This is an HTML version of an attachment to the Freedom of Information request 'Information about COPD'.
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COMMISSION OF THE EUROPEAN COMMUNITIES 
Brussels, 30.6.2009 
SEC(2009) 894 Part 2 
COMMISSION STAFF WORKING DOCUMENT 
Accompanying document to the 
 
Proposal for a COUNCIL RECOMMENDATION on smoke-free environments 
 
IMPACT ASSESSMENT (ANNEXES) 
 
{COM(2008) 328 final} 
{SEC(2008) 895} 
{SEC(2008) 896} 

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Annex I – Mandate of the Impact Assessment Inter-service 
 

                 Steering Group 

Annex II – Green Paper Consultation 

Annex III – Targeted stakeholder consultation 
16 
Annex IV – Regulatory framework 
38 
A. Framework Convention on Tobacco Control (FCTC) 
38 
B. EU provisions relating to exposure environmental tobacco smoke 
40 
C. Member States' smoke-free regulations on smoke-free environments 
43 
Annex V – Health effects of ETS exposure 
148 
A. Relative risk estimates for ETS-associated diseases and conditions                   148 
B. Health effects of ETS exposure in childhood and smoking in pregnancy           158                       
Annex VI – Effects of smoke-free policies 
159 
A. Summary of evidence from smoke-free jurisdictions 
159 
B. Findings from the evaluation of Scottish smoke-free legislation 
193 
C. UK Regulatory Impact Assessments 
196 
Annex VII – Quantitative analysis 
202 
Annex VIII – Monitoring and evaluation 
242 
Annex IX - Technological approaches to controlling ETS 
245 
Annex X – Cost-effectiveness of smoking cessation interventions 
264 
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ANNEX  I  –  MANDATE OF THE IMPACT  ASSESSMENT  INTER-SERVICE  STEERING 
GROUP 

 
COMMISSION OF THE EUROPEAN COMMUNITIES 
Health and Consumer Protection Directorate-General 
 
 
Directorate C - Public Health and Risk Assessment 
C6 – Health measures 
Brussels, 21 December 2007 
SANCO C6 
 
Inter-Service Group for the Impact Assessment on a proposal for a Council 
Recommendation on Smoke-free environments 
Mandate  
1. ISSUE AT STAKE 
Exposure to environmental tobacco smoke (ETS) is a source of widespread excess 
morbidity and mortality in the EU. Chronic exposure to second-hand smoke has been 
established as a cause of many of the same diseases caused by active smoking. 
According to conservative estimates, passive smoking killed 79,000 adults in the 
EU-25 in 2002.  
Exposure to ETS imposes significant costs on the economy, including the direct 
costs relating to increased healthcare expenditure and the indirect costs linked to 
productivity losses. The overall economic burden on EU-27 has yet to be estimated. 
National legislation differs widely across the Member States. Recently, 
comprehensive smoke-free laws have been adopted in Ireland, Italy, Malta, Sweden, 
UK, Lithuania, Finland, Estonia, France and Slovenia. However, not all 
governments have made attempts to better protect their citizens from tobacco smoke 
while a number of others have encountered serious difficulties in introducing and/or 
implementing comprehensive smoke-free legislation.  
Hospitality sector has proved the most contentious area of regulation. This is of 
particular concern given the exceptionally high concentrations of ETS in bars and 
restaurants.  
The obstacles to introducing effective smoke-free measures are similar in many 
Member States, including the opposition form tobacco and hospitality industries, 
fear of negative economic impact (e.g. on the hospitality sector, government’s 
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revenues from tobacco taxes or tobacco-related employment), misconceptions 
regarding smoke-free regulations (difficult to enforce, unpopular), non-compliance 
with existing requirements etc. 
At EU level, the issue of smoke-free environments has so far been addressed in non-
binding resolutions and recommendations which called on Member States to ensure 
protection from second-hand tobacco smoke. In addition, a number of occupational 
health and safety directives set out general requirements covering all risks to 
workers health and safety together with some specific restrictions on smoking in the 
workplace, e.g. requiring ventilation and protection of non-smokers in rest rooms 
and rest areas; banning smoking in areas where carcinogens and mutagens are 
handled, or requiring employers to protect pregnant and breast-feeding staff. 
In January 2007, the Commission launched a Green Paper consultation on the best 
way to promote smoke-free environments in the EU. The great majority of 
contributors expressed support for further EU action. An EU Recommendation and 
binding EU legislation were the two most popular policy options, favoured by 
around 40% of institutional respondents each.  
At international level, the WHO Framework Convention on Tobacco Control 
(FCTC) creates a legal obligation to provide protection from exposure to tobacco 
smoke in indoor workplaces, public transport and indoor public places. The second 
Conference of the Parties to the Convention in July 2007 adopted guidelines on 
smoke-free environments formulating the "golden standard" that every Party should 
aim to achieve within five years of the FCTC entry into force for that Party.  
2. DECISION OF THE COMMISSION 
Based on the outcome of the Green Paper consultation, the Commission intends to 
adopt a follow-up Communication with a proposal for measures in the fourth quarter 
of 2008.  An EC proposal for a Council Recommendation on smoke-free 
environments is included in the Commission’s Agenda Planning (reference n° 
2008/SANCO/005). The intention of the Recommendation is to encourage and 
facilitate the introduction of smoke-free laws at national and, where appropriate, sub-
national level, to transpose the FCTC guidelines on smoke-free environments into 
the EU context and to monitor/evaluate the progress towards smoke-free throughout 
the EU. 
3. THE IMPACT ASSESSMENT 
The Impact Assessment on the foreseen Commission imitative on smoke-free 
environments will follow the set of logical steps recommended in the European 
Commissions Impact Assessment Guidelines SEC (2005)791.  
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The Impact Assessment Inter-service Steering Group (ISSG) will accompany the 
preparation of the Impact Assessment. Its main tasks are described below. Three 
meetingq of the ISSG are expected to take place in the course of 2007-2008. 
An external contractor is contributing to the Impact Assessment. 
3.1. 
Consultation of interested parties 
Gathering opinions and information from interested parties is important for a policy-
development process. 
In addition to the Green Paper consultation, three stakeholder consultation meetings 
are scheduled for 2008. The Commission may also consult the Member States on 
different elements of the Impact Assessment through the Council Working Party on 
Public Health.  
The Steering Group should contribute to identifying the relevant sectors within their 
policy areas and the main topics of consultation. 
3.2. 
Assess and analyse the problem 
One of the main objectives of the Impact Assessment will be to assess and analyse 
the social (health), economic and environmental burden related to exposure to 
second-hand tobacco smoke, its root causes as well as the evolution of the problem.  
The Steering Group should contribute to the analysis of the problem by identifying 
information and data from projects conducted in the framework of major EU 
programmes, Commission sources, Member States, international organisations, 
stakeholders and the scientific community. 
3.3. Identify 
objectives 
The overall objectives identified in the SANCO Scoping Paper are to improve public 
health through reductions in tobacco-related illness and mortality and to reduce 
healthcare expenditure for treating tobacco-related diseases. The specific objectives 
include reduced exposure to second-hand smoke and reduced rates of active 
smoking. The operational objective is to create a political environment for decisive 
and clear smoke-free action at Member States' level, in line with the international 
obligations under the FCTC. 
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The Steering Group should contribute to the definition and refinement of the 
identified objectives so that they correspond with the problem definition and meet 
the SMART criteria. 
3.4. Identify 
the 
options 
The next step of the IA will be to establish which policy options and delivery 
mechanisms are most likely to achieve the established objectives. 
The policy options available are: 
1.  No change of the status quo 
2.  Coordination and exchange of best practices between Member States  
3.  Commission Recommendation 
4.  Council Recommendation 
5.  Binding EU legislation 
The Steering Group should contribute with their expertise in order to better define 
and, if need be, adjust the shortlist of options for further analysis. 
3.5. 
Analyse the impacts 
The analysis of impacts involves trying to predict, across a range of different policy 
areas, the likely consequences (both intended and unintended) of the short-listed 
policy options.  
The Steering Group should contribute with their expertise to the identification of the 
main social (health), economic and environmental impacts of each option, who will 
be affected and over what timescale.  
3.6. 
Compare the options 
Once the relevant impacts have been analysed, the next step will be to compare the 
options according to various criteria with a view to facilitating the choice of the most 
preferable alternative or mix of options. 
The Steering Group should contribute to comparing the strengths and weaknesses of 
each of the policy options in relation to the main objective(s) and taking into account 
the principles of proportionality and subsidiarity. 
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3.7. Evaluation 
Within the framework of the Impact Assessment analysis, an attempt should be made 
to define some core indicators for the main policy objectives and to outline the 
monitoring and evaluation arrangements envisaged.  
The Steering Group should contribute to identifying the key indicators as well as 
possible monitoring and evaluation strategy. 
4. TIMETABLE 
1st meeting of the ISSG   
14 December  
Start of contractor’s work on the IA 
Mid-December 
Problem definition received from the contractor 
18 February 
2nd meeting  of the ISSG 
22 February 
Summary of the report received from the contractor and  10 March  
distributed to ISSG members 
Stakeholder consultation 
Mid March 
Draft report received from the contractor 
14 April 
3rd  meeting of the ISSG 
4th week of April 
Final report received from the contractor and distributed to ISSG   Mid-May 
Final IA distributed to ISSG members 
Beg. June 
Submission to the IA Board  
Mid-June 
Meeting with the IA Board  
9 July 
Opinion of IA Board 
End July 
Evaluation by IA Board completed 
End August 
Launch of inter-service consultation 
Beg. September 
Translation 
Beg. October 
Launch of the written procedure  
Beg. November 
Adoption by the College 
Mid-November 
 
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ANNEX II – GREEN PAPER CONSULTATION 
On 30 January 2007, the Commission published a Green Paper "Towards a 
Europe free from tobacco smoke: policy options at EU level"
(COM(2007) 27 
final) to launch a broad public consultation on the best way to promote smoke-free 
environments in the EU. This was preceded by informal consultation with selected 
stakeholders in April-May 2006 which helped define the Green Paper questions.  
The Green Paper examined the health and economic burdens associated with 
passive smoking, public support for smoking bans, and the measures taken so far at 
national and EU level. The Commission invited the stakeholders' views on the scope 
of measures to tackle passive smoking and the most appropriate form of EU 
intervention.  
The Commission received more than 300 contributions from a wide range of 
stakeholders, including EU Institutions, Member States' authorities, the health sector, 
tobacco-related organisations, the social partners and individuals.  
 
Public 
Health-related 
Tobacco-
Social 
Other 
authorities 
organisations 
related 
partners 
organisations 
EU 
NGOs 
Manufacture 
Inter-sectoral 
Individuals 
Institutions 
45 
22 
7 
140 
2 
National govts 
Research 
Distribution 
HORECA 
MEPs 
18 
14 
5 
7 
2 
National 
Healthcare 
Growing 
Other 
Other industry 
parliaments 
professionals 
2 
1 
1 
4 
18 
Regional and 
Pharmaceutical 
Smokers' NGOs 
 
 
local 
industry 
4 
13 
4 
  
Trade 
unions 
 
 

37 
81 
35 
15 
143 
 
The governments of 17 EU Member States as well as the governments of three 
EFTA States replied to the consultation. The Employment, Social Policy, Health and 
Consumer Affairs (EPSCO) Council held a public debate on the possible options for 
EU action to promote smoke-free environments on 31 May 2007. In addition, the 
European Parliament adopted a resolution on the Green Paper on 24 October 2007.  
The great majority of contributors welcomed the Green Paper as a timely addition to 
the EU and global debate on smoke-free policies and expressed support for further 
efforts to promote smoke-free environments throughout the EU. 
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Scope of smoke-free policies 
11%
27%
Comprehensive ban
Exemptions
No reply 
62%
 
Over 60% of institutional respondents (including 13 Member States) believed that 
the best option is a comprehensive ban on smoking in all enclosed workplaces and 
public places, with only minimum exemptions for places that are de facto 
somebody’s homes, such as designated rooms in nursing homes or mental health 
settings. A quarter of respondents (including four Member States) favoured different 
types of exemptions, e.g. for hospitality venues or separate smoking areas.  
Policy options 
45%
41%
40%
36%
35%
30%
25%
20%
14%
15%
10%
10%
7%
6%
5%
0%
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 legisl
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B
 
As for the desirable level of EU involvement in promoting smoke-free environments, 
an EU Recommendation and binding EU legislation were the two most popular 
policy options with around 40 % support each. One in eight respondents opted for 
more than one policy options, either in parallel or over time. The need to take into 
account and support the FCTC guidelines on smoke-free environments was also 
emphasised. 
The EP resolution urged the Member States to introduce comprehensive bans on 
smoking within two years and invites the Commission to table an appropriate 
legislative proposal in case of unsatisfactory progress. 
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In the EPSCO Council, the majority of Member States were of the opinion that the 
EU’s role in promoting smoke-free environments should be mainly to support and 
coordinate national efforts, e.g. through a Council Recommendation.  
All the replies to the Green Paper and the summary report are published on 
Commission's website.1 
Building on the support received in the Green Paper consultation, the Commission 
decided to put forward a follow-up initiative on smoke-free environments by the end 
of 2008. This would assist Member States in implementing comprehensive smoke-
free laws in line with the FCTC guidelines. 
 
GREEN PAPER QUESTIONS 
 (1) 
Which of the two approaches suggested in Section IV would be more 
desirable in terms of its scope for smoke-free initiative: a total ban on 
smoking in all enclosed public spaces and workplaces or a ban with 
exemptions granted to selected categories of venues? Please indicate the 
reason(s) for your choice. 
(2) 
Which of the policy options described in Section V would be the most 
desirable and appropriate for promoting smoke-free environments? What 
form of EU intervention do you consider necessary to achieve the smoke-
free objectives? 
(3) 
Are there any further quantitative or qualitative data on the health, social or 
economic impact of smoke-free policies which should be taken into 
account?  
(4) 
Do you have any other comments or suggestions on the Green Paper? 
 
                                                 
1  
 http://ec.europa.eu/health/ph_determinants/life_style/Tobacco/smoke_free_en.htm 
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LIST OF INSTITUTIONAL CONTRIBUTORS TO THE GREEN PAPER  
Public authorities 
European institutions 
 European 
Parliament 
EU 
 Council 
EU 
National governments 
1. 
Ministry of Health, Family and Youth of Austria 
AT 
2. 
Belgian Government 
BE 
3. 
Ministry of Health  
BG 
4. 
Ministry of Health 
CZ 
5. 
Federal Government of Germany 
DE 
6. 
Danish Government 
DK 
7. 
Standing Committee of the EFTA States 
EEA EFTA 
8. 
Ministry of Health and Consumer Protection 
ES 
9. 
Ministry of Social Affairs  
EE 
10. 
French Government 
FR 
11. 
Ministry of Health  
HU 
12. 
Ministry of Health 
IE 
13. 
Ministry of Health 
LV 
14. 
Ministry of Health 
MT 
15. 
Dutch Government  
NL 
16. 
Ministry of Health   
PL 
17. 
Ministry of Health  
SI 
18. 
Ministry of Social Affairs 
SE 
19. 
Department of Health 
UK 
National parliaments 
1. 
Bundesrat DE 
2. 
Danish Parliament's Health and European Affairs Committee 
DK 
3. 
French Senate 
FR 
4. 
Social Affairs Committee of the Swedish Parliament 
SE 
Regional and local authorities 
1. 
Regional Management of the Waldviertel 
AT 
2. 
Provincial Administration for Health, Hospitals and Personnel of Styria  
AT 
3. 
Committee for Welfare, Public Health and Family of the Flemish  BE 
Parliament 
4. 
Bavarian State Ministry for the Environment, Health and Consumer  DE 
Protection 
5. 
Minicipality of Illingen 
DE 
6. 
Government of Aragon (Department of Health and Consumer Protection) 
ES 
7. 
Swedish Association of Local Authorities and Regions  
SE 
8. 
Fresh Smoke Free North East (SFNE) 
UK 
9. 
Smoke Free Derwentside 
UK 
10. 
Smoke-free Bristol (SFB) 
UK 
11. 
Smoke Free Norfolk 
UK 
12. 
Cheshire & Merseyside Tobacco Alliance 
UK 
13. 
Heart of Mersey 
UK 
 
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Health-related organisations 
Health NGOs and health promotion 
Framework Convention Alliance (FCA) and the Global Smokefree  International 
Partnership (GSP) 
Smoke Free Partnership (SFP) 
EU  
European Network for Smoking Prevention (ENSP) 
EU  
International Network of Women Against Tobacco Europe Board – INWAT- EU  
Europe 
European Federation of Allergy and Airways Diseases Patients' Associations  EU  
(EFA) and International Primary Care Respiratory Group (IPCRG) 
Association of European Cancer Leagues (ECL) 
EU  
European Public Health Alliance (EPHA) 
EU  
European Heart Network (EHN) 
EU  
European  Union  of  Nonsmokers  (EUN) 
EU   
l'Union Européenne des Non-Fumeurs (UEN) 
EU 
My Lungs (Moje Pluca) 
BA  
(Association for a Smoke-Free Environment (RookVrij vzw – Vereniging  BE 
voor een rookvrije leefomgeving ) 
Cyprus National Coalition for Smoking Prevention 
CY  
Bundesvereiningung für Gesundheit 
DE 
German Cancer Aid (Deutsche Krebshilfe)  
DE  
Smoke-Free Forum (Forum Rauchfrei) 
DE  
Berlin Non-Smokers’ Alliance (Nichtraucherbund Berlin e.V.)  
DE   
Non-Smokers' Initiative for Germany (Nichtraucher-Initiative Deutschland) 
DE   
German Lung Foundation (Deutsche Lungenstiftung) 
DE   
Association for Tobacco Prevention in Aragon (Asociación para la  ES 
Prevención del Tabaquismo en Aragón, APTA) 
INWAT-España 
ES   
Afectados por el  Tabaco/ No Fumadores  (AFECTA) 
ES 
Nofumadores.org ES 
 
Spanish Association Against Cancer (Asociación Española Contra el  ES 
Cancer) 
ASH Finland 
FI   
Cancer Society of Finland 
FI  
Finnish Heart Association  
FI  
Pulmonary Association Heli 
FI  
French Cancer League 
FR  
Paris Without Tobacco 
FR  
French Alliance Against Tobacco 
FR 
Public benefit Association of Patients Cured with Oxygene  
HU  
Hungarian Foundation of Health Prevention 
HU  
Health 21 Hungarian Foundation 
HU  
Generatio 2020 Egyesület 
HU  
Alleanza per la salute mentale - Brescia  
IT  
(Alliance for Mental Health – Brescia) 
Dutch cancer Society, Netherlands 
NL  
Heart Foundation, Dutch Asthma Foundation and STIVORO 
Dutch Nonsmokers Association Clean Air Nederland 
NL  
(Portguese Confederation on Smoking Prevention (Confederação Portuguesa  PT  
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de Prevenção do Tabagismo, COPPT) 
Slovenian Coalition for Tobacco Control 
SI 
Action on Smoking and Health (ASH) 
UK  
ASH Scotland 
UK  
British Heart Foundation 
UK  
Association for Nonsmokers’ Rights (ANSR) 
UK  
The Roy Castle Lung Cancer Foundation 
UK 
Scientific institutions 
1. 
European Respiratory Society (ERS) 
EU 
2. 
Europe Region of the International Union against Tuberculosis and Lung  EU   
Disease                                         
3. 
Austrian Nicotine Institute (ARGE) 
AT 
4. 
German Cancer Research Center (DKFZ) 
DE 
5. 
Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin 
DE 
(German Pneumonology Society) 
6. 
Hellenic Thoracic Society 
EL 
7. 
Finnish Institute of Occupational Health  
FI 
8. 
Italian Society of Respiratory Medicine (SiMER) and Italian Federation  IT 
Against Pulmonary Diseases and Tuberculosis (FIMPST). 
9. 
Italian Interdisciplinary Scientific Association for Research in Lung Disease  IT 
(AIMAR) 
10. 
Dutch Society of Pulmonologists (NVALT) 
NL 
11. 
National School of Public Health, Universidade Nova de Lisboa 
PT 
12. 
Portuguese Society of Pneumology (Sociedade Portuguesa de Pneumologia)  PT 
13. 
National Institute of Public Health of the Republic of Slovenia 
SI 
14. 
Cancer Research UK 
UK 
Professional organisations 
1. 
European Network of Quitlines 
EU 
2. 
European Medical Students' Association (EMSA) 
EU 
3. 
European Pharmaceutical Students' Association (EPSA) 
EU 
4. 
European Pharmaceutical Union  (EPU) 
EU 
5. 
Pharmaceutical Group of the European Union  (PGEU) 
EU 
6. 
NÖ Landeskliniken-Holding   
AT 
(Lower Austrian Provincial Clinics Holding) 
7. 
German Medical Association (Bundesärztekammer) 
DE 
8. 
German Medical Action Group Smoking or Health 
DE 
9. 
Balearic Islands Health Services (IB – Salut) 
ES 
10. 
Doctors Against Smoking network in Finland (DAT) 
FI 
11. 
Health Professionals against Tobacco 
SE 
12. 
British Psychological Society (BPS) 
UK 
13. 
Royal College of Physicians (RCP) 
UK 
14. 
Royal College of Physicians of Edinburgh (RCPE) 
UK 
15. 
Royal College of Nursing (RCN) 
UK 
16. 
Royal College of General Practitioners (RCGP) 
UK 
17. 
Faculty of Public Health of Royal College of Physicians (FPH) 
UK 
18. 
British Medical Association (BMA) 
UK 
Pharmaceutical industry 
1. 
Johnson and Johnson  
International 
2. 
Association of the European Self-Medication Industry (AESGP) 
EU 
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3. 
Novartis  
International 
4. 
Pfizer  
International 
Tobacco-related organisations 
Manufacturers 
1. 
Confederation of European Community Cigarette Manufacturers (CECCM)  EU 
2. 
European Cigar Manufacturers Association (ECMA) 
EU 
3. 
European Smoking Tobacco Association (ESTA) 
EU 
4. 
Groupement des Industries Europeennes du Tabac (GITES) 
EU 
5. 
International Smokeless Tobacco Company's 
International 
6. 
Philip Morris International (PMI) 
International 
7. 
British American Tobacco, Cyprus 
CY 
8. 
Association of the German Smoking Tobacco Industry (Verband der  DE 
Deutschen Rauchtabakindustrie) 
9. 
Federal Association for the Cigar Industry (Bundesverband der DE 
Zigarrenindustrie– BdZ) 
10. 
Tobacco Manufacturers Association of Denmark (Tobaksindustrien) 
DK 
11. 
Estonian Tobacco Manufacturers Association 
EE 
12. 
Spanish Association of Tobacco Companies 
ES 
(Asociacion Empresarial del Tabaco) 
13. 
Finnish Tobacco Industries´ Federation  
FI 
14. 
Hungarian Association of Tobacco Industry  
HU 
15. 
Irish Tobacco Manufacturers Advisory Committee 
IE 
16. 
Lithuanian Tobacco Manufacturers' Association  
LT 
17. 
Latvian Tobacco Manufacturers Association  
LV 
18. 
British American Tobacco Malta Ltd. 
MT 
19. 
Nederlandse Vereniging voor de Sigarenindustrie 
NL 
(Dutch Association of Cigar Industry) 
20. 
Ritmeester Cigars 
NL 
21. 
Gallaher Norway AS and Gunnar Stenberg AS.  
NO 
22. 
Tobacco Manufacturers' Association 
UK 
Wholesalers and retailers 
1. 
European Tobacco Wholesaler Association  
EU 
2. 
Confédération Européenne des Détaillants en Tabac (CEDT) 
EU 
(European Confederation of Tobacco Retailers) 
3. 
Interbranch organisation for the tobacco retail trade (NSO) 
NL 
4. 
Belangenvereniging Tankstations, BETA 
NL 
 
Association of petrol station operators 
5. 
The Imported Tobacco Products Advisory Council (ITPAC) 
UK 
Growers 
1. 
Regional Union of Tobacco Growers in Grudziadz (change name) 
PL 
2. 
Regional Union of Tobacco Growers in Augustow 
PL 
Trade unions 
1. 
Federation of the Trade Unions of the Tobacco Industry Employees  PL 
(FZZPPT) 
2. 
Tobacco Workers Alliance (TWA)  
UK 
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Smokers' NGOs 
1. 
Austrian Smokers Network 
AT 
2. 
Netzwerk Rauchen – Forces Germany e.V 
DE 
3. 
Smoker's Society 
HU 
4. 
Freedom Organisation for the Right to Enjoy Smoking Tobacco (FOREST) 
UK 
Social partners 
Inter-sectoral organisations 
1.   
European Association of Craft, Small and Medium-sized Enterprises  EU 
(UEAPME) 
2.   
Austrian Federal Chamber of Labour 
AT 
3.   
Austrian Chamber of Commerce (WKO) 
AT 
4.   
Confederation of German Employers' Associations (Bundesvereinigung der  DE 
Deutschen Arbeitgeberverbände, BDA) 
5.   
Confederation of Danish Industries 
DK 
6.   
Confederation of Hungarian Employers and Industrialists 
HU 
7.   
National Association of Entrepreneurs and Employers 
HU 
Hospitality sector 
1.   
European Federation of Food Agriculture and Tourism Trade Unions  EU 
(EFTAT) 
2.   
HOTREC - Hotels, Restaurants & Cafés in Europe 
EU 
3.   
Federació Catalana de Locals d’Oci Nocturn (FECALON) 
ES 
4.   
Trade Association of Hungarian Caterers 
HU 
5.   Equilibrum 
Association 
PL 
6.   
ARESP® – Associação da Restauração e Similares de Portugal 
PT 
7.   
SLTA - Scottish Licensed Trade Association 
UK 
Other 
1.   
Danish Employers Association for the Financial Sector (FA) 
DK 
Other  
MEPs 
1.   
Jörg Leichtfried MEP 
AT 
2.   
Alyn Smith MEP 
UK 
Other industry 
1. 
European Alliance for Technical Non-smoker Protection (EATNP) 
EU 
 
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ANNEX III– TARGETED STAKEHOLDER CONSULTATION 
As part of the Impact Assessment exercise, DG SANCO organised two stakeholder 
consultation meetings (one with business organisations, the other with civil society 
and social partners) on 19th March 2008. The meeting was jointly facilitated by the 
contractor and DG SANCO. The purpose of the stakeholder meeting was to seek 
input from various stakeholders, in order to make the research process as transparent 
as possible and obtain valuable information from stakeholders directly, information 
that is not always available through other data sources. During the meeting the 
contractor presented interim study results in addition to the study’s methodological 
approach. DG SANCO presented the five policy options under consideration in the 
Impact Assessment. Finally, the contractor conducted an exercise to systematically 
collect expert knowledge and opinion on the likely effects of the proposed policies 
on various key inputs to the analysis. 
Invitations were sent to the main stakeholders at EU level but all “spontaneous 
applications” from interested national organisations were also accepted. A 
background document was sent out to all registered participants, which included 
information on the objectives of the stakeholder consultation, the problem definition 
and methodological approach, and description of policy options.  
In total 38 stakeholders attended the two meetings, and following the meetings DG 
SANCO received a total of 27 written responses from various organisations. 
The sections below contain the consultation questions, the list of all invited 
organisations, the minutes of the stakeholder meetings and the summary of the 
written contributions received thereafter.   
 
CONSULTATION QUESTIONS 
1)  Is the description of the problem and its consequences adequate?  
a.  Are there any important aspects of the problem and consequences that have 
not been addressed or been addressed insufficiently? 
b.  Has the problem been defined adequately in terms of ETS prevalence? 
c.  Has the problem been defined adequately in terms of ETS morbidity? 
d.  Has the problem been defined adequately in terms of ETS mortality? 
e.  Has the problem been defined adequately in terms of ETS health care costs? 
f. 
Has the problem been defined adequately in terms of ETS non-health care 
costs? 
g.  Are you aware of any more recent evidence or data sources that are worth 
investigating in order to further sharpen the problem definition? 
 
2)  Are the available policy options adequately identified and analysed? Are there 
any other EU actions that should be considered? 
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3)  Please rank the five possible policy options (to the extent possible) in terms of 
their effects on various parameters (i.e. write down ‘policy 1’, ‘policy 2’, etc. at 
the most appropriate place on each of the lines below). It is ok to write two 
policies on top of each other if you want to assign an equal rank. 
 
To further clarify this task, we provide an example below. 
 
Exposure to ETS at home: 
 
    2    
    1      

 
          
   3 
 
  4 
5           
Decrease
No change
Increase  
In this example the respondent ranked both policy option 1 and 2 as having an equally 
large decreasing effect on ETS exposure at home. The respondent thought that policy 3 
would not cause any change in ETS exposure at home, and that both policy 4 and 5 had 
an increasing effect on ETS exposure at home, where the increasing effect of policy 5 
was considered larger than the effect of policy 4 

 
Social (health) impacts 
 
 
Exposure to ETS in workplaces and public places: 
 

Decrease
No change
Increase
 
 
Exposure to ETS at home: 
 
Decrease
No change
Increase
 
 
Prevalence of active smoking and tobacco consumption 
 
Decrease
No change
Increase
 
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Uptake of smoking 
 
Decrease
No change
Increase
 
 
Mortality, morbidity and disability from ETS 
 

Decrease
No change
Increase
 
 
Social acceptability of smoking 
 

Decrease
No change
Increase
 
 
Support for smoke-free policies 
 

Decrease
No change
Increase
 
 
Possible other impacts (please specify) 
 
Decrease
No change
Increase
Increase
 
 
Economic impacts 
 
Healthcare expenditure on tobacco-related diseases (e.g. lung cancer, COPD etc) 
 
Decrease
No change
Increase
 
Workers' productivity (e.g. lost wages, sick leave, etc) 
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Decrease
No change
Increase
 
 
Cleaning and maintenance costs 
 
Decrease
No change
Increase
 
 
Hospitality industry revenues and employment 
 
Decrease
No change
Increase
 
 
Tobacco industry revenues and employment: 
 

Decrease
No change
Increase
 
 
Pharmaceutical industry revenues and employment: 
 

Decrease
No change
Increase
 
 
Retail sector revenues and employment: 
 
Decrease
No change
Increase
 
 
 
 
 
Other sectors' revenues and employment 
 

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Decrease
No change
Increase
 
 
Implementation and enforcement costs 
 
 
Decrease
No change
Increase
 
 
Possible other impacts (please specify) 
 
Decrease
No change
Increase
 
 
Environmental impacts 
 
 

Indoor air pollution 
 
Decrease
No change
Increase
 
 
Possible other impacts (please specify) 
 
Decrease
No change
Increase
 
 
 
 
 
 
 
 
 
4)  Please further quantify these effects (to the extent possible) the effects of the five 
policy options on the main inputs to the model. 
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Overall exposure to ETS 

 
2006 
2008 
2013 
 
EB data 
Current 
Policy 1 
Policy 2 
Policy 3 
Policy 4 
Policy 5 
estimate 
Indoor workplaces and offices (QB 31b.1) 
- EU average 
19%
 15.4% 
   
 
 
 
- 25th percentile 
11%
 8.5% 
   
 
 
 
- 75th percentile 
23%
 19.1% 
   
 
 
 
Restaurants and bars (QB 31b.5) 
- EU average 
39%
 24.0%
 
 
 
 
 
- 25th percentile 
21%
 6.2%
 
 
 
 
 
- 75th percentile 
47%
 41.0% 
 
 
 
 
 
 
Workers' exposure to ETS  
 
2006 
2008 
2013 
 
EB data 
Current 
Policy 1 
Policy 2 
Policy 3 
Policy 4 
Policy 5 
estimate 
Offices (QB 31b.1 cross-tabulated with QB31a) 
- EU average 
32%
 25.5% 
   
 
 
 
- 25th percentile 
17%
 13.0% 
   
 
 
 
- 75th percentile 
40%
 32.7% 
   
 
 
 
Restaurants and bars (QB 31b.5 cross-tabulated with QB31a) 
- EU average 
70%
 43.0%
 
 
 
 
 
- 25th percentile 
33%
 17.6%
 
 
 
 
 
- 75th percentile 
87%
 71.5%
 
 
 
 
 
 
 
ETS exposure at home (any exposure; exposure assumed to be unaffected by 
smoking bans)  

 
2006 
2008 
2013 
 
EB data 
Current 
Policy 1 
Policy 2 
Policy 3 
Policy 4 
Policy 5 
estimate 
Exposure to ETS at home (QB 30) 
- EU average 
43%
43.4%
 
 
 
 
 
- 25th percentile 
34%
32.8%
 
 
 
 
 
- 75th percentile 
49%
51.0%
 
 
 
 
 
 
5)  Is there any supplementary data on the social (health), economic or 
environmental aspects of the problem which should be taken into account? 
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ORGANISATIONS INVITED TO TARGETED CONSULTATION  
I.  EU  AND  INTERNATIONAL  EXPERTS,  CIVIL  SOCIETY  AND  SOCIAL 
PARTNERS 

EU AGENCIES   
1.  Eurofound - European Foundation for the Improvement of Living and Working 
Conditions  
2.  OSHA - European Agency for Safety and Health at Work 
3.  EMEA - European Medicines Evaluation Agency  
INTERNATIONAL ORGANISATIONS 
4.  WHO Tobacco Free Initiative  
5.  WHO Regional Office for Europe  
6.  FCTC Secretariat   
HEALTH AND ENVIRONMENT STAKEHOLDERS: 
Members of EU Health Policy Forum 
7.  Assembly of European Regions (AER)  
8.  European Consumers Organisation (BEUC)  
9.  Standing Committee of European Doctors (CPME)  
10.  Association of European Cancer Leagues (ECL)  
11.  European Disability Forum (EDF)  
12.  European Federation of Allergy and Airways Diseases Patients' Associations (EFA)  
13.  European Federation of Nurses Associations (EFN)  
14.  European Heart Network (EHN)  
15.  European Network for Smoking Prevention (ENSP)  
16.  European Patients’ Forum (EPF)  
17.  European Public Health Alliance (EPHA)  
18.  European Public Health Association EUPHA  
19.  EuroHealthNet  
20.  European Hospital and Healthcare Federation (HOPE)  
21.  Pharmaceutical Group of the European Union  (PGEU)  
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Members of Consultative Forum on Environment and Health  
22. International Network on Children’s Health, Environment and Safety (INCHES)   
23.  European Academy of Allergology and Clinical Immunology (EAACI)  
24.  European Environmental Bureau  
25.  Green Facts Foundation asbl  
26.  European Respiratory Society (ERS)  
27.  European Centre for Ecotoxicology and Toxicology of Chemicals (ECETOC)  
28.  European Public Health Alliance Environment Network (EEN)  
29.  European Federation of Allergy and Airways Diseases Patients’ Associations (EFA)  
30.  European Federation of Environmental Health (EFEH)  
31.  (European) Society for Research on Environment and Health (European SREH) 
Other stakeholders' associations 
32. Framework Convention Alliance (FCA) and the Global Smokefree Partnership 
(GSP)  
33. European Smoke-free Partnership (SFP)  
34. International Network of Women Against Tobacco Europe Board – INWAT-Europe  
35. European  Union  of  Nonsmokers  (EUN)  
 
36. Europe Region of the International Union against Tuberculosis and Lung Disease  
37. European Network of Quitlines  
38. European Pharmaceutical Union  (EPU)  
39. European Association of Service Providers for Persons with Disabilities (EASPD)  
40. Confederation of Family Organisations in the EU  (COFACE) 
41. International Union Against Cancer (UICC)  
42. Action on Smoking and Health (ASH)  
SOCIAL PARTNERS 
Inter-sectoral organisations 
43.  European Trade Union Confederation (ETUC)  
44.  Confederation of European Business (BusineessEurope)  
45.  European Association of Craft, Small and Medium-Sized Enterprises (UEAPME)  
46.  European Centre of Enterprises with Public Participation and of Enterprises of 
General  Economic Interest (CEEP)  
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47.  Association of European Chambers of Commerce and Industry 
(EUROCHAMBRES)  
Hospitality sector organisations 
48.  EFTAT: European Federation of Food Agriculture and Tourism Trade Unions  
49.  HOTREC – Hotels, Restaurants and Cafés in Europe  
SELF-INVITED 
50.  Vlaams Instituut voor Gezondheidspromotie vzw  
51.  Fondation contre les affections respiratoires et pour l'éducation à la sante 
(F.A.R.E.S.) 
52.  German Cancer Research Center  
53.  German Medical Association Action Group on Smoking or Health (GMASH)  
54.   International Health and Social Affairs Office Veneto Region - Brussels 
Representation 
55.  NHS Health Scotland 
56.  Cancer Research UK 
57.  Forest (Freedom Organisation for the Right to Enjoy Smoking Tobacco) 
II. INDUSTRY 
TOBACCO-RELATED ORGANISATIONS 
1.  Confederation of European Community Cigarette Manufacturers (CECCM)  
2.  British American Tobacco (BAT) 
3.  Japan Tobacco International (JTI) 
4.  Imperial Tobacco Ltd. (ITL) 
5.  European Cigar Manufacturers Association (ECMA)  
6.  European Smoking Tobacco Association (ESTA) 
7.  Groupement des Industries Européennes du Tabac (GITES)  
8.  International Smokeless Tobacco Company's  
9.  Philip Morris International (PMI)  
10. European Tobacco Wholesaler Association (EU)  
11. European Confederation of Tobacco Retailers (ECTR)  
Self-invited 
12. ESTOC – European Smokeless Tobacco Council  
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PHARMACEUTICAL INDUSTRY   
13.  Association of the European Self-Medication Industry (AESGP) (brings together all 
NRT producers)  
14.  Johnson and Johnson  
15.  GlaxoSmithKline  
16.  Pfizer  
17.  Novartis  
OTHER 
18.  European Alliance for Technical Non-smoker Protection (EATNP)   
19.  European Federation of Cleaning Industries (FENI)  
20.  European Insurance and Reinsurance Federation (CEA)  
21.  The European Association of Event Centres (EWC)  
22.  The European Engineering Industries Association (ORGALIME)  
Self/invited 
23.  Smoke Free Systems AG  
24.  Asecos GmbH  
 
