The authors of the study, from Imperial College London and the Public Health Foundation of India (PHFI), say the findings suggest that the implementation of smoke-free legislation in India may have resulted in substantial health benefits for the population, particularly for women and children.
“This study suggests that, in India, there is good evidence that smoke-free laws in workplaces are associated with a reduction in second-hand smoke at home,” said Dr John Tayu Lee, from the School of Public Health at Imperial College London, who led the study.
“The results support the idea of ‘norm spreading’, whereby restrictions on smoking in public places make it seem less acceptable to expose others to second-hand smoke more generally, including at home,” said Dr Christopher Millett, from the School of Public Health at Imperial. “They highlight the importance of accelerating the implementation of smoke-free legislation more widely in India.” Dr Millett is also a Visiting Senior Research Fellow at PHFI.
According to the survey, there are 110 million smokers in India. National legislation prohibiting smoking in public places and workplaces was introduced in 2008, but the law is not comprehensive as it permits designated smoking areas in large restaurants and hotels. Enforcement of the law is highly variable and the penalty is a modest fine of 200 rupees, equivalent to $3.80. Nationally, 30 per cent of adults report being exposed to second-hand smoke at work, with 52 per cent exposed at home.
Studies in the USA, Ireland and Scotland have found that implementation of comprehensive smoke-free laws has been associated with reduced second-hand smoke in homes, but there has been little information about whether these benefits exist in low- and middle-income countries.
Dr Monika Arora, Director of Health Promotion & Tobacco Control at the Public Health Foundation of India, said: “This is a very important and timely study as the Ministry of Health and Family Welfare is scaling up its National Tobacco Control Program to all states of India under its twelfth five year plan. This evidence highlights the effectiveness of smoke-free legislation in India and further highlights the changing norms in support of smoke-free, which will provide substantial population level health benefits in India. India currently allows designated smoking areas under COTPA and evidence from this study does make a case for enforcing 100 per cent smoke free public places to further enhance the impact of smoke-free legislation in India.”
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