Abstract

Background: In March 2004, Ireland implemented comprehensive smoke-free regulations. Some were concerned this would cause pub patrons to move their smoking and drinking from inside pubs to inside homes. This article aims to assess whether nationwide smoke-free policies are associated with more smoking or drinking inside the home. Methods: Participants were 1917 adult smokers (> 18-years old) from Ireland (n = 582), Scotland (n = 507) and the rest of the United Kingdom (n = 828), which did not have smoke-free laws at the time of the interview, who completed a random digit-dialed telephone survey in February to March 2006. The percentage of alcoholic drinks consumed in the home versus pubs was compared by country as well as the percentage of daily cigarette consumption occurring in the home after work. Results: Irish respondents reported a significantly lower percentage of alcoholic drinks consumed in the home compared to Scotland and the rest of the United Kingdom, and cigarette consumption in the home was comparable in all three regions. Conclusions: Smoking and drinking in the home was not greater in smoke-free Ireland than in the United Kingdom, where there was not a smoke-free law at the time of the survey. These findings add further support to the enactment of comprehensive smoke-free laws, as called for in the Framework Convention on Tobacco Control.

Introduction

On 29 March 2004, the Republic of Ireland introduced comprehensive smoke-free legislation covering all indoor workplaces, including bars and restaurants. The law led to near total elimination of tobacco smoke pollution across a wide range of public venues, including restaurants and bars, and this was accompanied by increasing support among smokers for smoke-free laws in public venues.1 However, one of the fears debated during deliberations about the law was that it would drive smokers out of the pubs and lead to more drinking and smoking inside the home thereby exposing children to these vices.2,,3 Exemplifying this sentiment was the following testimony of a senior health official in England, ‘… (a ban) was not a good thing on health grounds, apart from anything else, because you get a displacement of smoking from some public areas to the home’.3

Contrary to this opinion, there is some evidence from other countries that bans in venues such as restaurants and bars stimulate smokers to make their homes smoke-free.4 Indeed, the proportion of homes of Irish smokers in which smoking was allowed indoors significantly decreased from 85% before the ban to 80% 9 months after the ban.1 However, to date, there is no evidence on drinking or on actual cigarette consumption in or around the home, where it is not banned. It is possible that although the Irish ban led to a greater proportion of home smoking bans, it also increased smoking at home for those homes in which indoor smoking was still allowed. This possibility can be empirically tested via data on actual cigarette consumption at home.

The objective of this article is to assess whether Irish smokers consumed a greater fraction of their alcoholic drinks and cigarettes in the home compared with smokers in Scotland or the rest of the United Kingdom, where smoking was still allowed in public places at the time of the study.

Methods

Sample

To evaluate the question of whether smokers in Ireland stay home more often to drink and smoke, we compared reports of alcohol usage and home smoking among a random sample of Irish smokers compared to similarly selected random samples of smokers in Scotland and the United Kingdom, where smoking in pubs was unregulated at the time. Participants were 1917 adult smokers (> 18 years old) from Ireland (n = 582), Scotland (n = 507) and the rest of the United Kingdom (n = 828), who completed a random digit-dialed telephone survey in February to March 2006. These participants were part of a larger cohort study conducted as part of the International Tobacco Control (ITC) Policy Evaluation Project,5 and the results are weighted to be representative of the adult smoker population within each country. Respondents were recruited using probability sampling methods with telephone numbers selected at random from the population of each country, within strata defined by geographic region and community size. List assisted telephone numbers were obtained from Survey Sampling International. Eligible households were identified by asking a household informant to provide the number of adult smokers. The next birthday method6 was used to select the respondent in households with more than one eligible adult smoker. Participants were mailed compensation equivalent to £7 (UK) or €10 (Ireland) following each survey. The study protocol was standardized across the two regions, and was reviewed and cleared by the Research Ethics Board of the University of Waterloo and by the University of Stirling.

Measures

The measures included in the ITC Ireland/UK Survey were originally adapted from the ITC Four Country Survey (ITC-4), a cohort telephone survey of over 2000 adult smokers in each of four countries, Canada, USA, UK and Australia, conducted annually since 2002.7,,8

Drinking patterns

The measure that we employed to capture drinking in different locations was adapted from Treno et al.9 Respondents were asked: ‘In the past week, approximately how many alcoholic beverages have you consumed over the entire week at each of the following places?’ ‘At home, at the homes of others, at parties or events in a social venue, at pubs and bars, at restaurants, or somewhere else?’ In addition to the absolute number of drinks consumed, we also calculated the percentage of the total drinks from each enumerated drinking place.

Smoking patterns

A smoker was defined as an individual who reported smoking at least once a month. Respondents were asked, ‘How often have you allowed yourself a cigarette?’ The following responses resulted in categorization as a smoker: ‘Daily’, ‘Less than daily, but at least once a week’, ‘Less than weekly, but at least once month’. Respondents reported the mean number of cigarettes smoked per day. Respondents also reported ‘about how many cigarettes do you smoke inside your house during the evening—that is from after work onward?’ This was divided by the mean number of cigarettes smoked per day to obtain the percent of cigarettes per day that were smoked in the home during the evenings.