 
 
 
 
 
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MINUTES FROM THE STAKEHOLDER CONSULTATION MEETING 
COMMISSION OF THE EUROPEAN COMMUNITIES 
Health and Consumers Directorate-General 
 
Directorate C - Public Health and Risk Assessment 
  C6 - Health Law and International 
Brussels, 
SANCO/C6/ (2008)  
 
Minutes from the Stakeholders consultations on Smoke-Free Environment 
Brussels, 19 April 2008 
 
This meeting with stakeholders is an integral part of the ongoing Impact Assessment 
supporting the Commission's smoke-free initiative scheduled for end 2008. It follows 
an open online consultation performed through the Green Paper in 2007 and should 
inform the IA in particular regarding the assessment of the impacts.  
Two separate meetings took place, one with the business representatives in the 
morning, and the other with the health experts, civil society and social partners in the 
afternoon. The second meeting was split into two meetings (see below). The 
meetings were chaired by Thea Emmerling (C6) with also unit 02 present and Evi 
Hatziandreau and Han de Vries from RAND.  
RAND has been commissioned to assess the economic and social impacts of ETS 
within EU-27 and examine the likely impacts of five policy options.  
RAND presented briefly its methodological approach to the stakeholders. They also 
underlined that they aim in particular to develop figures on mortality rates post 2002 
for the EU as well as figures regarding the cost of mortality in the EU which is 
currently only available for the US.  
DG SANCO (A Jassem) presented the policy options being considered.  These are: 
 
1) No change from the status quo 
2) Open method of coordination 
3) Commission recommendation 
4) Council recommendation 
5) Binding EU legislation 
The five Policy options are not mutually exclusive. They can complement each other 
either in parallel or over time. 
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Industry stakeholders (morning session): 
 
PARTICIPANTS' LIST 
 
Name Organisation 
Fürste Cynthia 
BAT 
Verna Florian 
JTI 
Massimiliano Di Domenico 
Japan Tobacco International 
Pederiva Antonella 
CECCM 
Bulk Johan 
ECMA 
Gueroult Perinne 
ESTA 
Decourchelle Jean-Marie 
GITES 
Doms Kristof 
PMI 
Zenner Carsten 
Tobacco Wholesaler 
Triglia Flaminia Consuelo 
ECTR 
Treven Stina 
Smoke Free Systems (EATNP?) 
Koch Hubert 
ASECOS 
Hatziandreu Evi 
Rand 
de Vries Han 
Rand 
Emmerling Thea 
SANCO C6 
Jassem Anna 
SANCO C6 
Holl Michaela 
SANCO 02 
Stiernon Christophe 
SANCO 02 
(illegible) 
Independence/democracy group in 
the EP 
 
Regarding the suggested RAND modelling approach, the stakeholders insisted on the 
fact that smokers and non-smokers should be examined separately as the burden on 
smokers is much larger. In order not to inflate the ETS prevalence figures, smokers 
should be excluded from the model.   
The representative from the IND group in the EP questioned the fact that ETS 
prevalence is based on Eurobameter data which is self–reported .  
The JTI representative pointed out that the ETS prevalence figure for Italy was 
relatively high even after the introduction of the ban in the country. RAND replied 
that the Eurobometer is the only source of comparable EU-wide data on exposure but 
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added that also studies based on cotinine or CO2/nicotine measurements are 
examined.  
On healthcare costs, it was criticised that the focus in primarily on US data, in 
addition dating back to 10 years ago. RAND said that they hope to collect and 
receive more recent evidence and take it into account. 
The participants requested that a glossary is included in the Impact Assessment 
report as the industry defines certain terms (such as prevalence/incidence) 
differently. 
The manufacturers of technological equipment to reduce ETS insisted on the fact 
that smoke-free policies should be goal-driven rather than determine the way to 
achieve this goal (=ban on smoking). In this context, they criticised the fact that the 
consultation document started from the assumption that only a ban can guarantee 
protection from ETS and did not look into technology-based solutions that could 
possibly achieve the same level of non-smokers' protection. It was also pointed out 
that the document did not properly differentiate between national policies based on a 
total ban (e.g, UK, Ireland) and policies leaving room for technological solutions 
(Sweden, Italy, some German Laender). This was complemented by another 
intervention that asked for a clear overview of the national policies currently in place 
or about to be implemented. A representative from ASECOS drew attention to the 
ongoing efforts in Germany to develop standards and testing guidelines for such 
technologies in order to ensure that they fulfil the stated pollution reduction. A 
representative of Smokefree systems pointed to the negative economic impact due to 
absenteeism of smoking employees when a total ban is imposed (8 billion euros a 
year apparently). SANCO asked for data regarding costs and benefits of technology 
based ETS protection.  
Tobacco industry expressed disappointment that the consultation document only 
looked at different policy instruments rather than the scope of a smoke-free initiative 
(full ban indoors vs smoking ban with exemptions). The question of the role of the 
stakeholders in this IA consultation was raised, as the decision on a total ban had 
apparently already been taken. Thea Emmerling responded that the IA report will 
take into account, to the extent possible, the stakeholders’ views but at the same time 
will build on the outcome of the Green Paper consultation, which demonstrated a 
strong support for comprehensive smoke-free policies. She also explained that the 
choice of the policy instrument would have an impact on the exact content of the 
policy (e.g. Council Recommendation could have a wider scope than binding EU 
legislation). BAT representative referred to a declaration by the previous 
Commissioner in reply to an MEP question to include the technological solutions in 
the IA. SANCO said that there were very few peer-reviewed studies on this issue but 
invited the participants to submit any relevant data. A representative from Smoke-
free systems pointed to the potential costs resulting for policy option 5 (directive 
based on employment rules) if MS that are already advanced had to revise their 
legislation.  
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A representative from PMI pointed out, that also option 1 (status quo) would be quite 
beneficial given the ongoing dynamics at national level and FCTC guidelines.  
 
Health and social stakeholders (afternoon session): 
 
PARTICIPANTS' LIST 
 
Name Organisation 
Sylvie Jacquet 
Eurofound 
Luk Joossens 
ECL 
Grogna Francis 
ENSP 
Escuin Susana 
EPHA 
Gilljam Hans 
EuroHealthNet 
(Chave John) "Darnica Minos" 
PGEU 
Berteletti Kemp Florence 
SFP 
Amos Amanda 
INWAT 
Huydts Marijke 
EUN 
Peeters Annemie 
Vlaams Instituut 
Pettiaux Michel 
F.A.R.E.S. 
Pötschke-Langer Martina 
DKFZ 
Wiebel Friedrich 
GMASH 
Ronfini Franceso 
Office Veneto Region 
Smith Rebekah 
BusinessEurope 
Hoffmann Helen 
UEAPME 
Vallini Marc 
HOTREC 
Crowley Grainne 
Cancer Research UK 
Logstrup Susanne 
EHN 
May Uwe 
AESGP 
Wojciechowski Krzysztof 
Johnson and Johnson 
Jenewein Joerg 
GlaxoSmithKline 
Sophie Crousse 
GlaxoSMithKline 
Hollingsworth Andrew 
Novartis 
Hatziandreu Evi 
Rand 
De Vries Han 
Rand 
Palkonen Susanna 
EFA 
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Emmerling Thea 
SANCO 
Jassem Anne 
SANCO 
Holl Michaela 
SANCO 02 
Stiernon Christophe 
SANCO 02 
 
Clark Simon 
Forest 
 
The health and social stakeholders unanimously objected to the presence of a 
representative of the smokers’ NGO Forest. The first suggestion of the chair was to 
discontinue the whole meeting as a meaningful discussion was not possible under 
these circumstances. The only possibility to avoid the dissolution was to split the 
meeting in two provided that both sides agreed, which was case. 
Smoke-free Partnership stressed the paramount importance of workers’ protection 
and asked that data on exposure in the workplace be included in the IA. Health 
stakeholders acknowledged that it is difficult for policies to regulate home exposure. 
On the other hand, a representative of Business Europe questioned whether it is 
feasible to distinguish between mortality/morbidity triggered by ETS exposure at 
home and at work.  
INWAT-Europe stressed the socio-economic inequalities in smoking and exposure 
to second-hand smoke - and referred to Scottish research which showed that the 
impact of smoke-free legislation was biggest among the most disadvantaged groups, 
which had fewer smoking restrictions prior to the ban. DKFZ and INWAT-Europe 
also pointed to the gender specificities of active and passive smoking - according to 
the Scottish data, ¾ of death from passive smoking prior to the ban were in women. 
This is apparently also confirmed by the WHO data.  
Regarding the home exposure, it was emphasised that Scottish research showed that 
smoking has not displaced from work to home after a ban, but that on the contrary a 
ban helped also to reduce ETS prevalence at home. These findings are consistent 
with data from IE, NZ and US.  
DKFZ pointed to the fact that in a federal country like Germany, ETS prevalence 
varies considerably across the country, with different laws in place at regional level.  
On the economic burden, RAND explained that they used US data as there is no 
published evidence from Europe. They asked for data on healthcare costs of 
cardiovascular diseases, lung cancer and COPD as well as any data on non-
healthcare costs (e.g. the cost of the time lost while smoking during working hours). 
Several participants pointed to additional evidence and promised to submit data in 
writing.  
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It was suggested that the mortality figures should be put into perspective (e.g. ETS 
deaths = 1 plane crash per day) and/or compared with the burden of other 
comparable hazards such as exposure to toxic substances. 
Pharmaceutical industry highlighted the importance of cessation policies as a 
flanking measure and referred to the EP resolution on the Green Paper. 
Smoke-free partnership and INWAT-Europe pointed out that whichever policy 
option is chosen as a result of the Impact Assessment, it should be equipped with a 
transparent monitoring and evaluation mechanism. 
Regarding the preferred policy option, no clear picture emerged The majority of   
participants seemed to be in favour of binding legislation, referring also to the EP 
resolution which called for such legislation. Others pointed to possible negative 
impacts if more advanced national legislation would need to be adjusted and/or the 
fact that a recommendation could establish not only a minimum standard for 
working protection, but also a gold standard for a more comprehensive policy.  
One participant (HOTREC) expressed preference for action at national level given 
the EU level competences for health and the subsidiary issue.  
A representative of FOREST (a UK-based smokers’ lobby) had a separate brief 
discussion with SANCO and RAND after the afternoon session.  
He started by questioning the review of literature as performed by RAND and 
referred to a comprehensive, however contested study carried out for the tobacco 
industry in 2001 which came to very different conclusions as far as passive smoking 
is concerned. RAND responded by explaining that their review included summary 
studies that are being referred to and published in scientific peer-reviewed journals 
and government reports. The study at stake is not referred to separately.  
The FOREST representative argued that smoking bans accelerate existing negative 
economic trends in hospitality sector and mentioned that some pubs and bars in the 
UK went out of business and promised to submit data supporting this thesis.  
He claimed that the concept of freedom of choice is forgotten and the interest of the 
citizen is not taken into consideration during this consultation without an 
involvement of smokers interest groups. He therefore was grateful for having been 
given the opportunity to explain his concerns and promised to follow up by 
submitting data. 
He did not question the need for ETS legislation in principle, but pointed out that 
total bans are too strict and more flexible options (e g Spain) are to be favoured.  
Procedural issues:  
The participants of both sessions said that it was very difficult to rank the policy 
options and their likely impacts, as they do not have enough knowledge on the 
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different options and understanding of what exactly the content and scope of each 
option would be.  
It was agreed with all participants that any further evidence, data etc. can be 
submitted to the SANCO functional mailbox by 7 April.  
 
End 
 
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SUMMARY OF WRITTEN CONTRIBUTIONS 
 
This section summarises the written contributions to the consultation based on the 
type of organisation. Many institutions reiterated their responses to the Green Paper 
“Towards a Europe free from tobacco smoke: policy options at EU level”.    
1.  Health-related organisations  
Health NGOs and health promotion 
The largest number (14) of written responses to the stakeholder consultation were 
received from health promotion organisations, including NGOs, scientific 
institutions and public administration bodies 
Nine health organisations provided a coordinated reply arguing that a combination of 
a strong Council Recommendation (policy option 4) based on article 8 guidelines 
and a revision of the existing directives based on the Framework Directive on 
workplace safety and health 89/391/EEC, including in particular, extending the 
scope of the Carcinogens and Mutagens Directive 2004/37 (policy option 5) to cover 
tobacco smoke would have the biggest potential to support and/or strengthen 
comprehensive smoke-free legislation at national level and thus reduce exposure to 
tobacco smoke and related health and economic burden. While six of these 
organisations assumed that the effectiveness of option 4 and 5 would be similar, the 
other three thought that a Council Recommendation on its own would have less 
impact. Policy options 1 to 3 (continuing current work, Open Method of 
Coordination and Commission Recommendation) would have no impact on the key 
measures identified. The cost for industry sectors were not a primary concern for 
these organisations, but it was argued that the hospitality industry is not adversely 
affected by smoke-free legislation while spending on tobacco products is redirected 
to other goods and services in more labour intensive sectors.     
Two organisations argued strongly in favour of binding legislation as the only viable 
policy option. Moreover, one health organisation felt that classifying tobacco smoke 
as a carcinogen would be the most important basis for policy options 3 to 5. 
One health NGO felt that more attention should be given in the report to the “likely 
beneficial impact of reducing ETS on inequalities in health in Europe. A number of 
respondents provided further evidence, e.g. on the costs of treating cardiovascular 
and respiratory diseases, social effects of Scottish smoke-free legislation and 
workers' exposure to tobacco smoke across the EU.  
Pharmaceutical industry 
The pharmaceutical industry felt that the revision of binding EU legislation (such as 
Directive 67/548/EEC on Dangerous Substances in order to classify tobacco smoke 
as a carcinogen and the Directive on Workplace Safety and Health 89/391/EEC) 
complemented by a strong Council Recommendation, tackling wider tobacco-control 
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issues, would be the best way to reduce tobacco-related burden. Moreover, smoke-
free policies can be the most effective when they are complemented by effective 
flanking policies, such as awareness raising campaigns and increased access to 
smoking cessation services and therapies.  
All, except one health organisation completed answers to question 3 and 4 of the 
stakeholder consultation. 
2.  Tobacco-related organisations   
Manufacturers 
The majority of tobacco manufacturers expressed support for an EU-wide ban with 
exemptions in order to accommodate the interests of those who do not wish to be 
exposed to ETS and those who wish to smoke in venues.  
It was argued that business owners should have a role in deciding how to implement 
solutions that work best for their customers. In this context, it was felt the 
Commission should review the cost effectiveness of various options, including the 
technological approaches (such as ventilation) for reducing exposure to ETS in its 
impact assessment.  
One respondent questioned the health risks of second-hand smoke to non-smokers, 
arguing that the concentration of chemicals contributed to indoor air by smoking is 
very low (below the threshold for responses to chemical exposure). It was also 
claimed that the proper assessment of the epidemiological studies leads to a 
conclusion that “persons exposed to ETS have no greater incidence of disease than 
non-exposed persons”  
It was argued that while there may be an initial, sharp decrease in cigarette 
consumption over the few weeks around the implementation of the ban, sales recover 
after a few months and return back to original levels to follow a long-term trend of 
gradual decline.  
The additional studies suggested to be incorporated in to the impact assessment 
related to the economic impact of smoking bans on hospitality sector, impacts on 
smoking behaviour and cigarette sales volumes, and the effectiveness of ventilation.     
Overall no tobacco-related organisations completed quantitative answers to 
stakeholder questions 3 and 4, pointing out that it is difficult to comment on the 
“efficiency” of policy options without clearer indications of their policy content.  
However, the major EU-level association of cigarette manufacturers, supported by 
the associations of cigars and smoking tobacco, provided some qualitative comments 
on the two questions.  
It was argued that – given the FCTC process and the existing EU provisions on ETS 
- policy 1 (the “status quo”) is likely to have an impact on exposure to ETS which is 
similar to the expected impact of the four other policy options. Should a total 
smoking ban be considered, all policy options would decrease exposure to ETS in 
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workplaces and public places but would increase exposure at home, since smokes 
would have fewer opportunities to smoke in public places. All policy options would 
also impact negatively on revenue and employment in drinking establishments as 
well as workers productivity due to smoking breaks outside the building.  
Smokers’ NGOs 
The Smokers NGO expressed concern that the policy options had less to do with 
“protecting” non-smokers from the effects of ETS and more to do with the 
“denormalisation” of smoking. This group felt that people should have the right to 
smoke in some public places and proprietors should have the right to accommodate 
adults who choose to smoke without inconveniencing those who do not wish to 
smoke or socialise in a smoking environment. The group argued that the Impact 
Assessment should examine the social and humanitarian impact a comprehensive 
ban would have on smokers as well as technological solutions for controlling ETS.  
3.  Social partners  
There were two written responses from inter-sectoral employer organisations and 
one response from employer organisation in the hospitality sector. Continuing 
current EU programmes and awareness-raising campaigns (option 1) was the 
preferred policy option for all three organisations. They were opposed to binding EU 
legislation on the grounds that the issue of second-hand smoke is best addressed at 
Member States' level, depending on existing national arrangements and culture. It 
was also argued that passive smoking is a public health concern and not that of 
health and safety at work. 
The three organisations felt it was not possible to respond the stakeholder 
consultation questions (3 and 4) in a meaningful way because giving an “expert 
guess” is too subjective and the policy content of the different policy options is not 
clear enough.  
4.  Producers of technical equipment 
The two other industry groups that responded to the consultation were pro-technical 
solutions alliance group and a manufacturer of smoking stations and cabins. These 
groups felt that smoking stations and cabins are effective at protecting non-smokers 
from ETS and creating smoke-free workplaces, and precipitate a general decrease in 
smoking.     
These two submissions are discussed in more detail in Annex V. 
Stakeholder ratings on the effects of the five policy options on ETS exposure 
In question 4 stakeholders were presented with tables showing the estimated 2008 
ETS prevalence across the EU-27. Separate estimates were provided for each of the 
different venues. Stakeholders were asked to fill out a table with their estimates for 
2013 average ETS prevalence for each of the five policy options.  
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Of the 15 responses, all were received from health-related organisations. The 
average stakeholder ratings on the percent reduction in ETS prevalence ratio 
compared to the baseline are shown in the table below. 
Table 1:   Stakeholder ratings on percent reduction in ETS prevalence ratio compared to 
baseline 
Stakeholders ratings on percent reduction in ETS prevalence ratio compared to 
Venue 
baseline 
Policy 2 
Policy 3 
Policy 4 
Policy 1 
Policy 5 
Open method 
Commission 
Council 
No change 
Binding 
of 
recommendati
recommendati
status quo 
legislation 
 
coordination 
on 
on 
overall exposure - indoor 
workplaces and offices 
0% 
-1% 
-2% 
-66% 
-81% 
overall exposure - bars and 
restaurants 
-1% -2% -5% -70% -89% 
workers' exposure - indoor 
workplaces and offices 
0% -1% -1% -66% 
-89% 
workers' exposure - bars 
and restaurants 
0% 
-1% 
-2% 
-75% 
-94% 
exposure at home 
0% 
-1% 
-3% 
-12% 
-20% 
 
List of written contributions  
Health-related organisations (17) 
Health NGOs and health promotion 
European Foundation for the Improvement of Living and Working Conditions 
(EUROFOUND) 
International network of Women Against Tobacco Europe Board (INWAT) 
Flemish Institute for Health Promotion (VIG) 
German Smoke-Free Alliance 
Smoke Free Partnership  
European Network for Smoking Prevention (ENSP) 
European Heart Network (EHN) 
European Federation of Allergy and Airways Diseases Patients’ Associations (EFA) and 
International Primary Care Respiratory Group (IPCRG) 
Association of European Cancer Leagues   
European Union of Non-smokers  
European Public Health Alliance (EPHA) 
Stockholm Centre of Public Health  
German Cancer Research Centre 
Veneto Region, Health Department  
Pharmaceutical industry  
Pfizer  
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Association of the European Self-Medication Industry (AESGP)  
Tobacco-related organisations (6) 
Manufacturers  
European Smoking Tobacco Association (ESTA) 
European Cigar Manufacturers Association (ECMA) 
Imperial Tobacco Limited  
Confederation of European Community Cigarette  Manufacturers (CECCM)  
Groupement des Industries Euopeennes du Tabac (GITES)  
Smokers’ NGOs  
Freedom Organisation for the Right to Enjoy Smoking Tobacco (FOREST) 
Social partners (3) 
Inter-sectoral organisations  
BusinessEurope - The Confederation of European Business 
European Association of Craft, Small and Medium-sized Enterprises (UEAPME) 
Hospitality sector  
HOTREC – Hotels, Restaurants & Cafes in Europe  
Other (2) 
Other industry  
European Alliance for Technical Non-smoker Protection (EATNP)  
Smokefree Systems 
 
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ANNEX IV– REGULATORY FRAMEWORK 
A) FRAMEWORK CONVENTION ON TOBACCO CONTROL (FCTC) 
The WHO’s Framework Convention on Tobacco Control (FCTC), ratified by 26 
Member States and the Community, creates a legal obligation for all Parties to adopt 
and implement effective measures to protect people from exposure to tobacco smoke 
in all indoor workplaces, public transport and indoor public places.  
 
The second Conference of the Parties to the Convention in July 2007 adopted 
comprehensive guidelines on protection from exposure to tobacco smoke 
formulating the "golden standard" that every Party should aim to achieve within 5 
years of the Convention's entry into force for that Party.  
Article 8 of the FCTC  
Protection from exposure to tobacco smoke 
1. Parties recognize that scientific evidence has unequivocally established that 
exposure to tobacco smoke causes death, disease and disability. 
2. Each Party shall adopt and implement in areas of existing national jurisdiction as 
determined by national law and actively promote at other jurisdictional levels the 
adoption and implementation of effective legislative, executive, administrative 
and/or other measures, providing for protection from exposure to tobacco smoke in 
indoor workplaces, public transport, indoor public places and, as appropriate, other 
public places. 
Ratification of the FCTC (situation on 19 June 2008) 
The European Community signed the FCTC on 16 June 2003, on the first possible 
occasion, and deposited its instrument of ratification on 30 June 2005. 
Member State 
Signature  
Ratification notified  
Ratification expected 
European 
16/06/2003 
30 June 2005 
 
Community 
Austria 
23/08/2003 
15 September 2005 
 
Belgium  
22/01/2004 
1 November 2005 
 
Bulgaria 22/12/2003 
07 
November 
2005 
 
Cyprus 24/05/2004 
26 
October 
2005  
Czech Republic 
16/06/2003 
 
Not yet ratified 
Denmark 16/06/2003 
16 
December 
2004* 
 
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Member State 
Signature  
Ratification notified  
Ratification expected 
Estonia 08/06/2004 
27 
July 
2005 
 
Finland 
16/06/2003 
24 January 2005 
  
France 16/06/2003 
19 
October 
2004  
Germany 24/10/2003 
16 
December 
2004  
Greece 16/06/2003 
27 January 2006 
 
Hungary 16/06/2003 
07 
April 
2004 
 
Ireland 16/09/2003 
07 
November 
2005 
 
Italy 16/06/2003 
02 
July 
2008   
Latvia 10/05/2004 
10 
February 
2005 
 
Lithuania 
22/09/2003 
16 December 2004 
  
Luxembourg 
16/06/2003 
30 June 2005 
 
Malta 
16/06/2003 
24 September 2003 
 
Poland 
14/06/2004 
15 September 2006 
 
Portugal 
09/01/2004 
08 November 2005  
 
Romania 
25/06/2004 
27 January 2006 
 
Slovakia 
19/12/2003 
04 May 2004 
 
Slovenia 
25/09/2003 
15 March 2005  
 
Spain 
16/06/2003 
11 January 2005 
 
Sweden 
16/06/2003 
7 July 2005 
 
The Netherlands 
16/06/2003 
27 January 2005 
 
United Kingdom 
16/06/2003 
16 December 2004 
 
Complete list: http://www.who.int/tobacco/framework/countrylist/en/ 
 
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B) EU PROVISIONS RELATING TO EXPOSURE ENVIRONMENTAL TOBACCO SMOKE 
BINDING LEGISLATION 
At EU level, a number of occupational health and safety Directives set out 
requirements covering most risks to workers' health and safety, general risk 
prevention and some specific restrictions on smoking at the workplace. 
The Health and Safety Framework Directive 89/391/EEC2 requires the employer to 
ensure the health and safety of workers in every aspect related to work and to 
evaluate the risks to the health and safety of workers at work. ETS should therefore 
be considered as included in the risk assessment and appropriate preventive 
measures should be implemented, where necessary. 
Several other health and safety at work Directives lay down restrictions on smoking 
at work. The Workplace Directive 89/654/EEC3, the Mineral and Extractive 
Industries drilling Directive 92/91/EEC4 and the Mineral and Extractive Industries 
surface and underground works Directive 92/104/EEC5 require measures to be 
introduced for the protection of non-smokers against discomfort caused by tobacco 
smoke in rest areas and rest rooms. The Carcinogens and Mutagens Directive 
2004/37/EC6 provides for the use of "no smoking" signs in areas where workers are 
exposed, or likely to be exposed, to carcinogens or mutagens and prohibits smoking 
in these areas. Directive 83/477/EEC7 on the protection of workers from the risks 
related to exposure to asbestos at work introduces an obligation  to constitute areas 
where there should be no smoking when the risk assessment identifies the 
concentration of asbestos fibres in the workplace air at a level equal to, or above, the 
reference value. The Pregnant and Breastfeeding Workers Directive 92/85/EEC8 lists 
chemicals classified as carcinogenic (R45) and carbon monoxide among chemical 
agents in respect of which the employer should assess the nature, degree and 
                                                 

Council Directive on the introduction of measures to encourage improvements in the safety 
and heath of workers at work, OJ L 183, 29.6.89, p.1. 

Council Directive concerning the minimum safety and health requirements for the 
workplace, OJ L 393, 30.12.89, p.1. 

Council Directive concerning the minimum requirements for improving the safety and health 
protection of workers in the mineral-extracting industries through drilling, OJ L 348, 
28.11.92 p.9. 

Council Directive on the minimum requirements for improving the safety and health 
protection of workers in surface and underground mineral-extracting industries, OJ L 404, 
31.12.92 p.10. 

Directive of the European Parliament and the Council on the Protection of workers from the 
risks related to exposure to carcinogens or mutagens at work, OJ L 229, 29.6.2004, p.23. 

Council Directive on the protection of workers from the risks related to exposure to asbestos 
at work, OJ L 263, 24.9.83, p.25. 

Council Directive on the introduction of measures to encourage improvements in the safety 
and health at work of pregnant workers and workers who have recently given birth or are 
breastfeeding, OJ L 348, 28.11.92, p.1. 
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duration of exposure of pregnant workers and workers who have recently given birth 
or are breastfeeding. This should be followed by further action by the employer to 
ensure that the exposure of these workers to such risks is avoided. Lastly, the 
Explosive Atmospheres Directive 99/92/EC9 requires measures to be introduced to 
prevent the ignition of explosive atmospheres. 
NON-BINDING LEGISLATION 
The  1989 Council Resolution 89/C 189/0110 on smoking in public places invited 
Member States to:   
1. Ban smoking in all forms of public transport;  
2. Ban smoking in enclosed premises open to the public which form part of the 
following public or private establishments: 
a)  Establishments where services are provided to the public, whether for a charge or 
free, including the sale of goods;  
b)  Hospitals, establishments where health care is given and all other medical 
establishments;  
c)  Establishments where elderly persons are received;  
d)  Schools and other premises where children or young people are received or 
housed;  
e)  Establishments where higher education and vocational training are given;  
f)  Enclosed establishments used for entertainment (cinemas, theaters, etc.) ; radio 
and television studios open to the public;  
g)  Enclosed establishments where exhibitions are held;  
h)  Establishments and enclosed places where sports are practised;  
i)  Enclosed premises of underground and railway stations, ports and airports.  
                                                 

Directive of the European Parliament and Council on minimum requirements for improving 
the safety and health protection of workers potentially at risk from explosive atmospheres, 
OJ L 23, 28.1.2000. 
10 
OJ C 189, 26.7.1989, p. 1-2. 
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The 2002 Council Recommendation 2003/54/EC11 on the prevention of smoking 
and on initiatives to improve tobacco control called on Member States to implement 
legislation and/or other effective measures in accordance with national practices and 
conditions at the appropriate governmental or non-governmental level that provide 
protection from exposure to environmental tobacco smoke in indoor workplaces, 
enclosed public places, and public transport. Priority consideration should be given 
to, inter alia, educational establishments, health care facilities and places providing 
services to children.  
                                                 
11 
OJ L 22, 25.1.2003, p. 31–34. 
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C) MEMBER STATES' SMOKE-FREE REGULATIONS ON SMOKE-FREE ENVIRONMENTS
 
Austria 
Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and restaurants 
Comments  
workplaces 
public places 
transport 
facilities 
facilities 
Smokers and 
Smoking 
Smoking 
Smoking 
Smoking 
No restrictions 
The Tobacco Act entered into force in Jan. 
non-smokers 
rooms allowed 
banned 
rooms allowed 
banned 
2005. The Act sets out a ban on smoking in 
should, if 
providing that 
altogether 
providing that 
altogether for 
all "publicly accessible rooms" (understood 
possible be 
smoke is not 
In trains, 
smoke is not 
children up to 
as all enclosed spaces accessible to the 
given separate  penetrating the 
smoking 
penetrating 
the age of 18: 
general public including means of transport 
offices. If this 
general non-
rooms 
the general 
In other 
and private offices which have contact with 
is not possible, 
smoking area. 
allowed 
non-smoking 
facilities 
clients). 
smoking 
 
providing 
area. 
possibility of 
 
should be 
 
that smoke 
 
smoking 
In most public places, it is possible to create 
banned. 
is not 
rooms 
a separate smoking room provided that 
 
penetrating 
providing that 
smoke is not penetrating the general non-
In addition, 
the general 
smoke is not 
smoking area. Such smoking rooms are 
smoking is 
non-
penetrating 
expressly prohibited in educational or other 
banned except 
smoking 
the general 
facilities where children and adolescents are 
for separate 
area. 
non-smoking 
supervised, accommodated or sheltered. 
smoking 
 
area. 
 
rooms in 
 
There are no sanctions for non-compliance. 
offices which 
 
have contact 
Hospitality sector is currently exempt from 
with 
the Tobacco Act and subject to a voluntary 
customers. 
agreement with the Ministry of Health, Family 
 
and Youth.  
 
Smoking in workplaces is regulated by the 
Health and Safety at Work Act, which 
stipulates that smokers and non-smokers 
should, if possible be given separate offices. 
If this is not possible, smoking should be 
banned.  
 
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In July 2009, the parliament approved an 
amendment of the Tobacco Act, introducing 
a partial smoking ban in hospitality venues 
as of January 2009. In venues larger than 80 
m2  smoking will be allowed only in separate 
smoking rooms which do not occupy more 
than 50% of the surface.  Businesses smaller 
than 50 m2 will be able to decide to allow 
smoking throughout while business between 
50 and 80m2 will be able to allow smoking if 
they can prove that it is not possible to 
arrange for a separate smoking room. 
 
The revision envisages fines for both 
business owners and guests. 
 
Federal Act No 167 amending the Federal Act on the manufacture and marketing of tobacco products and advertising for tobacco 
products and the protection of non-smokers (Tobacco Act) 
 
Published on 30 December 2004 
 
The National Council has decided that: 
 
The Federal Act on the manufacture and marketing of tobacco products and advertising for tobacco products and the protection of non-smokers 
(Tobacco Act), BGB1 No 431/1995, as last amended by Federal Act BGB1 I No 74/2003, shall be amended as follows: 
 
3. In § 1 Z 10 the full-stop at the end of the clause shall be replaced with a comma.  The following Z 11 shall be inserted: 
‘11. “public place” shall mean any place which may be entered at all or certain times by a group of persons who are not restricted a priori, 
including the movable installations of public and private buses, trains, airplanes and boats.’ 
 
 
7. The text and heading of § 13 shall read: 
 
‘Protection of non-smokers 
§ 13. (1) Without prejudice to provisions of labour law and the provisions under § 12, the smoking ban shall apply to rooms in public places. 
(2) As an exception to the ban under (1), rooms may be designated in establishments covered by (1) comprising a sufficient number of rooms in 
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which smoking is permitted, provided that tobacco smoke does not drift into the area designated for the smoking ban and therefore does not 
breach the smoking ban. 
(3) The exception under (2) shall not apply to schools or other establishments in which children or young people are supervised, admitted or 
accommodated. 
(4) (1) shall not apply to 
  1. the hotel and restaurant industry; 
  2. businesses under § 111 (2) Z 2, 3, 4 or 5 GewO; 
  3. events within the meaning of § 2 (1) z 25 GewO; 
  4. tobacconists.’ 
 
8. The following § 13a shall be inserted after § 13: 
§ 13a. (1) Smoking bans in accordance with §§ 12 and 13 shall be identified by means of the smoking ban notice “No smoking” in rooms and 
establishments covered by the smoking ban. 
(2) Instead of the smoking ban notice under (1), smoking bans in accordance with §§ 12 and 13 may also be identified by means of no-smoking 
symbols clearly showing the existing smoking ban. 
(3) Smoking ban notices under (1) or the no-smoking symbols under (2) shall be affixed in a sufficient number and size for them to be seen clearly 
throughout the room or establishment.’ 
 
10. The following § 14a shall be inserted after § 14: 
§ 14a. Any person who breaches the obligation to identify smoking bans, provided that this action does not form the basis of a case punishable 
according to the jurisdiction of the courts or is not subject to other administrative provisions entailing more stringent penalties, thereby commits an 
administrative infringement and shall be penalised with a fine of up to 720 euro.’ 
 
Health and Safety at Work Act – summary of relevant provisions 
 
Protection of non-smokers 
 
To the extent permitted by the type of operation, non-smokers must be protected against the effects of tobacco smoke. In offices and similar work 
rooms (e.g. bays reserved to foremen), smokers and non-smokers must, if possible, be given separate spaces. If this is not possible, smoking 
must be banned. Smoking is banned in sanitary and changing rooms.  
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Belgium  
 

Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and restaurants 
Comments  
workplaces 
public places 
transport 
facilities 
facilities 
In 
Smoking 
Smoking 
Smoking 
Smoking 
In restaurants, smoking  Royal decree of 13th December 2005 
workplaces, 
banned 
banned 
banned 
banned 
allowed in separately 
banning smoking in public places and Royal 
smoking 
altogether 
altogether 
altogether 
altogether 
ventilated rooms where  decree of 19 January 2005 protecting 
allowed in 
no eating allowed 
workers against tobacco smoke 
separately 
 
 
ventilated 
In bars, smoking 
As of 1 Jan. 2006:  
rooms 
allowed in ventilated 
1) Ban on smoking in all enclosed public 
intended 
areas 
places without the possibility of creating 
exclusively 
smoking areas.  
for smoking 
2) Ban on smoking in all enclosed 
workplaces, except for bars and 
restaurants. The employer may install a 
separate, ventilated room destined 
exclusively for smoking with the employees' 
agreement.   
As of Jan. 2007, smoking in restaurants and 
other catering establishments is allowed 
only in separate, ventilated rooms where 
food is not be permitted and whose surface 
cannot exceed ¼ of the total surface. 
Non-food and snack-food venues which 
have less than 30% of their sales from food 
servings continue to be exempt (at least 
50% of the surface has to be reserved for 
non-smokers, except in establishments 
below 50m² ). 
 
