Abstract
France implemented a comprehensive smoke-free law in two phases: Phase 1 (February 2007) banned smoking in workplaces, shopping centres, airports, train stations, hospitals, and schools; Phase 2 (January 2008) banned smoking in hospitality venues (bars, restaurants, hotels, casinos, nightclubs). This paper evaluates France’s smoke-free law based on the International Tobacco Control Policy Evaluation Project in France (the ITC France Project), which conducted a cohort survey of approximately 1,500 smokers and 500 non-smokers before the implementation of the laws (Wave 1) and two waves after the implementation (Waves 2 and 3). Results show that the smoke-free law led to a very significant and near-total elimination of observed smoking in key venues such as bars (from 94–97% to 4%) and restaurants (from 60–71% to 2–3%) at Wave 2, which was sustained four years later (6–8% in bars; 1–2% in restaurants). The reduction in self-reported smoking by smoking respondents was nearly identical to the effects shown in observed smoking. Observed smoking in workplaces declined significantly after the law (from 41–48% to 18–20%), which continued to decline at Wave 3 (to 14–15%). Support for the smoke-free laws increased significantly after their implementation and continued to increase at Wave 3 (p<.001 among smokers for bars and restaurants; p<.001 among smokers and p = .003 for non-smokers for workplaces). The findings demonstrate that smoke-free policies that are implemented in ways consistent with the Guidelines for Article 8 of the WHO Framework Convention on Tobacco Control (WHO FCTC) lead to substantial and sustained reductions in indoor smoking while also leading to high levels of support by the public. Moreover, contrary to arguments by opponents of smoke-free laws, smoking in the home did not increase after the law was implemented and prevalence of smoke-free homes among smokers increased from 23.2% before the law to 37.2% 5 years after the law.
Highlights
The public health harms associated with exposure to secondhand smoke have been well documented including premature death, lung cancer, heart disease, and coronary obstructive pulmonary disease (COPD) [1,2,3,4]
Media campaigns were held in France prior to the launch of each phase of the ban to inform the public about the forthcoming policies and to provide education about the health effects associated with exposure to second-hand smoke
Ethics Statement Prospective respondents were contacted via telephone and information was provided by the interviewer using a script built into the computer assisted telephone interview (CATI) program regarding the topic of the survey, the research institutions involved; prospective respondents were informed that all responses would be confidential
Summary
The public health harms associated with exposure to secondhand smoke have been well documented including premature death, lung cancer, heart disease, and coronary obstructive pulmonary disease (COPD) [1,2,3,4]. Comprehensive smoke-free laws, if well-designed and implemented with strong enforcement measures, have been shown to greatly reduce or eliminate secondhand smoke in public venues [5,6,7,8]. Article 8 of the WHO Framework Convention on Tobacco Control (FCTC), which France ratified in 2004, obligates Parties to adopt effective measures to provide protection from exposure to second-hand smoke. Media campaigns were held in France prior to the launch of each phase of the ban to inform the public about the forthcoming policies and to provide education about the health effects associated with exposure to second-hand smoke
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