New anti-smoking rules good but not enough

Smoking in Malta remains rampant. It is abundantly clear that the rise in cigarette prices is too small an inducement for smokers to give up their habit.

A 2008 European health interview survey showed that 32 per cent of men and 21 per cent of women in Malta are smokers. Of these, 72 per cent usually smoke 20 cigarettes a day, 20 per cent smoke between 20 and 40 and 2.5 per cent smoke more than 40 cigarettes a day.

The next generation provides no solace because the proportion of 15-year-olds who smoke in Malta is higher than that of countries such as Italy and England – 10 per cent of boys and 14 per cent of girls.

In 2010, 26 per cent of male and nine per cent of female deaths were attributed to lung cancer, which is closely related to cigarette smoking.

It was recently announced that Mater Dei Hospital will become completely smoke-free next month, forcing smokers to use three booths set up in the extensive grounds. Even smoking in a car on the hospital grounds will become illegal.

Welcome news indeed. However, one should not be too optimistic because, despite a legal smoking ban in public places, the study mentioned above had shown that passive smoking is highest in places of entertainment (28 per cent), followed by the workplace and the school (24 per cent) and at home (20 per cent).

The smoking ban did contribute to a drop in the heart disease death rate and hospital admissions in every country where it was introduced. Unfortunately, it has had no impact in Malta where the ban has held sway since April 2004, a local study revealed.

The authors suspect that in places of entertainment the law is not enforced for fear of losing out on business. This notion was backed by The Times when 14 bars in Paceville were visited over two evenings and patrons could be noticed smoking with impunity. An Italian study based in bars, cafés and restaurants in 2009 had shown that customers had increased by three per cent, a clear sign that we collectively prefer a smoke-free environment.

The impact of second-hand smoke cannot be overestimated: a 1992 study by the American Heart Association had indicated that those exposed to environmental tobacco smoke at home had their risk of death due to heart disease increase by about 30 per cent.

Children are particularly vulnerable because they not only inhale smoke but also pick up the belief that smoking is acceptable.

The medical complications are serious and include the risk of chest infections, ear infections, admissions to hospital with wheezing or asthma and cot death. Thankfully, this is being slowly addressed by recent legislation such as prohibiting smoking in playgrounds.

Even more can be done. For example, a campaign called Fresh Start, meant to stop people smoking in cars when children are travelling with them, has been launched by the Welsh government. And an outright ban will be considered depending on the success of this three-year campaign. This is because the level of toxic chemicals rises to very high levels in cars, even with a window open. This is tantamount to parents deliberately poisoning their children.

The British Medical Association has gone further, urging a total ban on smoking in cars, regardless of the occupant’s age because even the elderly are put at risk when inhaling second-hand smoke.

We can and must do more and the public health authorities should be seriously considering such options.