Legal provisions 

 
19 JANVIER 2005. - Arrêté royal relatif à la protection des travailleurs contre la fumée de tabac 
Article 1er. Le présent arrêté s'applique aux employeurs et aux travailleurs, ainsi qu'aux personnes y assimilées, visés à l'article 2, § 1er, 1°, a) à d) 
et 2°, de la loi du 4 août 1996 relative au bien-être des travailleurs lors de l'exécution de leur travail. 
Art. 2. Le présent arrêté ne s'applique pas : 
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1° dans tous les lieux fermés où sont présentées à la consommation des denrées alimentaires et/ou des boissons et où il est autorisé de 
fumer, en application des articles 2, § 2, et 3, § 1er, de l'arrêté royal du 15 mai 1990 portant interdiction de fumer dans certains lieux 
publics;2° dans les lieux fermés de toutes les institutions de services sociaux et des prisons, qui sont à considérer comme des espaces 
privés, et où les résidents et non-résidents peuvent fumer sous les conditions qui leur sont fixées;3° dans les habitations privées, à 
l'exception des espaces destinés exclusivement à un usage professionnel et où des travailleurs sont occupés. 
Art. 3. Pour l'application du présent arrêté, on entend par : 
1° la loi : la loi du 4 août 1996 relative au bien-être des travailleurs lors de l'exécution de leur travail;2° espace de travail : a) tout lieu de 
travail, qu'il se trouve dans une entreprise ou un établissement, ou en dehors de ceux-ci, et qu'il se trouve dans un espace ouvert ou 
fermé, à l'exception de l'espace à ciel ouvert; b) et tout espace ouvert ou fermé dans l'entreprise ou l'établissement, où le travailleur a 
accès;3° équipements sociaux : les installations sanitaires, le réfectoire et les locaux destinés au repos ou destinés aux premiers soins;4° 
fumoir : local où il est autorisé de fumer et qui est exclusivement destiné à cet effet; 5° le Comité : le Comité pour la prévention et la 
protection au travail ou, à défaut, la délégation syndicale ou, à défaut, les travailleurs eux-mêmes conformément aux dispositions de 
l'article 53 de la loi. 
Art. 4. Tout travailleur a le droit de disposer d'espaces de travail et d'équipements sociaux exempts de fumée de tabac. 
Art. 5. § 1er. L'employeur interdit de fumer dans les espaces de travail, les équipements sociaux, ainsi que dans les moyens de transport qu'il met à 
la disposition du personnel pour le transport collectif du et vers le lieu de travail. 
§ 2. Par dérogation à l'interdiction visée au § 1er, il est possible de prévoir un fumoir dans l'entreprise, après avis préalable du Comité. Ce 
fumoir est efficacement ventilé. Le règlement d'accès à ce fumoir pendant les heures de travail est fixé après avis préalable du Comité. Ce 
règlement ne peut pas causer d'inégalité de traitement entre les travailleurs. 
Art. 6. L'employeur prend les mesures nécessaires pour veiller à ce que les tiers qui se trouvent dans l'entreprise soient informés des mesures qu'il 
applique en vertu du présent arrêté.  
Full text at: http://www.juridat.be/cgi_loi/loi_F.pl?cn=2005011939 
 
13 DECEMBRE 2005. Arrêté royal portant interdiction de fumer dans les lieux publics  
Article 1er. 
Pour l’application du présent arrêté on entend par :  
1° fumer : le fait de fumer des produits à base de tabac ou des produits similaires;  
2° lieu fermé : lieu isolé de l’environnement par des parois, pourvu d’un plafond;  
3° lieu accessible au public : lieu dont l’accès n’est pas limité à la sphère familiale;  
4° Etablissement Horeca : tout lieu ou local accessible au public, quelles que soient les conditions d’accès, dont l’activité principale et permanente 
consiste à préparer et/ou servir des repas et/ou des boissons pour consommation sur place ou non, et ce même gratuitement;  
5° boissons contenant de l’alcool éthylique : les boissons visées à l’article 16 de la loi du 7 janvier 1998 concernant la structure et les taux des 
droits d’accise sur l’alcool et les boissons alcoolisées;  
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6° débit de boissons : établissement Horeca dont l’activité principale et permanente consiste à servir des boissons, parmi lesquelles des boissons 
contenant de l’alcool éthylique, pour consommation sur place, sans que le service des boissons soit conditionné à la consommation d’un plat 
préparé.  
7° friterie : lieu dont l’activité principale consiste à préparer et servir pour consommation immédiate et dans des récipient jetables, des repas cuits 
ou réchauffés dans la graisse ou l’huile de friterie exclusivement. Le lieu doit être aménagé ou conc¸u de telle sorte qu’il autorise à un nombre 
maximum de personnes, à fixer par le Ministre, de consommer simultanément;  
8° fumoir : local fermé où il est permis de fumer;  
9° Ministre : le Ministre ayant la Santé publique dans ses attributions.  
Art. 2. Il est interdit de fumer dans les lieux fermés accessibles au public.  
A l’intérieur et à l’entrée de chaque lieu visé à l’alinéa 1er, des signaux d’interdiction de fumer conformes au(x) modèle(s) fixé(s) ou approuvé(s) 
par le Ministre de la Santé publique doivent être apposés de telle sorte que toutes les personnes présentes puissent en prendre connaissance.  
Il est interdit de fumer dans les débits de boissons et autres établissements Horeca situés dans un lieu fermé accessible au public, s’ils ne sont 
pas isolés de ce lieu par des parois, un plafond et une porte.  
Tout élément susceptible d’inciter à fumer ou qui porte à croire que fumer est autorisé, est interdit dans les lieux visés au premier et deuxième 
alinéas.  
Art. 3. § 1er. Nonobstant les dispositions de l’article 2, l’exploitant d’un débit de boissons, qu’il s’agisse d’une personne physique ou d’une 
personne morale, peut installer une zone clairement délimitée dans laquelle il est permis de fumer selon les formes et les conditions prévues aux 
paragraphes suivants.  
§ 2. La possibilité d’installer une zone clairement délimitée dans laquelle il est permis de fumer est accordée :  
— soit à l’exploitant d’un débit de boissons qui certifie sur l’honneur, ou apporte la preuve à l’aide d’une attestation dont le modèle a été fixé par le 
Ministre, que, pour cet établissement, la part des achats de produits destinés à la fabrication et à la vente de repas n’excède pas un tiers des 
achats totaux de boissons et de denrées alimentaires;  
— soit à l’exploitant de plusieurs établissements qui certifie sur l’honneur ou apporte la preuve à l’aide d’une attestation dont le modèle est fixé par 
le Ministre, que, pour cet établissement, la part des ventes de repas n’excède pas un tiers des ventes totales de denrées alimentaires;  
— soit à l’exploitant d’un débit de boissons qui certifie sur l’honneur qu’il sert uniquement les repas légers prévus à l’article 2, § 2, 1°, de l’arrêté 
royal du 13 juin 1984 instaurant les conditions d’exercice de l’activité professionnelle de restaurateur ou de traiteur-organisateur de banquets dans 
les petites et moyennes entreprises du commerce et de l’artisanat.  
§ 3. Cette possibilité est également ouverte à toute personne qui crée ou reprend un nouvel établissement sur la base d’une estimation :  
— dans le cas où il crée ou reprend un établissement, de la part des achats de produits destinés à la fabrication et à la vente de repas par rapport 
aux achats totaux de boissons et de denrées alimentaires;  
— dans le cas où il crée ou reprend plusieurs établissements, de la part des ventes de repas par rapport aux ventes totales de denrées 
alimentaires.  
§ 4. La zone réservée aux fumeurs doit être établie de manière à réduire au maximum les inconvénients de la fumée vis-à-vis des non-fumeurs.  
Sa superficie doit être inférieure à la moitié de la superficie totale du local dans lequels des plats préparés et/ou des boissons sont servies à la 
consommation, sauf si cette superficie totale est inférieure à 50 mètres carrés.  
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Un ou plusieurs signaux d’interdiction de fumer, conformes aux modèles fixés par le Ministre, doivent être apposés dans les espaces réservés aux 
non fumeurs, de manière telle que toute personne présente puisse en prendre connaissance.  
§ 5. Le Ministre peut fixer des conditions complémentaires auxquelles doivent répondre les débits de boissons où il est autorisé de fumer. Ces 
conditions sont relatives à :  
— l’installation d’un système d’aération garantissant un débit minimal de renouvellement d’air;  
§ 6. Nonobstant les dispositions du § 1er, ne bénéficie pas de l’autorisation d’installer une zone clairement délimitée dans laquelle il est permis de 
fumer :  
—l’exploitant d’un débit de boissons qui est situé dans un lieu fermé accessible au public, si l’établissement n’est pas isolé du lieu par des parois 
et un plafond;  
— l’exploitant d’un débit de boissons situé dans une enceinte sportive.  
Art. 4. Nonobstant les dispositions de l’article 2, l’exploitant d’une friterie peut installer une zone où il est autorisé de fumer qui répond aux 
conditions de l’article 3, §§ 4 et 5.  
Art. 5. § 1er. Nonobstant les dispositions de l’article 2, un fumoir répondant aux conditions du § 2 du présent article peut être installé dans les 
établissements Horeca où il est interdit de fumer en vertu du présent arrêté.  
§ 2. Le fumoir doit être clairement identifié comme local réservé aux fumeurs et seules des boissons peuvent y être servies.  
Le fumoir doit être muni d’un système d’extraction ou d’épuration d’air.  
Le fumoir doit être installé de manière à réduire au maximum les inconvénients de la fumée vis-à-vis des non-fumeurs et ne peut être une zone de 
transit.  
La superficie du fumoir ne peut excéder un quart de la superficie totale du local dans lequel des plats préparés et/ou des boissons sont servies à la 
consommation.  
Le Ministre fixe des conditions complémentaires auxquelles doit répondre le fumoir.  
Art. 6. L’exploitant et le client, chacun pour ce qui le concerne, d’un établissement visé aux articles 2, 3, 4 et 5 est responsable du respect des 
dispositions du présent arrêté.  
Art. 7. Toute infraction au présent arrêté est recherchée, poursuivie et punie conformément à la loi du 24 janvier 1977 relative à la protection de la 
santé des consommateurs en ce qui concerne les denrées alimentaires et autres produits.  
Art. 8. Sans préjudice de l’article 9, l’arrêté du 15 mai 1990 portant interdiction de fumer dans certains lieux publics est abrogé.  
Art. 9. Le présent arrêté entre en vigueur le 1er janvier 2006.  
Par mesure transitoire, les établissements Horeca visés aux articles 3, 4 et 5 peuvent satisfaire aux dispositions de l’arrêté royal du 15 mai 1990 
jusqu’au 1er janvier 2007.  
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Bulgaria 
Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces  
public places  
transport 
facilities 
facilities 
restaurants 
Smoking 
Smoking  
Smoking 
Smoking 
Smoking 
In venues of more 
The Decree of Council of Ministers No. 
allowed in 
banned 
banned 
allowed in 
banned 
than 60 seats, 
329/08.12.2004 entered into force in Jan. 2005. 
ventilated 
altogether in 
altogether. 
ventilated 
altogether 
smoking is allowed 
In indoor workplaces and public places smoking 
smoking 
some public 
 
smoking 
in separated and 
is only allowed in ventilated smoking rooms and 
rooms 
places (e.g. 
In passenger 
rooms 
ventilated halls 
is banned altogether in educational facilities and 
cultural 
trains, less 
 
most of public transport. 
institutions). 
than half of 
In smaller venues, 
 
In others, 
the carriages 
smoking allowed in 
Smoking in pubs, bars and restaurants is 
allowed in 
may be 
ventilated smoking 
permitted in zones or halls for smoking equipped 
ventilated 
designated to 
areas 
with ventilation systems. 
smoking rooms 
permit 
 
 
smoking. 
Having initially rejected the Ministry of Health 
 
proposal for a full smoking ban in Feb.2007, in 
In vessels, 
November 2008 the Cabinet agreed to such a 
smoking 
ban as of June 2010. The proposal is now being 
allowed in 
discussed by the parliament. 
ventilated 
 
smoking 
rooms 
 
Legal provisions 
 

THE HEALTH LAW 
 
Published in SG 70/10 August 2004, effective as of 1st of January 2005. 
 
…………………………….. 
 
Art. 56.(1) Smoking shall be prohibited in the covered public places, including the public transport and the public working premises. 
(2) The Council of Ministers shall determine with an ordinance the conditions and the order, under which will be admitted as exception smoking in 
detached zones of the places of para 1. 
 
 
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ORDINANCE 
on the Conditions and the Order of Permitted Smoking as an Exception in Separated Enclosed Areas of Indoor Public Places and Indoor Places of 
Employment 
 
Adopted on 8 December 2004 
 
CHAPTER I 
GENERAL PROVISIONS 
 
Art. 1. The present Ordinance shall define the conditions and order under which smoking as an exception shall be permitted in separated 
enclosed areas of indoor public places, inclusive of means of public transport, and indoor places of employment. 
Art. 2. No exceptions from the smoking prohibition shall be permitted in: 
 1. 
nursery schools, kindergartens, schools and places of extra-curriculum educational forms- clubs, circles, schools etc.; 
 2. 
Institutions of higher education; 
 3. 
Cultural institutions- cinemas, theatres, concert halls, galleries, cultural centers, libraries etc. 
 4. 
Internet  clubs 
 5. 
Areas in premises for production and trade with foodstuffs in which preservation, preparation, production, cooking and trade with 
foodstuffs is being effected, exclusive of integrated halls for on-premises consumption. 
 6. 
Buses, trolley cars, trams, subway-cars , mini-buses for rout taxis and taxicabs both for the passengers and the driver of the 
vehicles; 
 7. 
subway  terminals; 
 8. 
Bulgarian passenger airplanes; 
 9. 
Elevators in all buildings 
 10. 
Premises with separated places of work. 
Art. 3. Indoor public places of smoking permitted as an exception in the separated enclosed areas, shall be the buildings of general 
access- administrative institutions, places of accommodation, means of shelter, halls of on-premises consumption in catering and entertainment 
establishments, medical and health institutions, sports, commercial and other facilities as well as some means of public transport. 
 
CHAPTER II 
Conditions and Order of Permitted Smoking as an Exception in Separated Enclosed Areas of Indoor Public Places and Indoor Places of 
Employment 
Art.4. (1) Smoking in indoor public places under art. 3 shall be permitted provided it is done in the separated enclosed areas. 
(2) Separated enclosed area in the sense of paragraph 1 shall be: 
1. Specifically designated enclosed area provided mechanical ventilation and permanent sign on the door “Smoking place” is secured. 
2. Part of the commercial area of catering and entertainment establishment of seating capacity less then 60 seats. 
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Art.5. (1) The areas under art.4, paragraph2, section 1 must meet the following conditions: 
 1. 
they are to have mechanical ventilation providing 10 fold air exchange per hour through sucking in that shall continually work 
throughout the establishment’s working hours and as an exception, at technical impossibility for installing mechanical ventilation, natural ventilation 
shall be used. 
 2. 
they are to be designated by ordinance of the person using the establishment. 
(2) The person using the establishment shall provide the effective functioning and maintenance of the mechanical ventilation. 
(3) Corridors, lobbies, stairway platforms and sanitary and hygiene areas cannot be designated for smoking areas. 
Art. 6. (1) In the smoking area, separated under art.4, para. 2, section 2, the number of seats shall not exceed half of the seating capacity 
in the catering and entertainment establishment. 
(2)The tables in the area under art. 1 shall be designated with sign “Table for smokers”. 
Art. 7. (1) In catering and entertainment establishments of more than 60 seats, smoking shall be permitted in the separated hall designated 
with permanent marking “Hall for smokers”. 
(2) The number of smoking seats shall not exceed half of the seating capacity in the establishment. 
Art. 8. Catering and entertainment establishments with separated smoking area, as well as smoking halls, must have mechanical inflow 
ventilation that is to provide fresh air exceeding 40 m3 per hour and that shall work continuously during the working hours of the establishment. 
Art. 9. In the areas, separated under art. 4, para.2 and art. 7, para. 1, no person aged under 18 shall be allowed. 
Art. 10. (1) In the places of accommodation and means of shelter smoking shall be permitted in less than half of the number of rooms. 
(2) The doors of non-smoker rooms shall have permanent marking. 
Art. 11. (1) In passenger trains less than half of the carriages may be designated as carriages of permitted smoking. 
(2) A carriage for which the booking tickets are sold shall not be designated for smoker carriage if it is the only one. 
(3) The non-smoker carriage shall bear permanent marking. 
(4) In sleeping-cars and wagon lids, as well as in trains with only one carriage, compartments for smokers shall be designated and 
smoking shall be prohibited in the passages and sanitary and hygiene areas of the carriage. 
(5) In the restaurant-cars an area under art.4, para.2, section 2 shall be separated as the number of seats in the smoking area must not 
exceed half of the total seating capacity. 
Art. 12. Smoking is permitted at the railway terminals, sea ports and airports only in areas meeting the requirements under art. 5.  
Art. 13. (1) Smoking in the enclosed areas of vessels is permitted only in areas meeting the requirements under art. 5. 
(2) In the vessels, cabins for smokers shall be designated and they shall not exceed half of the total number of cabins. 
Art. 14. In buildings with separated working places, the employers may designate special smoking areas meeting the requirements under 
art. 5 by ordinance. 
Art. 15. (1) Persons who use establishments under art. 3 and employers under art. 14. shall secure the effectiveness measurement of the 
mechanical ventilation by an accredited laboratory. 
(2) The measurement reports shall be kept at the site and shall be presented at the inspection to the state health inspectors. 
Art. 16. The below persons shall bear the responsibility for observing the requirements of the present Ordinance: 
 1. 
persons keeping the establishments under art. 2 and 3; 
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 2. 
Persons staying in the indoor public places; 
 3. 
Employers 
 4. 
Workers and officials in the indoor working premises. 
ADDITIONAL PROVISION 
§ 1. In the sense of the Ordinance: 
“separated working place” is the place in the premises at which the worker or official performs services or they have access to in 
connection with the executed work. 
TRANSITIONAL AND FINAL PROVISIONS 
§2.  Persons using the existing as per 01 of January 2005 buildings under art. 3 and the employers under art. 14 shall undertake the 
required actions for measurement under art. 15, para.1 until 30 of June, 2005. 
§ 3. The control of the Ordinance obedience shall be carried out by the state health inspectors. 
§ 4. The Ordinance have been issued on the grounds of art. 56, para. 2 of Health Law. 
§ 5. The Ordinance shall come into force on 01 of January, 2005.  
EN 
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Czech Republic 
Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces 
public 
transport 
facilities 
facilities 
restaurants 
places 
Ban on 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking 
Act No 379/2005 on protective measures against 
smoking in 
allowed in 
banned 
banned 
banned 
allowed in 
damage caused by tobacco products, alcohol and 
the presence 
ventilated 
altogether 
altogether 
altogether 
ventilated 
other addictive substances bans smoking entered into 
of non-
designated 
 
except for 
 
designated 
force in Jan. 2006.  
smokers 
areas 
 
ventilated 
 
areas 
 
 
 
 
areas in 
 
 
In most public places, including bars and restaurants, 
 
 
psychiatric 
 
 
smoking is allowed in ventilated designated areas and 
 
 
and detox 
 
is banned altogether in education and healthcare 
 
 
wards 
 
facilities and means of public transport. 
 
 
 
 
 
 
In addition, Act No 262/2006, Labour Code, lays down 
 
the obligation for employees not to smoke at the 
 
workplace or on other premises where non-smokers 
are also exposed to the effects of smoking. 
 
In Jan. 2008, the Health Committee of the Parliament 
voted for the total ban of smoking in all enclosed 
public places, including bars and restaurants. The 
second reading in the Chamber of Deputies took  
place in February. Three other options (exemption for 
venues below 100 m2, smoking and non-smoking 
areas divided by a wall, decision left to individual 
owners) were listed as possible options in addition to 
the original total-ban proposal. The third reading (vote) 
is scheduled for September, following which the bill 
will be submitted for the approval of the Senate (upper 
chamber). 
 
 
 

EN 
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Legal provisions 
 
379/2005 Coll. 
 
ACT of 19 August 2005 
on measures for protection against harm caused by tobacco products, alcohol and other dependency producing substances and on 
amendment to related laws 
 
Amendment: 225/2006 Coll. 
 
 
Section 8 
  
 
(1) It shall be prohibited to smoke: 
  
a) in public areas, consisting in enclosed premises accessible to the public, means of public transport, publicly accessible premises of buildings 
related to public transport, platforms, shelters and waiting rooms for public road and railway transport and municipal public transport, except for 
structurally separated premises reserved for smoking which are ventilated to areas outside the building at all times when persons are present, 
  
b) in the internal and external spaces of all types of schools and educational facilities,7) 
  
c) in common catering facilities operated on the basis of inn-keeping activities,5) unless such facilities have special premises reserved for smokers 
that are designated by a clearly visible sign “Area reserved for smoking” or in a similar manner and that have adequate ventilation according to the 
requirements stipulated by the special regulation;4) 
  
d) in enclosed entertainment areas, such as cinemas, theatres, exhibition and concert halls, and also in sports halls and premises where working 
meetings are held, except for special, structurally separated premises reserved for smoking with adequate ventilation according to the 
requirements stipulated by the special regulation;4) 
  
e) on inner premises of health-care facilities of all types, except for enclosed psychiatric departments or other facilities for treatment of addictions, 
on premises that are structurally separated and are ventilated to areas outside the building at all times when persons are present. 
  
 
(2) In buildings of State authorities, bodies of territorial administrative units, facilities established by the State or a territorial administrative 
unit providing public services, and financial institutions including their common catering facilities, the persons entrusted with their management 
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shall be obliged to ensure that citizens are protected in these buildings against harm caused by smoking. This shall in no way prejudice the 
provisions of paragraph 1 above. 
  
 
(3) Premises reserved for smokers must be designated by their operator by a clearly visible sign “Area reserved for smoking” or in a similar 
manner. 
  
 
(4) At least half of the cars in each train of the public railway transport system must have no premises reserved for smoking. 
  
 
 
Labour Code 
No. 262/2006 Coll. 
 
§106(4)  
[The employee shall] (…) not smoke at workplaces and other premises where non-smokers are also exposed to the effects of smoking. 
 
 

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Cyprus 
 

Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces  
public places  
transport 
facilities 
facilities 
restaurants 
Employer 
Smoking 
Banned 
Smoking 
Smoking 
Smoking allowed in 
Under the protection of Health (Control of 
should 
allowed in 
altogether 
allowed in 
allowed in 
designated smoking  smoking) Law of 2002 {N.75(I)/2002}, smoking is 
ensure that 
designated 
all public 
designated 
designated 
areas  
banned completely in all public transport. 
non-smoking 
smoking areas  
transport 
smoking 
smoking areas  
 
employees 
 
vehicles, incl. 
areas  
 
Smoking in public places is allowed in 
are protected 
 
taxis, as well 
 
designated smoking areas with adequate air 
as private 
expulsion system. The same rules apply to 
cars that 
hospitality venues – however  establishments  
carry 
which have more than one room shall designate 
passengers 
one room for those who wish to smoke. 
below 16 
 
years old.  
In workplaces, employers – having consulted 
employees – set out in writing a policy in 
smoking which protects employees who do not 
smoke or do not wish to smoke in the workplace. 
Legal provisions 
No 75(I) of 2002 
ACT PROVIDING FOR THE TAKING OF MEASURES TO COMBAT SMOKING  
 
Ban on smoking in enclosed areas 
10.-(1) No person may smoke in a no-smoking area, except in a special area especially put aside for smokers and which has an adequate system 
to expel the air. 
(2) Anyone responsible for a no-smoking area in which the provisions of (1) above are being contravened shall be considered responsible for this 
contravention unless it can be demonstrated that he or she took all reasonable measures to prevent smoking in this area.  
(3) Anyone contravening the provisions of (1) and (2) above shall be guilty of an offence and, if convicted, shall be liable to a fine not exceeding 
one thousand pounds or a prison term not exceeding six months, or the two punishments in conjunction. 
  
Ban on smoking on public transport 
11.-(1) Smoking by any person shall be banned on all public transport vehicles.  
(2) Anyone contravening the provisions of (1) above shall be guilty of an offence and, if convicted, shall be liable to a fine not exceeding one 
thousand pounds or a prison term not exceeding six months, or the two punishments in conjunction. 
 
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Ban on smoking in private vehicles transporting persons aged under sixteen years 
12.-(1) No person may smoke in a private vehicle transporting persons aged under sixteen years.  
 (2) Anyone contravening the provisions of (1) above shall be guilty of an offence and, if convicted, shall be liable to a fine not exceeding one 
thousand pounds or a prison term not exceeding six months, or the two punishments in conjunction. 
 
Smoking in restaurants, cafes, etc. 
13.-(1) Anyone who runs or owns any restaurant, café-restaurant, cafeteria, bar or café, discotheque, night club or any other similar venue may:  
(a) set aside an area specifically for smokers and ensure that:  
(i) sufficient area is provided for people who smoke or wish to smoke and that such areas are fitted with an air-expulsion system;  
(ii) no person may smoke in areas designated for people who do not smoke or do not wish to smoke, and  
(b) if a restaurant, café-restaurant, bar etc. has more than one room, set aside at least one of these rooms for people who smoke or who wish to 
smoke.  
 (2) Owners or person running the venue referred to in (1) above must:  
(a) (i) place signs in areas for non-smokers, clearly and legibly showing that smoking is forbidden, and 
(ii) place in conspicuous positions in all other others signs showing clearly and legibly the general warnings laid down on the dangers of smoking 
and 
(b) install in areas for smokers adequate systems to expel the air.  
(3) Anyone contravening the above provisions shall be guilty of an offence and, if convicted, shall be liable to a fine not exceeding one thousand 
pounds or a prison term not exceeding six months, or the two punishments in conjunction. 
 
Smoking in workplaces  
14.-(1) Every employer must, after consulting the employees who may be affected or their representatives, set out in writing and implement a 
policy on smoking in every workplace, based on the principle that employees who do not smoke or do not wish to smoke at the workplace must be 
protected from smoke at the workplace.  
(2) The policy referred to in (1) above must in particular meet the following conditions: 
  
(a) In each work place, the employer shall ensure that a copy of the policy on smoking is placed in a conspicuous place and, if required, that each 
employee, applicant or employee representative is provided with a copy of the policy, and  
(b) in each work place, the employer shall ensure that clear and legible signs are placed in conspicuous places showing the areas where smoking 
is forbidden or allowed.  
(3) The provisions of this Article shall not prevent an employer from allowing smoking in enclosed areas with an adequate air-expulsion system 
where only workers who are smokers are located and who request, in writing, that they be allowed to smoke in such an area.  
(4) Anyone contravening the provisions of this Article shall be guilty of an offence and, if convicted, shall be liable to a fine not exceeding one 
thousand pounds or a prison term not exceeding six months, or the two punishments in conjunction. 
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Denmark 
Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces   
public places  
transport 
facilities 
facilities 
restaurants 
Smoking may 
 Possibility of 
Smoking 
Hospitals and 
Smoking banned 
Possibility of 
Smoke-Free Environments Act entered into 
be allowed in 
smoking rooms 
banned 
similar 
altogether  
smoking rooms and  force on 15 August 2007. 
workplaces 
and booths 
altogether 
institutions may 
 
booths where food 
 
which serve as 
 
permit patients 
 In educational 
and drinks are not 
The Act allows bans smoking as a general rule, 
a workplace 
On 
and their family 
institutions for 
served 
with the following exemptions: 
for on person 
passenger 
members to 
adolescents 16 
Pubs below 40m2 
1. It is permitted to establish ventilated smoking 
at a time 
ships, 
smoke in 
years and older 
that do not serve 
booths and rooms at workplaces, at educational 
 
possibility of 
extraordinary 
that also serve as 
food are exempt. 
institutions for adolescents 16 years and older, 
Possibility of 
smoking 
circumstances 
dwellings, 
in places to which the public has access and at 
smoking 
rooms and 
adolescents may 
hospitality establishments. The explanatory 
rooms and 
booths 
be allowed to 
memorandum accompanying the Smoke-free 
booths 
smoke in 
Act states that the smoking booth typically has a 
designated 
ceiling and is enclosed by three sidewalls, the 
smoking rooms 
fourth side being open. It either purifies the air 
and in their own 
through high-quality dust and gas filters which 
rooms.  
lead the cleaned air back into the booth, or is 
 
equipped with a mechanical extraction system 
which leads the polluted air out. 
2. Smoking may be permitted in rooms that 
solely serve as a workplace for one person. 
3. Smoking may be permitted at small pubs with 
a bar-room floor space (excluding the bar) not 
exceeding 40 m2 if the establishment does not 
serve food. 
 
Fines only for employers  
 
The new law will be evaluated in 2009-2010. 
 
Legal provisions 
 
Ministry of the Interior and Health, Denmark 
 
Act No. 512 of 6 June 2007  
Smoke-free Environments Act  
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Part 1  
Purpose, scope, etc.  
§1. The purpose of the Act is to promote smoke-free environments with the aim of preventing harmful health effects of environmental tobacco 
smoke and to prevent involuntary exposure to environmental tobacco smoke.  
§2. This Act shall apply to:  
1) workplaces, including offshore installations;  
2) institutions and schools for children and adolescents;  
3) other educational institutions;  
4) indoor rooms to which the public has access;  
5) means of public transport and taxis; and  
6) hospitality establishments.  
Subsection 2. Subsection 1 includes Danish ships, aircraft registered in Denmark and aircraft registered in other countries that operate under a 
Danish operating permit, regardless of whether the ship or aircraft is located outside Danish territory. The Act shall not apply, however, to ships 
based in the Faroe Islands or Greenland or to aircraft from airline companies based in the Faroe Islands or Greenland.  
§3. A special room for smoking shall be defined in this Act as a special room with good opportunities for natural or artificial ventilation. The room 
may not serve as a passage or contain functions used by other people.  
Subsection 2. A smoking booth shall be defined in this Act as a detached unit with a natural or artificial ventilation system.  
 
Part 2  
General provisions  
§4
. In rooms etc. that are governed by this Act, smoking shall be prohibited indoors, unless the other provisions of this Act state otherwise.  
§5. Each employer shall prepare a written policy on smoking that shall be accessible to all the employees of the workplace.  
Subsection 2. The smoking policy shall contain at least the following:  
1) information on whether and where smoking is permitted at the workplace;  
2) information on the consequences of violating the smoking policy of the workplace.  
 
Part 3  
Workplaces, institutions, schools etc.  
Indoor workplaces  
§6. Smoking shall be prohibited indoors at workplaces, cf. §4.  
Subsection 2. It may be decided that smoking is permitted in work rooms that solely serve as a workplace for one person at a time.  
Subsection 3. It may be decided to arrange special rooms for smoking or smoking booth in which smoking is permitted.  
Institutions and schools for children and adolescents  
§7. At child-care centres, primary and lower secondary schools, leisure centres and the like that mainly have enrolled children and adolescents 
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younger than 16 years, children, adolescents and students shall be prohibited from smoking on the property of the institution.  
Subsection 2. For residential institutions, accommodation facilities, boarding schools, continuation schools and the like that mainly have enrolled 
adolescents 15–16 years old and older and that also serve as dwellings for these adolescents, it may be decided that the adolescents are allowed 
to smoke in designated smoking rooms and in their own rooms.  
§8. For people not governed by §7, smoking shall be prohibited on the outdoor areas of the institution to which children and adolescents have 
access.  
Subsection 2. It may be decided to arrange special rooms for smoking or smoking booths where the relevant people are permitted to smoke.  
Other educational institutions  
§9. At educational institutions not governed by §7, it may be decided that students may smoke in rooms that are made available as a studying 
space and are only used by one student at a time.  
Subsection 2. It may be decided to arrange special rooms for smoking and smoking booths in which students are permitted to smoke.  
Special workplaces  
§10. Hospitals and similar institutions may permit patients and their family members to smoke in extraordinary circumstances.  
§11. At nursing homes, residential institutions for adults, accommodation facilities for adults with special needs and similar institutions, each 
resident may decide whether smoking is permitted in the room or dwelling that serves as the resident’s private home.  
Subsection 2. Residents may be instructed not to smoke in their room or dwelling during the time in which employed staff are present.  
§12. In private homes in which a publicly funded service in the form of personal or practical help is delivered, residents may be instructed not to 
smoke during the time in which employed staff are present as a condition for receiving this service.  
§13. In drop-in centres and similar facilities for socially vulnerable people in which there is only one room for users, it may be decided that smoking 
is permitted.  
§14. In the institutions of the Danish Prison and Probation Service, the detainee or prisoner may decide whether smoking is permitted in the room 
of the detainee or prisoner.  
Subsection 2. Detainees and prisoners may be instructed not to smoke in their rooms during the time in which a staff member is present.  
Subsection 3. The Minister for Justice shall lay down more detailed regulations governing the matters specified in subsection 2.  
§15. In municipal family child care and in other family child care regulated by a municipality, cf. §24 and §25 of the Act on Social Services, smoking 
shall be prohibited in the home in which family child care is provided and in other rooms used for child care during the operating hours of the family 
child care.  
Subsection 2. Rooms that are primarily designed as the rooms in which the children play and are otherwise present will be required to be free of 
environmental tobacco smoke at all times.  
§16. For workplaces in private dwellings in which the employer works in the home and in which external employees work, §6 shall apply.  
Subsection 2. If the rooms in which work takes place serve as private dwelling space, smoking shall be permitted when the external employee is 
not at work.  
§17. It may be decided that smoking is permitted on ships in rooms that serve as a private dwelling for one person at a time.  
 
Part 4  
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Public space etc.  
§18. Smoking shall be prohibited in indoor rooms to which the public has access, cf. §4.  
Subsection 2. It may be decided that special rooms for smoking and smoking booths will be arranged in which smoking may take place.  
§19. In hotel rooms, cabins on ships and similar rooms that host overnight guests on a commercial basis, it may be decided that the guests are 
permitted to smoke.  
§20. In means of public transport and taxis, smoking shall be prohibited indoors, cf. §4.  
Subsection 2. On passenger ships, it may be decided that special rooms for smoking and smoking booths will be arranged in which smoking is 
permitted.  
 
Part 5  
Hospitality establishments  
§21. Smoking shall be prohibited indoors at hospitality establishments, cf. §4.  
Subsection 2. A hospitality establishment shall be defined as a room in which food or beverages are served to be consumed at or near the place at 
which the sales take place.  
Subsection 3. It may be decided that special rooms for smoking and smoking booths will be arranged in which smoking is permitted.  
Subsection 4. Food and beverages shall be prohibited from being served or brought into the special rooms for smoking or smoking booths at 
hospitality establishments. Each hospitality establishment may decide, however, to permit guests to bring their beverages into the special rooms 
for smoking or smoking booths.  
§22. It may be decided that smoking is permitted indoors at small hospitality establishments (pubs) that:  
1) have a licence to serve alcohol;  
2) do not serve food;  
3) have floor space not exceeding 40 m2; and  
4) have tables and chairs on the floor space.  
Subsection 2. Small hospitality establishments (pubs) located in the same building as another hospitality establishment shall be governed by 
subsection 1 if the small hospitality establishment (pub) has an independent entrance from the street and if it appears to be an independent small 
hospitality establishment (pub) to the customers.  
 
Part 6  
Provisions on supervision  
§23. Each employer, owner, restaurant manager, supervisor and leaseholder shall ensure that smoking solely takes places in accordance with the 
provisions of this Act.  
§24. The enforcement of compliance with this Act and the rules established pursuant to this Act shall be supervised by the Danish Working 
Environment Authority, cf. §79a of the Working Environment Act; the Danish Maritime Authority, cf. §20a of the Act on Safety at Sea; and the 
Minister for Transport and Energy, cf. §150f of the Air Navigation Act and §66a of the Offshore Safety Act.  
 
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Part 7  
Employee relationships  
§25. An employee’s violation of the prohibition on smoking at a workplace shall be handled in accordance with the rules applying to the employee’s 
other conditions of employment.  
 
Part 8  
Provisions on penalties 
 
§26. A fine shall be imposed on anyone who:  
1) violates §5; or  
2) violates an order issued pursuant to §79a, subsection 1 of the Working Environment Act, §20a, subsection 1 of the Act on Safety at Sea, §150f, 
subsection 1 of the Air Navigation Act or §66a, subsection 1 of the Offshore Safety Act.  
Subsection 2. A fine shall be imposed on any employer, owner, restaurant manager, supervisor or leaseholder who permits smoking indoors in 
violation of the rules in this Act.  
Subsection 3. Companies and the like (legal persons) may be penalized in accordance with the rules of Part 5 of the Criminal Justice Act.  
 
Full text in English at: http://www.sum.dk/artikler_sum_uk/Files/Fil1/4203.pdf 
 
 
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Estonia  
 

Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces  
public places  
transport 
facilities 
facilities 
restaurants 
Smoking 
In some public 
Smoking 
Smoking 
Smoking 
Smoking allowed 
The tobacco law of May 2005 entered into force 
allowed in 
places smoking 
banned 
allowed in 
banned 
only in separately 
in June 2005 except the provisions relating to 
smoking 
banned 
altogether 
designated 
altogether 
ventilated and 
hospitality sector which entered into force in 
rooms or 
altogether (e.g. 
 
rooms or 
except the 
negatively 
June 2007. 
areas 
shops), in 
In trains and 
areas  
premises of 
pressurised 
 
others (cultural 
passenger 
institutions of 
smoking rooms 
In workplaces and most public places, there is a 
institutions, 
ships, 
higher education 
where no food is 
possibility of creating a separately ventilated 
sport and 
smoking 
in designated 
served 
smoking room or smoking area. 
recreational 
allowed in 
rooms or areas  
 
facilities). In 
designated 
Smoking in bars and restaurants is only allowed 
others allowed 
rooms or 
in in enclosed smoking rooms with separate 
in smoking 
areas  
ventilation systems. 
rooms or areas 
  
 
 
 
 
Legal provisions 

Tobacco Act 
Passed 4 May 2005 
 
§ 29. Places where smoking is prohibited 
 Smoking is prohibited: 
1) in rooms of children’s social welfare institutions and their designated territories; 
2) in rooms of pre-school child care institutions, nursery-primary schools, primary schools, basic schools, upper secondary schools, vocational 
educational institutions, hobby schools, open youth centres or youth or project camps and their designated territories; 
3) in rooms of pharmacies; 
4) in industrial premises and warehouses of enterprises; 
5) in sales areas of shops and mobile shops; 
6) in catering establishments, except rooms provided for in subsection 31 (1) of this Act; 
7) in enterprises where services specified in clause 3 (2) 4) of the Trading Act or other services are offered, in rooms open for clients (except in 
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accommodation establishments); 
8) in space intended for sports; 
9) in changing rooms and lavatories if not in private use; 
10) in public transport shelters, passenger waiting rooms and passenger terminals; 
11) in vehicles used for the provision of passenger service, except  in vehicles specified in clause 30 (2) 6) of this Act; 
12) in the immediate vicinity of tanker vessels, petrol storage tanks or petrol pumps; 
13) in the vicinity of flammable or combustible substances, at a site with flammable or combustible storage areas, places where dangerous goods 
are loaded, in the vicinity of consignments ready to be loaded, near standing transport units and in transport units; 
14) in the territory of an explosive substances store, at a distance of up to twenty metres from the place where explosive substances are stored on 
board a ship, in the rooms of a pyrotechnic articles store or in the vicinity of ammunition containing explosive substances; 
15) in the workings of a mine, lamp rooms and battery-charging rooms and at a distance of up to twenty metres from a portal; 
16) upon loading of cartridges in the vicinity of propellant, in weapons magazines, weapons stores and weapons rooms; 
17) in forests and other areas covered with vegetation during a fire hazard period; 
18) in pedestrian tunnels; 
19) corridors and stairwells of apartment buildings, and other rooms which are in common use in apartment buildings; 
20) in other places prescribed by legislation. 
 
