Smoke Free Hospitality presentation at a Tobacco Free Cities Program Meeting in Beijing, China in March 2013.

1. Smoke Free Hospitality
Tobacco Free Cities Program Meeting
Beijing, China
March 2013
Michael Eriksen, ScD and Carrie Whitney, MPH
Institute of Public Health
Georgia State University

2. Clean indoor air laws make a
difference…
Clean indoor air laws impact the hospitality industry
in terms of:
1) Economics
2) Employee Health
3) Public Health
Bill Gates and Baidu CEO Robin Li wear
shirts reading “Say no to forced smoking”

3. “Forced smoking” kills people…
• 600,000 deaths annually from secondhand
smoke exposure (mostly women and children)
• More women die in China from exposure to
second hand smoke than die from smoking
themselves

4. “Forced smoking” occurs in
China and around the world…
• 40% of children and 33% of
nonsmoking adults are exposed
to secondhand smoke globally
• Over 50% of the people in the Western Pacific
region are exposed to secondhand smoke
(highest rate in the world)
• 47% of youth in China are exposed to
secondhand smoke in their home

5. Smoke free laws are a win-win-
situation…
Experience demonstrates that clean indoor air laws:
• “protect nonsmokers from involuntary exposure to secondhand
smoke
• contribute to a reduction in overall cigarette consumption
• protect hospitality workers from adverse respiratory conditions
• are well accepted by the general public” (Eriksen, 2007)
(Callinan, 2010)

6. Smoke free hospitality does not
cost anything…
• Economic research shows that
smoke free restaurant
ordinances do not negatively
impact restaurant sales
(Glantz, 1994)
• Restaurants and bars operating
in smoke free ordinances sell
for higher prices than those
that are not, indicating smoke
free restaurants/bars have
higher profits (Alamar, 2004;
2007)

7. Smoke free hospitality protects
employee health…
• Scientific review of literature from 2000-2010 finds
that smoke free legislation reduces SHS exposure,
respiratory and sensory symptoms, and heart attacks
from SHS, and smokers are more likely to quit (Hahn,
2010)
• Health outcomes vary by subpopulation
• Policies are effective only if implemented properly
• Studies show significantly lower cotinine levels in
hospitality workers who work in a smoke free venue
compared to one where smoking is allowed
(Lawhorn, 2013)

8. Smoke free legislation protects
hospitality workers - the research…
• New York, USA: statewide smoking ban for restaurants, bars and
bowling facilities (Farrelly et al., 2005)
• 3 months post ban: exposure to SHS as measured by self report and
saliva cotinine decreased
• 12 months post ban: SHS exposure continued to decline
• Minnesota, USA: statewide smoke free policy covering indoor public
places and workplaces (Liu et al., 2012)
• Nonsmoking patrons and bar/restaurant workers are at an increased
risk for lung cancer death, ischemic heart disease and asthma due to
SHS
• Calculated lifetime excessive risk for U.S. servers in bars/restaurants
that allow smoking:
• 214 lung cancer deaths
• 3,001 ischemic heart disease deaths
• 1,420 new asthma cases each year in the U.S. among bar/restaurant
workers that are exposed to SHS

9. Smoke free hospitality protects
public health…
• Risk of developing heart disease for nonsmokers exposed
to SHS at home or work increases by 25–30% (U.S.
Surgeon General’s Report, 2006)
• U.S. studies show that smoke free laws for indoor
workplaces and public places are associated with “rapid,
sizeable reductions in hospitalizations for acute
myocardial infarction” (CDC, 2008)
• Two years after comprehensive smoke free legislation
went into effect in Uruguay, hospitalization for acute
myocardial infarctions decreased by 22% (Sebrie´ et al.,
2012)
• Smoke free legislation results in lower risks of smoking-
related cardiac, cerebrovascular and respiratory diseases
• Benefit increases based on the strength of the law (Tan and
Glantz, 2012)

10. Strong support for smoke free
hospitality…
• Diners prefer to eat out in restaurants with smoke free policies
• The 2008 Zagat Survey of 132,000 Americans found that 77% of
diners would eat out less if smoking were permitted in local
restaurants (Zagat, 2008)

11. Dangerous exposure to
secondhand smoke in China…
Indoor air particles measured among 404 restaurants and bars in five
cities (Beijing, Xi’an, Wuhan, Kunming and Guiyang) (Liu et al., 2011a)
• 23 venues with complete smoking bans, 9 partial bans, 313
permitted smoking
• Smoking observed in 77% of all venues surveyed
• Secondhand smoke exposure was
significantly higher among venues
allowing smoking

