Smoke‐free licensed premises: what will be the broader public health benefits?

On 2 July 2007, the Australian State of New South Wales (NSW) followed the lead of Ireland, Italy and some States in the United States and implemented a total indoor ban on tobacco use in licensed premises. The legislation, which now ensures all enclosed public spaces are smoke free (with the exception of the private gaming rooms in the Sydney casino), is expected to make an important contribution to reducing the public health burden of tobacco use. Smoking bans in Italy in 2005 produced an initial reduction in cigarette consumption by 8% and reduced the rate of admission for myocardial infarction for persons under the age of 60 by 11%. However, the potential benefits of such smoke-free policies may be broader. The use of tobacco, consumption of alcohol, and gaming are closely associated, and smoke-free legislation prohibiting tobacco use in bars and clubs may reduce excessive alcohol consumption and gaming within these venues. The vigorous opposition to smoke-free legislation by industry associated with tobacco, liquor and gaming suggests a concern that tobacco users, who spend more money on alcohol and gaming compared with non-smokers, may disinvest in such activities. If industry research is accurate, such concerns may be well founded. For example, just one week after the implementation of the legislation in NSW, a survey conducted by the Australian Hotels Association reportedly found gaming machine revenue had fallen between 10-30%. While supporting pre-legislation assertions of the industry, the findings may be indicative of broader social and public health benefits of the ban. A rigorous evaluation of the effect of the legislation on other social and health-related behaviours may strengthen the case for other governments to adopt such strong public policy.