§ 30. Places where smoking is restricted 
(1) In the cases not specified in § 29 of this Act, the possessor of a room or a restricted area shall, at the discretion thereof, decide whether 
smoking is allowed in the room or restricted area, taking account of subsections (3) and (4) of this section and § 31 of this Act. 
(2) In the following places, smoking is allowed only in a smoking room or smoking area: 
1) the premises of state and local government agencies; 
2) the premises of institutions of higher education; 
3) the premises of cultural institutions; 
4) the premises of recreation centres; 
 5) the premises of agencies or enterprises providing health services; 
 6) local trains, long-distance trains and passenger ships; 
7) rooms where a game of chance, betting or a totalizator is organised; 
8) the office premises and other public premises of enterprises; 
9) sports halls and sports facilities and recreational facilities. 
(3) A smoking room is a room located in a building or a vehicle to which the following requirements apply: 
1) the room is designated with verbal information which permits smoking or with a corresponding symbol; 
2) information “Suitsetamine kahjustab tervist!” [Smoking harms health!] is displayed in the room in Estonian in a visible place and in 
reasonable size; 
3) the room is negatively pressurised; 
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4) air outflow in the room is not less than 8.4 litres/second per square metre, and if the room is not used, the air outflow may be reduced to 
25 per cent of the normal air exchange; 
5) the air outflow ventilation system is separate and continuous or connected to other continuously operating air outflow systems by a 
separate duct. 
(4) A smoking area is an area located in a building or a vehicle without barriers which has a local ventilation system and to which the following 
requirements apply: 
1) the area is designated with verbal information which permits smoking or with a corresponding symbol; 
2) information “Suitsetamine kahjustab tervist!” [Smoking harms health!] is displayed in the room in Estonian in a visible place and in 
reasonable size; 
3) an effective ventilation system ensures the movement of air directly into the outdoor environment. 
 
§ 31. Smoking in catering establishments 
(1) It is allowed to smoke in a catering establishment only in smoking rooms prescribed for smoking or in the immediate vicinity of the sales 
premises of the catering establishment on a seasonal extension located outdoors. 
(2) Catering, where food is sold together with its preparation and serving or just its serving for consumption on the premises shall not be provided 
in a smoking room specified in subsection (1) of this section. 
(3) A seller has the right not to serve any persons who ignore the prohibitions and restrictions established regarding smoking in catering 
establishments and has the right to request that such persons leave. 
 
Full text in EN: http://www.legaltext.ee/et/andmebaas/tekst.asp?loc=text&dok=X90018&pg=&tyyp=&query=&ptyyp=&keel=en
EN 
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Finland  
Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces  
public places  
transport 
facilities 
facilities 
restaurants 
Smoking  
Smoking 
Smoking 
Smoking 
Smoking 
Smoking allowed in 
The Tobacco Act banned smoking in indoor 
banned on 
allowed in 
allowed in 
allowed in 
banned 
separately 
public premises and public transport as of 1977 
the joint and 
designated 
designated 
designated 
altogether 
ventilated smoking 
and in indoor workplaces as of 1995 except for 
public 
smoking rooms 
smoking 
smoking 
 
rooms where no 
designated smoking rooms.  
premises of 
rooms 
rooms 
 
food or drink is 
 
workplaces 
served 
In workplaces, smoking is banned in joint and 
and the 
 
public premises as well as in areas which have 
areas 
Exemption for 
contacts with clients except for designated 
accessible to 
restaurants of over 
smoking rooms. In any other premises at the 
clients 
50m2 on 
workplaces, employers are to ensure that 
except for 
international 
employees are not involuntarily exposed to 
designated 
vessels 
tobacco smoke. 
smoking 
 
rooms. 
Environmental tobacco smoke has been 
In any other 
classified as a carcinogen in 2000. 
premises at 
 
the 
The smoking ban has been extended to bars 
workplaces, 
and restaurants as of June 2007. Smoking is 
employers 
only allowed in separately ventilated smoking 
are to ensure 
rooms where no food or drink is served. The 
that 
requirements for the construction, ventilation, 
employees 
supervision and maintenance of the smoking 
are not 
rooms were set out by the Decree of Ministry of 
involuntarily 
Social Affairs and Health (964/2006). 
exposed to 
 
tobacco 
Establishments had the possibility to apply for a 
smoke. 
two-year transition period (provided that 
 
arrangements are put in place so that tobacco 
 
smoke does not spread to smoke-free areas). 
 
Some 500 establishments were able to obtain a 
partial exemption from the law until June 2009. 
 
 
 
 

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Legal provisions 
ACT ON MEASURES TO REDUCE TOBACCO SMOKING 
No. 693/1976 
Issued in Helsinki on 13 August 1976. 
 NB. Provisions amended by Act 700/2006 enter into force on 1 June 2007. 
CHAPTER 2 – Scope of application  
 
Section 2 (23.10.1992/953)  
 
For the purposes of this Act,  
10) indoor premises means closed indoor premises with ceiling, floor and walls, or premises of which it is possible to construct closed premises by 
installing an additional level and which are intended for housing, staying, as waiting space or for working; (21.7.2006/700)  
11) work premises means indoor or outdoor premises where people work; (21.7.2006/700)  
12) smoking area means a separate room placed on indoor premises that has been approved by the building inspection authority; (21.7.2006/700)  
13) smoke-free area means indoor premises or part thereof where smoking is prohibited; (21.7.2006/700)  
14) joint premises of the workplace means facilities for rest and eating meals, sanitary premises as well as other premises intended for the staff or 
being in their joint use, corridors, halls and staircases as well as indoor premises intended for convening together; (21.7.2006/700)  
15) public premises of the workplace means indoor premises to which the public has unrestricted access; (21.7.2006/700)  
16) premises intended for clients or customers of the workplace means indoor premises reserved for clients or customers or being at their disposal. 
(21.7.2006/700)  
 
CHAPTER 5 – Protecting the population from health harms caused by ambient tobacco smoke (19.8.1994/765) 
 
Section 11 a 
(21.7.2006/700) 
 
Ambient tobacco smoke is a carcinogen. The provisions laid down in this Act and in occupational safety and health legislation are applied in regard 
to protecting from it at work.  
 
Section 12 (21.7.2006/700) 
 
Smoking is prohibited 
1) on the indoor premises of day-care centres for children and of educational institutions intended for students, and in their outdoor areas primarily 
intended for persons under the age of eighteen; 
2) on the indoor premises of government agencies and authorities and comparable public bodies intended for the public and clients; 
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3) at public events arranged indoors to which the public has unrestricted access; 
4) inside public means of transport; and 
5) on the joint and public premises of workplaces and on their indoor premises intended for clients and customers unless otherwise provided 
below.  
 
If an establishment allows smoking in the restaurant’s outdoor serving area or elsewhere in an outdoor area in the establishment’s possession, the 
establishment shall see to it that tobacco smoke does not spread through an open window, door or other opening or ventilation to the indoor 
premises of the restaurant.   
 
Section 13 
(19.8.1994/765) 
 
The proprietors of indoor premises or public means of transport referred to in section 12 and the organisers of public events may, however, allow 
smoking in a room intended for this purpose or in part of the facilities or space as long as no tobacco smoke can enter those indoor premises 
where smoking is prohibited. A separate room or other space for smoking shall not, however, be located in conjunction with indoor premises 
primarily used by persons under the age of eighteen. 
 
Contrary to what is provided in section 12, paragraph 1 (2), (4) and (5) smoking may be allowed in rooms for accommodation of customers in 
hotels and corresponding establishments as well as in restaurants on board a vessel in international maritime traffic whose serving area is not 
larger than 50 m2. On premises with a larger serving area, an area of maximum 50 per cent may be reserved for smokers. In that case it has to be 
seen to it, however, that tobacco smoke does not spread to the area where smoking is prohibited. The restaurant facilities in a hotel and restaurant 
complex that are open at the same time are regarded as one and the same restaurant. By serving area is meant an area reserved for eating the 
food or drinking the drinks served there.  (21.7.2006/700) 
 
Contrary to what is provided in section 12, subparagraphs 2 and 5, smoking can be allowed in rooms for accommodation in hotels and 
corresponding establishments, as well as in restaurants and corresponding establishments whose serving area is not larger than 50 m2. On 
premises with a larger serving area, an area of maximum 50 per cent may be reserved for smokers. In that case it has to be seen to it, however, 
that tobacco smoke does not spread to the area where smoking is prohibited. The restaurant facilities in a hotel and restaurant complex that are 
open at the same time are regarded as one and the same restaurant. By serving area is meant an area reserved for eating the food or drinking the 
drinks served there. (9.4.1999/487) 
 
Following negotiation with employees or their representative, employers are required to prohibit or restrict smoking so that employees are not 
involuntarily exposed to tobacco smoke on any work premises at the workplace where smoking is not prohibited under section 12, subparagraph 5. 
 
What is provided in section 12, subparagraph 5, and in paragraph 3 of this section on the prohibition and restriction of smoking on common and 
work premises at workplaces shall not apply to any work premises which are located in the home of the worker or the business entrepreneur or 
EN 
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other professional, or to other work premises in the exclusive use of persons belonging to the same family and others living in the same household. 
 
The proprietors of indoor premises and organisers of public events referred to in section 12 above, or the proprietors of space intended for smoking 
referred to in paragraph 1 of this section shall put up signs indicating where smoking is prohibited and where smoking is allowed. Further 
provisions concerning such signs and their placement may be laid down by decree. 
 
Section 13 a (19.8.1995/765) 
 
Any person who smokes in a means of public transport or on indoor or outdoor premises where this is prohibited under the provisions of section 12 
or 13, and who does not discontinue such smoking despite being asked to do so, may be removed from the means of public transport or indoor or 
outdoor premises by the proprietor of the vehicle or a member of the transport personnel, the organiser of the public event or the proprietor of the 
indoor or outdoor premises in question or his or her representative, unless such removal can be considered unreasonable. 
 
Section 13 b (21.7.2006/700) 
 
Smoking can be allowed on the indoor premises of restaurants only in a separate smoking area approved for smoking. In that can case it must, 
however, be seen to it that tobacco smoke does not spread to the area where smoking is prohibited. It is prohibited to serve food or drink, or to eat 
or drink in the smoking area. 
 
Section 13 c  (21.7.2006/700) 
 
It is prohibited to work in the smoking area except for work that is necessary for the keeping of order, fire and rescue services and work that is 
necessary for safety. The smoking area may be cleaned only after the area has been carefully aired, taking into account what is otherwise 
provided by statute regarding the occupational safety and health of employees. 
 
Section 13 d  (21.7.2006/700) 
 
The smoking area must be reasonably large in proportion to the size of the restaurant’s serving area or the number of places for customers. 
Provisions of the Land Use and Building Act (132/1999) and provisions issued in virtue of it apply to the construction and maintenance of and 
repairs and alterations to the smoking area.  
 
The establishment shall draw up a self-control plan specifying how the functionality of the smoking area is ensured and how the conditions and 
order in the smoking area can be supervised from outside it.  
 
Further provisions on the minimum and maximum size of the smoking area or on the proportion of the area to the size of the restaurant’s serving 
EN 
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area or number of places for customers may be issued by Government decree. 
 
Further provisions on the requirements for the structure and functionality of the smoking area as well as on the drawing up, content and 
implementation of the self-control plan required of the establishment as referred to in paragraph 2 may be issued by decree of the Ministry of 
Social Affairs and Health.   
 
Section 13 e  (21.7.2006/700) 
 
The occupational safety and health authorities, the municipal supervisory authority referred to in section 14 a and, as necessary, the police shall 
notify the authority granting licence to serve alcoholic beverages referred to in section 21 of the Alcohol Act (1143/1994) of any violation of the 
provisions on the smoking area and the building inspection authority of any violation of the provisions and regulations on construction and 
maintenance of or repairs and alterations to the smoking area. The occupational safety and health authority and the municipal supervisory 
authority referred to in section 14 a shall notify each other of any violation of the above-mentioned provisions and regulations. 
 
Full text available at: http://www.finlex.fi/en/laki/kaannokset/1976/en19760693.pdf 
 
 
Decree of the Ministry of Social Affairs and Health No 964 
concerning smoking rooms in restaurants and other catering establishments 
Issued in Helsinki on 3 November 2006 
By decision of the Ministry of Social Affairs and Health 
 
pursuant to Section 13(d)(4) of Act 693/1976 of 13 August 1976 on measures to reduce smoking, as amended by Act 700/2006, , the following is 
enacted: 
 
Section 1 
Structure of the smoking room 
The smoking room shall be air-tight. 
The top of the door shall be at least 400 millimetres from the ceiling.   
Access to the smoking room shall be arranged in such a way that no tobacco smoke can escape
 
Section 2  
Ventilation 
Smoking rooms shall always be under lower air pressure. Air may enter a smoking room only via a door from an adjacent room or ventilator.  
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The flow of extracted air from the smoking room shall be at least 30 cubic decimetres per second per square metre of floor. However, the flow 
through the door opening shall be at least 180 cubic decimetres per second per square metre of the opening. The ventilator must be positioned in 
such a way that the air is extracted efficiently from all parts of the smoking room. 
The extracted air shall be led via a separate channel to a point above the roof of the structure. 
 
Section 3 
Monitoring 
It shall be possible to monitor the smoking room from outside.  
The smoking room or extraction channel shall be fitted with a fixed measuring device so that the extraction flow from the room can be monitored 
from outside the room. 
The ventilation of the smoking room shall be checked regularly and the findings recorded. 
 
Section 4 
Maintenance 
A plan shall be drawn up for the use and maintenance of the smoking room. The plan shall show clearly the values planned, the points which need 
to be inspected and maintained, and how frequently maintenance is required. The plan shall also include a self-monitoring plan and a use and 
maintenance guide. 
 
Section 5 
Entry into force 
This Regulation shall enter into force on 1 June 2007 
The provisions of Section 2(3) shall not apply to restaurants which were built prior to the entry into force of this Regulation. 
The measures necessary to implement this Regulation may be launched prior to the date of its entry into force.  
 
EN 
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France 

Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces  
public places  
transport 
facilities 
facilities 
restaurants 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking allowed in 
A decree banning smoking in places for 
allowed in 
allowed in 
allowed in 
banned 
banned 
separately 
collective use and considerable strengthening 
separately 
separately 
separately 
altogether 
altogether, incl. 
ventilated smoking 
the provisions under the 1991 Loi Evin was 
ventilated 
ventilated 
ventilated 
outdoor areas of 
rooms in which no 
issued on 16 Nov. 2006. A ban on smoking in 
rooms in 
smoking rooms 
smoking 
educational and 
services are 
enclosed workplaces and public places entered 
which no 
in which no 
rooms in 
childcare 
provided 
into force as of February 2007 and in hospitality 
services are 
services are 
which no 
facilities 
venues as of January 2008. 
provided 
provided 
services are 
 
 
provided 
In workplaces and most public places, there is a 
possibility to create separately ventilated 
smoking rooms in which no service is to be 
provided. The smoking room should not occupy 
more than 20% of the overall surface of the 
establishment and should not exceed 35 m². 
 
Legal provisions 
 

Code de la santé publique 
Article L3511-7 
Il est interdit de fumer dans les lieux affectés à un usage collectif, notamment scolaire, et dans les moyens de transport collectif, sauf dans les 
emplacements expressément réservés aux fumeurs.  
Un décret en Conseil d'Etat fixe les conditions d'application de l'alinéa précédent.  
 
 
 
 
 
 
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Décret n° 2006-1386 du 15 novembre 2006 fixant les conditions d’application de l’interdiction de fumer dans les lieux affectés à un usage 
collectif 
  
NOR: SANX0609703D 
  
Article 1  
  
La section 1 du chapitre Ier du titre unique du livre V de la troisième partie du code de la santé publique est remplacée par les dispositions 
suivantes :  
  
« Section 1  
   
« Interdiction de fumer 
  
dans les lieux affectés à un usage collectif  
  
« Art. R. 3511-1. - L’interdiction de fumer dans les lieux affectés à un usage collectif mentionnée à l’article L. 3511-7 s’applique : 
  
« 1° Dans tous les lieux fermés et couverts qui accueillent du public ou qui constituent des lieux de travail ; 
  
« 2° Dans les moyens de transport collectif ; 
  
« 3° Dans les espaces non couverts des écoles, collèges et lycées publics et privés, ainsi que des établissements destinés à l’accueil, à la 
formation ou à l’hébergement des mineurs. 
  
« Art. R. 3511-2. - L’interdiction de fumer ne s’applique pas dans les emplacements mis à la disposition des fumeurs au sein des lieux mentionnés 
à l’article R. 3511-1 et créés, le cas échéant, par la personne ou l’organisme responsable des lieux. 
  
« Ces emplacements ne peuvent être aménagés au sein des établissements d’enseignement publics et privés, des centres de formation des 
apprentis, des établissements destinés à ou régulièrement utilisés pour l’accueil, la formation, l’hébergement ou la pratique sportive des mineurs et 
des établissements de santé. 
  
« Art. R. 3511-3. - Les emplacements réservés mentionnés à l’article R. 3511-2 sont des salles closes, affectées à la consommation de tabac et 
dans lesquelles aucune prestation de service n’est délivrée. Aucune tâche d’entretien et de maintenance ne peut y être exécutée sans que l’air ait 
été renouvelé, en l’absence de tout occupant, pendant au moins une heure. 
EN 
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« Ils respectent les normes suivantes : 
  
« 1° Etre équipés d’un dispositif d’extraction d’air par ventilation mécanique permettant un renouvellement d’air minimal de dix fois le volume de 
l’emplacement par heure. Ce dispositif est entièrement indépendant du système de ventilation ou de climatisation d’air du bâtiment. Le local est 
maintenu en dépression continue d’au moins cinq pascals par rapport aux pièces communicantes ; 
  
« 2° Etre dotés de fermetures automatiques sans possibilité d’ouverture non intentionnelle ; 
  
« 3° Ne pas constituer un lieu de passage ; 
  
« 4° Présenter une superficie au plus égale à 20 % de la superficie totale de l’établissement au sein duquel les emplacements sont aménagés 
sans que la superficie d’un emplacement puisse dépasser 35 mètre carrés. 
  
« Art. R. 3511-4. - L’installateur ou la personne assurant la maintenance du dispositif de ventilation mécanique atteste que celui-ci permet de 
respecter les exigences mentionnées au 1° de l’article R. 3511-3. Le responsable de l’établissement est tenu de produire cette attestation à 
l’occasion de tout contrôle et de faire procéder à l’entretien régulier du dispositif. 
  
« Art. R. 3511-5. - Dans les établissements dont les salariés relèvent du code du travail, le projet de mettre un emplacement à la disposition des 
fumeurs et ses modalités de mise en oeuvre sont soumises à la consultation du comité d’hygiène et de sécurité et des conditions de travail ou, à 
défaut, des délégués du personnel et du médecin du travail. 
  
« Dans les administrations et établissements publics dont les personnels relèvent des titres Ier à IV du statut général de la fonction publique, le 
projet de mettre un emplacement à la disposition des fumeurs et ses modalités de mise en oeuvre sont soumises à la consultation du comité 
d’hygiène et de sécurité ou, à défaut, du comité technique paritaire. 
  
« Dans le cas où un tel emplacement a été créé, ces consultations sont renouvelées tous les deux ans. 
  
« Art. R. 3511-6. - Dans les lieux mentionnés à l’article R. 3511-1, une signalisation apparente rappelle le principe de l’interdiction de fumer. Un 
modèle de signalisation accompagné d’un message sanitaire de prévention est déterminé par arrêté du ministre chargé de la santé. 
  
« Le même arrêté fixe le modèle de l’avertissement sanitaire à apposer à l’entrée des espaces mentionnés à l’article R. 3511-2. 
  
« Art. R. 3511-7. - Les dispositions de la présente section s’appliquent sans préjudice des dispositions législatives et réglementaires relatives à 
l’hygiène et à la sécurité, notamment celles du titre III du livre II du code du travail. 
EN 
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« Art. R. 3511-8. - Les mineurs de moins de seize ans ne peuvent accéder aux emplacements mentionnés au premier alinéa de l’article R. 3511-2. 
»  
  
Article 2  
  
A la section unique du chapitre II du titre unique du livre V de la troisième partie du code de la santé publique, les articles R. 3512-1 et R. 3512-2 
sont remplacés par les dispositions suivantes : 
  
« Art. R. 3512-1. - Le fait de fumer dans un lieu à usage collectif mentionné à l’article R. 3511-1 hors de l’emplacement mentionné à l’article R. 
3511-2 est puni de l’amende prévue pour les contraventions de la troisième classe. 
  
« Art. R. 3512-2. - Est puni de l’amende prévue pour les contraventions de la quatrième classe le fait, pour le responsable des lieux où s’applique 
l’interdiction prévue à l’article R. 3511-1, de : 
  
« 1° Ne pas mettre en place la signalisation prévue à l’article R. 3511-6 ; 
  
« 2° Mettre à la disposition de fumeurs un emplacement non conforme aux dispositions des articles R. 3511-2 et R. 3511-3 ; 
  
« 3° Favoriser, sciemment, par quelque moyen que ce soit, la violation de cette interdiction. »  
  
Article 5  
  
Les dispositions du présent décret entrent en vigueur le 1er février 2007. Toutefois les dispositions des articles R. 3511-1 à R. 3511-8 et de l’article 
R. 3511-13 du code de la santé publique en vigueur à la date de publication du présent décret restent applicables jusqu’au 1er janvier 2008 aux 
débits permanents de boissons à consommer sur place, casinos, cercles de jeu, débits de tabac, discothèques, hôtels et restaurants.  
  
Full text at: http://www.legifrance.gouv.fr/affichTexte.do?cidTexte=JORFTEXT000000818309&dateTexte 
 
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Greece 
 

Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces   public places  
transport 
facilities 
facilities 
restaurants 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking 
No restrictions 
The Health Regulations Y1/GP oik.76017 
allowed in 
allowed in 
banned 
allowed in 
allowed n 
(FEK∗ 1001/v.b /01-08-02) and Y1/GPoik. 
designated 
designated 
altogether. 
designated 
designated 
82942 (FEK∗ 1292/v. b/12-09-03) entered 
smoking 
smoking 
On ships 
smoking 
smoking areas 
into force in September 2003. 
areas  
areas  
allowed in 
areas  
- for 
 
designated 
employees in 
Smoking in workplaces, public places, and 
smoking 
institutions of 
healthcare facilities is allowed in designated 
rooms. 
primary and 
smoking areas equipped with ventilation 
secondary 
and is banned completely in means of 
education and 
public transport There are no restrictions on 
both for 
smoking in the hospitality sector. 
employees 
 
and students 
A draft Law for the total smoking ban in all 
in institutions 
public places as of Jan. 2010 has been 
of tertiary 
prepared by the Ministry of Health and 
education 
Social solidarity and presented to the 
Parliament in May 2008. 
 
Legal provisions 
Decision No YI/G.P./OIK. 76017 
of  29 July 2002 
 
Imposing a ban on smoking in public places, means of transport and health service units. 
                                                 
 
 
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THE MINISTER FOR HEALTH AND WELFARE 
(HEALTH REGULATION) 
 
We issue this Health Regulation, which shall apply throughout the country. 
 
I. We ban smoking in the following areas: 
 
a. In all buildings housing public service offices, offices belonging to bodies established under public law and those belonging to bodies established 
under private law which are supervised and subsidised by the State; in organisations and other institutions (Hellenic Telecommunications 
Organization, Public Power Corporation, Hellenic Post, etc.); and in workplaces which belong to private bodies, as well as in public waiting areas 
(airport waiting areas, railway station waiting areas, bus station waiting areas, etc.); 
b) In all health service units, such as: 
 1) 
Hospitals 
 
2) Private Clinics 
 
3) Health Centres 
 
4) District Surgeries 
 
5) Public Surgeries 
6) Surgeries belonging to bodies established under public law and those belonging to bodies established under private law (Social Insurance 
Institute, etc.) 
 
7) Private Surgeries – Dental Surgeries 
 8) 
Pharmacies 
 
9) Other Primary Health Care (PHC) services 
 
10) In all areas not mentioned above, where health services are provided. 
c) In all education premises, such as: 
 
1) Primary Schools (Public or Private) 
 
2) Secondary and Post-secondary Schools (Public or Private) 
 
3) Universities, Technical Institutions and general tertiary education institutions 
 
4) Private Tuition Centres 
d) In al  nurseries, kindergartens, crèches and playgrounds. 
Special areas shall be designated for smokers in the workplace, where powerful ventilation systems shall be in place, in all buildings housing public 
service offices, offices belonging to bodies established under public law and those belonging to bodies established under private law, which are 
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subject to supervision and subsidies by the State, in organisations and other institutions (Hellenic Telecommunications Organization, Public Power 
Corporation, Hellenic Post, etc.), and in hospitals, private clinics, health centres and surgeries belonging to bodies established under public law 
and those belonging to bodies established under private law (Social Insurance Institute, etc). 
In the case of primary and secondary schools and private tuition centres, the above mentioned regulations shall apply only to employees who wish 
to smoke, while in the case of tertiary education institutions they shall apply both to employees (scientific, administrative and auxiliary personnel) 
and students. 
The areas shall be designated by directors/supervisors of the competent bodies in accordance with their needs, so that the fundamental function of 
their services is not impeded. 
 
II. Smoking is also banned in means of transport: 
  1) Buses (KTEL, city buses, coaches, school buses, etc.) 
  2) Trains (Hellenic Railways Organisation, METRO, Athens-Piraeus Electric Railways, etc.) 
  3) Ships operating on domestic routes: a well ventilated smoking room shall be designated if possible on every deck  
  4) Airplanes operating on domestic routes 
 5) 
Taxi 
 
III. Moreover, smoking is also banned in all public health facilities pursuant to the provisions of Article 5 of Health Regulation No A1b/8577/83 
(Government Gazette 526/83 II), with the exception of non-food serving bars and traditional cafés in accordance with Article 37, and entertainment 
places in accordance with Article 41. 
In particular, in the facilities referred to in Articles 37, 38 and 39 and in the food-serving facilities referred to in Article 40 of the aforementioned 
Health Regulation, smoking shall be permitted within a section of the clients area, which shall be divided physically or visibly and shall be marked 
with a special sign that shall read 'smoking area'. The non-smoking area, which shall comprise a surface area of at least 50% of the entire clients 
area, shall be depicted in the plans for obtaining a permit to set up and operate a business and it shall be inscribed on the operating permit. 
The smoking area shall have a special mechanical system of continuous and complete air renewal. 
In cases where the above mentioned facilities use open-air spaces exclusively or in conjunction with an enclosed clients area in order to provide 
additional seating, smoking shall be permitted in the open-air spaces in accordance with the provisions in force. 
 
IV. Those responsible for implementing the provisions of this Health Regulation are as follows: 
Regarding hospitals and private clinics: Managers and Administrative Directors; 
Regarding all other areas mentioned above: the direct supervisors of the services where smoking areas are located; 
Regarding all other areas belonging to private companies: the operators. 
 
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Transitional provisions 
Existing public health facilities and health service units shall implement this Regulation within a reasonable period of time stipulated by the 
competent health service, and no later than six months. 
In particular, those responsible for public health facilities shall affix a ground plan of the clients area next to the operating permit on a scale of 1 to 
50, in which both smoking and non-smoking areas shall be depicted in accordance with the provisions of this Regulation. 
Moreover, the administration of public services, bodies established under public law and bodies established under private law which are 
supervised and subsidised by the State, of organisations and other institutions (Hellenic Telecommunications Organization, Public Power 
Corporation, Hellenic Post, etc.), as well as those responsible for public waiting areas, shall ensure that the aforementioned provisions are 
implemented within a reasonable period of time and no later than six months. 
 
 
Penalties 
Any person infringing this Regulation shall be prosecuted and punished in accordance with Article 3 of Emergency Act No 2520/40 (Government 
Gazette 273/40 I) on Health Regulations, as replaced by Article 1 of Act No 290/1943 (Government Gazette 185 I), which was ratified by Act 
No 303/1946 and replaced by Article 4(4) of Act No 2207/94 (Government Gazette 65 I), and replaced once again by Article 11(10) of Act 
No 2307/95 (Government Gazette 113/95 I). 
Moreover, any person infringing the provisions of this Regulation within health units shall be subject to the following administrative penalties: 
 
a) regarding patients who infringe this Regulation: disciplinary discharge note; 
 
b) regarding visitors or companions who infringe this Regulation: expulsion from the unit; 
 
c) regarding those responsible for implementing the provisions of this Regulation and those working in health units: disciplinary penalties shall 
be imposed in accordance with the provisions of the Civil Service Code. 
The competent health and other state bodies shall be responsible for implementing this Regulation. This Regulation shall enter into force a 
fortnight after its publication in the Government Gazette. 
 
 
Decision No Y1/GP/OIK 82942 
of 1 September 2003 
Supplementing Health Regulation No Y1/GP/76017/29.7.02 (Government Gazette 1001 II/1.8.2002)  imposing a ban on  smoking in public places, 
means of transport and health service units. 
THE MINISTER 
EN 
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FOR HEALTH AND SOCIAL WELFARE 
 
We supplement Health Regulation No Y1/GP/76017/29.7.02 (Government Gazette 1001/1.8.2002 II) as follows: 
Subparagraph 5 shall be added to paragraph 1(4), as follows: 
Smoking shall be forbidden in public and private waiting areas, reception areas, places of public gathering and business, meeting rooms, 
conference auditoriums, amphitheatres, etc. Regarding other workplaces, areas where smoking shall be banned or permitted shall be 
systematically and spatially designated , following dialogue and bilateral agreements between employees and employers. 
The competent health and other state bodies shall be responsible for implementing this Regulation. This Regulation shall enter into force a fortnight 
after its publication in the Government Gazette. 
 
EN 
81  
 EN

 
Germany 
 
Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces  
public places  
transport 
facilities 
facilities 
restaurants 
Employers 
Smoking 
Smoking 
Smoking 
Smoking 
Differs by Land 
Regulations at federal level: 
obliged to 
banned at 
banned 
banned at 
banned at 
 
 
protect non-
Länder level. In 
altogether at 
Länder level. 
Länder level. In 
Bans on smoking in  The amendment of the workplace ordinance, 
smokers 
some states 
federal level 
In some 
a few Länder 
hospitality 
which entered into force in Oct. 2002, requires 
against 
smoking rooms 
 
Länder 
smoking rooms 
establishments in all  that the employer has to take “all necessary 
passive 
are allowed 
 
smoking 
are allowed; 
Länder. Most of the 
measures to effectively protect non-smoking 
smoking  at 
 
rooms are 
smoking banned 
Länder allow for 
employees against the health hazards of 
federal and 
allowed 
in outdoor areas 
separate smoking 
tobacco smoke in the workplace”. The 
Länder  
of schools 
rooms. Some allow 
amendment in 2008 specified that a ban on 
(state)  level 
also for other 
smoking in the workplace is one of the ways to 
except for 
exemptions such as  provide protection. In workplaces open to the 
workplaces 
the creation of 
public (i.e. primarily hospitality sector but also 
accessible to 
private clubs or 
other areas where smoking by customers and 
the public 
smoking in tents at 
visitors is allowed) the employers’ obligations 
wine and beer 
are more limited and "go only as far as the 
festivals. 
nature of the enterprise and the type of 
 
employment allow". 
 
 
The federal government prohibited smoking in 
government buildings, on public transport 
(including taxis) and at public transport stations 
in February 2007 and this measure came into 
effect on 1st September 2007.  
 
Regulations at Länder (state) level 
 
In March 2007, the Germany's 16 Länder 
concluded a framework agreement with the 
federal government on introducing a smoking 
ban in the areas where the states have 
responsibility (Land and local institutions, 
educational facilities, health care facilities, 
EN 
82  
 EN

 
cultural institutions, sport facilities, hospitality 
venues and other public places). Each Land had 
to enact the law through its own legislature. 
 
Between August 2007 and July 2008, all 16 
Länder adopted bans on smoking in enclosed 
public places including bars, pubs and 
restaurants. The laws differ from Land to Land, 
in particular in the hospitality sector. Most of the 
Länder (except for Bavaria) allow for smoking in 
separate smoking rooms. Some allow also for 
other exemptions such as the creation of private 
smoking clubs. 
 
On 30 July 2008, the Federal Constitutional 
Court declared the smoke-free regulations of two 
Länder (Baden-Württemberg and Berlin) partly 
unconstitutional because of discriminatory 
exemptions. The Court noted that single-room 
pubs, which cannot create physical y separate 
areas for smokers as could larger bars and 
restaurants, are placed at a considerable 
disadvantage by the existing laws. Likewise, the 
smoking ban in the discotheques is not justified 
as long as other types of venues are allowed to 
create separate smoking rooms. 
The Court decided that current rules are to 
remain in effect until the end of 2009, by which 
time the Länder will have to make 
constitutionally correct laws. The court offered 
two options: a total smoking ban in the 
hospitality sector without any exemptions or 
exemptions for small single-room venues in 
addition to the possibility of separating rooms.  
Until the smoking rules are revised, the Court 
has granted provisional exemptions to pubs of 
less than 75 m2 that do not serve meals and do 
EN 
83  
 EN

 
not allow people under 18 and to separate 
rooms in discotheques, provided that smoking is 
not permitted on the dance floor and that people 
under 18 are not allowed into any part of the 
disco. 
The Court decision indirectly applies to all 
German Länder – except for Bavaria that 
enacted strict smoking ban whose 
constitutionality has been confirmed in a 
separate Court ruling.  
 
