Abstract
Environmental Tobacco Smoke (ETS) is a major, preventable cause of morbidity and mortality, disproportionately impacting vulnerable populations. Policy measures, guided by the WHO’s Framework Convention of Tobacco Control, have focused on the broad adoption of smoke-free laws. While smoke-free policies are effective in reducing ETS exposure, limited policy dissemination and suboptimal implementation strategies have limited their impact.New research reported by Berman and colleagues in this journal brings these issues into sharper focus. Substantial advances in tobacco control policy have been achieved in Israel, including widening of smoke-free laws, since the passing of a Knesset bill in 2012. However, Berman and co-authors present found no reduction in ETS exposure in a nationally representative sample of non-smoking Israeli adults in 2016 compared with an earlier benchmark measured in 2011. In line with research from international settings, they found that ETS exposure was higher among a traditionally vulnerable subpopulation. The findings serve to remind us that the mere adoption of a policy will not translate into meaningful public health impact without applying best practice implementation strategies. Above all, this work emphasizes the continual need for new research to improve existing policies and inform new policy approaches in pursuit of an end to the harm arising from the global tobacco epidemic.
Highlights
Environmental Tobacco Smoke (ETS) is a major, preventable cause of morbidity and mortality, disproportionately impacting vulnerable populations
This finding is disappointing in light of evidence that there has been no reduction in the proportion of non-smokers exposed to ETS or the concentration of cotinine, an ETS biomarker, since 2011, when these investigators analyzed the same outcomes in an earlier Israeli cohort [13]
These perplexing findings raise the question: have hard fought tobacco policy gains, delivered via Knesset vote, produced little benefit to the health of the public? Experience has taught us that political will is predicated on public support, which is more likely to arise when policies are perceived as beneficial. Could these findings prove to be a setback in Israel’s ongoing policy efforts to curb the tobacco epidemic?
Summary
Environmental Tobacco Smoke (ETS) is a major, preventable cause of morbidity and mortality, disproportionately impacting vulnerable populations. Marked disparities in ETS exposure have been noted: in the U.S for example, Correspondence: vrees@hsph.harvard.edu Department of Social and Behavioral Sciences, Center for Global Tobacco Control, Harvard T.H. Chan School of Public Health, Kresge Building, 6th Floor, 677 Huntington Ave, Boston, MA 02115, USA These disparities underscore the need for rigorous health policy measures that protect the general population from ETS exposure, and reach the known vulnerable populations who experience a disproportionate burden of harm.
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