By Fanny McKellips, Queen’s University

It is a well-accepted fact that smoking and second-hand smoke have harmful effects on health.

For this reason, many measures are taken by governments to decrease smoking and exposure to second-hand smoke. Canadian provinces, for instance, have banned smoking in all public places and workplaces. In the United States, 25 states have banned smoking in public places. While this limits exposure of non-smoking adults to secondhand smoke, it may create a displacement of smoking from public places to homes. Could this mean that children and infants, who cannot make their own decision to be exposed to second-hand smoke, are negatively affected by smoking bans? This issue is not well understood as the literature surrounding smoking bans tends to focus on the health impact on adults.

Exposure to second-hand smoke from cigarettes has harmful effects such as increasing the risk of heart disease and lung disease, and the decision to smoke has a negative impact on more than just the individual making the decision. In children, second-hand smoke is known to increase the risk of asthma and lower respiratory infections (CDC 2017). Also at risk are unborn babies who are exposed to the chemicals through their mother’s placenta. Infants of mothers who smoke tend to have a lower birth weight and gestational age and are at a higher risk of sudden infant death syndrome (American Pregnancy Association, 2011).

Because of the negative societal costs of smoking, governments intervene and put policies in place to provide disincentives for smoking and to reduce exposure to second-hand smoke. An example of this is an excise tax on cigarettes which disincentivizes smoking through an increase in its cost. The resulting government revenue can then be redistributed to society. Another example is a ban on smoking in public places such as bars and restaurants. This protects non-smokers from being exposed to second-hand smoke. In Canada, Toronto was the first city to restrict smoking in public places in 1999. Since 2008, all provinces have banned smoking in public places and workplaces (Statistics Canada, 2008).

Smoking bans lead to a reduction in the exposure of adults to secondhand smoke. They can, however, also have unintended effects. For example, Adam and Cotti (2008) found that local smoking bans in the United States led to increased fatal drunk driving accidents which could be caused by smokers driving further distances to smoke and drink in a bar outside the smoking ban area. Adda and Cornaglia (2010) found that smoking bans in recreational areas increase the time that smokers spend at home. They suggest that this could increase exposure to non-smokers and in particular young children.

McGeary et al. (2017) have set out to answer this question by exploring the impact of smoking bans in the United States on the health of children and infants. The authors use detailed information on the smoking bans at the state, city or county level, which they match to the birth records. Data are from the Census of Births from Vital Statistics and the National Health Interview Survey (NHIS). From the Vital Statistics on natality, the authors obtain information on all births (specifically, birth weight and gestational age) in the United States between 1990 and 2012. They also obtain demographic information on the parents. From the NHIS, the authors obtain information on child health outcomes that are linked to second-hand smoke such as asthma, hay fever, respiratory allergies and ear infections.

In states without a statewide ban, some cities and counties have enacted a smoking ban. McGeary et al. (2017) take advantage of this variation to identify the effect of smoking bans on child health. To understand how smoking bans affect the health of infants and children, the authors use a difference-in-difference approach. Variations in whether or not a smoking ban is in place and when it was established allow to the authors to estimate the effect of a smoking ban on the health of children and infants in areas with a smoking ban compared to similar children and infants in areas without a smoking ban. In their analysis, the authors control for state fixed effects, year fixed effects as well as excise taxes.

Findings suggest that overall smoking bans do increase the health of children and infants. In the case of infants, they find that smoking bans are associated with a 13-gram increase in birth weight. This result is strongest in the case of low-income mothers. The authors also investigate the transmission mechanism of the positive impact of smoking bans on birthweight, finding that it is due to both a reduction in exposure of the mother to secondhand smoke as well as a reduction in prenatal smoking. The results also suggest that 100% bans are more effective than limited bans, such as banning smoking only in workplaces. In the case of children under the age of 18, the authors find that smoking bans are associated with a reduction in respiratory allergies, asthma attacks, ER visits, ear infections and reports of fair or poor health.