Legal provisions  
Verordnung über Arbeitsstätten  
(Arbeitsstättenverordnung - ArbStättV) 
§ 5 Nichtraucherschutz 
(1) Der Arbeitgeber hat die erforderlichen Maßnahmen zu treffen, damit die nicht rauchenden Beschäftigten in Arbeitsstätten wirksam vor den 
Gesundheitsgefahren durch Tabakrauch geschützt sind. Soweit erforderlich, hat der Arbeitgeber ein allgemeines oder auf einzelne Bereiche der 
Arbeitsstätte beschränktes Rauchverbot zu erlassen. 
(2) In Arbeitsstätten mit Publikumsverkehr hat der Arbeitgeber Schutzmaßnahmen nach Absatz 1 nur insoweit zu treffen, als die Natur des 
Betriebes und die Art der Beschäftigung es zulassen. 
Full text at: http://www.bundesrecht.juris.de/bundesrecht/arbst_ttv_2004/gesamt.pdf  
 
Summary of Länder legislation by DEHOGA 
BUNDESVERBAND 
Situation as of 9 April 2008 
EN 
84  
 EN

 
Entry into 
Land 
Rules on separate smoking 
Signposting 
Scope 
Exemptions 
Fines 
force/ 
(bill) 
rooms 
obligations 
adoption 
•  Smoking is banned in 
• Beer, wine and 
•  As an exemption from para. 1  •  Reference to general  • Only for 
• 01.08.200
Baden-
catering establishments: 
festival tents, 
– in completely separated 
smoking ban 
customers: up to 

Württemberg 
pubs, bars, night clubs, 
outside catering 
side-rooms, provided these 
•  In both smoking and 
€40, or up to 
(LNRSG) 
winegrowers’ taverns and 
facilities and travel 
are clearly indicated as 
no-smoking areas 
€150 for repeat 
 
all other catering 
industry (§7, para. 1, 
smoking rooms. Smoking is 
(§§7, para. 2, 
offences 
• 25.07.200
 
establishments (including 
subpara. 2) 
permitted in these rooms if 
subpara. 1 and 8, 

temporary ones) (§7, para.  •  Toilet access routes 
and as long as non-smoker 
para. 1, subpara. 2) 
http://www.pro-
1, subpara. 1) 
•  Forming a club in 
protection is not compromised 
rauchfrei.de/Gese • Clubhouses 
order to circumvent 
(§7, para. 2). Model: §§7 and 
tzentwurf-Baden- •  Discotheques (§7, para. 1, 
the rules is not 
14(1) LBOAVO 
Wuerttemberg.pd
subpara. 1) 
allowed 
•  For clarification: not in 

discotheques 
•  Total smoking ban 
•  Private parties, as 
•  For smokers and  • 01.01.200
Bavaria 

None None 
  §1 GastG, 1998 version, in 
long as the catering 
establishment 

(GSG) 
as far as rooms are 
establishment 
operators 
 
publicly accessible 
operator agrees 
between €5 and 
 
•  Discotheques (Article 2, No  •  ‘Club solutions’ 
€1 000 
• 12.12.200
8 in conjunction with Article 
possible 

http://www.pro-
3, para. 1, subpara. 1) 
•  So far only for 2008: 
rauchfrei.de/Gese
smoking is permitted 
tzentwurf-
in beer festival tents 
Bayern.pdf 
•  §1 GastG, 1998 version 
•  (Hotel and 
•  Separated side-rooms for 
•  Both smoking and no- •  For smokers up 
• 01.01.200
Berlin 
• Travel industry 
guesthouse rooms, 
smoking may be provided. 
smoking areas (§5, 
to €100 

(NRSG) 
establishments involved in 
§4, para. 1, No 1) 
The number of places in the 
subpara. 1) 
• For catering 
Fines as 
events 
no-smoking area must be 
establishment 
from 
 
•  No exemptions for festival 
substantially higher than the 
operators up to 
1.7.2008 
tents or clubhouse catering 
number of places in the 
€1 000 
http://www.pro-
 
facilities 
smoking room.  
•  Operators also for 
rauchfrei.de/Gese
•  Not in discotheques to which 
failure to display 
• 08.11.200
tzentwurf-
young people under the age 
signs 

Berlin.pdf 
of 18 are admitted (§4, para. 
3). 
EN 
85  
 EN

 
Entry into 
Land 
Rules on separate smoking 
Signposting 
Scope 
Exemptions 
Fines 
force/ 
(bill) 
rooms 
obligations 
adoption 
•  The question of whether 
serving in smoking rooms is 
permitted is controversial. It is 
not possible to imply a ban 
from the legislation. However, 
smoking rooms should be 
designed and used in such a 
way as to prevent a health 
hazard as a result of passive 
smoking. 
•  §1 GastG, 1998 version, 
• Exemptions may be  •  The smoking ban does not 
•  Only smoking areas 
• For smokers 
• 01.01.200
Brandenburg 
closed rooms 
granted by the Land 
apply in catering 
(§5) 
between €5 and 

(NiRSchG) 
•  General smoking ban in 
health department, 
establishment side-rooms, as 
100 
Fines as 
discotheques 
as long as structural 
long as structural or other 
• For catering 
from 
 
• Shopping centres 
or other measures 
measures ensure that the 
establishment 
1.7.2008 
•  Beer, wine and festival 
ensure that third 
health of third parties is not at 
operators 
http://www.pro-
 
tents (§§2, para. 1, No 8 
parties are not put at 
risk. 
between €10 and 
rauchfrei.de/Gese
and paras 2 and 3, Nos 8 
risk (§4, para. 3) 
•  For clarification: not in 
1 000 
• 14.12.200
tzentwurf-
and 9) 
discotheques (§4, para. 2, 

Brandenburg.pdf
subpara. 2) 
• Catering establishments 
•  None apart from 
•  Separated side-rooms may 
•  Only to indicate the 
•  Smokers up to 
• 1 January 
Bremen 
where drinks or prepared 
separate side-rooms 
be established. They must be 
smoking ban (§4) 
€500 
2008 
(BremNiSchG) 
foods are served on a 
separated structurally in an 
• Catering 
commercial basis on the 
effective manner which 
establishment 
 
 
spot (§1 GastG) 
prevents others being put at 
operators up to 
• Fines 
•  Discotheques (§2, para. 1, 
risk by passive smoking. Any 
€2 500 
from 
http://www.pro-
No 8) 
side-room must be smaller 
•  Operators also for 
1.7.2008 
rauchfrei.de/Gese
than the main room used by 
failure to display 
tzentwurf-
customers. The room in which 
signs 
Bremen.pdf 
the bar is located is usually 
the main room (§3, para. 5) 
•  Also in discotheques (but only 
in side-rooms without a dance 
EN 
86  
 EN

 
Entry into 
Land 
Rules on separate smoking 
Signposting 
Scope 
Exemptions 
Fines 
force/ 
(bill) 
rooms 
obligations 
adoption 
floor) 
• Establishments where 
•  Festival tents at 
•  Separated smoking rooms 
•  Only smoking areas 
• For smokers 
• 1 January 
Hamburg 
drinks or prepared foods 
local temporary 
may be established. They 
(§2, para. 3, subpara. 
between €20 and 
2008 
(HmbPSchG) 
are served for consumption 
events and 
must be separated 
2 and §3) 
200 
on the spot (catering 
clubhouses of 
structurally in an effective 
• For catering 
 
 
establishments), including 
registered societies 
manner which prevents 
establishment 
•  Adopted 
those operated as 
are exempted from 
others being put at risk by 
operators 
on 
http://www.pro-
discotheques. 
the smoking ban 
passive smoking, and must 
between €50 and 
04.07.200
rauchfrei.de/Gese •  The smoking ban also 
(§2, para. 4) 
be ventilated and indicated by 
500 

tzentwurf-
applies to catering 
specific signs 
• Operators must 
Hamburg.pdf 
establishments in shopping 
(§2, para. 3, subpara. 1) 
ask smokers to 
 
centres 
•  Also in discotheques 
stop smoking or 
• Proclaime
•  Applies to all fully enclosed 
leave the 
d on 
rooms 
premises, or must 
11.07.200
(§2, para. 1, Nos 9 and 11 
call the police. 

in conjunction with para. 2, 
They can also be 
subpara. 1) 
fined for failure to 
display signs. 
•  §1 GastG, 1998 version, 
•  Club rooms used 
•  Completely separated side-
•  Both smoking and no- •  For smokers up 
• 1.10.2007 
Hessen 
closed rooms in all catering 
only by club 
rooms which must not be the 
smoking areas (§2, 
to €200 
(HessNRSG) 
establishments 
members and not 
main room for customers may 
para. 4, §3) 
• For catering 
 
• Discotheques 
open to the public 
be established in catering 
establishment 
• Adopted 
 
• Winegrowers’ taverns 
are not covered. 
establishments. The smoking 
operators up to 
on 
• Temporary catering 
• Innovation clause: 
room must not be bigger than 
€2 500 
06.09.200
http://www.pro-
establishments in sports 
technical measures 
the main room. 
(appropriate 

rauchfrei.de/Gese
and multipurpose halls, 
which offer 
•  Also in discotheques 
measures to 
tzentwurf-
Shisha bars, private 
equivalent protection 
(§2, para.4) 
prevent 
Hessen.pdf 
parties, hybrid 
to a smoking ban 
infringements) 
establishments, e.g. 
•  Beer, festival and 
gambling halls 
wine tents in use for 
a maximum of 21 
days (§2, para. 5) 
•  §1 GastG, 1998 version 
•  (Accommodation 
•  Smoking areas may be 
•  Both smoking and no- •  For smokers up 
• 1 August 
Mecklenburg-
•  (Accommodation 
establishments may 
established as separate 
smoking areas (§2, 
to €500 
2007 
EN 
87  
 EN

 
Entry into 
Land 
Rules on separate smoking 
Signposting 
Scope 
Exemptions 
Fines 
force/ 
(bill) 
rooms 
obligations 
adoption 
Western 
establishments, hotels, 
designate individual 
rooms (§2, para. 1) 
para. 1, subpara. 2, 
• For catering 
• For 
Pomerania 
guest houses) 
guest rooms as 
•  Also in discotheques 
§3) 
establishment 
catering 
(NichtRSchG) 
• Discotheques 
smoking areas, §2, 
operators up to 
establish
•  Winegrowers’ taverns (§10, 
para. 1) 
€10 000 
ments 
 
para. 1, No 10) 
•  Operators also for 
from 
failure to display 
1.1.2008; 
http://www.pro-
signs 
fines from 
rauchfrei.de/Gese
1.8.2008 
tzentwurf-
Mecklenburg-
Vorpommern.pdf 
•  Closed rooms in catering 
• In accommodation  •  The smoking ban does not 
• Smoking area 
• Smokers 
• 1 August 
Lower Saxony 
establishments which are 
establishments, 
apply in a completely 
(§3, para. 1, No 7) 
• Catering 
2007 
(Nds.NiRSG) 
accessible to customers 
smoking may be 
separated side-room in an 
•  Permanent and clearly 
establishment 
• Fines 
• Discotheques 
permitted in the 
establishment, provided it 
visible signs at the 
operator 
from 
 
•  Wine, beer and festival 
restaurant/bar etc. if 
does not exceed half the size 
entrance; size and 
•  Operators also for 
1.11.2007 
tents, winegrowers’ taverns 
food and drink are 
of the total area accessible to 
colour at the 
failure to display 
• 11.07.200
http://www.pro-
(§1, para. 1, subpara. 1, 
served exclusively to 
customers 
operator’s discretion 
signs  

rauchfrei.de/Gese
No 10) 
persons staying 
(§2, para. 2) 
•  No-smoking area (§1,  • Offences may 
tzentwurf-
also in clubhouses with 
there (§2, para. 2, 
•  Also in discotheques 
para. 4) 
give rise to a fine 
Niedersachsen.p
commercially run catering 
No 1) 
of between €5 
df 
facilities 
•  Clubs may not be 
and €1 000 
•  Shopping centres (‘market 
founded in order to 
hall regulation’), so-called 
circumvent the rules 
‘large solution’ (§1, para. 
1/1, subpara. 2) 
 
•  Cafés, bars and 
•  The smoking ban 
•  Separated smoking rooms 
•  Both smoking and no- • Smokers 
• 1 January 
North Rhine–
restaurants, regardless of 
does not apply to 
may be established. They 
smoking areas (§3, 
• Catering 
2008 
Westphalia 
the type, size and number 
temporary festival 
must take up a lesser 
para. 2, subpara. 1, 
establishment 
of rooms 
tents or 
 
private 
proportion of the 
No 2 and §4, subpara. 
operators failing 
 
• Including discotheques 
parties in 
establishment’s area (§4, 
2) 
to display signs 
• For 
•  Reference to usual 
restaurants (§4, 
subparas 2 and 3) 
• Operators must 
restaurant
EN 
88  
 EN

 
Entry into 
Land 
Rules on separate smoking 
Signposting 
Scope 
Exemptions 
Fines 
force/ 
(bill) 
rooms 
obligations 
adoption 
terminology in §1 GastG 
para. 4)
•  Also in discotheques 
take the 
s from 
http://www.pro-
‘Use of clubs and 
necessary 
01.07.200
rauchfrei.de/gese
societies whose 
measures to 

tzgebung-
exclusive purpose is 
enforce the 
nordrhein-
the common 
smoking ban 
westfalen.htm 
consumption of 
• Offences may 
tobacco’ (§3, para. 
give rise to a fine 
7) 
of between €5 
• Innovation clause: 
and €1 000 
technical measures 
which offer 
equivalent protection 
to a smoking ban 
(§3, para. 8) 
• Catering establishments 
• Smoking may be 
•  Separated side-rooms for 
•  Both smoking and no- •  Up to €500 for 
• 15 Februa
Rheinland-Pfalz
within the meaning of the 
permitted 
smokers may be established. 
smoking areas (§7, 
catering 
ry 2008 
(NRSG) 
Catering Establishment Act 
(appropriately 
The area and number of 
para. 2 and 3, §9) 
establishment 
are smoke-free. This 
indicated) in wine, 
seats in rooms where 
operators failing 
 
 
applies to all bars, cafés 
beer and other 
smoking is allowed must not 
to display signs 
•   5 October 
and restaurants and all 
festival tents if used 
be bigger than in the other 
•  Up to €1 000 for 
2007 
 
other rooms where 
at the same location 
(no-smoking) rooms used by 
catering 
customers are present, 
for no more than 21 
customers (§7, para. 2) 
establishment 
 
including dance floors in 
consecutive days 
•  Also in discotheques (but only 
operators failing 
discotheques and other 
(§7, para. 3) 
in side-rooms without dance 
to enforce the 
http://www.pro-
dance establishments in 
floors) 
smoking ban 
rauchfrei.de/Gese
buildings or parts of 
 
 
 
 
 
tzentwurf-
buildings (§7, para. 1) 
Rheinland-
• Does not apply for a period 
Pfalz.pdf 
of three months from 
11.2.2008 for owner-
 
managed one-room 
catering establishments 
without other staff, if signs 
 
to this effect are clearly 
EN 
89  
 EN

 
Entry into 
Land 
Rules on separate smoking 
Signposting 
Scope 
Exemptions 
Fines 
force/ 
(bill) 
rooms 
obligations 
adoption 
placed in the entrance area
 
 
 
 
VGH RHP: 
interim 
arrangement 
11.2.2008 
•  §1 GastG independent of 
• Owner-managed 
•  Separated smoking rooms, 
• Owner-managed 
•  Up to €1 000 for 
• 15 Februa
Saarland 
the type of licence 
catering 
The area and number of 
smoking 
catering 
ry 2008 
• Accommodation 
establishments. This 
seats must not be bigger than 
establishments must 
establishment 
 
establishments 
means that no staff 
the rest of the rooms used by 
have signs identifying 
operators who fail   
• Discotheques 
other than the 
customers (§3, para. 3, No 1) 
them as such (§3, 
to display signs 
• Fines 
 
•  Festival tents (§2, para. 1, 
operator are 
•  For clarification: also in 
para. 8) 
•  Up to €1 000 for 
from 
No 7) 
employed, apart 
discotheques (§3, para. 5), 
•  Both smoking and no-
catering 
1 June 
 
• Clubhouses 
from occasional 
but only in side-rooms without 
smoking areas (§3, 
establishment 
2008 
• Does not apply at the 
assistance from 
dance floor 
para. 8 and §4) 
operators who fail 
http://www.pro-
moment to Shisha bars 
adult family 
to enforce the 
rauchfrei.de/Gese
members. 
smoking ban 
tzentwurf-
•  Applies also to 
•  Up to €200 for 
Saarland.pdf 
clubhouses 
customers who 
•  Beer, wine and other 
infringe the 
 
festival tents, if used 
smoking ban 
temporarily for no 
more than 14 
VGH Saarland 
consecutive days 
interim 
(§3, para. 7) 
EN 
90  
 EN

 
Entry into 
Land 
Rules on separate smoking 
Signposting 
Scope 
Exemptions 
Fines 
force/ 
(bill) 
rooms 
obligations 
adoption 
arrangement 
27.3.2008 
•  §1 GastG, 1998 version 
•  None, other than 
•  Separated side-rooms for 
•  Both smoking and no- •  Up to €5 000 for 
• 1 Februar
Saxony 
•  Establishments subject to 
separate side-rooms 
smoking are permitted. The 
smoking areas (§4, 
smokers or 
y 2008 
(SächsNSG) 
the provisions of the GastG
biggest room must be no-
No 3, §5, para. 2) 
catering 

 
 Discotheques 
smoking. 
establishment 
 
• Does not apply for a period 
•  For clarification: not in 
operators 
• 26.09.200
of three months from 
discotheques (§4, No 3) 
•  Operators also for 

http://www.pro-
27.3.2008 for owner-
failure to display 
rauchfrei.de/Gese
managed one-room 
signs 
tzentwurf-
catering establishments 
Sachsen.pdf 
without staff, provided this 
is clearly indicated in the 
 
entrance area. 
 
 
VGH Saxony 
interim 
arrangement 
27.3.2008 
•  §1 GastG independently of  •  None, other than 
•  Closed rooms may be 
• Smoking room (§4, 
•  Up to €1 000 for 
• 1 January 
Saxony Anhalt 
the type of licence 
separate side-rooms 
established in which smoking 
No 6) 
smokers 
2008 
• Shopping centres 
is allowed, provided they are 
• Otherwise an 
•  Up to €1 000 for 
 

 
  Other buildings in which 
separated in such an effective 
obligation to provide 
catering 
services are provided  
way as to prevent any 
information, but no 
establishment 
• Fines 
http://www.pro-
(§2, No 10) 
hazards as a result of passive 
rules on how (§6, 
operators 
from 
rauchfrei.de/Gese •  Discotheques (§2, No 11) 
smoking and are specifically 
subpara. 1) 
•  Operators also for 
1 July 
tzentwurf-
indicated as smoking rooms. 
failure to display 
2008 
EN 
91  
 EN

 
Entry into 
Land 
Rules on separate smoking 
Signposting 
Scope 
Exemptions 
Fines 
force/ 
(bill) 
rooms 
obligations 
adoption 
Sachsen-
(§4, subparas 2 and 3) 
signs 
Anhalt.pdf 
•  The room size is of no 
consequence; unlike in other 
Länder, catering 
establishment operators are 
free to decide which room 
should be the smoking room. 
•  Not in discotheques 
•  §1 GastG, 1998 version 
•  For private parties, 
•  Separated smoking rooms 
•  Only smoking area 
•  Up to €1 000 for 
• 1 January 
Schleswig-
•  All fully enclosed rooms 
separate event 
may be established. These 
(§3) 
smokers 
2008 
Holstein 
• Discotheques 
rooms may be 
must be separated 
•  Up to €1 000 for 
(NiSchG) 
 
•  Catering establishments in 
designated as 
structurally in such an 
catering 
shopping centres (§2, para. 
smoking rooms. 
effective manner that any 
establishment 
• Adopted 
 
2 in conjunction with para. 
•  Beer, wine and other 
health risk to others as a 
operators 
on 
1, No 7) 
festival tents 
result of passive smoking is 
•  Operators also for 
21 Novem
http://www.pro-
operating 
prevented. 
failure to display 
ber 2007 
rauchfrei.de/Gese
temporarily for a 
•  The smoking room should be 
signs 
tzentwurf-
maximum of 21 
the smaller room. 
Schleswig-
consecutive days 
•  Also in discotheques. 
Holstein.pdf 
•  Rooms may also change, e.g. 
larger hall and smaller room 
•  §1 GastG, 1998 version 
•  (Hotel and 
•  Separated smoking rooms 
•  Only smoking area 
• For smokers 
• 1 July 
Thuringia 
•  Act applies also to hotels, 
guesthouse rooms, 
may be established. These 
(§5, subpara. 2) 
between €20 and 
2008 
(ThürNRSchG) 
but not to accommodation 
§4, para. 1, subpara. 
must be separated 
200 
rooms 
 
1) 
structurally from the other 
• For catering 
 
•  Publicly accessible club 
rooms in such a way that 
establishment 
•   
rooms are included 
there is no permanent 
operators 
20.12.200
 
•  Discotheques (§2, No 7, 9, 
exchange of air (§5) 
between €50 and 

10 in conjunction with §3, 
•  For clarification: also in 
500 
http://www.pro-
paras 1 and 2) 
discotheques 
•  Operators also for 
rauchfrei.de/Gese
failure to display 
tzentwurf-
signs 
Thueringen.pdf 
EN 
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Available in German at:  
http://www.dehoga-bundesverband.de/uploads/branchenthemen/nichtraucherschutz/synopse_nrsgesetze_in_den_bundeslaendern.pdf 
 
Further info: http://www.pro-rauchfrei.de/gesetzgebung.htm 
 
EN 
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Hungary  
 
Enclosed 
Enclosed 
Public 
Health care Education 
Bars and 
Comments  
workplaces  
public 
transport 
facilities
facilities 
restaurants  
places  
 
 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking 
In restaurants , 
Smoking in workplaces and public places is 
allowed in 
allowed in 
allowed in 
allowed in 
banned 
smoking allowed in 
regulated by Act XLII of 1999 on the Protection 
designated 
designated 
designated 
designated 
altogether 
designated areas  
of Non-Smokers and Certain Regulations on the 
areas  
areas  
areas  
areas  
in areas within 
 
Consumption and Distribution of Tobacco 
 
 
public 
In primarily non-
Products  
Banned 
Banned 
education 
food 
 
altogether on 
altogether in 
institutions that 
establishments, 
According to the Act, in workplaces and most 
means of local 
institutions 
are also used 
smoking may be 
public places smoking is allowed in designated 
public 
providing 
by students 
conducted without 
areas. In education facilities, most forms of 
transport, local 
basic health 
 
the designation of a  public transport and most healthcare facilities, 
and suburban 
services or 
 
smoking area. 
smoking is banned altogether. 
railways and on 
outpatient 
 
 
scheduled 
care, in the 
In January 08, Health Minister stated that the 
intercity buses 
customer 
Health Ministry is drafting a comprehensive 
areas of 
smoking ban covering all indoor workplaces and 
pharmacies 
public places, including bars and restaurants. In 
and in 
May, there has been a change at the post of the 
institutions 
health minister. 
providing 
 
inpatient 
The draft law would need to be approved by the 
care  
cabinet before it is submitted to the parliament. 
principally to 
 
children. 
 
Legal provisions 
Act XLII of 1999 on the Protection of Non-Smokers and Certain Regulations on the Consumption and Distribution of Tobacco Products 
 
Fundamental Provisions on the Consumption of Tobacco Products 
 
Section 2. 
(1) With the exception of areas designated for smoking - and with the deviation contained in Subsection (3)- smoking is prohibited 
a) in confined areas, which are open to persons using the services of public institutions; 
EN 
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b) on means of public transport; 
c) at events held in confined spaces; 
d) at places of work, in the cases defined in a separate legal regulation and according to the instructions of the employer. 
 
(2) Smoking areas may not be designated 
a) at the premises of medical institutions providing basic health services or outpatient care, or departments of medical institutions offering such 
services, and in the customer areas of pharmacies, furthermore, in buildings of providers of health services providing inpatient care principally to 
children; 
b) in nursery schools; 
c) in areas within public education institutions, other than those referred to in Paragraph b), that are also used by students; 
d) in institutions of child care and child protection; 
e) in communal areas of social institutions offering personal solicitude services; 
f) on means of local public transport, local and suburban railways and on scheduled 
intercity buses; 
g) in the confined areas of sports facilities serving the performance of sport activities. 
 
(3) In derogation of the provisions set forth in Subsection (1)- if not prohibited by any fire regulations - smoking may be conducted without the 
designation of a smoking area 
a) in the public and guest areas of restaurants and other establishments of the entertainment and hospitality industry which are designated 
exclusively for serving foodstuffs and beverages for guests, if hot and cold food as well as pastries are not served there to be consumed on the 
premises, or are served only as a supplementary service in accordance 
with the sphere of business activities 
 
(4) A smoking area may only be designated in the same premises if the air space thereof can be separated from the other part of the premises or if 
the separation can be resolved satisfactorily with the use of an air control device. The area designated for smoking may only be in a confined 
space if the required ventilation conditions are met by means of doors and windows or with the installation of other technical equipment, and the 
presence in such space of other non-smoking persons arising from the function of the premises - in addition to the execution of tasks in the course 
of employment activities, with due consideration of the provisions of Act XCIII of 1993 on Labor Safety - is not required. 
 
Section 4. 
(6) An operator of a public institution providing entertainment or hospitality services may declare the institution a non-smoking establishment. In 
this case there is no need to designate a smoking area in the institution. The non-smoking status of the institution must be displayed in an easily 
visible manner using unambiguous wording or signs at the entrance to the institution open to the general public, as well as in all places used by 
guests. 
EN 
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Italy  
Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces  
public 
transport 
facilities 
facilities 
restaurants 
places  
Smoking 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking allowed 
Art. 51 of Law 3 of 16 January 2003 set out a  
allowed only 
allowed only 
banned 
allowed only 
allowed only in 
only in separately 
comprehensive smoking ban applicable to all 
in separately 
in separately 
altogether 
in separately 
separately 
ventilated smoking 
enclosed premises, except private ones and to 
ventilated 
ventilated 
ventilated 
ventilated 
rooms that occupy 
separately ventilated smoking rooms. The 
smoking 
smoking 
smoking 
smoking rooms 
less than half of the  technical requirements for smoking rooms have 
rooms 
rooms 
rooms 
overall serving area  been set out by the decree of 23 December 
2003 
 
The law entered into force in January 2005.  
 
Legal provisions 
 

Law No 3 of 16 January 2003 
 
Article 51 
(Safeguarding the health of non-smokers) 
1. Smoking shall be prohibited in enclosed premises, apart from: 
        a) private premises not open to users or the public; 
        b) premises reserved for smokers and indicated as such. 
2. The establishments and workplaces referred to in paragraph 1 (b) must be equipped with installations in regular operation for the ventilation and 
circulation of air.  In order to ensure the essential levels of the right to health, the technical properties of the installations for the ventilation and 
circulation of air shall be defined, within 180 days after the date of publication of this law in the Gazzetta Ufficiale, in a regulation to be proposed by 
the Minister for Health and issued in accordance with Article 17 (1) of Law No 400 of 23 August 1988 and subsequent amendments.  The same 
regulation shall define the premises reserved for smokers and the specimen signs relating to the implementation of the provisions of this article. 
3. In catering establishments, in accordance with paragraph 1 (b), one or more rooms must be reserved for non-smokers and their surface area 
must be more than half of the overall serving area of the establishment. 
4. In a regulation to be proposed by the Minister for Health and issued in accordance with Article 17 (1) of Law No 400 of 23 August 1988 and 
subsequent amendments, other enclosed premises where smoking is permitted may be specified in compliance with the provisions of paragraphs 
EN 
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1-3.  There must be provision in this regulation for all facilities accommodating people on a non-voluntary basis to have rooms reserved for 
smokers. 
Prime Ministerial Decree of 23 December 2003    
Implementation of Article 51 (2) of Law No 3 of 16 January 2003 as amended by Article 7 of Law No 306 of 21 October 2003 on 
'safeguarding the health of non-smokers'. 
Article 1: 
1. This Decree transposes the Agreement between the State, the Regions and the Autonomous Provinces of Trento and Bolzano on safeguarding 
the health of non-smokers, that was ratified at the Standing Conference for Relations between the State, the Regions and Autonomous Provinces 
of Trento and Bolzano of 24 July 2003.  
Article 2: 
1. Annex 1, which is an integral part of this Decree, sets out the technical requirements for smoking rooms, their respective ventilation systems and 
for the specimen signs regarding the smoking ban. 
 
Annex 1 
Technical requirements for smoking rooms, their respective ventilation systems and for the specimen signs regarding the smoking ban. 
1. Smoking rooms, in accordance with Article 51(1b) of Law No 3 of 16 January 2003, shall be marked accordingly and set up in such a way as to 
be appropriately separated from adjacent rooms, where smoking is prohibited.  To this end, smoking rooms shall comply with the following 
structural requirements:  
a) they shall be enclosed on all four sides by floor-to-ceiling walls; 
b) they shall have an entrance with an automatically closing door which is normally in the closed position;  
c) they shall have appropriate signs that are in accordance with the provisions set out in points 9 and 10;  
d) they may not consist of rooms through which non-smokers have to pass. 
2. Smoking rooms shall be equipped with appropriate mechanical means of forced ventilation in order to guarantee an additional supply of external 
fresh air or that is transmitted from other adjacent rooms where smoking is prohibited.    The additional supply of fresh air shall be appropriately 
filtered.  The minimum additional supply of air that shall be ensured is equivalent to 30 litres/second for each person who may be present in the 
room, in accordance with the law in force, on the basis of a density rating of 0.7 persons/ m².  The maximum number of persons permitted on the 
basis of the capacity of the establishment shall be indicated at the entrance.  
3. Smoking rooms shall be kept at a vacuum of at least 5 Pa (Pascal) in relation to the surrounding areas.  
4. Smoking areas in catering establishments, in accordance with Article 51 of Law 3 of 16 January 2003, 
shall, in all cases, be less than half of the overall serving area of the establishment. 
5. The air from smoking rooms may not be recycled and shall be extracted to the outside through appropriate systems and functional openings, in 
accordance with the provisions of the law in force on external atmospheric emissions and in compliance with municipal hygiene and building 
regulations. 
6. The design, installation, maintenance and inspection of ventilation systems shall comply with safety and energy saving rules and regulations in 
EN 
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force, and with the technical standards of the Italian Unification Body (UNI) and of the Italian Electrotechnical Committee (CEI).   Authorised 
entities shall provide an appropriate declaration that the systems have been installed in accordance with the rules of the trade and that they comply 
with the law in force.  The Installation certificates attesting the appropriateness of the extraction systems and the annual certificates on the 
inspection and maintenance of the ventilation systems, shall, for the purpose of the required check, be kept at the disposal of the competent 
authorities.   
7. Appropriate clearly visible signs pointing out this prohibition shall be posted in rooms where smoking is prohibited.     For the purpose of 
uniformity within the national territory that is technically possible, these signs shall bear the words 'No Smoking' supplemented by the statutory 
requirements regarding the penalties applicable to offenders and the parties responsible for ensuring compliance with this prohibition and for 
detecting infringements.          
8. In establishments with several rooms, in addition to the specimen sign set out in point 7, signs bearing only 'No Smoking' shall be posted in 
entrances or in prominent places. 
9. Smoking rooms shall be marked, for reasons of uniformity referred to in point 7, with appropriate illuminated signs clearly indicating 'Smoking 
Area'.  
10. Signs referred to in point 9 shall, in all cases, be supplemented by other illuminated signs bearing, for reasons of uniformity set out in point 7, 
the words 'Ventilation System Out of Order: Please Do Not Smoke'  that are automatically triggered in the event of failure or malfunctioning of the 
additional ventilation systems and at the same time switch off the sign indicating the reserved area.  
11. Any room which does not comply, even temporarily, with the technical requirements set out above may not implement the rules referred to in 
Article 51 of Law No 3 of 16 January 2003. 
 
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Ireland  
Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces   public places  
transport 
facilities 
facilities 
restaurants 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking banned 
The relevant sections of the Public Health 
banned 
banned 
banned 
banned 
banned 
altogether 
(Tobacco) Acts 2002 and 2004 came into force 
altogether 
altogether 
altogether 
altogether 
altogether 
in March 2004, banning smoking in all 
with the 
workplaces, including bars and restaurants. 
exception of 
 
nursing 
There are exemptions for dwellings and places 
homes, 
that act as de-facto residences such as hotel 
hospices and 
bedrooms, prisons, nursing homes and 
psychiatric 
psychiatric hospitals. However, all employers 
hospitals 
(even those who are exempt) have a duty of 
care to employees and may introduce smoke-
free policies.  
 
 
 
Legal provisions 
 
Public Health (Tobacco) (Amendment) Act 2004 
 
16.
—The Principal Act is amended by the substitution of the following section for section 47: 
 
‘‘47.—(1) Subject to subsection (7), the smoking of a tobacco product in a specified place is prohibited. 
(2) A person who contravenes subsection (1) shall be guilty of an offence. 
(3) Where in relation to a specified place there is a contravention of subsection (1), the occupier, manager and any other person for the time being 
in charge of the specified place concerned shall each be guilty of an offence. 
(4) In proceedings for an offence under this section, it shall be a defence for a person against whom such proceedings are brought to show that he 
or she made all reasonable efforts to ensure compliance with this section. 
(7) This section shall not apply to— 
(a) a dwelling, 
(b) a prison, 
(c) subject to paragraph (d), a place or premises, or a part of a place or premises, that is wholly uncovered by any roof, whether fixed or movable, 
(d) an outdoor part of a place or premises covered by a fixed or movable roof, provided that not more than 50 per cent of the perimeter of that part 
is surrounded by one or more walls or similar structures (inclusive of windows, doors, gates or other means of access to or egress from that part), 
EN 
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(e) a bedroom in— 
(i) a premises registered under Part III of the Tourist Traffic Act 1939 in a register established and maintained under that Part, 
(ii) a premises for the time being specified in a list published, or caused to be published, under section 9 of the Tourist Traffic Act 1957, or 
(iii) any other premises in which a person carries on business, being a business that consists of or includes the provision, in those premises, of 
sleeping accommodation to members of the public, 
(f) a room that, in furtherance of charitable objects, is used solely for the provision of living accommodation,  
(g) in premises owned or occupied by a person whose main objects are the provision of education, a room that, in furtherance of those objects 
(other than objects relating to the provision of primary or secondary education), is used solely for the provision of living accommodation, 
(h) a nursing home, 
(i) a hospice, 
(j) a psychiatric hospital, or 
(k) the Central Mental Hospital. 
(8) In this section— 
‘specified place’ means— 
(a) a place of work, 
(b) an aircraft, train, ship or other vessel, public service vehicle, or a vehicle used for the carriage of members of the public for reward other than a 
public service vehicle, insofar as it is a place of work, 
(c) a health premises, insofar as it is a place of work, 
(d) a hospital that is not a health premises, insofar as it is a place of work, 
(e) a school or college, insofar as it is a place of work, 
(f) a building to which the public has access, either as of right or with the permission of the owner or occupier of the building, and which belongs to, 
or is in the occupation of— 
(i) the State, 
(ii) a Minister of the Government, 
(iii) the Commissioners of Public Works in Ireland, 
or 
(iv) a body established by or under an Act of the Oireachtas, insofar as it is a place of work, 
(g) a cinema, theatre, concert hall or other place normally used for indoor public entertainment, insofar as it is a place of work, 
(h) a licensed premises, insofar as it is a place of work, or 
(i) a registered club, insofar as it is a place of work.’’. 
 
Full text at: http://acts.oireachtas.ie/en.act.2002.0006.1.html and http://www.oireachtas.ie/documents/bills28/acts/2004/A0604.pdf 
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Lithuania  
Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces   public places  
transport 
facilities 
facilities 
restaurants 
Special 
Smoking 
Smoking 
Smoking 
Smoking 
Banned altogether 
The Law on Tobacco Control of 1995 banned 
premises 
banned 
banned 
banned 
banned 
except cigar and 
smoking in educational establishments, 
(places) may 
altogether 
altogether 
altogether 
altogether 
pipe clubs specially 
healthcare facilities and some public places 
be set aside   
except for 
fitted for the 
(Internet cafes, sports premises). In workplaces, 
which are 
 
long-distance 
purpose of smoking.  special premises (places) may be set aside.  
separated 
trains where 
 
from non-
individual 
 
The Hygiene Norm 122:2006 adopted by the 
smoking 
cars must be 
Order of Ministry of Health Care of Nov. 2006 
premises and 
designated 
determines requirements for „special premises 
meet certain 
for smokers 
(places) in workplaces”.  The order specifies that 
ventilation 
and aircrafts 
smoking premises must be separated from 
requirements.  
where 
workplace, sanitary and domestic lodging which 
 
separate 
are also used by nonsmoking workers, clients or 
 
places shall 
visitors, situated in such a way that it is not 
be 
necessary to walk via them for nonsmoking 
designated 
workers, clients or visitors and meet certain  
for smokers 
ventilation requirements. 
and non-
As of Jan. 2007, the amendment to the Tobacco 
smokers 
Control Law introduced a ban on smoking in 
bars, restaurants and other hospitality venues. 
One exception, however, is special cigar and 
pipe clubs. The specification of order on 
establishment and conditions of cigars clubs, 
approved by the government decision of Dec. 
2006, determines, that equipment of cigar clubs 
are the same as for special smoking places in 
workplaces (the requirements of Hygiene Norm 
122:2006 are applied). According to information 
from the ministry of health, there is only one 
cigar and bar pipe in Lithuania. 
As of July 2008, the new amendment of the Law 
extended the ban on smoking from Internet 
clubs and sport premises to all enclosed public 
places. 
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Legal provisions 

LAW  
ON TOBACCO CONTROL 
 
20 December 1995 No I-1143 
Vilnius 
 
(As amended on 15 June 2006 – No X-699 and 26 June 2008 – No X-1637) 
Article 19. Restrictions on the Consumption of Tobacco Products 
1. It shall be prohibited to smoke (consume tobacco products) in the Republic of Lithuania: 
1) in all educational establishments, health care facilities and their territories; 
2) at indoor workplaces. Special premises (places) may be set aside in undertakings, institutions and organisations where smoking shall be 
permitted. The requirements for fitting out and operating smoking premises (places) shall be set forth by the Government of the Republic of 
Lithuania or an institution authorised by it. 
3) in common-use residential and other public premises where non-smokers may be forced to breathe tobacco smoke-polluted air; 
4) in all types of public transport, except for long-distance trains where individual cars must be designated for smokers and non-smokers and also 
on aircraft where separate places shall be designated for non-smokers and smokers; 
5) in restaurants, café, bars and other catering establishments, clubs, discotheques, internet cafes (internet clubs, etc.), gaming-houses (casino), 
salons of slot-machines or bingo and other leisure establishments, in premises where sport competitions and other events take place and other 
public service premises, except for cigar or pipe clubs specially fitted out for this purpose. The procedure and conditions of establishing cigar and 
pipe clubs shall be set forth by the Government of the Republic of Lithuania or an institution authorised by it. 
3. Municipal councils shall have the right to prohibit smoking in public places (parks, squares, etc.) and other public places falling within the scope 
of their competence. 
 
4. The administrative bodies of a legal person must ensure that its personnel, clients and visitors are not forced to breathe tobacco smoke-polluted 
air; they must also ensure that non-smoking warnings or signs are displayed in visible locations and special premises (places) be set aside and 
fitted out for smoking with notices or signs indicating their location.  
 
PROCEDURE AND CONDITIONS FOR THE ESTABLISHMENT OF CIGAR AND PIPE CLUBS 
ADOPTED 
by the Government of the Republic of Lithuania 
by Resolution No 1320 of 22 December 2006 
 
I. GENERAL PROVISIONS 
EN 
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1. The procedure and conditions for the establishment of cigar and pipe clubs (hereinafter referred to as "this Procedure") apply to cigar and pipe 
clubs in which it is not prohibited to smoke (consume tobacco products) pursuant to Article 19(1), point 5, of the Tobacco Control Law of the 
Republic of Lithuania (Official Gazette 1996, No. 11-281; 2003, Nr. 117-5317). 
2. The term "cigar and pipe club" as used in this Procedure shall mean premises meeting the requirements of this Procedure specifically 
established for the smoking of tobacco products. 
Other terms used in this Procedure shall be understood as defined in the Tobacco Control Law of the Republic of Lithuania. 
 
