear outside. We have also seen a rise in smoking ban relationships, people who met only because they were in a smoking shelter together. Others say the ban has increased isolation as more people drink and smoke at home.

One feared side-effect was that more smoking at home would increase the risk of children inhaling passive smoke. Amanda Amos, professor of health promotion at Edinburgh University, said: "That was one of the real concerns, that people would say: 'I can't smoke at work or in the pub, so I'll smoke at home'. In fact that wasn't the case. There may have been some, but we found that when you restrict people smoking they don't compensate and generally levels of consumption drop, so they are smoking fewer cigarettes and not smoking more in the home."

But as well as its benefits to passive smokers, many experts also believe the ban is encouraging more people to quit.

Phil Hanlon, professor of public health at Glasgow University, said the legislation had given added impetus to efforts to cut smoking. In Scotland around 25 per cent of the population smokes. "Smoking prevalence was falling and had been falling for over 20 years by about 1 per cent a year at a population level," he said. "I would say we were stuttering a bit in that trend of decline and the smoking ban gave life to it again.

"So we have continued a trend that was two decades long and given it legs again."

While those working in the public health arena would suggest nothing but positives from the smoke-free legislation, others are quick to point out that there have been losers too.

Paul Waterson, from the Scottish Licensed Trade Association, claimed as many as 1,000 pubs in Scotland have been forced to close in the past five years. While not the only factor in closures, he said the smoking ban had had a major impact on businesses.

"Before the ban came in, looking purely in business terms, we were talking about losing staff, losing pubs and business. We were told this was nonsense and our pubs would be busy with people who didn't come into pubs because they were too smoky. We were told it would be good for business. That wasn't true then and it's not true now.

"We have seen over 800 public houses closing since 2005. That figure is probably low and we would say it is nearly 1,000 in Scotland that have gone."

Waterson said as a result "hundreds if not thousands" of staff had lost their jobs, but pubs had seen no new customers.

"It has decimated the Scottish licensed trade. There are other factors which people will obviously say have contributed to that – the low prices in supermarkets being the main one and a general decline in business conditions being the other. But really the starting point for this and the most important factor has been the smoking ban."

Unsurprisingly, the Scottish Government and anti-smoking campaigners continue to highlight the benefits and defend the ban against criticism.

Public health minister Shona Robison said: "Many people who used to be put off going to pubs and clubs because of the smoky atmosphere are now able to enjoy a smoke-free night out.

"The reasons for pubs closing down are complex and include cut-price alcohol sold in supermarkets, economic conditions and changing social habits.

"The vast majority of people – including smokers – agree that the smoking ban has been a landmark change which has already saved many lives. Scots can be proud in leading the rest of the UK in bringing in a smoking ban."

Sheila Duffy, chief executive of anti-tobacco charity ASH Scotland, added: "We are now feeling real health benefits from the ban which protects workers and others from the harmful impact of second-hand smoke.

"The legislation is widely supported and it is now hard to believe that we let smoking go on so long in our public places."

So what is the next target to encourage cutting down on smoking in Scotland?

Some experts have their eye on passive smoking in the home, while others have even suggested a ban on smoking in cars carrying children.

Prof Hanlon agreed more work was needed to cut down passive smoking elsewhere, such as in the home or cars – particularly where children are exposed.

He said: "We need to try to work out how to protect children from second-hand smoke."

But Prof Hanlon said a ban on smoking in cars with children was not the direction he envisaged going in, as these were personal spaces.

"But I think what we want is a change in the social norm so you just wouldn't smoke with kids around," he added.Case Studies:

THE SMOKER

STUART Waiton, pictured top, is a lecturer in Dundee and has smoked on and off for the past 25 years and now smokes about four cigarettes and two pipes a day.

The 43-year-old said the smoking ban had changed the atmosphere in pubs, and he finds the altered attitude to smokers since the legislation "depressing".

He said: "The fact I have to go outside to have a cigarette is an irritation, but it's nothing compared to the sense of depression that there is no 'public' in Britain in terms of a public that organises its own affairs without having experts setting the agenda.

"Previously people were quite happy to sit and smoke and talk. Now you have people standing outside, so something they had been doing for 20 years without any bother is suddenly not an accepted thing – I am a danger to other people and they might see me as a danger and, therefore, I must stand outside the pub.

"That is depressing."

Waiton said after the ban it became a novelty to visit pubs in England, where smoking was allowed until July 2007.