The authors also use data from the National Health Survey to explore whether smoking bans do in fact lead to increased smoking inside the home from displaced workers. They find evidence that smoking bans lead to decreased smoking inside the home. This negates the hypothesis of smoking displacement. In fact, smoking bans have the additional benefit of reducing exposure of infants and children to second-hand smoke by reducing smoking inside the home.

This research addresses an important gap in the literature about whether smoking bans can have a negative effect on infants and children. When putting in place public policies that affect the health of citizens, it is critical to understand all impacts of these policies, both through direct and indirect channels. The unintended consequence of exposing children to more second-hand smoke would have an opposite effect from that intended. While this research uses data from the United States, the result that smoking bans have a positive impact on the health of children and infants should hold in Canada as well. These results have significant public policy implications for Canada, where all provinces have put in place smoking bans. Not only are these policies reducing exposure to second-hand smoke in public places such as restaurants, but they also have the indirect effect of increasing birth weights, an important indicator of the health of infants. Smoking bans are therefore an effective choice of public policy to reduce smoking and exposure to second-hand smoke.

Even though smoking bans have a positive impact on society, Canada does not have a smoking ban in all areas of federal jurisdiction. For example, not being under provincial responsibility, Indian Reserves are not subject to smoking bans. While some Indian Reserves have their own smoking ban, on other Indian Reserves it is still possible to smoke in restaurants (CBC, 2015). Since the results of this research suggest that smoking bans have a net benefit to society, public policymakers should encourage jurisdictions not currently included under the bans to adopt similar policies.

Finally, while smoking bans do reduce smoking and are a great step in the right direction, this research is a reminder that some infants and children in Canada are still victims of secondhand smoke in their homes which they cannot avoid. Public policy should strive to further protect non-smokers and, in particular, children and infants, from the harmful effects of second-hand smoke.

Health Canada has recently proposed extending a smoking ban to multi-dwelling units such as apartments (CBC, 2017). This would protect non-smokers from second-hand smoke in their living area and also protect children living in multi-dwelling units from the second-hand smoke of their parents. McGeary et al. (2017) found that 100% bans were more effective than partial bans in increasing the health of children and youth. Perhaps the effect could be even greater if smoking bans could be extended to multi-dwelling units.

References

Adams S, Cotti C, “Drunk Driving after the Passage of Smoking Bans in Bars,” Journal of Public Economics, 2008: 92(5-6): 1288-1305.

Adda J, Cornaglia F, “The Effects of Bans and Taxes on Passive Smoking,” American Economic Journal: Applied Economics, 2010:2(1), 1-32.

American Pregnancy Association, “Second Hand Smoke and Pregnancy,” 2011. http://americanpregnancy.org/pregnancy-complications/second-hand-smoke-and-pregnancy/. (Last Accessed, March 4, 2018).

CBC, “Legions, First Nations Exempt from New Anti-Smoking Rules,” 2015. http://www.cbc.ca/news/canada/sudbury/legions-first-nations-exempt-from-new-anti-smoking-rules-1.2895055. (Last Accessed, March 4 2018).

CBC, “Health Canada Proposing Smoking Bans in Apartments, Raising Legal Age to 21,” 2017. https://www.ctvnews.ca/health/health-canada-proposing-smoking-ban-in-apartments-raising-legal-age-to-21-1.3301124. (Last Accessed, March 4 2018).

Centers for Disease Control and Prevention (CDC), “Second Hand Smoke Facts,” 2017. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/secondhand_smoke/general_facts/index.htm. (Last Accessed, March 4, 2018).

McGeary, K. A., Dave, D. M., Lipton, B. J., & Roeper, T. “Impact of Comprehensive Smoking Bans on the Health of Infants and Children,” National Bureau of Economic Research Working Paper, 23995, 2017.

Statistics Canada, “Smoking Ban Legislation in Canadian Provinces and Municipal Bylaws in Seleced Cities,” 2008 http://www.statcan.gc.ca/pub/82-003-x/2006008/article/smoking-tabac/t/4060721-eng.htm. (Last Accessed, March 4, 2018).