12. Support for smoke free
hospitality in China…
Sample of 814 restaurants and bars in five Chinese cities (Beijing,
Xi’an, Wuhan, Kunming and Guiyang) found (Liu, 2011b):
• 86% of nonsmoking subjects were exposed to at least a day of SHS
at work each week
• 51% knew SHS could cause heart disease
• 17% supported prohibiting smoking in restaurants ; 11% supported
prohibiting smoking in bars
• 53% of subjects were willing to prohibit/restrict smoking in their
venues
• 82% of those unwilling to restrict smoking thought smoking bans
would reduce revenue
• 63% unwilling to restrict smoking thought indoor air quality depended
on ventilation rather than bans
Study indicates support for smoking bans among Chinese
restaurant and bar owners and highlights knowledge gaps

13. Smoke free laws as the wave of
the future…
• As of January 2013, 84 nations have enacted a 100% smoke free
law, and 57 of the 84 laws include both restaurants and bars
(American Nonsmokers’ Rights Foundation, 2013)
• Article 8 of the FCTC calls for ratifying parties to implement clean
indoor air laws to protect citizens from SHS exposure in indoor
workplaces and public places (WHO, 2003)

14. Michael Eriksen
Dean, Institute of Public Health
Georgia State University
meriksen@gsu.edu
Carrie Whitney, MPH
Research Specialist, Tobacco Control
cwhitney8@gsu.edu
Additional information available at:
TobaccoAtlas.org
TobaccoPortal.org

15. References and Resources
• Alamar B and Glantz S. 2004. Smoke free ordinances increase restaurant profit and value. Contemporary
Economic Policy, 22(4): 520–525.
• Alamar B and Glantz S. 2007. Effect of Smoke-Free Laws on Bar Value and Profits. American Journal of
Public Health, 97(8): 1400–1402.
• American Nonsmokers’ Rights Foundation. 2013. Smokefree Status of Workplaces and Hospitality Venues
around the World. http://www.no-smoke.org/pdf/internationalbarsandrestaurants.pdf.
• Callinan J, Clarke A, Doherty K, Kelleher C. 2010. Legislative smoking bans for reducing secondhand smoke
exposure, smoking prevalence and tobacco consumption. Cochrane Database of Systematic Reviews,
4(CD005992). DOI: 10.1002/14651858.CD005992.pub2.
• CDC. 2008. Reduced Hospitalizations for Acute Myocardial Infarction After Implementation of a Smoke-
Free Ordinance --- City of Pueblo, Colorado, 2002—2006, MMWR 57(51&52);1373-1377.
• Eriksen M and Chaloupka F. 2007. The economic impact of clean indoor air laws. CA: A Cancer Journal for
Clinicians, 57:367–378.
• Eriksen M, Mackay J, Ross H. The Tobacco Atlas. Fourth Ed. Atlanta, GA: American Cancer Society; New
York, NY: World Lung Foundation; 2012.
• Farrelly M, et al. 2005. Changes in hospitality workers’ exposure to secondhand smoke following the
implementation of New York’s smokefree law. Tobacco Control, 14:236–241.
• Glantz S and Smith L. 1994. The effect of ordinances requiring smoke-free restaurants on restaurants.
American Journal of Public Health, 84(7):1081-1085.
• Hahn E. 2010. Smokefree Legislation: A Review of Health and Economic Outcomes Research. American
Journal of Preventive Medicine, 39(6S1):S66 –S76.
• Lawhorn N, et al. 2013. Workplace exposure to secondhand smoke among non-smoking hospitality
employees. Nicotine Tobacco Research, 15(2):413-8.

16. References and Resources
Continued
• Liu R, et al. 2011a. A cross-sectional study on levels of secondhand smoke in restaurants and bars in
five cities in China. Tobacco Control, 20:397e402. doi:10.1136/tc.2009.033233.
• Liu R, et al. 2011b. Restaurant and bar owners' exposure to secondhand smoke and attitudes
regarding smoking bans in five Chinese cities, Int J Environ Res Public Health. 8(5):1520-33.
• Liu R, Bohac DL, Gundel LA, et al. 2012. Tobacco Control, Published Online First.
doi:10.1136/tobaccocontrol-2012-050831.
• Sebrie´ E, et al. 2012. Hospital admissions for acute myocardial infarction before and after
implementation of a comprehensive smoke-free policy in Uruguay. Tobacco Control,
doi:10.1136/tobaccocontrol-2011-050134.
• Tan C and Glantz S. 2012. Association Between Smoke-Free Legislation and Hospitalizations for
Cardiac, Cerebrovascular, and Respiratory Diseases : A Meta-Analysis, Circulation 126:2177-2183.
• U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure
to Tobacco Smoke: A Report of the Surgeon General. Atlanta: U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion,
National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health,
2006 .
• World Health Organization. 2003. WHO Framework Convention on Tobacco Control.
http://www.who.int/tobacco/framework/WHO_FCTC_english.pdf.
• Zagat. 2008. Press Release, “ZAGAT RELEASES 2008 AMERICA'S TOP RESTAURANTS SURVEY.”