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Debate on smoking ban – how dangerous passive smoking is outdoors

Will smoking soon be banned in certain outdoor areas?
Will smoking soon be banned in certain outdoor areas? Photo: Getty Images/Westend61

November 28, 2024, 3:31 pm | Read time: 6 minutes

Smoking has been banned indoors in public buildings, on public transport, and in restaurants in all federal states since 2008. Now, the EU wants to go one step further and also restrict smoking in outdoor public places. The EU Commission’s proposals are the subject of heated debate. Does such a ban make sense from a health perspective? FITBOOK Editorial Director Melanie Hoffmann explains the studies on the risks of passive smoking in general – and especially outdoors.

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As part of the “Europe’s Beating Cancer Plan,” the EU is working towards a “tobacco-free generation” by 2040, in which less than five percent of the population consumes tobacco.1 Currently, according to a report by the EU Commission, 700,000 people in the EU lose their lives every year due to tobacco consumption, tens of thousands of them due to passive smoking. This is why the EU wants to extend the smoking ban from indoor public spaces to outdoor areas.2 But how sensible is this really? Are we really exposed to such large amounts of tobacco smoke outdoors that it can damage our health?

Table of Contents

Where the EU wants to introduce a smoking ban

In the report mentioned above, the EU Commission calls on its member states to “extend the scope of smoking bans to important outdoor areas, including recreational areas for children such as public playgrounds, amusement parks, and swimming pools, as well as public buildings and bus stops.”

The demand for a smoking ban first requires the approval of the EU Parliament. However, if this approval is granted, this does not mean that the member states will have to implement the ban. It would then be an official recommendation from the Commission. Whether or not they introduce a more extensive smoking ban will then be decided by the governments of individual countries.3 In Germany, there is already a lively debate as to whether smoking should be further restricted.

The EU’s proposals are based on recommendations and reports from the World Health Organization. Among other things, it has analyzed the status of smoke-free areas in various countries. The WHO experts concluded that 60 countries had implemented smoking bans in outdoor areas where children typically spend time (e.g., playgrounds). 25 countries have banned smoking in cars where under-18s are present. In general, the ban on smoking in outdoor areas applies to places where vulnerable people (including children and sick people) are present or where people are involuntarily exposed to tobacco smoke with no alternative (e.g., at bus stops).4

How unhealthy is passive smoking?

Let’s take a look at the research findings on the effects of passive smoking in general and especially outdoors.

Passive smoking is associated with a number of health risks in people who are not active smokers. In adults, inhaling tobacco smoke produced by other people’s smoking increases the risks of diseases such as coronary heart disease, strokes, and lung cancer. In women, passive smoking is thought to increase the risk of breast cancer, cervical cancer, and complications during childbirth (including lower birth weight of the infant).5,6,7

Passive smoking can also cause sudden infant death syndrome. In children, it can lead to respiratory infections, ear infections, and asthma attacks.

In addition to the possible long-term effects, passive smoking can also lead directly to health problems. A 2011 study concluded that it can cause harmful inflammatory and respiratory reactions within 60 minutes, which can last for at least three hours after exposure to tobacco smoke.8

In view of the health risks posed by passive smoking, smoking bans are primarily an effort to protect the non-smoking population. In other words, to minimize their exposure to involuntary inhalation of tobacco smoke. If smoking bans also lead to active smokers smoking less or even giving up the unhealthy habit completely, this is a desirable side effect.

More on the topic

What is the danger posed by outdoor tobacco smoke?

Nicotine measurable in the air outside

But how great is the danger of tobacco smoke in the open air? Many people can probably confirm from personal experience that it does not evaporate as quickly as some smokers who do not want to know about smoking bans would like to think. After all, most people have smelled – and therefore inhaled – tobacco smoke on the street in the city, for example, even though the person smoking was a short distance away or no longer visible. In fact, a study from the Netherlands showed the smell of tobacco smoke means there is nicotine in the air. The amount of nicotine detected was particularly high when several smokers came together to smoke in an outdoor area. The concentration in the air increased with each additional smoker.9

Nicotine enters the body through passive smoking

A study from 2012 went even further and investigated the direct effect of passive smoking in the fresh air. Test subjects spent three hours in outdoor smoking areas of bars and restaurants. A control group spent the same period of time in a public outdoor area where people did not smoke. Using saliva and urine samples, the scientists detected significantly increased cotinine levels in the people who had been exposed to passive smoking outdoors. Cotinine is the substance to which nicotine is metabolized in the human body. This means that the test subjects had inhaled nicotine. In some study participants, the cotinine level was still elevated a day later. The researchers concluded that the passive inhalation of tobacco smoke could lead to health problems.10

Study on “third-hand smoke”

In 2022, a research project provided further worrying findings on the passive inhalation of tobacco smoke. It investigated the effect of “third-hand smoke.” This refers to smoke particles, e.g., on clothing and hair. What is called passive smoking in Germany is called “secondhand smoke” in English-language research. In the study, the smoke particles in question caused changes in the urine and blood that were associated with DNA damage. This, in turn, is linked to inflammation and impairment of the immune system.11

This article is a machine translation of the original German version of FITBOOK and has been reviewed for accuracy and quality by a native speaker. For feedback, please contact us at info@petbook.de.

Sources

  1. European Commission. Commission recommends stronger measures on smoke-free environments to better protect public health (accessed on November 27, 2024) ↩︎
  2. European Commission. Commission proposes to extend coverage of smoke-free environments. (accessed on November 27, 2024) ↩︎
  3. Laubach, R. Smoking ban with reservations - What is in the EU plans? Handelsblatt (accessed on 27.11.2024) ↩︎
  4. WHO. WHO report on the global tobacco epidemic, 2023 (accessed on November 27, 2024) ↩︎
  5. Centers for Disease Control and Prevention (CDC). Health Problems Caused by Secondhand Smoke (accessed on November 27, 2024) ↩︎
  6. Flor, L.S., Anderson, J.A., Ahmad, N. et al. (2024). Health effects associated with exposure to secondhand smoke: a Burden of Proof study. Nature. ↩︎
  7. Cao, S., Yang, C., Gan, Y. & Lu, Z. (2015).The Health Effects of Passive Smoking: An Overview of Systematic Reviews Based on Observational Epidemiological Evidence. PLOS ONE. ↩︎
  8. Flouris, A., Koutedakis, Y. (2011). Immediate and short-term consequences of secondhand smoke exposure on the respiratory system. Current Opinion on Pulmonary Medicine. ↩︎
  9. Bommelé, J., Cremers, H., Den Hollander W., et al. (2024). Secondhand smoke exposure in public outdoor spaces in the Netherlands: The stronger the smell, the more exposure to nicotine. Tobacco Induced Diseases. ↩︎
  10. St Helen G, Bernert JT, Hall DB, Sosnoff CS, et al. (2012). Exposure to secondhand smoke outside of a bar and a restaurant and tobacco exposure biomarkers in nonsmokers. Environ Health Perspect. ↩︎
  11. Adhami, N., Chen, Y., Martins-Green, M. (2017). Biomarkers of disease can be detected in mice as early as 4 weeks after initiation of exposure to third-hand smoke levels equivalent to those found in homes of smokers. Clinical Science. ↩︎
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