II. CONDITIONS FOR THE ESTABLISHMENT OF CIGAR AND PIPE CLUBS 
 
3. Cigar and pipe clubs may be established only in such places where, pursuant to Article 19(1) of the Tobacco Control Law of the Republic of 
Lithuania, it is not prohibited to smoke (consume tobacco products). 
4. Cigar and pipe clubs shall meet the requirements laid down by legal acts for the establishment and operation of smoking rooms in firms, 
institutions and organisations. 
5. Cigar and pipe clubs may be established solely in closed premises having a separate entrance (which is not also an entrance to the staircase of 
a residential building or an entrance to the premises of restaurants, cafes, bars, other public catering establishments, clubs, discotheques and 
other firms, institutions and organisations). 
6. Cigar and pipe clubs shall be established in such a way that persons do not need to walk through them in order to reach other public spaces, 
workplaces, sanitary facilities or other premises, and persons working in such premises serving customers and visitors are not required to breathe 
in tobacco smoke via contaminated air. 
7. At the entrance to cigar and pipe clubs there shall be a clearly visible indication that the premises in question are a cigar and pipe club and a 
warning that smoking and air contaminated with tobacco smoke is harmful to health and may cause cancer and lung, cardiovascular or other 
diseases.  
8. The warning referred to in paragraph 7 of this Procedure shall be clear and legible.  The board on which the warning is to be displayed shall not 
contain any text or signs in addition to the warning. 
 
HYGIENE STANDARD HN 122:2006 "REQUIREMENTS FOR THE ESTABLISHMENT AND OPERATION OF ISOLATED 
SMOKING ROOMS (AREAS) IN FIRMS, INSTITUTIONS AND ORGANISATIONS" 
 
I. GENERAL PROVISIONS 
 
1. This Hygiene Standard lays down the requirements for the establishment and operation of isolated smoking rooms (areas) in firms, institutions 
and organisations. 
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2. This Hygiene Standard shall be complied with by all natural and legal persons of the Republic of Lithuania and by branches of legal persons of 
foreign states established in the Republic of Lithuania (hereinafter – "persons") which are planning, setting up, reconstructing or operating firms in 
which isolated smoking rooms (areas) are established and by those persons carrying out state monitoring and control. 
3. Persons shall be liable for infringements of the requirements of this Hygiene Standard in accordance with the law. 
4. The term used in this Hygiene Standard and its definition: 
Isolated smoking room (area) – a special room (area) established in firms, institutions and organisations in which it is permitted to smoke. 
 
III. REQUIREMENTS RELATING TO THE ESTABLISHMENT AND OPERATION OF ISOLATED SMOKING ROOMS (AREAS) 
 
6. Isolated smoking rooms (areas) shall be separate from working areas and from sanitary and domestic facilities which are also used by non-
smoking employees, customers and visitors. 
7. Isolated smoking rooms (areas) shall be established in such a way as to ensure that non-smoking employees, customers and visitors do not 
have to walk through them. 
8. Materials which do not absorb smells and are easy to clean shall be used for the surfaces of walls, floors and furniture of isolated smoking 
rooms (areas). 
9. Isolated smoking rooms (areas) shall be clean and be periodically cleaned using water. 
10. Isolated smoking rooms (areas) shall be equipped with non-inflammable ashtrays or urns for cigarette butts. 
11. The air pressure of buildings in which isolated smoking rooms (areas) are established and of their ventilation systems shall be distributed in 
such a way as to ensure that, under normal conditions of building use, air passes from cleaner to more contaminated areas. The pressure in 
isolated smoking rooms shall be maintained at a lower level than that of adjacent rooms. Clean air shall generally be channelled to that part of 
rooms where the air is least contaminated and be removed from the part where contaminants are more intensively present or their concentration is 
greatest [5.1]. 
12. The quantity of outside air channelled to isolated smoking rooms (areas) per 1 m2 of floor area shall not be less than 36 m3/h, and the quantity 
of air removed shall be not less than 72 m3/h.   
13. The limit values for concentrations of air contaminants (benzene, formaldehyde) in isolated smoking rooms (areas) shall not exceed the 
statutory requirements [5.2]. 
14. The concentration of nicotine in the ambient air of isolated smoking rooms (areas) shall not exceed 10 µg/m3 (limit concentration established 
on the basis of an air sample taken over a period of 24 hours).  
15. The microclimate of isolated smoking rooms (areas) shall comply with statutory requirements [5.3]. 
16. Checks on the air quality of isolated smoking rooms (areas) and measurements relating to the effectiveness of ventilation systems, as laid 
down by this Hygiene Standard, shall, for self-monitoring purposes, be carried out not less than once every three years by accredited or approved 
laboratories. 
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17. In isolated smoking rooms (areas) there shall be at least one warning concerning the health risks of smoking taken from the list of warnings 
concerning the health risks of smoking contained in the annex.  The warning concerning the health risks of smoking shall be displayed in a 
prominent place, be written legibly in block capitals on a contrasting background and be replaced at least once a year. 
 
 
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Latvia 
Enclosed 
Enclosed public 
Public transport 
Health care 
Education 
Bars and 
Comments  
workplaces   
places  
facilities 
facilities 
restaurants 
Smoking allowed 
Smoking allowed 
Smoking banned 
Smoking allowed 
Only in higher 
Smoking 
The 1996 Law On 
only in ventilated 
only in ventilated 
altogether 
only in ventilated 
education 
allowed in 
Restrictions regarding Sale, 
rooms intended 
rooms 
 
rooms 
institutions 
ventilated 
Advertising and Use of 
exclusively for 
intended exclusively  Exceptions are long-
intended exclusively 
possibility of 
smoking rooms  Tobacco Products was 
smoking 
for smoking 
distance trains, 
for smoking 
creating 
(not larger than  amended in 2005. As of 
 
 
ships and aircraft, 
 
ventilated rooms  50% of the total  July 2006, smoking in 
 
 
where there shall be  Internal regulations 
intended 
area) where 
enclosed workplaces and 
separate railway 
of the relevant exclusively for 
services can be  public places is allowed 
carriages, cabins or 
institutions may  smoking 
provided or 
only in specially designated 
lounges which are 
provide for the 
 
ventilated rooms  smoking rooms intended 
designated for 
possibility of   
intended 
exclusively for smoking.  In 
smokers 
patients or inmates 
 
exclusively for bars and restaurants, it is 
to smoke also 
smoking 
allowed to smoke in 
outside of smoking 
 
separate rooms where 
rooms taking into 
 
services can be provided.  
account their 
 
 
physical and mental 

In April 2008, the 
condition. 
parliament approved an 
amendment to the Law 
setting out stricter 
limitations on smoking in 
Latvia. As of July 2009, 
smoking will be banned 
altogether in public places. 
As of April 2010, it will be 
also banned to smoke in 
bars and restaurants. 
 
In addition, smoking will be 
banned in outside areas of 
schools, parks etc. 
 
 
 
 

EN 
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Law on Restrictions regarding Sale, Advertising and Use of Tobacco Products 
 
Section 1 sets out the following definitions 
9)  specially dedicated smoking premises – an area set aside for smoking, contained by means of fixed structural elements and fitted with an 
extractor fan to prevent tobacco smoke from permeating other areas. This area is to be designated by means of a sign bearing an appropriate 
inscription or a symbol. This area shall not be used for the provision of basic services by an institution, trader, any other legal person or self-
employed person; 
12)  specially dedicated smoking area – a separate area designated by means of a sign bearing an appropriate inscription or a symbol and 
complying with fire safety regulations situated outside a building in the open air, or premises or part of premises fitted with an air ventilation system, 
or part of the premises of a summer (open-air) cafe; 
15) premises which are separated for smoking – a separate room contained by means of fixed structural elements and designed for the receipt 
of basic services and for smoking, and fitted with an extractor fan. This area may occupy up to 50% of the total area open to the public and must 
be situated as far as possible from the entrance to the latter. The area is to be designated by means of a sign bearing an appropriate inscription or 
a symbol; 
 
Section 11 prohibits to smoke: 
1) in educational and correction institutions, except in institutions of higher education in which it is permitted to smoke in premises, which are 
specially designated for smoking; 
2) in medical treatment institutions, social care and rehabilitation establishments, except in premises, which are specially designated for smoking. 
The internal procedure regulations of the relevant institutions and establishments may provide for the possibility of the patients of the institutions or 
the inmate of the establishments to smoke also outside of the premises, which are specially designated for smoking, taking into account the 
physical and mental condition of such patients or inmates; 
3) closer than 10 meters from the entrance of buildings or structures (also on the outside steps and landings), where State or local government 
institutions and capital companies in which more than 50 per cent of the capital shares (stock) is owned by the State or local governments are 
located.  
4) in the shelters at public transport stops; 
5) in the stairwells of multi-apartment residential buildings; 
6) in places of work in work-spaces and areas of common use, with the exception of specially designated smoking areas; 
7) in public buildings, structures and premises (cinemas, concert and sports halls, other sports buildings and structures, post offices and other 
institution hal s, discotheques and dance halls, etc.), with the exception of separate premises, which are specially designated for smoking. This 
prohibition does not apply to existing apartments in public buildings; 
8) in all kinds of public means of transport and taxis, with the exception of long-distance trains, ships and aircraft, where there shall be separate 
railway carriages, cabins or lounges which are designated for smokers;  
9) during sport and other public events in stadiums and other enclosed territories, with the exception of areas, which are specially designated for 
smoking. 
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(2) Smoking in cafes, restaurants and other public catering locations, casinos and gaming halls shall only be allowed in premises, which are 
specially designated for smoking, or premises, which are separated apart for smoking. It is permitted to smoke in summer (outside) cafes only in 
areas, which are specially designated for smoking. 
 
EN 
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Luxembourg  
Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces  
public places  
transport 
facilities 
facilities 
restaurants 
The 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking ban in The law of 11 August 2006 entered into force in 
employer is 
banned 
banned 
allowed only in 
banned 
restaurants except September 2006. The law bans smoking in 
obliged to 
altogether 
altogether 
smoking rooms 
altogether 
for separate   
enclosed public places, public transport, 
ensure that 
except for 
(one per 
ventilated smoking  healthcare and education facilities. 
workers are 
taxis 
establishment) 
rooms which do not   
effectively 
occupy more than  The law obliges the employer to take all 
protected 
25% of the total  necessary measures to protect employers 
from passive 
area of the venue. 
against passive smoking but does not set out an 
smoking. 
 
outright ban on smoking. 
In drinking 
 
establishments that 
A total ban on smoking (except for separate 
also serve food, 
smoking rooms) applies in restaurants and a 
smoking banned 
partial ban (during dining hours) to drinking 
during dining hours. 
establishments that also serve food. No 
 
restrictions for venues that do not serve food. 
  
Legal provisions 
Loi du 11 août 2006 relative à la lutte antitabac 
 
Art. 6. (1) 
Il est interdit de fumer: 
1. à l’intérieur et dans l’enceinte des établissements hospitaliers; 
2. dans les locaux à usage collectif des institutions accueillant des personnes âgées à des fins d’hébergement, y compris les ascenseurs et 
corridors; 
3. dans les salles d’attente des médecins, des médecins-dentistes et des autres professionnels de la santé ainsi que des laboratoires d’analyses  
médicales; 
4. dans les pharmacies; 
5. à l’intérieur des établissements scolaires de tous les types d’enseignement ainsi que dans leur enceinte; 
6. dans les locaux destinés à accueillir ou à héberger des mineurs âgés de moins de seize ans accomplis; 
7. dans tous les établissements couverts où des sports sont pratiqués; 
8. dans les salles de cinéma, de spectacles et de théâtre ainsi que dans les halls et couloirs des bâtiments qui les abritent; 
9. dans les musées, galeries d’art, bibliothèques et salles de lecture, ouverts au public; 
10. dans les halls et salles des bâtiments de l’Etat, des communes et des établissements publics; 
11. dans les autobus des services de transports publics de personnes, même à l’arrêt ou en stationnement; 
EN 
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12. dans les voitures de chemin de fer et dans les aéronefs; 
13. dans les établissements de restauration et les salons de consommation des pâtisseries et des boulangeries; 
14. dans les discothèques au sens de la réglementation portant nomenclature et classification des établissements classés, dont l’accès n’est pas 
expressément réservé aux personnes ayant atteint ou dépassé l’âge de seize ans; 
15. dans les galeries marchandes et les salles d’exposition ouvertes au public; 
16. dans les locaux de vente de tous commerces de denrées alimentaires. 
(2) L’interdiction dont question au point 1 du paragraphe 1er ne vaut pas dans des fumoirs spécialement aménagés à cette fin par l’exploitant d’un 
établissement hospitalier. 
Exception faite de fumoirs aménageables à l’intérieur de services psychiatriques fermés, un seul fumoir peut être admis par établissement 
hospitalier. Ce fumoir devra être localisé à distance des services et aménagé de façon à ce que la fumée de tabac n’atteigne ni le personnel ni le 
public. L’accès aux fumoirs est strictement réservé aux patients hospitalisés qui en font la demande. 
(3) Pour les lieux dont question au point 13, une pièce séparée peut être installée dans laquelle l’interdiction dont question au présent article ne 
vaut pas. 
La pièce séparée doit être munie d’un système d’extraction ou d’épuration d’air. Les caractéristiques techniques du système d’extraction ou 
d’épuration d’air seront fixées par règlement grand-ducal. 
La pièce séparée doit être installée de manière à réduire au maximum les inconvénients de la fumée vis-à-vis des non-fumeurs et ne peut être une 
zone de transit. 
La superficie de la pièce séparée ne peut excéder un quart de la superficie totale du local dans lequel des plats préparés sont servis à la 
consommation. 
La pièce séparée doit être clairement identifiée comme local réservé aux fumeurs. Un ou plusieurs signaux rappelant l’interdiction de fumer dans 
les espaces réservés aux non-fumeurs doivent être posés de telle sorte que toute personne présente puisse en prendre connaissance. 
L’exploitant des lieux est tenu de prendre des mesures empêchant les mineurs âgés de moins de seize ans accomplis d’avoir accès à la pièce 
séparée. 
L’exploitation de la pièce séparée est soumise à l’autorisation préalable du ministre ayant la Santé dans ses attributions, qui ne l’accorde sur 
rapport de l’Inspection sanitaire que si les exigences prévues au présent article sont remplies. 
L’Inspection sanitaire veille au respect des exigences précitées. 
(4) L’interdiction de fumer s’applique également aux débits de boissons où des plats sont servis, aux plages horaires situées entre douze et 
quatorze heures ainsi qu’entre dix-neuf et vingt et une heures. 
 
Art. 16. L’article 5 de la loi modifiée du 17 juin 1994 concernant la sécurité et la santé des travailleurs au travail est complété par un paragraphe 
(3) nouveau libellé comme suit: 
«3. L’employeur doit prendre toutes les mesures pour assurer et améliorer la protection de la santé physique et psychique des travailleurs, 
notamment en assurant des conditions de travail ergonomiques suffisantes, en évitant dans la mesure du possible le travail répétitif, en organisant 
EN 
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le travail de manière appropriée et en prenant les mesures nécessaires afin que les travailleurs soient protégés de manière efficace contre les 
émanations résultant de la consommation de tabac d’autrui. 
Un règlement grand-ducal, pris sur avis du Conseil d’Etat et de l’assentiment de la Conférence des Présidents de la Chambre des Députés pourra 
préciser les obligations de l’employeur ci-avant définies.» 
 
Art. 18. L’article 36, paragraphe 2, alinéa 1 de la loi modifiée du 24 décembre 1985 fixant le statut général des fonctionnaires communaux est 
complété par une lettre c) libellée comme suit: 
«c) en prenant les mesures nécessaires afin que les fonctionnaires soient protégés de manière efficace contre les émanations résultant de la 
consommation de tabac d’autrui.» 
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Malta  
 

Enclosed 
Enclosed public 
Public transport 
Health care 
Education 
Bars and 
Comments 
workplaces  
places  
facilities 
facilities 
restaurants 
(incl. private 
workplaces) 
Smoking allowed 
Smoking allowed 
Smoking banned 
Smoking banned 
Smoking banned 
Smoking allowed  Smoking in public transport, 
only in enclosed 
only in enclosed, 
altogether 
altogether 
altogether 
only in enclosed, 
healthcare institutions and education 
smoking rooms 
smoking rooms 
 
 
 
smoking rooms 
institutions has been banned by the 
(the Smoking in 
 
 
Tobacco Control Act (Act XLII of 
Premises Open 
 
1986 as amended by Act IX of 2003) 
to the Public 
 
Regulations, 
The Smoking in Premises Open to 
2004, L.N. 414 of 
the Public Regulations (L.N. 414 of 
2004 
2004) banned smoking in enclosed 
 
workplaces and public places as of 5 
April 2004 with the exception of 
enclosed smoking rooms which meet 
certain technical specifications and 
approved by the Competent 
Authority.  
 
For bars and restaurants below 60 
m², the ban entered into force on 5 
April 2005. 
 
Legal provisions  
 
L.N. 414 of 2004  
 
TOBACCO (SMOKING CONTROL) ACT (CAP. 315) 
Smoking in Premises Open to the Public Regulations, 2004 
 
Interpretation 
2. In these regulations, unless the context otherwise requires 
“employee” means a person who is employed by an employer; 
EN 
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“designated smoking room” means an enclosed room that is designated for smoking; 
“responsible person” means any person who is ultimately responsible for any establishment to which these regulations apply and shall include any 
person acting on his behalf or any employer; 
“premises” means catering premises and other similar premises from which food and drink are served to the public either with or without payment; 
“employer” means a person who employs one or more persons and includes such person as may ultimately be in charge of any premises; 
“smoking” includes the carrying of any lighted tobacco product; 
“workspace” means any indoor or other enclosed space where employees perform their duties as employees, and includes any adjacent corridor, 
lobby, stairwell, elevator, lift, cafeteria, washroom or other common area frequented by such employees during the course of their employment. 
 
Ban on smoking in enclosed establishments. 
3. Smoking is hereby banned in any enclosed private or public premises which is open to the public except in designated smoking rooms. 
 
Designated smoking rooms 
4. Designated smoking rooms shall 
(i) be totally separate from areas or rooms normally occupied by non smokers; and 
(ii) have walls from floor to ceiling; and 
(iii) have all apertures leading onto other closed areas, or rooms, tight fitting and that they shall be kept so closed while the premises are open for 
business; and 
(iv) be clearly marked as being reserved for persons who smoke; and 
(v) be situated in such a manner that they do not require non-smokers to pass through them. 
 
Duty of responsible person 
5. It shall be the duty of the responsible person to: 
(a) designate rooms for smoking; 
(b) adopt measures to ensure that smoking only takes place in designated smoking rooms; 
(c) adopt measures to ensure that by the 5th October, 2004 the exposure of non-smokers to tobacco smoke in designated smoking rooms, is 
reduced in accordance with criteria as approved from time to time by the Superintendent of Public Health and published in the Gazette; 
 
Provided that in the case of licensed premises whose area is less than sixty square meters, the responsible person shall adopt the measures 
referred to in paragraph (c) hereof by the 5th April 2005. 
 
Smoking prohibited in any workspace. 
6. No person shall smoke in any workspace or public place except in a designated smoking room. 
 
Exemption. 
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7. These regulations shall not apply to individual rooms in any accommodation premises used for sleeping purposes and which are occupied solely 
by smoking patrons: 
Provided that this exemption does not affect other rooms occupied or which may be occupied by non-smokers. 
 
Full text at: http://www.sahha.gov.mt/showdoc.aspx?id=310&filesource=4&file=LN414_English.pdf 
 
 
TOBACCO (SMOKING CONTROL) ACT 
ACT XLII of 1986, as amended by Act IX of 2003; and Legal Notice 424 of 2007. 
 
Prohibition of smoking in certain premises and public transport. 
14. (1) No person shall smoke any cigarette, cigar, tobacco or tobacco product on any public transport, in any cinema, theatre, hospital, clinic or 
other health institution, or in any television studio in any debate, discussion or other programme broadcast locally for public viewing whether live or 
pre-recorded; or in any 
other place or establishment or part thereof as the Minister may from time to time prescribe; nor shall any person smoke any such item in any 
classroom, corridor, yard or appurtenance of a school, day home or similar premises used by children under eighteen years of age. 
For the purposes of this subarticle "school" includes a kindergarten, nursery school or similar premises. 
(2) It shall be the duty of the person in charge of any premises mentioned in subarticle (1), and of the driver and conductor of any public transport, 
to ensure that an appropriate sign or notice is put up in a prominent place or places as the case may require, so as to attract attention that smoking 
is prohibited, and it shall also be the duty of any such person to ensure that no smoking takes place on the premises or public transport, as the 
case may be. 
 
Full text at: http://docs.justice.gov.mt/lom/legislation/english/leg/vol_7/chapt315.pdf 
 
L.N. 44 of 2002 
OCCUPATIONAL HEALTH AND SAFETY AUTHORITY ACT, 2000 
(ACT NO. XXVII OF 2000) 
 
Work Place (Minimum Health and Safety Requirements) Regulations, 2002 
 
1. (2) These regulations shall come into force: 
(a) on the date of publication for workplaces used for the first time after the date of publication of these regulations; and 
(b) on the 1st January, 2003 for all other workplaces already in use before the date of publication of these regulations. 
 
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2. (1) These regulations shall be considered as the minimum occupational health and safety requirements applicable mutatis mutandis to every 
workplace and to every work activity, and shall apply whenever required by the features of the workplace, the work activity being carried out, the 
circumstances prevailing, and the degree or nature of a hazard.  
(2) Nothing in these regulations shall debar the Authority from issuing any order to any employer or to any employee in any workplace if in the 
opinion of an Officer of the Authority there is a risk to the health or safety of a person or persons. 
 
28. (1) The employer shall identify those areas in which smoking could cause a risk of fire or explosion, and he shall ensure that smoking is not 
allowed in such areas. 
(2) The employer shall identify areas, which are physically separate from other areas where smoking is allowed, in which smoking is prohibited, so 
as to protect non-smokers against discomfort caused by tobacco smoke. 
 
(3) The employer shall put up appropriate signs indicating that smoking is prohibited in those areas in which smoking is not allowed. 
 
Full text at: http://www.msp.gov.mt/documents/laws/ohs/ohs_ln_44.pdf 
 
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Netherlands 
 

Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces  
public places  
transport 
facilities 
facilities 
restaurants 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking allowed 
The Tobacco Act of 1988 banned smoking in 
allowed only 
allowed only in 
allowed only 
allowed only in 
allowed only in 
only in enclosed 
government, education and healthcare building 
in enclosed 
enclosed 
in enclosed 
enclosed 
enclosed 
smoking rooms 
as of 1990. 
smoking 
smoking rooms 
smoking 
smoking rooms 
smoking 
where no service is 
 
rooms 
 
rooms 
 
rooms 
provided 
The 2002 amendment of the Tobacco Act 
 
 
 
 
introduced smoking bans in (private) workplaces 
 
 
 
except for bars and restaurants and in public 
transport as of Jan. 2004. Since Jan. 2005, self-
regulation in the hospitality industry. 
 
The further amendment in 2007 extended the 
ban on smoking to bars and restaurants as of 1 
July 2008.  
 
In all venues, it is possible to set up special 
enclosed smoking rooms. There are no 
requirements for size or ventilation.  
 
The text of the Tobacco Act on 1 January 2005 
 
An Act of 10 March 1988, laying down measures to control the use of tobacco, in particular for the protection of the non-smoker 
 
§ 5. Smoking bans 
 
Article 10 
1. For the institutions, departments and businesses that are managed by the State and by the public bodies, the competent authority shall take 
such measures that the facilities provided by them can be used and work carried out in them without experiencing hindrance or nuisance from 
smoking. 
2. The measures referred to in the first paragraph shall in any case include the imposing, designation and maintenance of a smoking ban in areas 
belonging to categories designated by an Order in Council. Restrictions can be applied to the ban in accordance with regulations imposed by the 
Order in Council. 
 
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Article 11 
1. An Order in Council can be used to oblige those persons who – in a capacity other than that within the meaning of in Article 10 – are responsible 
for the management of buildings or institutions for healthcare, welfare, social services, art and culture, sport, social-cultural work or education, in as 
much as those buildings or institutions belong to categories designated by Order in Council, to take measures as referred to in Article 10 (1). 
2. Article 10(2) is applicable correspondingly. 
 
Article 11a 
1. Employers are obliged to take such measures that employees are enabled to carry out their work without experiencing hindrance or nuisance 
from smoking by others. 
2. Operators of means for the conveyance of passengers are obliged to take such measures that passengers are enabled to complete their journey 
without thereby experiencing hindrance or nuisance from smoking. 
3. Dutch airline companies are obliged to take such measures that passengers on board of their aircraft during their use for civil aviation on flights 
to and from airports in Dutch territory are enabled to complete their journey without thereby experiencing hindrance or nuisance from smoking. 
4. Those persons who – in capacities other than those referred to in Articles 10 or 11 – are responsible for the management of buildings accessible 
to private individuals, in as much as those buildings belong to categories designated by Orders in Council, are obliged to take measures as 
referred to in Article 10 (1). 
5. Restrictions can be applied to the obligations referred to in this Article by Order in Council. For example, it may be determined that the 
restrictions referred to in the first paragraph do not apply to the following, designated by that measure: 
a.  
categories of employers; 
b.  
areas in buildings; 
c.  
other places where work is being carried out. 
Further rules may be laid down in such cases. 
§ 6. Administrative penalties 
 
Article 11b
 
1. In the matter of the violations referred to in the appendix, Our Minister can impose a penalty on the natural or legal person to whom the violation 
can be attributed. 
2. The magnitude of the penalty shall be determined in the manner provided for in the appendix, subject to the condition that the sum to be paid 
because of an individual violation will be no more than: 
a.  
€ 450,000 in the case of a violation of Articles 5 or 5a, if the violation has been   committed  by  a  manufacturer,  a  wholesaler or an 
importer of tobacco products; 
b.  
€ 4,500 in cases other than those referred to under a. 
3. Our Minister can set the penalty at a figure lower than provided for in the appendix if the magnitude of the penalty in a given case has to be 
regarded as disproportionately high on the grounds of special circumstances. 
4. The activities in connection with the implementation of the first paragraph are performed by persons who have not been involved in drawing up 
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the report referred to in Article 11f and the investigation which preceded it. 
5. The power to impose a penalty lapses if criminal proceedings have been instituted against the perpetrator in the matter of the violation on the 
grounds of which the penalty can be imposed, and the examination in court has already begun, or if the right to criminal proceedings has lapsed in 
accordance with Article 74 of the Penal Code. 
6. Contrary to the provisions of the first paragraph, the violation cannot be settled with a penalty if the penalty provided for in the appendix in the 
matter of the violation is significantly exceeded by the commercial advantage achieved with the violation. 
7. The right to pursue criminal proceedings lapses if Our Minister has already imposed a penalty. 
 
Article 11c 
1. The appendix determines the amount of the penalty to be imposed for each violation described therein. 
2. The appendix can be amended by Order in Council. 
3. An Order in Council laid down in pursuance of the second paragraph shall enter into force no earlier than eight weeks following the date of 
publication of the Bulletin of Acts, Orders and Decrees in which it has been placed. An announcement of its placing shall be made to both Houses 
of the States General forthwith. 
4. An Order in Council, as referred to in the second paragraph shall be laid down on the recommendation of Our Minister, in consultation with Our 
Minister of Justice. 
 
Article 11d 
The person against whom such an action is instituted is not obliged to make any statement in the matter if he can reasonably conclude that a 
penalty will be imposed on him because of a violation. He shall be informed of this before information is orally requested from him. 
 
Article 11e 
1. If Our Minister intends to impose a penalty, he shall inform the person referred to Article 11b (1) from that, giving the reasons on which the 
intention is based. 
2. Contrary to section 4.1.2 of the General Administrative Law Act, Our Minister shall give the person an opportunity to put forward his view, in 
writing or orally as he chooses, within a reasonable period before the penalty is imposed. 
3. Our Minister can decide not to apply the second paragraph in as much as the person has already been given an earlier opportunity to put 
forward his view and since then no new facts or circumstances have become apparent. 
4. If the person wishes to put forward his view orally but has insufficient mastery of the Dutch language, at his request Our Minister shall arrange 
for the appointment of an interpreter to support him unless it is reasonable to assume that there is no need for this. 
 
Article 11f 
1. If a civil servant appointed pursuant to Article 13 determines that a violation described in the appendix has been committed, he shall draw up a 
report on the matter. 
2. The report shall in any case include mention of: 
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a.  
the violation, with reference to the relevant statutory regulation and the description in the appendix; 
b.  
an indication of the place where, and the time when, the violation was committed; 
c.  
the facts and circumstances forming the grounds for determining that a violation has been committed; 
d.  
the statement from the person referred to in Article 11d, if made. 
3. The report shall be sent to Our Minister. 
4. A copy of the report shall be sent or given to the perpetrator. 
5. At the request of the person referred to in Article 11b (1), who insufficiently understands the report because of his poor knowledge of the Dutch 
language, Our Minister shall as far as possible ensure that the contents of the report are presented to that person in a language that he 
understands. 
 
Article 11g 
1. Our Minister shall impose the penalty by decree. 
2. The decree shall in any case include mention of: 
a.  
the violation, with reference to the relevant statutory regulation and the description in the appendix; 
b.  
the information referred to in Article 11f (2) under b and c; 
c.  
the magnitude of the penalty and the period within which it must be paid. 
3. At the request of the person referred to in Article 11b (1), who insufficiently understands the decree because of his poor knowledge of the Dutch 
language, Our Minister shall as far as possible ensure that the contents of the decree are presented to that person in a language that he 
understands. 
 
Article 11h 
The operation of the decree referred to in Article 11g shall be suspended until the period for lodging an appeal has elapsed or, if an appeal has 
been submitted, until a decision has been made on the appeal. 
 
Article 11i 
1. The power to impose a penalty shall lapse after the passage of three years from the day on which the violation was committed. 
2. A decree imposing a penalty interrupts the period referred to in the first paragraph. 
 
Article 11j 
1. A penalty shall be paid within six weeks of the entering into force of the decree by which the penalty is imposed. 
2. The penalty shall be increased by the statutory interest, calculated from the day falling six weeks after the publication of the decree. 
3. If payment is not made within the period referred to in the first paragraph, the person on whom the penalty has been imposed will be ordered, in 
writing, to pay the sum of the penalty, increased by the costs of the warning, within two weeks. 
4. In the event of failure to pay within the period referred to in the third paragraph, Our Minister can collect the penalty owed, increased by the 
costs of the warning and the collection, by writ of execution. 
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5. The writ of execution shall be served by bailiff’s notification, at the expense of the person on whom the penalty has been imposed and shall 
result in entitlement to enforcement in the sense of the Second Book of the Dutch Code of Civil Procedure. 
6. During a period of six weeks from the day on which the writ is served, objection may be made against the writ of execution by issuing a 
summons against the State. 
7. The objection shall not suspend the enforcement, unless the appeal court decides otherwise, when requested, in interlocutory proceedings. 
8. The objection cannot be based on the claim that the penalty has been unlawfully set or has been set at too high a sum. 
9. The power to collect shall lapse two years after the decree relating to the imposition of the penalty has become irrevocable. 
 
§ 7. Further provisions  
 
Article 12 
The recommendation for an Order in Council pursuant to Article 7, Article 9 (4) and Article 11a, shall not be made earlier than four weeks after the 
draft has been presented to both Houses of the States General. 
 
Article 13 
1. The civil servants appointed by decree from Our Minster shall be charged with monitoring the observance of the provisions of, or pursuant to, 
the provisions of this Act. 
2. An announcement of a decree as referred to in the first paragraph shall be made by publication in the Netherlands Government Gazette. 
 
 
 
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Poland  
 

Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces  
public places  
transport 
facilities 
facilities 
restaurants 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking allowed in 
The 1999 tobacco act provides for a smoking 
banned in 
allowed in 
banned 
allowed in 
allowed in 
separate rooms (if 
ban in rooms in work establishments and public 
rooms in 
separate 
altogether. 
separate 
separate 
there is more than 
places, except for separate smoking rooms. 
work 
smoking rooms 
In trains 
smoking rooms. 
rooms 
one room). 
 
establishmen
 
smoking is 
 
 
In one-room 
Smoking is also prohibited in public transport on 
ts except for 
 
allowed in 
In special 
establishments, 
the base of internal regulations and 
separate 
appointed 
cases, a doctor 
smoking allowed in 
organisational arrangements. 
smoking 
wagons 
may grant a 
designated areas 
 
rooms 
patient a 
In hospitality venues that have more than one 
 
derogation from 
room, smoking is allowed in separate rooms. In 
the smoking 
one-room establishments, smoking is allowed in 
ban. 
designated areas. 
 
 
The parliamentary initiative for a comprehensive 
ban on smoking in all enclosed workplaces and 
public places, including hospitality sector has 
been tabled in the parliamentary health 
committee in March 2008. It would need three 
readings in the lower chamber and one reading 
in the upper chamber to become law. 
 
 
Legal provisions 
 
Law on the Protection of Public Health Against the Effects of Tobacco Use 
of 9 November 1995 
 
As amended on 5 November 1999  
 
Article 5. 1. The smoking of tobacco products outside insulated and suitably adapted rooms shall be prohibited: 
  1)  in health care institutions, without prejudice to paragraph 2, 
  2)  in schools and educational establishments, 
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  3)  in rooms in work establishments and other public utility buildings and in small, single-room gastronomic establishments, apart from in distinctly 
separate areas. 
1a. The introduction of the ban on smoking tobacco in the places referred to in paragraph 1 shall be the responsibility of the proprietor or tenant of 
those premises. 
2. In special cases, a doctor providing treatment to a patient who has been admitted to a health care establishment may grant that patient a 
derogation from the prohibition on the smoking of tobacco products. 
3. The Minister of Defence, the Minister of Internal Affairs and the Minister of Justice shall adopt Decrees laying down rules on the consumption of 
tobacco products on premises which come under their respective authority. 
4. Municipal councils may adopt bye-laws designating places in municipal premises, other than those referred to in paragraph 1, as smoke-free 
zones. 
(implementing legislation) 
 
Article 13. 1. Any person who: 
  1)  smokes tobacco products in places which are subject to the prohibition laid down in Article 5, 
  2)  permits the smoking of tobacco on premises which are under his authority in contravention of the prohibitions laid down in Article 5, 
shall be liable to a financial penalty. 
 
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Portugal 
 

Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces   
public places  
transport 
facilities
facilities 
restaurants 
 
 
Smoking 
In most places 
Smoking 
Smoking 
Smoking 
Venues smaller than  The law banning smoking in most public 
allowed in 
smoking 
banned 
banned 
banned 
100 m² can allow  places was passed in June 2007 and came 
enclosed 
allowed in 
altogether 
altogether 
altogether 
smoking in separate  into force on 1 Jan. 2008.  
rooms or 
enclosed 
with the 
 
 
ventilated smoking 
 
designated 
rooms or 
exception of 
In hospitals 
In higher 
areas or rooms.  
In workplaces and most public places, it is 
areas that 
designated 
uncovered 
and 
education 
 
allowed to smoke in areas which are either 
prevent 
areas that 
areas on 
psychiatric 
system, smoking   Venues bigger than  physical y separated or equipped with 
tobacco smoke 
prevent 
vessels. 
services, 
allowed in 
100 m² can allow  ventilation or other mechanisms preventing 
from spreading 
tobacco smoke 
 
smoking 
enclosed rooms 
smoking in enclosed   smoke from spreading into adjacent areas. 
into adjacent 
from spreading 
allowed in 
or designated 
rooms or designated  Smoking is banned altogether in means of 
areas 
into adjacent 
enclosed 
areas that 
areas that prevent public transport and education facilities. 
 
areas 
rooms or 
prevent tobacco  tobacco smoke from   
 
 
designated 
smoke from 
spreading into 
Bars and restaurants smaller than 100 m² can 
areas that 
spreading into 
adjacent areas which  choose to allow smoking in areas which are 
prevent 
adjacent areas 
should not occupy either physically separated or equipped with 
tobacco 
rooms 
more than 30% and  ventilation or mechanisms preventing smoke 
smoke from 
40% of the overall  from spreading into adjacent areas. 
spreading into 
surface, respectively.    
adjacent 
 
In bars and restaurants larger than 100 m², 
areas rooms  
smoking is allowed in separate smoking 
 
rooms which do not occupy more than 40% of 
the overall surface or in areas equipped with 
ventilation or other mechanisms preventing 
smoke from spreading into adjacent areas 
which do not occupy more than 30% of the 
overall surface. 
 
 
 
 
 
 

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Legal provisions  
Law No 37/2007 of 14 August 2007 
 
Approving rules to protect citizens from involuntary exposure to tobacco smoke and  measures to reduce demand related to 
dependency and giving up smoking 
 
CHAPTER I 
General provisions 
 
Article 2 
Definitions 
 
d) ‘Permanent work areas’ – places where workers must spend more than 30% of their respective daily working time; 
 
g) ‘Workplace’ – the entire area in which a worker works where he/she is under the direct or indirect supervision of the employer;  
 
CHAPTER II 
Restrictions on tobacco consumption 
 
Article 3 
 
General principle 
The provisions of this chapter are aimed at setting restrictions on tobacco consumption in closed areas intended for collective use, so as to 
guarantee protection against involuntary exposure to tobacco smoke.  
 