He said: "I was suddenly in a situation where I was in a pub where I could smoke and it felt strangely liberating.

"It occurred to me to be a bizarre thing that it was accepted now in Scotland that you were, in a sense, killing people if you smoked in a bar, and yet you could go to England and kill people and no-one seemed to mind."

Waiton said what currently annoyed him most was schools teaching children to lecture their parents about the dangers of tobacco.

The father-of-two said: "My children's teachers are educating them to educate me not to smoke, which I find profoundly insidious."

He said his children had made a point of showing him a no-smoking poster they had made. "Ironically, they had spelt it incorrectly, with 'smocking' instead of smoking. I thought that was brilliant as I am always saying: if only your teachers educated you – rather than trying to socialise you to socialise me – you might actually be able to spell."

THE PUBLICAN

LYNN Adams runs two pubs in Hamilton, South Lanarkshire, and has seen her business decline since the smoking ban came in.

She said her pubs had not seen the increase in non-smokers promised by politicians when the ban was being promoted.

"My main concern about the ban is that there does not seem to be a great reduction in the number of people smoking," she said. "You can walk up the street and there are as many people out on the street smoking.

"We are trying to encourage our young people not to smoke and we are just displaying it in their faces."

Adams, who has smoked for about 30 years, said she would not encourage anyone to start. "But we are also dealing with a legal substance which is banned and I can't get my head around that."

She said the ban had also led to more litter on the street and harmed the social aspect of pub life.

"This is a community pub. You build up the atmosphere with people in and there's a buzz and they are all blethering.

"What happens now is people are in the pub, having a conversation, then they are away for a cigarette and it kills off the atmosphere."

Adams said turnover had dropped by at least 13 per cent since the ban.

"That was the start of the decline of the pub trade," she said. "You have people buying carry-outs, staying at home and having parties because they can have a drink and a cigarette without going in and out."

Though not wanting to reverse the ban, she said ventilated areas, which smokers and non-smokers could share, would be welcome.THE DOCTOR

DR GARY Hamilton finds it hard to put into words how he feels about the smoking ban.

"I don't think I can express how wonderful I think it is," the Glasgow GP said.

"Who stands to lose from it? People who are making money out of people smoking."

Dr Hamilton also said it was hard to understate the benefits of stopping smoking, which he believed more people had done since the ban came into force.

"It affects all your systems. You are evaporating a tar and putting it into your body and it just clogs things up and stops it working properly and causes cancer. It is just a totally bad thing for you."

He also pointed to evidence suggesting that illnesses linked to smoking had decreased since the ban.

But Dr Hamilton said he was still seeing patients with illnesses caused by passive smoking, most commonly husbands or wives exposed in the home.

"You might find a wife who says 'I have never smoked' and she has got a cancer and it has been through passive smoking her husband's cigarettes," he said.

Dr Hamilton said there were still smokers who would refuse to quit, no matter how often they were told about the health benefits.

But in general, he said, people did appear to be influenced by measures such as the ban on smoking in public places.

"There's evidence that links cigarettes to chronic disease, and if there is less smoking there will be less illness," he said.

"We see people giving up all the time. We see people coming in to get us to prescribe something to help them quit and, along with the chemists, we can help them. I get a great kick when someone says 'I haven't smoked for a certain length of time'."

THE QUITTER

ANNE Banks, a smoker for 36 years, finally kicked the habit shortly after the smoking ban came into force.

"When we started having the grandchildren, it wasn't so much for me I wanted to give up. It was for them," she said.

"I used to look after them quite a bit and take them out and to the beach, and I couldn't catch them as I had no breath left.

"So I said, that's it, I'll have to stop smoking."

Banks, 54, had struggled to give up her 20-a-day smoking habit previously, despite working in a cancer treatment centre in Edinburgh.

"I saw the patients coming in every day with cancer, but that never stopped me," she said.

But now Banks, who lives in Kelty, Fife, said she was more active since giving up smoking due to the help of a group support.

"I can breathe better. I feel better, and people even say I look better," she said.

She said she welcomed the smoking ban and believed it had been a good thing for Scotland.

"I think a lot of people have stopped since the ban. A lot of people I know have quit since then," she said.

"People at my work have said, 'if you can stop, I can stop' and they have all be trying and a lot have succeeded."

Banks, however, is still trying to get her husband to give up smoking. Already he is banished from the house if he wants to smoke.