Irish smokers were also asked ‘Has the smoking ban in public places affected the rules about smoking in your home?’ Response options were that the ban made them reduce the amount they smoke at home, increase the amount they smoke at home, or it hasn't affected smoking in their home.

Statistical analysis

Ireland was defined as the intervention group because its smoke-free law was in effect at the time of the survey; Scotland and the rest of the United Kingdom were the control groups because neither had smoke-free laws at the time of the survey. Descriptive statistics for the main outcome measures were calculated and one-way analysis of variance was used to determine if there were statistically significant differences among the three regions (Ireland, Scotland, and the rest of the United Kingdom).

Results

Alcoholic beverages consumed at home

The average reported number of alcoholic beverages consumed per week was significantly lower among Irish smokers (7.4) compared to those in Scotland (10.8) and the rest of the United Kingdom (9.5) (P < 0.01; data not shown). As shown in figure 1, smokers in Ireland also reported drinking a significantly lower percentage of their weekly alcoholic beverages at home (30%), compared to smokers in Scotland (40%) and the rest of the United Kingdom (35%) (P < 0.01). In contrast, smokers in Ireland drank a larger percentage of their weekly alcoholic beverages in pubs and bars (42%) compared to smokers from Scotland (37%) and the rest of the United Kingdom (40%), although this was not statistically significant (P = 0.21).

Figure 1

Percent of all alcoholic beverages consumed in the past week

Figure 1

Percent of all alcoholic beverages consumed in the past week

Smoking at home

The average reported number of cigarettes smoked per day differed slightly between countries (Ireland–17.5, Scotland–17.7, rest of the United Kingdom–16.1, P = 0.02, data not shown). As shown in figure 2, the percent of cigarettes smoked per day that were smoked inside the home during the evening was comparable between countries (Ireland–39%, Scotland–46%, rest of the United Kingdom–43%, P = 0.33). Most Irish smokers reported the smoking ban did not affect their smoking behavior at home (71%). However, 22% reported that since the smoke-free law they had placed stronger restrictions on smoking in their home compared to 6% who reported they smoked more in the home after the ban (data not shown).

Figure 2

Percent of cigarettes smoked per day that were smoked inside the house during the evening (after work onward)

Figure 2

Percent of cigarettes smoked per day that were smoked inside the house during the evening (after work onward)

Discussion

This article reveals that the percentage of smokers in Ireland who reported drinking or smoking at home after their smoke-free law was not higher than the rest of the United Kingdom, as had been predicted by some. Our study shows that smokers in Ireland consume the same fraction of their alcoholic drinks in pubs as smokers in places without comprehensive clean indoor air laws, although Irish smokers consumed fewer total alcoholic beverages per week compared to UK smokers. Additionally, drinking and smoking in the home is not any higher in Ireland compared to the rest of the United Kingdom. This is consistent with studies that have reported that smoke-free laws do not have a detrimental effect on bar revenues.10–13 More importantly, however, the results of this study should put to rest any suggestion that smoke-free laws cause smokers to smoke and drink more often in the home. This result extends the finding of Borland et al. 4 and Fong et al.1 that found evidence of smoke-free bars leading to increased smoke-free homes among smokers. The more fine-grained measures of consumption employed in the present analyses allow us to be much more confident in concluding that the last refuge model, positing that smoke-free bars and restaurants lead smokers to take smoking and drinking into the home, is not true.

The main limitation of this study is that the data is cross-sectional and it might reflect different underlying smoking and drinking patterns between Irish smokers and those in Scotland and the rest of the United Kingdom. However, if this were true, there would have to have been a huge difference in pub-based smoking and drinking to explain why Irish smokers are still more likely to drink in pubs, and is inconsistent with the previous finding that the ban has led to less smoking in the home. These cross-sectional data on the focal measures of consumption within the home are completely consistent with the longitudinal data documenting the increase in smoke-free homes in Ireland after the ban.1

By dispelling the myth of displacement of smoking, these findings add further support to the enactment of comprehensive smoke-free laws, as called for in the Framework Convention on Tobacco Control.

Acknowledgements

Funding for this research was provided by grants from the National Cancer Institute of the United States (through the Roswell Park Transdisciplinary Tobacco Use Research Center, P50 CA111236), the Canadian Institutes of Health Research (79551), Cancer Research UK (C312/A3726), and the Scottish Executive. The funding sources had no role in the study design, in the collection, analysis, and interpretation of data, in the writing of the report and in the decision to submit the article for publication. As indicated in the article, the study protocol was reviewed and cleared by the Research Ethics Board of the University of Waterloo and by the University of Stirling. The Corresponding Author grants on behalf of all authors, an exclusive license on a worldwide basis to the BMJ Publishing Group Ltd, and its Licensees to permit this article (if accepted) to be published in BMJ editions and any other BMJPGL products and to exploit all subsidiary rights, as set out in the licence (bmj.com/advice/copyright.shtml).

Conflict of interest: None declared.

Key points

  • While there are several studies that examine the effects of smoke-free laws, few utilize data from nationally representative samples of smokers and even fewer compare levels of smoking and alcohol drinking in the home in places with and without these laws.

  • Results from this study show that in smoke-free Ireland, smoking and drinking in the home is not greater than in the UK, where there was not a smoke-free law.

  • These findings add to the body of evidence that shows that the hospitality industry does not suffer in places with smoke-free laws.

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