Article 4 
Prohibition of smoking in certain places 
1. It is prohibited to smoke: 
a) In places housing sovereign bodies, services and bodies of the Public Administration and public legal persons; 
b) In workplaces;  
c) In places where the public is dealt with directly; 
d) In establishments providing health care, namely hospitals, clinics, health centres and nursing homes, doctors’ surgeries, first aid posts and other 
such facilities, laboratories, pharmacies and places where medicinal products not requiring a prescription are dispensed;  
e) In homes and other institutions looking after the elderly or persons with a disability or handicap; 
f) In places intended for persons under 18 years of age, namely nurseries, crèches and other establishments looking after infants, children’s homes 
and youth homes, after-school and holiday clubs, children’s camps and holiday camps and other similar establishments; 
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g) In educational establishments, irrespective of the age of the students and level of schooling, including, specifically, classrooms, study rooms, 
staff rooms and meeting rooms, libraries, gymnasiums, halls and corridors, bars, restaurants, canteens, refectories and recreational areas; 
h) In vocational training centres; 
i) In museums, establishments housing collections that can be visited and places keeping categorised cultural objects, cultural centres, archives 
and libraries, conference rooms, reading rooms and exhibition halls; 
j) In enclosed performance halls and spaces and other enclosed areas intended for art and performance, including lobbies, access areas and 
adjoining areas; 
l) In enclosed entertainment areas and places intended for performances of a non-artistic nature;  
m) In the enclosed areas of sports facilities; 
n) In enclosed exhibition and show areas; 
o) In retail complexes and shopping centres and commercial establishments selling goods to the public; 
p) In hotels and other tourist establishments providing accommodation services; 
q) In restaurants and bars, including those with rooms or areas for dancing; 
r) In canteens, refectories and bars belonging to public or private entities for use only by staff of these entities. 
s) In service areas and petrol stations; 
t) In airports, train stations, bus stations and sea and river ferry terminals; 
u) In the underground in areas open to the public, namely in end and intermediate stations, in all access areas and adjoining establishments and 
premises; 
v) In covered car parks; 
x) In lifts, goods lifts and similar facilities; 
z) In enclosed telephone boxes; 
aa) In enclosed areas housing automated teller machines; 
ab) In any other area where, as determined by the management or by other applicable legislation, particularly regarding the prevention of 
occupational hazards, smoking is banned. 
2. It is also prohibited to smoke in vehicles used for urban, suburban and interurban public passenger transport, in road, rail, plane, sea and river 
transport,  express, tourist and private hire services, in taxis, ambulances, vehicles for the transport of sick people and cable cars. 
 
Article 5 
Exceptions 
1. Notwithstanding the provisions of Article 4(1)(d), areas may be set up exclusively for patients who smoke in hospitals and psychiatric institutions, 
treatment and rehabilitation centres and residential centres for drug addicts and alcoholics, provided that these areas meet the requirements laid 
down in Article 5(5)(a), (b) and (c). 
2. Notwithstanding the provisions of Article 4, accommodation units may be set up in prisons, in cells or dormitories, for prisoners who smoke, 
provided that they meet the requirements laid down in Article 5(5)(a), (b) and (c). Smoking shall also be permitted in outdoor areas. 
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3. Smoking shall be permitted in outdoor areas in the places referred to in Article 4(1)(a), (b), (c), (d), (e), (h), (i), (j), (l), (m), (n), (o), (p), (q), (r) and 
(t), and in outdoor areas in the places referred to in Article 4(1)(g) within the higher education system. 
4. Smoking shall be permitted in outdoor areas in the places referred to in Article 4(1)(s), except in areas where vehicles are filled with fuel. 
5. Smoking may be permitted in areas expressly provided for this purpose in the places referred to in Article 4(1)(a), (b), (e), (j), (l), (n), (o), (p) and 
(t), in the places referred to in Article 4(1)(g) within the higher education system, and in the places referred to in Article (4)(1)(h) not frequented by 
persons under 18 years of age, provided that these areas meet the following requirements: 
a) They are duly indicated, with signs put up in visible places as laid down in Article 6; 
b) They are physically separated from the other premises, or have a ventilation device or other mechanism, provided that it is autonomous, which 
prevents smoke from spreading into adjacent areas. 
c) The air is ventilated directly to the outside by means of an extraction system to protect staff and non-smoking customers from the effects of 
smoke. 
6. In the premises referred to in Article 4(1)(q) with a public area of less than 100 m², the owner may choose to allow smoking, provided that the 
requirements laid down in Article 5(5)(a)(b) and (c) are met. 
7. In the premises referred to in Article 4(1)(q) with a public area equal to or larger than 100 m², smoking areas may be set up accounting for a 
maximum of 30% of the total area, or a physically separate space may be set up accounting for a maximum of 40% of the total area, provided that 
these areas comply with the requirements laid down in Article 5(5)(a)(b) and (c). These areas shall not include staff-only areas or areas in which 
workers must work for extended periods.  
8. In the places referred to in Article 4(1)(p), separate floors, accommodation units or rooms may be set up for smokers, accounting for a maximum 
of 40% of the total area, occupying adjacent areas or all of one or more floors, provided that these areas comply with the requirements laid down in 
Article 5(5)(a)(b) and (c). 
9. Notwithstanding Article 4(2) and the restrictions set out in the regulations issued by transport companies and harbourmasters, smoking shall be 
permitted in uncovered areas on vessels operating on sea and river routes. 
10. Notwithstanding Article 5(6), the decision to allow smoking must, wherever possible, result in the provision of separate areas for smokers and 
non-smokers. 
11. The entities running the establishments concerned shall be responsible for determining the smoking areas. To this end, the relevant 
occupational safety, hygiene and health services and the committees for occupational safety, hygiene and health or, in their absence, the 
employees’ representatives for occupational safety, hygiene and health, must be consulted. 
 
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Romania 
Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces  
public 
transport 
facilities
facilities 
restaurants  
places  
 
 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking allowed in 
Law no. 349/2002 entered into force in Dec. 
allowed in 
allowed in 
banned 
banned 
allowed in 
ventilated smoking 
2002.  According to Art. 3 (1-4) of the Law 
ventilated 
ventilated 
altogether 
altogether  
ventilated 
areas  
smoking in enclosed public places and 
smoking 
smoking 
except for taxis 
smoking areas  
 
workplaces, including bars and restaurants, 
areas  
areas  
 
is allowed in special ventilated smoking 
 
 
areas.  
 
 
 
Smoking is completely banned in medical 
care facilities (Emergency Ordinance 13/ 
2003). 
 
In September 2008, the Romanian parliament 
approved an Ordinance banning smoking in all 
enclosed workplaces and public places except 
for separately ventilated smoking rooms as of 
Jan.2009. In bars and restaurants, smoking 
rooms cannot exceed 50% of the total space 
designated for clients. Venues with a surface 
less than 100 m2 could choose to allow 
smoking.  
Legal provisions  
 
LAW NO 349 of 6th June 2002 
Regarding the prevention and fighting of the efects of the tobacco products consumption 
As modified by Emergency Ordinance No. 13 from 30th January 2003
 
 
ART.2  
 According to the present law:  
m)  By closed public areas we understand all the spaces from the central and local public institutions, economic, public nourishment, tourism, 
commercial, sports, health and sanitation, cultural units and institutions, all means of public transportation, bus stations, stations, airports, 
state or private, closed areas from the work place, or other spaces that the law mentions, except the specified and especially set smoking 
areas of their premises; 
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n) closed areas in the working place mean all the areas of the estates of the buildings, industrial halls, meeting rooms, council rooms, halls, 
corridors, toilets, elevators, offices and/or rooms used by one or more persons.” 
 
ART. 3 
(1)  No smoking in closed public areas; it is completely forbidden smoking in the sanitary units, state or private. 
(2)  The smoking is allowed in special smoking areas, if the following compulsory conditions are observed: 
a)  must be constructed in a way to allow smoking, but not to permit the entering of the polluted air in the closed public area; 
b)  must be ventilated, endowed with ashtrays and extinctors, and arranged according to the legal prescriptions regarding the 
prevention and extinction of the fires; 
c)  must be marked, in visible areas, by one of the following indicators: << Smoking area>>, <<Smoking place>>, <<Smoking 
room>>, << Room where smoking is allowed>>, so that any person will know that only in that specific room , smoking is allowed. 
The persons in charge of the above mentioned institutions, according  to the article 2 letter m) and n) will issue and apply internal 
regulations in order to separate the areas where smoking is allowed from those where smoking is forbidden, by marking of the last 
ones with indicators:<< No smoking>> or by using the international mark, the cigarette barred by a transversal line.” 
 
(3)  Bars, restaurants, discos and other public area with similar destination will delimitate and insure the ventilation of the smoking 
areas, so that the polluted air does not enter in the non smoking area.” 
 
(4)  The provisions of the second paragraph do not apply to the bars, restaurants, discos and other similar destination public areas 
whose manager or owner establishes and posts the warning: ”No smoking in this unit”. 
ART. 10 
a)  The infringement of the provisions of article 3, paragraph 1, is punished with a contraventional fine from 1,000,000 lei to 5,000,000 lei or 
with 20 hours of community service, in the case of the transgressive pupils or students, under the law`s conditions; 
b)  The infringement of the provisions of the article 3, paragraphs (3), (4) and (6) is punished with a contraventional fine from 10,000,000 lei 
to 50,000,000 lei; 
 
Ordinance No 5 of 30 January 2008 
amending and supplementing Law No 349/2002 preventing and combating the effects of the consumption of tobacco products 
Text enters into force on 14 February 2008  
 
On the basis of Article 108 of the Romanian Constitution and Article 1(III)(3) of Law No 373/2007 empowering the Government to issue 
ordinances, 
 
The Romanian government hereby adopts the following Ordinance. 
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Article I 
 
Law No 349/2002 preventing and combating the effects of the consumption of tobacco products, published in Official Gazette of Romania Part I No 
435 of 21 June 2002, as amended, is hereby amended and supplemented as follows: 
    1. Article 2(n) is amended and reads as follows: 
    "n) 'enclosed spaces in the workplace' means all spaces within buildings, such as industrial machine rooms, warehouses, meeting rooms, board 
rooms, halls, corridors, toilets, lifts, offices and rooms;". 
    2. Subparagraphs (2) to (4) of Article 3 are amended and read as follows: 
    "(2) In enclosed public places, smoking shall be permitted only in specially designated smoking rooms, which shall comply with the following 
compulsory conditions: 
    a) they are used solely for smoking; 
    b) they are not used for transit or access to the enclosed public place in question; 
    c) they are fitted with working ventilation systems that extract tobacco smoke; 
    d) they are equipped with ashtrays and fire extinguishers and fitted out in accordance with the fire-prevention and firefighting legislation in force; 
    e) they are visibly marked with one of the following signs: "Cameră pentru fumat" ("Smoking room"), "Încăpere în care este permis fumatul" 
("Room in which smoking is permitted") or "Loc pentru fumat ("Smoking area"), so that it is clear to all that smoking is permitted in that place only. 
    (3) Smoking is permitted in bars, discotheques, restaurants and other public places intended for similar purposes, only in specially designated 
areas complying with the following compulsory conditions: 
    a) they account for a maximum of 50% of the enclosed public place open to customers; 
    b) they are separated to ensure that they are completely sealed off from the rest of the enclosed public place; 
    c) they are not used for transit or access to the enclosed public place in question; 
    d) they are fitted with working ventilation systems that extract tobacco smoke; 
    e) they are equipped with ashtrays and fire extinguishers and fitted out in accordance with the fire-prevention and firefighting legislation in force; 
    f) they are visibly marked with one of the following signs: "Loc pentru fumat" ("Smoking area"), "Spaţiu pentru fumat" ("Smoking area"), "Încăpere 
în care este permis fumatul" ("Room in which smoking is permitted").  
    (4) Subparagraphs (2) and (3) shall not apply to enclosed public places whose owner, manager or director decides to display the following 
notice: "În această clădire fumatul este complet interzis" ("Smoking is totally prohibited in this building"), "În această instituţie fumatul este complet 
interzis" ("Smoking is totally prohibited in this institution"), "În această unitate fumatul este complet interzis" ("Smoking is totally prohibited in this 
establishment")." 
    3. Two new subparagraphs, (41) and (42), are inserted after Article 3(4) and read as follows: 
    "(41) Subparagraph (3) shall not apply to bars, discotheques, restaurants and other public spaces intended for similar purposes, where the total 
area of the enclosed public place open to customers is smaller than 100 m2, if the owner or manager of the establishment decides to display the 
following notice:  "În această unitate fumatul este permis" ("Smoking is permitted in this establishment"). 
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    (42) The Romanian Government shall take a decision as to whether to impose a complete ban on smoking in all enclosed public places, in full 
accordance with the relevant European Union policies and strategies."  
 
 
 
Slovakia 

Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces  
public 
transport 
facilities
facilities 
restaurants
places 
 
 
 
 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking is 
The act no. 377/2004 on the protection of non-
banned 
banned 
banned 
banned 
banned 
allowed in 
smokers was approved in 2004 and 
the 
altogether in 
altogether in 
altogether with 
altogether 
altogether 
separate areas 
amendment to the act no. 465/2005 in 2005.  
workplaces 
some public 
the exception of 
Smoking is banned in workplaces in the presence 
where also 
places such 
reserved cars in 
of non-smokers, in certain public places and in 
non-smokers 
as cultural 
trains 
public transport. In hospitality venues, smoking 
are present 
and sports 
should be restricted to separate areas. 
institutions, 
 
shops, 
Recently, the Slovak Health Ministry and the 
fastfoods. 
Public Health Authority prepared a proposal for 
 
strengthening current provisions. The draft 
 
amendment envisages a full smoking ban in all 
enclosed public places and a partial ban in bars 
and restaurants (establishments of over 200 m². 
metres would have to install separate smoking 
rooms). 
 
The draft bill has to be approved by the Cabinet, 
before it is submitted to the parliament. 
A number of initiatives to strengthen existing 
provisions failed in the past. 
 
Legal provisions  
 

377/2004 Coll. 
 
ACT 
of 26 May 2004 
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on the protection of non-smokers, amending and supplementing several acts 
 
Amendment: 465/2005 Coll. 
 
§ 7 
Ban on smoking 
 
(1) Smoking shall be prohibited: 
a) in means of regular rail passenger transport except reserved cars, in other means of regular domestic passenger transport, in waiting rooms and 
shelters at regular domestic passenger transport stops and stations, on covered platforms, in open public spaces intended for passengers of such 
transport services, and on open platforms within 4 metres of a designated area of the platform; 
b) in healthcare facilities; 
c) in primary and secondary schools, educational establishments, pre school establishments and children's play areas; 
d) in higher-education establishments and student residences; 
e) on social services premises, except in smoking rooms reserved for employees; 
f) on cultural premises and in enclosed sports facilities; 
g) in parts of official buildings and facilities accessible to the public, shops, theatres, cinemas, exhibition centres, museums and galleries; 
h) in mass catering establishments, except those with separate areas for smokers; 
i) in confectionery establishments and fast-food outlets; 
j) on premises where young people are detained or serving custodial sentences. 
 
(2) A ban on smoking at the workplace shall be laid down in separate legislation. 
 
(3) Municipalities may impose generally binding regulations restricting or prohibiting smoking in other places accessible to the public. 
 
 
124/2006 Coll. 
ACT 
 
of 2 February 2006 
 
on occupational safety and health protection and on the amendment of certain acts 
Section 6 
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General Obligations of the Employer 
(5) The employer shall be obliged to forbid smoking at workplaces where work is also performed by non-smokers, and ensure the enforcement of 
this prohibition, as well as the prohibition against smoking at workplaces12. 
 
Section 9 
Controlling Activities 
(1) The employer shall be obliged to systematically control and request compliance with legal regulations and other regulations applying to the 
ensuring of occupational safety and health protection, with principles of safe work, health protection at work and safe conduct at workplaces and 
safe working procedures, and in particular to control 
b) whether the employees are under the influence of alcohol, narcotics or psychotropic substances, during working time, and whether they adhere 
to the issued prohibition of smoking on the employer’s premises. 
 
Section 12 
Rights and Obligations of Employees 
 
(2) The employee shall be obliged to 
m) comply with the prohibition against smoking at workplaces. 
 
                                                 
12 For example, Act No 377/2004 Coll. on the protection of non-smokers and on the amendment of certain acts; Regulation of the Government of the Slovak 
Republic No 393/2006 Coll. on the minimum requirements for ensuring occupational safety and health protection in explosive atmosphere. 
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Slovenia 
Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces 
public 
transport 
facilities
facilities 
restaurants  
places  
 
 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking allowed only  The amendment to the 2005 Tobacco Act was 
allowed only 
allowed only 
banned 
banned 
banned 
in enclosed smoking 
adopted on 22 June 2007 and went into effect 
in enclosed 
in separate 
altogether 
altogether 
altogether, 
rooms intended 
on 5 Aug 2007 
smoking 
smoking 
with the 
including in 
exclusively for 
 
rooms 
rooms 
exception of 
outdoor spaces 
smoking 
The law introduced complete ban on smoking 
intended 
intended 
mental health 
of childcare and 
in all enclosed workplaces and public places, 
exclusively 
exclusively 
institutions 
educational 
incl. hospitality venues, with the exception of 
for smoking 
for smoking 
establishments 
separate ventilated smoking rooms. Smoking 
rooms should be reserved only for smoking 
(with no eating or drinking al owed inside) and 
should occupy not more than 20% of the 
overall surface. 
 
After its entry into force, the law was 
challenged by small bar owners and some 
MPs. However, in January 2008, the draft 
parliamentary amendment to weaken the law 
was rejected by the Health Committee of the 
National Assembly. 
 
Legal provisions 
 
The Act Amending the Restriction of the Use of Tobacco Products Act  
(Official Gazette of the Republic of Slovenia no. 60/2007)  
 
Article 2 
10. A smoking room is an enclosed area that is physically separate from other enclosed areas, and is specially regulated exclusively for smoking. 
 
Article 3 
Public spaces pursuant to this act are those designed for activities in the fields of healthcare, childcare, education, social work, traffic, public 
transport, trade, catering and tourism, sport and recreation, and culture. 
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Public spaces specified in the previous paragraph are specifically waiting rooms, conference rooms, cinema halls, theatres, health, childcare, 
education and social institutes, catering premises, shops, sports halls, means of public transport, lifts, cable cars, public toilets and other spaces 
where non-smokers are exposed to cigarette smoke against their will. 
 
Article 4 
Work premises pursuant to this act means any closed area under the control of an employer where work and services are performed for the 
employer. 
 
Article 16 
It shall be prohibited to smoke in an enclosed public space and work premises. Any space with a roof where more than half of the area of the 
appurtenant walls is completely closed shall be deemed an enclosed public space or work premises.  
Smoking shall also be prohibited in areas that pursuant to this act are not deemed enclosed spaces, if they are part of the appurtenant functional 
land of areas where childcare and education are provided.  
The previous paragraph notwithstanding, smoking shall be allowed: 
- in areas specially designated for smokers at residential facilities and other accommodation providers, 
- in senior citizens’ homes and jails in areas not intended for common use, should smokers alone reside there, 
- in areas specially designated for smokers in psychiatric hospitals and in areas specially designated for smokers at other treatment providers for 
mental patients, 
- in smoking rooms. 
Smoking rooms shall not be allowed in areas where healthcare, childcare or education are provided. 
The owner, tenant or manager of the spaces where smoking is prohibited shall be responsible for upholding the prohibition on smoking. 
 
Article 17 
Smoking rooms must meet the following conditions: 
- the space must be regulated so that air contaminated with tobacco smoke cannot flow freely from it into other spaces, 
- the space may not be designed for passage into other areas, and may not exceed more than 20% of the total surface area of the public space 
and/or work premises, 
- the space must be designed exclusively for smoking, with service not allowed in the space, 
- food and beverages may not be consumed in the space. 
The minister responsible for health shall set out the detailed conditions to be met by smoking rooms. 
Full text at:  
http://www.mz.gov.si/fileadmin/mz.gov.si/pageuploads/mz_dokumenti/vprasanja_in_odgovori/ZOUTI_velja_050807/ZOUTI_english_version.pdf 
EN 
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Spain 
 

Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and restaurants 
Comments  
workplaces  
public 
transport 
facilities
facilities 
places  
 
 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking 
In bars and 
The new Tobacco Act entered into force in 
banned 
banned 
banned 
banned 
banned 
restaurants larger 
December 2005.  
altogether 
altogether in 
altogether with 
altogether  
altogether  
than 100m2 as well 
 
places 
the exception of 
as in clubs and 
The Act sets a total ban on smoking in 
mentioned in 
separately 
gaming 
enclosed workplaces and most of the public 
Art. 7 
ventilated 
establishments when 
places. In some public places (e.g. 
 
smoking rooms 
they do not admit 
entertainment premises), it is possible to 
 Separately 
in airports, bus 
minors, smoking is 
create separately ventilated smoking rooms. 
ventilated 
stations, railway 
allowed only in 
 
smoking 
stations and 
separately ventilated 
In bars and restaurants larger than 100 m² as 
rooms 
ship and ferry 
smoking rooms. 
well as in clubs and gaming establishments, 
allowed in 
terminals. 
 
smoking is allowed only in separate smoking 
public 
 
Bars and restaurants 
rooms (not bigger than 30% of the total 
entertainme
smaller than 100m2 
surface). Smaller venues can opt to be either 
nt premises. 
can opt to be either 
smoking or non-smoking.  
 
smoking or non-
smoking 
 
 
 
Legal provisions  
Law No. 28/2005 of 26 December 2005 on health measures in relation to smoking and regulating the sale, supply, consumption, and 
advertising of tobacco products. 
Article 6.
 Restrictions on the consumption of tobacco products. 
The consumption of tobacco products shall take place exclusively in those premises or spaces where this is not totally prohibited or that are 
specially designated for this purpose. Accordingly, a distinction is made between those areas where smoking is completely banned and those 
others where, despite the ban, the designation of areas for the consumption of tobacco is permitted. 
Article 7. Total ban on smoking. 
In addition to those premises or spaces defined in the legislation of the Autonomous Communities, smoking shall be completely banned in the 
following: 
  a.   Public and private workplaces, with the exception of those areas in the open air. 
  b.   Centres and offices of the public administrations and public-law bodies. 
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  c.  
Health centres, services or establishments. 
  d.   Educational and training establishments, irrespective of the age of the student body and the type of teaching. 
  e.   Sporting facilities and premises where public entertainment events are held, provided these are not in the open air. 
  f.  
Premises where the public is dealt with directly. 
  g. 
 Shopping centres, including superstores and shopping malls, with the exception of areas in the open air. Smoking will not be permitted in 
bars, restaurants and other food and drink establishments situated within such centres and separated from the other premises thereof, 
irrespective of the surface area occupied, unless smoking areas are designated in accordance with this Law. 
  h.   Social care centres for persons under the age of 18. 
  i.  
Leisure or amusement centres accessible to persons under the age of 18, with the exception of spaces in the open air. 
  j.  
Cultural centres, reading rooms, exhibitions, libraries, conferences and museums. 
  k.  
Night clubs or clubs open to the general public during the times or periods that persons under the age of eighteen are admitted. 
  l.  
Areas or establishments where foods are manufactured, processed, prepared, consumed or sold. 
  m.   Lifts and goods lifts. 
  n.   Telephone boxes, ATM kiosks and other small spaces for public use. A “small space for public use” is one that occupies an area no 
greater than five square metres. 
  o.   Urban or inter-urban public transport vehicles, company vehicles, taxis, ambulances, funicular railways and cable cars. 
  p.   All premises in the suburban transport system (carriages, platforms, walkways, stairways, stations, etc.), with the exception of those 
spaces that are completely in the open air. 
  q.   Means of rail and sea transport, with the exception of those spaces in the open air. 
  r.  
Aircraft whose journeys start and end within the national territory and on board all flights operated by Spanish airlines, including those 
codeshared with foreign companies. 
  s.  
Service stations and similar establishments. 
  t.  
Any other premises where smoking is banned under this Law or another regulation, or by decision of the owner. 
Article 8. Designation of smoking areas. 
1. Smoking areas may be designated in the following premises or spaces where smoking is banned: 
     
Social care centres. 
     
Hotels, hostels and similar establishments. 
     
Bars, restaurants and other enclosed catering establishments with a surface area for customer or visitor use that is equal to or greater than 
100 m2, unless they are located within centres or buildings where smoking is prohibited in accordance with Article 7. 
     
Night clubs, gaming establishments or other establishments and clubs open to the general public during the times or periods that persons 
under the age of eighteen are not admitted, with the exception of those spaces in the open air. 
     
Theatres, cinemas and other enclosed public entertainment premises. In these cases, the smoking area must be situated outside the 
rooms where the performance takes place or the film is shown. 
     
Airports. 
     
Bus stations. 
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Railway stations and ship and ferry terminals. 
     
Any other premises where smoking is not banned and the owner decides to do so. 
     
In any premises or spaces where this is permitted by the legislation of the Autonomous Communities, other than in the instances listed in 
Article 7. 
2. Smoking areas may only be designated in the premises referred to in the above paragraph provided that the following minimum conditions are 
met: 
     
They must be correctly and visibly signposted, in Castilian and in the co-official language, with the information required by the 
corresponding Autonomous Community regulations. 
     
They must be physically separated from the other facilities of the centre or organisation and completely enclosed, and must not be an area 
through which non-smokers are required to pass unless the latter work or are employed in these areas and are over the age of 16. 
     
They must have independent ventilation systems or other devices or mechanisms that guarantee the extraction of smoke. 
     
In all cases, the surface area of the specially equipped area must be less than 10% of the total surface area intended for customers or 
visitors to the centre or establishment, except in those instances referred to in points b, c and d of the previous paragraph, where a 
maximum of 30% of the common areas may be set aside for smokers. Under no circumstances can the smoking areas designated in all of 
the premises or spaces referred to in paragraph 1 of this article have a total surface area greater than 300 m2.  
     
In the areas referred to in paragraph (1)b of this article, up to 30% of the rooms may be set aside for smoking guests. 
     
In establishments where two of the activities of those listed in this article take place (separated spatially), the usable surface area shall be 
calculated for each one of these independently, excluding common areas and passageways in which smoking will not be permitted under 
any circumstances. 
In all cases where it is not possible for these areas to meet the requirements laid down, the smoking ban will be maintained throughout the 
premises. 
3. Persons under the age of 16 will not be admitted to the smoking areas created in the establishments referred to in this Article. 
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Sweden 
Enclosed 
Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces  
public 
transport 
facilities
facilities 
restaurants  
places  
 
 
Employers 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking allowed only  The 1993 Tobacco Act introduced smoking 
obliged to 
allowed in 
banned 
banned 
banned 
in separate smoking 
ban in educational and healthcare facilities, 
ensure that 
separately 
altogether 
altogether 
altogether 
rooms where no food 
public transport and indoor public places.  In 
employees 
ventilated 
or drink is served or 
workplaces, there is no explicit ban on 
are not 
smoking 
consumed 
smoking but the employer is obliged to ensure 
involuntarily 
rooms 
that employees are not exposed to tobacco 
exposed to 
smoke against their will. 
tobacco 
 
smoke  
The Act extending the ban on smoking also to 
restaurants and bars entered into force on 1 
June 2005. Owners have the possibility to 
install a separately ventilated smoking room 
where no food or drink is to be served or 
consumed. 
 
Legal provisions 
 

Tobacco Act (1993:581) with amendments up to and including SFS 2005:369 
Restrictions on smoking in some premises and spaces and in some areas outdoors 
Section 2      Smoking is prohibited 
1.  in premises intended for child care, school activities or other activities for children  young people and in school playgrounds as well 
as in the equivalent outdoor areas at preschools and after-school recreation centres, 
2.  in premises intended for health and medical care, 
3.  in premises intended for joint use in residential accommodation and at establishments offering special service or care, 
4.  on means of transport in domestic public transport or in premises and other spaces intended for use by those travelling by such 
means of transport, 
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5.  in restaurants and other establishments serving food or beverages, except when the service is provided outdoors, 
6.  in premises other than those referred to in Sections 1 to 5 when a public meeting or public event as referred to in Chapter 2, 
Sections 1 to 3 of the Public Order Act (1993:1617) is arranged and in premises intended to be used by those taking part in such a 
meeting or event, and 
7.  in premises other than those referred to in Sections 1 to 6 if the general public has access to the premises. (SFS 2004:485). 
Section 3      Repealed by (SFS 1994:98). 
Section 4 In hotels and other establishments where temporary accommodation is offered on a commercial basis, smoking is to be 
prohibited in a certain number of the rooms or the equivalent. Section 2, item 4 shall apply instead as regards sleeping-compartments 
and other spaces made available for temporary accommodation on means of transport in domestic public transport. (SFS 2004:485). 
Section 5 The provisions of Section 2 do not apply regarding housing and other premises for accommodation which are not temporary. 
(SFS 1994:98). 
Section 6 Smoking is, notwithstanding the provisions of Section 2, items 2 to 4, 6 and 1,  permitted in parts of the premises or other 
spaces referred to there, if these parts have been specially set aside for smoking. The same applies to premises referred to in Section 2, 
item 1 and which are available only to members of staff. 
Notwithstanding the provision of Section 2, item 5, smoking is permitted in restaurants and in other establishments serving food or 
beverages in separate rooms that are specially set aside for smoking. Rooms where smoking is permitted may only comprise a small 
part of the area of such establishment. The rooms shall be located so that visitors do not have to pass through them. Employees shall 
only need to stay in the rooms temporarily, when people are smoking. Service or other similar activities may not be conducted in the 
rooms when people are smoking. However, this does not apply to such activities that are directly linked to the function of the rooms. 
Food or beverages may not be brought into these rooms. 
Deviations from Section 2, items 1 to 4, 6 and 7 and Section 4 are permitted if there are special reasons for so doing due to the 
nature of the space or the area available, its mode of usage or other circumstances. (SFS 2004:485). 
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Section 6 a The Government, or the authority appointed by the Government, may issue regulations on design and ventilation of such 
rooms referred to in Section 6, second paragraph. (SFS 2004:485). 
Section 7 A person who in his or her capacity of owner or who otherwise disposes over premises, another space or an outdoor area 
subject to any of the provisions of Section 2 and 4 is responsible to ensure compliance with the provisions. 
If any person smokes despite being requested not to smoke where smoking is not permitted, this person may be required to leave. 
(SFS 1994:98). 
Smoke-free working environment 
Section 8 In cases other than those intended in Sections 2 and 4, the employer is responsible for ensuring that an employee is not 
against his or her will exposed to tobacco smoke at the workplace or in similar premises where the employee is active. Here the persons 
referred to in Chapter 1, Section 2, first paragraph and Section 3 of the Work Environment Act (1977:1160) are to be considered as 
employees. (SFS 1994:98). 
 
 

EN 
140  
  EN

 
United Kingdom 
Enclosed 

Enclosed 
Public 
Health care 
Education 
Bars and 
Comments  
workplaces 
public 
transport 
facilities
facilities 
restaurants  
places  
 
 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking 
Smoking banned 
Comprehensive smoke-free laws went 
banned 
banned 
banned 
banned 
banned 
altogether 
into effect in March 2006 in Scotland, in 
altogether 
altogether 
altogether 
altogether 
altogether 
 
April 2007 in Northern Ireland and 
 
 
 
except for 
 
Wales and in July 2007 in England. 
 
semi-
 
 
residential 
All four regulations were subject to 
premises 
public consultations. 
(exemptions 
 
differ slightly 
The regulations differ slightly but as a 
in the four 
rule smoking is prohibited in all enclosed 
parts of the 
and substantially enclosed workplaces 
UK) 
and public places with minimum 
exemptions, mainly for residential 
premises such as long-stay care homes 
or mental health hospitals. Smoking is 
defined widely as being in possession of 
any lit product. 
 
English and Northern Irish laws give the 
power to the department of health to 
designate additional smoke-free places 
that need not be enclosed or 
substantially enclosed. 
 
England  
 
The Health Act 2006 came into force on 1st July 2007, prohibiting smoking in most wholly and substanially enclosed public places and workplaces 
with the exception of semi-residential premises. 
The following places are exempt from the legislation: 
•  private accommodation and private vehicles  
EN 
141  
  EN

 
•  designated hotel bedrooms  
•  designated rooms in adult residential care homes, hospices and prisons  
•  during performances where artistic integrity makes it appropriate for a person to smoke  
•  specialist tobacconist shops are exempt for the purposes of sampling cigars or small amounts pipe tobacco within the shop’s premises. 
However, cigarette smoking is not permitted.  
•  designated rooms in offshore installations  
•  designated room in a research or testing facility  
Smoking is also permitted in vehicles used for work purposes if they are for the sole use of one driver. Convertible cars used for work purposes are 
also exempt when the roof is completely removed or stowed. 
 
Legal provisions 
 
Health Act: 
http://www.opsi.gov.uk/ACTS/acts2006/ukpga_20060028_en_1 
 
Five sets of regulations set out the details of England's smoke-free legislation: 
1. The Smokefree (Premises and Enforcement) Regulations set out definitions of "enclosed" and "substantially enclosed" and the bodies 
responsible for enforcing smokefree legislation. 
http://www.opsi.gov.uk/si/si2006/20063368.htm 
2. The Smokefree (Exemptions and Vehicles) Regulations set out the exemptions to smokefree legislation and vehicles required to be smokefree. 
http://www.opsi.gov.uk/si/si2007/20070765.htm 
3. The Smokefree (Penalties and Discounted Amounts) Regulations set out the levels of penalties for offences under smokefree legislation.  
http://www.opsi.gov.uk/si/si2007/20070764.htm 
4. The Smokefree (Vehicle Operators and Penalty Notices) Regulations set out the responsibility on vehicle operators to prevent smoking in 
smokefree vehicles and the form for fixed penalty notices.  
http://www.opsi.gov.uk/si/si2007/20070760.htm 
5. The Smokefree (Signs) Regulations set out the requirements for no-smoking signs required under smokefree legislation.  
http://www.opsi.gov.uk/si/si2007/20070923.htm 
EN 
142  
  EN

 
 
Scotland 
The Smoking, Health and Social Care (Scotland) Act came into force on 26th March 2006, banning smoking in most wholly and substantially 
enclosed public places. The regulations that accompany the Bill include an outline of the premises to be classed as non-smoking, and an outline of 
the premises to be exempt from the Act. 
 
Premises classed as 'non-smoking' under the regulations are as follows: 
  
Restaurants 
   
Bars and public houses 
   
Shops and shopping centres 
  
Hotels 
   
Libraries, archives, museums and galleries 
   
Cinemas, concert halls, theatres, bingo halls, gaming and amusement arcades, casinos, dance halls, discotheques and other premises 
used for the entertainment of members of the public 
   
Premises used as a broadcasting studio or film studio or for the recording of a performance with a view to its use in a programme service 
or in a film intended for public exhibition 
   
Halls and any other premises used for the assembly of members of the public for social or recreational purposes 
   
Conference centres, public halls and exhibition halls 
  
Public 
toilets 
  
Club 
premises 
   
Offices, factories and other non-domestic premises in which more than one persons works 
  
Offshore 
installations 
   
Educational institution premises 
   
Premises providing care home services, sheltered housing, secure accommodation services that are non-domestic 
   
Hospitals, hospices, psychiatric hospitals, psychiatric units and health care premises 
   
Creches, day nurseries, day centres and other premises used for the day care of children or adults 
   
Premises used for, or in connection with, public worship or religious instruction, or the social or recreational activities of a religious body 
  
Sports 
centres 
   
Airport passenger terminals and any other public transportation facilities 
   
Public transportation vehicles 
   
Vehicles which one or more persons use for work 
   
Public telephone kiosks 
   
Exemptions under the regulations are: 
EN 
143  
  EN

 
  
Residential 
accommodation 
   
Designated rooms in adult care homes 
  
Adult 
hospices 
   
Designated rooms in psychiatric hospitals and psychiatric units 
   
Designated hotel bedrooms 
   
Detention or interview rooms which are designated rooms 
   
Designated rooms in offshore installations 
  
Private 
vehicles 
   
Designated laboratory rooms 
   
HM submarines and ships of the Royal Fleet Auxiliary 
 
Legal provisions 
 
The Smoking, Health and Social Care (Scotland) Act:  
http://www.opsi.gov.uk/legislation/Scotland/acts2005/asp_20050013_en_1 
 
The Prohibition of Smoking on Certain Premises (Scotland) Regulations 2006: Scottish Statutory Instrument 90 2006 
http://www.opsi.gov.uk/legislation/scotland/ssi2006/20060090.htm 
 
   
Northern Ireland 
 
Smoke-free public places legislation came into force in Northern Ireland on 30 April 2007 under The Smoking (Northern Ireland) Order 2006. 
There are only a few exemptions to the Order. The exemptions are: private accommodation, designated bedrooms in hotels, designated rooms in 
residential care homes, nursing homes and research and testing facilities, specialist tobacconists (for sampling purposes), prisons, young 
offenders centres and remand centres (certain areas are not exempt), designated rooms in residential accommodation in mental health units (until 
30 April 2008), a designated room used as a detention cell within a police station, an exercise area within a police station and an interview room 
within a Child Abuse and Rape Enquiry (CARE) suite (until 30 April 2008). 
 
Legal provisions 
 
The Smoking (Northern Ireland) Order 2006 
http://www.opsi.gov.uk/si/si2006/uksi_20062957_en.pdf 
EN 
144  
  EN

 
 
Wales  
 
The Smoke-Free Premises etc.(Wales) Regulations came into force on 2nd April 2007. There are few exemptions to the legislation. Exemptions 
include designated hotel bedrooms, designated rooms in research and testing facilities, designated rooms for use by adults in care homes, adult 
hospices and residential mental health units. 
 
Legal provisions 
 
Smoke-Free Premises etc.(Wales) Regulations 
http://www.opsi.gov.uk/legislation/wales/wsi2007/wsi_20070787_en_1 
 
EN 
145  
  EN

 
D) LAWS  BANNING SMOKING IN VEHICLES CARRYING CHILDREN – INTERNATIONAL OVERVIEW 
Jurisdiction                Applicable Age
Date Law
Date Law 
 
 
in Force 
Adopted 
Canadian provinces/territories 
1. Nova Scotia
19
April 1, 2008
Dec. 13, 2007 
2. Yukon Territory 
18 
May 15, 2008 
Apr. 22, 2008 
3. British Columbia 
16
date to be set
May 29, 2008 
4. Ontario 
16 
Jan. 21, 2009 
June 18, 2008 
Canadian municipalities 
 
 
 
5. Wolfville, Nova Scotia 
19
June 1, 2008
Nov. 19, 2007 
6. Surrey, British Columbia 
19 
July 31, 2008 
July 14, 2008 
7. Okotoks, Alberta 
16 
Sept. 1, 2008 
July 15, 2008 
U.S. states 
 
 
 
8. Arkansas                 if car  seat required1 
July 21, 2006 
Apr. 10, 2006 
9. Louisiana
132
Aug. 15, 2006
July 5, 2006 
10. California
18
Jan. 1, 2008
Oct. 10, 2007 
11. Maine 
16 
Sept. 1, 2008 
Apr. 10, 2008 
U.S. municipalities 
 
 
 
12. Bangor, Maine 
18
Jan. 18, 2007
Jan. 8, 2007 
13. Keyport, New Jersey 
18
Apr. 26, 2007
Apr. 24, 2007 
14. Rockland County, N.Y. 
18 
June 21, 2007 
June 15, 2007 
15. West Long Branch Borough, NJ  18 
June 9, 2007 
June 6, 2007 
Australian states and territories 
 
 
16. South Australia 
16
May 31, 2007
Apr. 5, 2007 
17. Tasmania 
18 
Jan. 1, 2008 
Dec. 19, 2007 
Countries 
 
 
 
EN 
146  
  EN

 
18. Cyprus 
16 
 
June 14, 2002 
19. South Africa 
12 
date to be set 
Feb. 23, 2008 
Other 
 
 
 
20. Puerto Rico 
13 
Mar. 2, 2007 
Mar. 2, 2006 
(US Commonwealth in Caribbean) 
EN 
147  
  EN

 
 ANNEX V–HEALTH EFFECTS OF ETS EXPOSURE 
A) RELATIVE RISK ESTIMATES FOR ETS-ASSOCIATED DISEASES AND CONDITIONS 
This Annex summarises the relative risk estimates reported in the literature for 
mortality and morbidity associated with those diseases where evidence is sufficient 
(or suggestive) to infer a causal relationship: lung cancer, coronary heart disease, 
stroke, respiratory conditions in adults (e.g. asthma, COPD) as well as respiratory 
conditions in children (e.g. asthma or wheezing) 
 
Table 4: Summary of Relative Risk estimates due to ETS for selected diseases 
Condition  
Work  Home 
  
Lowest 
Highest 
 Lowest 
Highest 
estimate 
estimate 
estimate  estimate 
Lung cancer  
1.03 2.01  1.16 1.29 
CHD  
1.11 1.21  1.25 1.42 
Stroke  
n/a n/a  0.50 1.82 
COPD/Asthma  
n/a n/a  1.2 2.6 
Childhood 
 n/a n/a  0.93 1.54 
asthma 
As shown in the table, relative risk estimates reported in the literature exhibit wide 
ranges. Even though the large majority of studies report relative risks greater than 
one with 95% significance, a few studies report ratios smaller than one. The highest 
estimates are reported for lung cancer due to ETS exposure at work (2.01), stroke 
due to ETS exposure at home (1.82) and COPD/Asthma due to ETS exposure at 
home (2.6).  Separate relative risks for ETS exposure at work were not reported for 
three diseases (stroke, COPD/Asthma and childhood asthma). 
The full range of relative risk estimates is summarised below. 
Lung Cancer 
Table 2 Relative risk of lung cancer for non smokers exposed to workplace ETS 
Reference 
Location  
No studies in meta-analysis 
RR (95% CI) 
(Stayner, Bena et al. 2007) 
Multiple 
22 
1.24 (1.18-1.29) 
EN 
148  
 
E

 
(Stayner, Bena et al. 2007) 
Multiple 22 
2.01 
(1.33-2.60) 
High exposure 
(Royal College of Physicians 
Multiple 
7 (1,582 lung cancer cases) 
1.03 (0.86-1.23) 
2005)  
Male and female 
(Surgeon General 2006) 
Multiple 
25  
1.22 (1.13-1.33) 
Non smokers vs. none 
(Surgeon General 2006)  
Europe 7 
1.13 
(0.96-1.34) 
Non smoker vs none 
 
Table 3 Relative risk of lung cancer for non smoking men exposed to workplace ETS 
Reference 
Location  
No studies in meta-analysis 
RR (95% CI) 
(Royal College of Physicians 
Multiple 
6 (246 lung cancer cases) 
1.12 (0.80-1.56) 
2005) Men 
(Surgeon General 2006) 
Multiple 25 
1.12 
(0.86-1.50) 
Men vs none 
 
Table 4 Relative risk of lung cancer for non smoking women exposed to workplace ETS 
Reference 
Location  
No studies in meta-analysis 
RR (95% CI) 
(Royal College of Physicians 2005)   Multiple 
19 (3,588 lung cancer cases) 
1.19 (1.09-1.30) 
Women 
(Surgeon General 2006) 
Multiple 25 
1.22 
(1.10-1.35) 
Women versus none 
 
Table 5 Relative risk of lung cancer for non-smokers exposed to home ETS from spousal smoking 
Reference 
Location  
No studies in meta-analysis 
RR (95% CI) 
(Surgeon General 2006)  
Multiple 
44 case control 
1.21 (1.13-1.30) 
Spousal smoking: Smoking versus 
non-smoking spouse   
(Surgeon General 2006) 
Multiple 
8 Cohort 
1.29 (1.125-1.49) 
Spousal smoking: Smoking versus 
non-smoking spouse   
(Surgeon General 2006) 
Europe 52 
1.16 
(1.03-1.30) 
Spousal smoking: Smoking versus 
non-smoking spouse. 
 
EN 
149  
 
E

 
Table 6 Relative risk for lung cancer for never smoking women exposed to home ETS from spousal 
smoking 
Reference 
Location  
No studies in meta-analysis 
RR (95% CI) 
(Taylor, Najafi et al. 2007) 
Multiple 
55 
1.27 (1.17-1.37) 
(Taylor, Najafi et al. 2007) 
Europe 
11 
1.31 (1.24-1.52) 
(Surgeon General 2006) 
Multiple 
52 
1.37 (1.05-1.79) 
Taylor et al (2001) Cited in (NHS 
Multiple 43 
1.29 
(1.17-1.43) 
Health Scotland, Ludbrook et al
2005)* 
(Royal College of Physicians 
Multiple 
46 (6,257 lung cancer cases) 
1.24 (1.14-1.34) 
2005) 
 
Table 7 Relative risk of lung cancer for never smoking men exposed to home ETS from spousal smoking 
 Reference 
Location  
No studies in meta-analysis 
RR (95% CI) 
(Royal College of Physicians 
Multiple 
11 (442 lung cancer cases) 
1.37 (1.02-1.83) 
2005) 
(Surgeon General 2006) 
Multiple 
8 Cohort 
1.29 (1.125-1.49) 
(Surgeon General 2006) 
Multiple 
52 spousal studies included in  1.22 (1.13-1.31) 
meta-analysis for SG report 
Coronary Heart Disease 
Table 8 Relative risk of CHD for non smokers exposed to home/work ETS 
Reference 
Location  
No. studies in 
RR (95% CI) 
meta-analysis 
(Surgeon General 2006) 
Multiple 
16 (9 cohort and 
1.27 (1.19-1.36) 
7 case-control) 
(Surgeon General 2006) 
Multiple 8 
1.16 
(1.03-1.32) 
Nonsmokers exposed to low to 
moderate (1-14 or 1-19 
cigarettes/day) SHS 
(Surgeon General 2006) 
Multiple 8 
1.44 
(1.13-1.82) 
Nonsmokers exposed to  moderate 
to high (≥15 or ≥20 cigarettes/day) 
SHS 
 
 

EN 
150  
 
E

 
Table 9 Relative risk of CHD for non smokers ever-exposed to workplace ETS 
Reference 
Location  
No, studies in 
RR (95% CI) 
meta-analysis 
Wells (1998a) Cited in (NHS Health  Multiple 

1.18 (1.04-1.34) for mortality 
Scotland, Ludbrook et al. 2005)* 
only (n=8)  
Ever-exposure to ETS in the 
workplace 
1.32 (1.01-1.72) for morbidity 
only (n=6) 
He et al (1999) Cited in (NHS 
Multiple 8 
1.11 
(1.00-1.23) 
Health Scotland, Ludbrook et al
2005)* 
Steenland (1999) Cited in (NHS 
Multiple  
1.21 
(1.04-1.41) 
Health Scotland, Ludbrook et al
2005)* 
 
Table 10 Relative risk of CHD for non smokers ever-exposed to home ETS from spousal smoking  
Reference 
Location  
Number of 
RR (95% CI) 
studies in meta-
analysis 

Glantz and Parmley (1991) Cited in 
Multiple 
10 
1.3 (1.2-1.4)  
(NHS Health Scotland, Ludbrook et 
al
. 2005) 
Wells (1994) Cited in (NHS Health 
Multiple 10 
1.42 
(1.15-1.75) 
Scotland, Ludbrook et al. 2005)* 
Law et al (1997) Cited in (NHS 
Multiple 19 
1.30 
(1.22-1.38) 
Health Scotland, Ludbrook et al
2005)* 
Thun et al (1999) Cited in (NHS 
U.S.  
17 
1.25 (1.17-1.33) 
Health Scotland, Ludbrook et al
2005) 
1.25 (1.17-1.33) for fatal CHD 
1.25 (1.17-1.33) for no fatal MI 
Thun et al (1999)Cited in (NHS 
Multiple 8 
1.22 
(1.13-1.32) 
Health Scotland, Ludbrook et al
2005)* 
Wells (1998a) Cited in (NHS Health 
Multiple 
18 
1.49 (1.29-1.78) for all home 
Scotland, Ludbrook et al. 2005)* 
(n=18) 
1.28 (1.02-1.61) for morbidity 
only (n=6) 
1.21 (1.09-1.35) for mortality 
(n=6) 
He et al (1999) Cited in (NHS Health  Multiple 
18 
1.25 (1.17-1.32) 
EN 
151  
 
E

 
Scotland, Ludbrook et al. 2005)* 
1.24 (1.17-1.32) for mortality 
only (n=14) 
He et al (1999) Cited in (NHS Health  Multiple 7 
1.31 
(1.21-1.42) 
Scotland, Ludbrook et al. 2005)* 
Never-smokers exposed to ETS by 
spouses who smoke more than 20 
cigarettes/day  
Stroke 
Table 11 Relative risk of stroke for non smokers exposed to home ETS from spousal smoking - Meta 
analysis  
Reference 
Location  
No. studies in 
RR (95% CI) 
meta analysis  
(Royal College of Physicians 2005) 
Multiple 
3 cohort 
1.27 (1.10-1.46) 
 
 
Table 12 Relative risk of stroke for never smokers exposed to home ETS from spousal smoking - Individual 
studies 
Reference 
Location  
Type of study 
RR (95% CI) 
and number of 
individuals (no. 
of stroke cases) 

Bonita et al  (1999) Cited (Royal 
New 
Case-control. 
1.82 (1.34-2.49) 
College of Physicians 2005) 
Zealand 
215 cases and 
1,366 controls 
 
Never smokers and former smokers 
who quit > 10 years ago exposed to 
ETS from spouse. Men and women 
You et al (1999) Cited in (Royal 
Australia Case-control.  1.70 (0.98-2.92) 
College of Physicians 2005). Men 
149 cases and 
and women 
210 controls. 
Lifetime non 
smoking men 
and women 
Anderson et al (2004) Cited in 
 
Case-control  
0.5 (0.2-1.3) 
(Royal College of Physicians 2005) 
Anderson et al (2004) Cited in 
 Case-control 
1.3 
(0.7-2.3) 
(Royal College of Physicians 2005) 
 
EN 
152  
 
E

 
Table 13 Relative risk of stroke for never smokers exposed to home ETS from spousal smoking - Individual 
studies (men only) 
Reference 
Location  
Type of study and number 
RR (95% CI) 
of individuals (no. of stroke 
cases) 

Iribarren et al  (2001) Cited in (Royal   
Cross-sectional 16,524 (42)  
0.25 (0.04-0.82)  
College of Physicians 2005) 
Lee et al  (1986) Cited in (Royal 
 
Case-control  
0.78 (0.23-2.24) 
College of Physicians 2005) 
Bonita et al  (1999) Cited in (Royal 
New Zealand 
Case-control. 215 cases and 
2.10 (1.33-3.32) 
College of Physicians 2005) 
1,366 controls 
 
Never smokers and former smokers 
who quit > 10 years ago exposed to 
ETS from spouse. 
Sandler et a (1989) cited in (Surgeon 
Washington 
Cohort 0.97 
(0.65-1.46) 
General 2006) 
country, Maryland 
U.S.  
ETS exposure in the home (self 
reported) 
 
Table 14 Relative risk of stroke for never smokers exposed to home ETS from spousal smoking - Individual 
studies (women only) 
Reference 
Location  
Type of study and number 
RR (95% CI) 
of individuals (no. of stroke 
cases) 

Iribarren et al  (2001) Cited in (Royal   
Cross-sectional 26,197 (95)  
1.23 (0.75-1.96) 
College of Physicians 2005) 
Lee et al  (1986) Cited in (Royal 
 
Case-control  
1.00 (0.54-1.91)  
College of Physicians 2005) 
Bonita et al  (1999) Cited in (Royal 
New Zealand 
Case-control. 215 cases and 
1.66 (1.07-2.57)  
College of Physicians 2005) 
1,366 controls 
Never smokers and former smokers 
who quit > 10 years ago exposed to 
ETS from spouse. 
Sandler et a (1989) cited in (Surgeon 
Washington 
Cohort 1.24 
(1.03-1.49) 
 
General 2006) 
country, Maryland 
U.S.  
 
ETS exposure in the home (self 
reported) 
EN 
153  
 
E

 
Respiratory effects in Adults from exposure to SHS (e.g. Asthma and 
COPD) 

Table 15 Relative risk of adult onset asthma for non smokers exposed to home and/or work ETS 
Reference 
Location  
Type of study 
RR (95% CI) 
(Number of 
participants) 

Robbins et al (1993) as cited in (NHS Health 
California, 
Cohort (3,917)  
1.57 (0.81-2.97) 
Scotland, Ludbrook et al. 2005) 
U.S. 
Self-reported astham 
Home and work 
Leuenberger et al (1994) as cited in (NHS Health 
Switzerland Cross 
sectional 
  1.39 (1.04-1.86) 
Scotland, Ludbrook et al. 2005) 
(4,197) 
Self-reported asthma 
Home and/or work SHS in the past 12 months 
among lifetime non-smoking Swiss adults 
Jaakola  et al (2003) as cited in (NHS Health 
Finland 
Case control (521)  
1.66 (0.99-2.78) 
Scotland, Ludbrook et al. 2005) 
Home and work 
ETS exposure in the previous 12 months 
(Surgeon General 2006)  
 Review 
40-60% 
ETS exposure (versus none) at home or work 
 
Table 16 Relative risk of adult onset asthma for non smokers exposed to home ETS (women only) 
Reference 
Location  
Type of study (Number of 
RR (95% CI) 
participants) 
Ng et al (1993) as cited in 
Singapore 
Cross sectional (1,438) 
1.6 (0.69-3.70) 
(NHS Health Scotland, 
Ludbrook et al. 2005) 
Self-reported adult onset 
asthma. 
Home (live with heavy smoker - 
more then 20 cigarettes/day) 
 
Table 17 Relative risk of adult onset asthma for non smokers exposed to work ETS 
Reference 
Location  
Type of study (Number of 
RR (95% CI) 
participants) 
Greer et al (1993) as cited in 
California, U.S.  
Cohort (3,577) 
1.5 (1.2-1.8) 
(Surgeon General 2006) 
EN 
154  
 
E

 
Self-reported asthma 
Amongst population of 3,577 
Seventh Day Adventists between 
1977 and 1987 
McDonnell et al (1999) as cited in  California, U.S. 
Case control (521) 
1.21 (1.04-1.39) 
(NHS Health Scotland, Ludbrook 
for seven year 
et al. 2005) 
increments-women 
Flodin et al (1995) as cited in 
Sweden 
Case control (79 cases) 
1.5 (0.8-2.5) 
(Surgeon General 2006) 
 
Table 18 Relative risk of COPD for non smokers exposed to home and work ETS 
Reference 
Type of study (Number of 
RR (95% CI) 
participants) 
Robbins  et al (1993) as cited in 
Cohort study 1977-1987 of 3,914 
1.7 (1.3-2.2) 
(Surgeon General 2006) 
adults aged 25 years and older 
Airways Obstructive Disease (self 
reported symptoms and physician 
diagnoses – asthma, chronic 
bronchitis, and emphysema). ETS 
exposure at home and work during 
childhood and adulthood 
Leunberger et al 1994) as cited in 
Cross-sectional survey of 4,197 
1.7 (1.3-2.2) (odds ratio) 
(Surgeon General 2006) 
Swiss adults 18-60 years old 
Self-reported chronic bronchitis. ETS 
exposure at home and work during 
previous 12 months 
Dayal et al (1994) as cited in 
Case control (219 lifetime non 
1.2 (0.8-1.7)  
(Surgeon General 2006) 
smokers versus 657 controls) 
Exposed to less than one pack of 
cigarettes per day (low) 
Obstructive respiratory disease (self 
reported physician-diagnosed asthma, 
chronic bronchitis, or emphysema   
Dayal et al (1994) as cited in 
Case control (219 lifetime non 
1.9 (1.2-2.9) 
(Surgeon General 2006) 
smokers versus 657 controls) 
Exposed to one or more pack of 
cigarettes per day (high) 
Obstructive respiratory disease (self 
reported physician-diagnosed asthma, 
chronic bronchitis, or emphysema   
Forastiere et al (2000) as cited in 
Cross sectional survey of 1,983 
1.75 (0.88-3.47) 
EN 
155  
 
E

 
(Surgeon General 2006) 
nonsmoking women  
Self-reported COPD in 4 areas of 
Italy 
Surgeon General’s (Surgeon General 
Qualitative Evidence synthesis 
1.2-2.0 
2006) 
COPD 
 
Table 19 Relative risk of COPD for non smokers exposed to home ETS from spouse  
Reference 
Condition 
Exposure 
Location  
Type of study 
RR (95% 
(Number of 
CI) 
participants) 
(Royal 
COPD 
Never smokers exposed to ETS 
 
8  
25% (10%-
College of 
from spouse 
43%) 
Physicians 
2005) 
Forastiere et 
Self reported 
 
4 areas of 
Cross sectional 
1.75 (0.88-
al (2000) as 
COPD  
Italy 
survey of 1,983 
3.47) 
cited in 
nonsmoking 
(Surgeon 
women  
General 2006) 
Kalandidi et 
Hospital 
Women’s whose husbands 
 Hospital 
based 
2.6 (90%CI 
al (1987) 
admissions for 
smoked one pack per day or 
Case-control 
1.3-5.0) 
COPD (Chronic 
less (low) 
study(cases: 103 
low 
Obstructive lung 
ever-married 
disease) 
Women’s whose husbands 
women aged 40-73  1.5 (0.8-
smoked more than one pack per 
non-smokers; 
2.7) high 
day (low) 
controls: 179 ever-
married non 
smoking women) 
Hirayama 
COPD mortality 
Spousal smoking (husband 
 Population 
based 
29% (low) 
(1981) 
from 
former smokers or smokes 19 
Cohort study of 
emphysema and 
cigarettes or less per day) (low)  
91,540 
49% (high) 
asthma) 
nonsmoking 
Spousal smoking (husbands 
Japanese 
Results not 
smoked 20 or more cigarettes 
housewives aged 
statistically 
per day) (high)  
40 years and older 
significant. 
 
Sandler et al 
COPD mortality 
Household smoking exposure 
Washington  Cohort study 
5.7 (1.2-
(1989) 
(from 
country, 
among 10,799 
26.8) 
emphysema and 
Maryland, 
residents (life time 
women 
bronchitis) 
U.S.  
nonsmokers) 
(n=13) 
0.9 (0.2-
5.3) men 
(n=6) 
EN 
156  
 
E

 
Respiratory effects in Children from exposure to SHS 
Table 20 Respiratory effects in Children from exposure to SHS 
Reference Condition 
Exposure 
Number 
of RR (95% CI) 
studies in 
meta-
analysis 

(Royal 
Early lower respiratory 
Children exposed when one 
Summary 
60% (47%-74%) 
College of 
illnesses (similar for 
or both parents smoke 
estimates 
Physicians 
wheezing and non-
2005) 
wheezing illnesses) 
(Royal 
Asthma at school age 
Children exposed when one 
Summary 
23% (14%-33%) 
College of 
or both parents smoke 
estimates 
Physicians 
2005) 
(Royal 
“Clinically defined 
Children exposed when one 
Summary 
39% (19%-64%) 
College of 
Asthma” in case control 
or both parents smoke 
estimates 
Physicians 
studies 
2005) 
(Surgeon 
Asthma prevalence 
Children exposed to smoking  12 Studies 
1.26 (1.15-1.38) 
General 2006) 
by either parent, 1976-1999 
that did not 
odds ratio 
adjust for 
potential 
confounders 
(Unadjusted 
pooled odds 
ratio) 
(Surgeon 
Asthma prevalence 
Children exposed to smoking  18 Studies 
1.22 (1.12-1.32) 
General 2006) 
by either parent, 1986-2000 
that adjusted 
odds ratio 
for a variety 
of potential 
confounders 
(Adjusted 
pooled OR) 
(Surgeon 
Asthma prevalence 
Children exposed to smoking  29 studies. 
1.23 (1.14-1.33) 
General 2006) 
by either parent 
Overall 
odds ratio 
pooled Odds 
ratio from all 
the studies, 
using adjusted 
values if 
available 
(Surgeon 
Childhood asthma and 
Maternal smoking 
Meta-analyses  1.31 (1.22-1.41) 
General 2006)  wheeze illness onset 
4 cohort 
studies for the 
first five to 
seven years of 
life 
(Surgeon 
Childhood asthma and 
Maternal smoking 
Meta-analyses  1.13 (1.04-1.22) 
General 2006)  wheeze illness onset 
4 cohort 
studies for 
EN 
157  
 
E

 
school years 
or throughout 
childhood, 
excluding 
infancy  
(Surgeon 
Childhood asthma or 
Smoking by either parent, 
15 case 
1.39 (1.19-1.64) 
General 2006)  wheeze prevalence 
1974-2000 
control 
studies 
(pooled OR) 
(Surgeon 
Childhood asthma or 
Maternal smoking, 1974-
15 case 
1.54 (1.31-1.81) 
General 2006)  wheeze prevalence 
2000 
control 
studies 
(pooled OR) 
(Surgeon 
Childhood asthma or 
Paternal smoking, 1974-
15 case 
0.93 (0.81-1.07) 
General 2006)  wheeze prevalence 
2000 
control 
studies 
(pooled OR) 
B) HEALTH EFFECTS OF ETS EXPOSURE IN CHILDHOOD AND SMOKING IN 
PREGNANCY 

Health effects of exposure to ETS in childhood 
There is conclusive evidence that exposure to SHS in  There is substantial  evidence that exposure to 
children causes: 
SHS in children causes: 
• Cot death 
• Development of asthma in those previously 
unaffected 
• Middle-ear disease (ear infections) 
 
• Respiratory infections 
 
• Asthma attacks in those already affected 
 
• Reduced lung function 
 
Health effects of smoking in pregnancy 
There is conclusive evidence that 
There is substantial evidence that 
There is suggestive evidence that 
smoking in pregnancy causes: 
smoking in pregnancy causes: 
smoking in pregnancy causes: 
• Placental complications 
• Ectopic pregnancy 
• Specific fetal malformations 
• Premature rupture of the 
• Miscarriage 
• Predisposition to smoke in later 
membranes 
life 
• Premature birth 
• Reduced rates of 
• ADHD 
breastfeeding 
• Perinatal death 
• Shorter duration of 
 
breastfeeding 
• Reduced fetal growth (low 
• Asthma 
 
birth-weight baby) 
• Cot death 
• Respiratory symptoms 
 
• Reduced lung function in 
 
 
infancy 
Source: BMA (2007) Breaking the cycle of children’s. exposure to tobacco smoke.
EN 
158  
 
E

 
ANNEX VI– EFFECTS OF SMOKE-FREE POLICIES 
A) SUMMARY OF EVIDENCE FROM SMOKE-FREE JURISDICTIONS 
This Annex provides summary tables for the non-economic and economic 
effects of smoke-free policies. The non-economic effects comprise ETS 
exposure among non-smokers, air quality, population health, smoking 
behaviour, and attitudes and compliance. The economic effects of smoking bans 
relate to the tobacco industry, hospitality sector, and other industries.  
ETS exposure among non-smokers  
The following tables summarise the effects of ETS exposure among non-
smokers using various measures including a) by self-report, b) by cotinine, c) by 
nicotine, and d) general (non-specific).  
Table 21 By self-report 
Study  
Country 
Setting 
Before 
After 
% reduction  
(Edwards, Bullen  New Zealand 
Work 
20% 
8% 
12% 
et al. 2008) 
Previous week in 
2003 compared to 
previous week in 
2006 
(WHO 2007) 
Ireland  
Work 
30 hrs 
0 hrs 
100% 
(Goodman, 
Ireland Pubs 
40 
hrs 
25 
99% 
Agnew et al. 
minutes 
2007) 
Before and one 
year post ban. 
42 Dublin pubs in 
73 bar workers 
Abrams 
et al  U.S. (New York) 
Hospitality  20 hrs 
6 hrs 
70% 
(2006) 
(Eisner, Smith et  U.S. (San 
 
28 hrs 
2 hrs  
93% 
al. 1998) 
Francisco) 
Reduction over 
the previous 7 
days 
Weekly, July 20,  U.S. (New York) 
Restaurant  19.8% 3.1%  16.7% 
2007 
patrons 
EN 
159  
 
E

 
New York Adult 
Bar 
52.4% 13.4% 39% 
Tobacco Survey 
patrons 
(n~2000 residents 
aged  ≥ 18 years). 
Pre: June 26 – 
July 23  2003 vs 
Post: April 1 – 
June 30 2004 
(Farrelly, 
U.S. (New York) 
Hospitality  12.1 
0.2 hrs  98% 
Nonnemaker et al
workers 
hrs 
(95%CI 
2005) 
(n=30, 
(95%CI  -0.1 to 
From baseline to 
p<0.01)  
8.1 to 0.5 hrs) 
12 months follow-
16.3 
up 
hrs) 
(Eisner, Smith et  U.S. (California) 
Bartenders  29 hrs  
2 hrs 
93% 
al. 1998)Median 
self-reported ETS 
per week (p 
<.001) 
 
Table 22 By cotinine (a principal nicotine metabolite and highly specific biomarker in 
saliva, urine, or blood) 
Study  
Country 
Setting 
Before 
After 

reduction 

WHO (2007) 
Ireland  Hospitality   69% 
Post implementation 
(Akhtar, Currie et  Scotland  (in 
children) 
  39% 
al. 2007) 
(Goodman, Agnew  Ireland 
Dublin bar men   
 
81% 
et al. 2007) 
(n=81) 
42 pubs. Before and 
one year post ban. 
(Semple, 
Scotland  
2.94 
0.41 
12% 
Maccalman  et al
ng/ml-1 
ng/ml-1 
2007)Pre and one 
year post ban 
Fernandez  et al,  Spain 
Work: Total ban  
 
 
53.1% 
ECTH (2007) 
Work: Designated   
 
21.4% 
areas 
Work: 
No 
  14.8% 
EN 
160  
 
E

 
restrictions 
Haw S, TSFS 
Scotland 
Public and private  0.57 
0.38 
33% 
Adult, non smokers, 
places 
ng/ml 
ng/ml 
aged 18-74 years old 
Haw S, TSFS 
Scotland 
Public and private   
 
49% 
Adult, non smokers, 
places 
aged 18-74 years old 
in non- smoking 
households 
Haw S, TSFS 
Scotland 
Public and private  0.92 
0.81 
12% 
Adult, non smokers, 
places 
ng/ml 
ng/ml 
aged 18-74 years old 
in smoking 
households 
(Mulcahy, Evans et  Ireland  
Hotel employees 
1.6 
0.5 
69% 
al. 2005) 
ng/mL 
ng/mL 
Median cotinine 
concentration 
(Mulcahy, Evans et  Ireland  
Bars 
35.5 
6.0 
83% 
al. 2005) 
µg/m3 
µg/m3 
(Mulcahy, Evans et  Ireland  Bars 
  69% 
al. 2005) Sample 
from 20 Galway city 
centre bars among 
35 hospitality 
workers at 15 hotels 
(Allwright 2004) 
Northern 
Ireland 
Bars 
  80% 
Control: 22.5% 
reduction in 
Northern Irish staff 
(Semple, 
Scotland Bar 
3.25 
0.55 
83% 
Maccalman  et al
ng/ml 
ng/ml 
2007) Feb 2006 to 
Feb 2007 
Weekly, July 20, New York 
 
0.078 
0.041 
47.4% 
2007 
ng/mL 
ng/mL 
New York Adult 
Tobacco Survey 
(n=1,594 saliva 
samples amongst 
non-smoking 
residents aged ≥ 18 
years). Pre: June 26 
– July 23  2003 vs 
Post: April 1 – June 
30 2004. Geometric 
EN 
161  
 
E

 
mean levels. 
(Menzies, Nair et al.  Scotland Bar 
workers 
5.15 
3.22 
(-1.93 
2006) 
ng/mL 
ng/mL 
ng/mL 
Serum cotinine 
95% CI -
levels (one month 
2.83 to -
after ban) 
1.03 
P<.001 
ng/mL) 
(Menzies, Nair et al.  Scotland Bar 
workers 
5.15 
2.93 
(-2.22 
2006) 
ng/mL 
ng/mL 
ng/mL 
Serum cotinine 
95% CI -
levels (two months 
3.10 to -
after ban) P<.001 
1.34 
ng/mL) 
Fernando 
et al.  New Zealand 
Non-smoking 
0.66 
0.08 
88% 
(2007) Average 
volunteers in bars  ng/ml 
ng/ml 
increase in cotinine 
before and after a 
3hr visit to 30 bars 
in 3 cities. 
Pre: Winter and 
Spring 2004 
Post: Winter and 
Spring 2005 
(NHS Health 
Scotland   
  39% 
Scotland, Ludbrook 
et al. 2005) 
SHS exposure in 
non-smoking adults 
and children 
(Cotinine) 
(Farrelly, 
U.S. (New York)  Hospitality 
3.6 
0.8 
78% 
Nonnemaker  et al
workers (n=24, ng/ml 
ng/ml 
2005) 
p<0.01)  
(95%CI  (95%CI 
From baseline to 12 
2.6 to 0.4 to 
months follow-up 
4.7 
1.2 
ng/ml) 
ng/ml) 
(Haw 2007) 
 
Scotland   
  89% 
Mean salivary 
cotinine one year 
post implementation 
 
Table 23 By nicotine  
Study  
Country 
Setting 
Before 
After 

reduction  

EN 
162  
 
E

 
WHO (2007) 
Ireland 
Bars 
 
 
83% 
(Lopez, Nebot et al. 2007)  Spain 
Hospitality  
88% 
60% 
28% 
Pre and post after one year.  
Public administration   
 
50% 
Universities  
 
65% 
Private sector 
 
 
100% 
Gorini  et al, ECTH (2007)  Italy (vs Austria) 
Hospitality  
44.07 
1.34 
97% 
In Austria: Before 24.53 
µg/m3  
µg/m3 
µg/m3  and after 24.14 
µg/m3g 
Discos 86.63 
1.94 
98% 
µg/m3 
µg/m3 
(Gorinin, Costantini et al.  Italy  
Bars 
19.02 
0.25 
99% 
2007) 
µg/m3  µg/m3 
Study locations: Florence 
and Belluno. Pre and two   Restaurants 
 
2.03 
0.10 
95% 
years post ban in sample of 
µg/m3  µg/m3 
28 bars. 
 Discos/pubs 
35.16 
0.01 
99% 
µg/m3  µg/m3 
Ellingsen et al (2006) 
 Bars/restaurants 
 
28 
0.6 
99% 
µg/m3 
µg/m3 
13 study sites 
(Johnsson, Tuomi et al.  Finland  
In food and dining  0.7 
0.6 
14% 
2006) Enforcement Finnish 
restaurants   
µg/m3 
µg/m3 
Tobacco Act (1 July 2003). 
Smoking allowed in 50%   
Bars and taverns  
10.6 
12.7 
+20% 
of service area (if service 
µg/m3 
µg/m3 
area >50m2 provided 
smoke does not spread in   
Discos and 
15.2 
8.1 
47% 
area where smoke 
nightclubs 
µg/m3 
µg/m3 
prohibited. N=16 
establishments across 3  
All establishments 
7.1 
7.3 
+0.1% 
Finnish cities. 
µg/m3 
µg/m3 
Nicotine: Geometric mean 
in establishments. 
 
Table 24 General (non-specific ETS exposure) 
Study  
Country 
Setting 
Before  After 
% reduction  
(Brownson, 
Multiple 
Work 
 
 
-60% (+4% to -
Hopkins  et al
97%) 
2002) 
EN 
163  
 
E

 
Hopkins  et al  Multiple  
  
60.5% 
(2001) 
(Andreeva 
Ukraine  
Work: 
 
 
OR 0.504 (95%CI 
2007) 
Complete ban 
0.335-0.758) 
Ukraine Work: 
restricted 
 
 
OR 0.622 (95% CI 
to isolated 
0.442-0.873) 
premises 
Ukraine Work: 
Non-  
 
OR 0.806 (95% CI 
isolated 
0.544-1,195) 
premises 
(Skeer, Cheng Massachusetts 
Designated 
 
 
2.9 times the odds 
et al. 2005) U.S. 
smoking areas 
of being exposed
n=3650 adults 
at work 
 
vs employees 
1.74 times the 
complete 
duration of 
smokefree ban 
exposure 
(Skeer, Cheng Massachusetts 
No restrictions   
 
10.27 times the 
et al. 2005) U.S. 
at work 
odds of being 
n=3650 adults 
exposed 
(survey) 
 
vs employees 
6.34 times the 
complete 
duration of 
smokefree ban 
exposure 
 
Table 25 Impact on air quality (PM2.5) 
Study  
Country 
Setting 
Before 
After 

reduction  

(Goodman, Agnew et al.  Ireland Bars 
   83% 
2007) 
42 Dublin pubs. Pre and 
post ban. 
(Semple, Maccalman et al.  Scotland Bars  
  86% 
2007) 
Baseline and 2 months 
after ban in 41 pubs in 5 
locations. 
(Office of Tobacco Control  Ireland Pubs 
40.2 
µg/m3 5.0 
µg/m3 88% 
2005) 
Dublin pubs - Pre and one 
year after ban 
EN 
164  
 
E

 
(Semple, Maccalman et al.  Scotland  
 
167 g/m3 16 
91% 
2007) 
g/m3 
Travers  et al (2004) U.S.A (New 
 412 
µg/m3 27 
µg/m3 93% 
14 bars where smoking  York) 
been allowed pre-ban  
Reaney (Reuters) 
Ireland Bar 
workers 
  
53% 
in pubs  
Pre and after one year of 
87.6% 
ban. 
(PM10) 
 
(Office of Tobacco Control  Ireland Irish 
pubs 
340 
µg/m3 23 
µg/m3 93% 
2005) U.S. & international 
Smoking pubs (n=87) (in 
pre column)  versus smoke-
free Irish pubs (n=41) 
(Alpert, Carpenter et al.  Massachusetts 
Hospitality 
  
93% 
2007) 
(U.S.) 
venues 
N=27 hospitality venues 
Lee et al (2007) 
Georgetown, 
Hospitality 
84 µg/m3 18 
µg/m3 79% 
Kentucky, U.S.   
venues and 
N=9 hospitality venues and 
one bingo 
one bingo hall. Average 
hall  
indoor concentrations. Pre 
and one week after 100% 
smoke-free workplace law. 
Lower level was sustained.  
Cummings, M (2007) Global  
 
182 µg/m3 23 
µg/m3 87% 
International Tobacco 
Control 
Results of global air 
monitoring studies: 2.531 
locations in 32 countries. 
Smoking versus smoke-
free 
 
Study 
Setting 
No. times PM2.5 higher in 
Hyland et al (2008) 
places with smoking vs no 
smoking  

PM2.5 in 1,822 bars, restaurants, retail 
outlets, airports, and other workplaces  Overall places  
8.9 (95% CI 8 to 10) 
in 32 geographically dispersed 
countries. 
Bars 
15.4 (95% CI 12.5 to 34.5) 
NB: A summary of smoke-free versus 
smoking places by country is available.  

Restaurants 
6.2 (95% CI 5.3 to 7.2) 
EN 
165  
 
E

 
Transportation places 
8.8 (95% CI 5.4 to 14.2) 
Other places 
7.0 (95%CI 5.4 to 9.0) 
Smoking and smokefree venues in  7.5 (85%CI 5.9 to 9.7) 
29 countries without 
comprehensive clean indoor air 
policies compared to Ireland, New 
Zealand and Uruguay.  
Health effects 
Table 26 Coronary events (Hospital admissions) 
Study  
Country 
Before 
After 
% reduction  
(Cesaroni, Forastiere et al. 2008) 
Italy  
 
 
11.2%  (95%CI 
6.9% - 15.3%) 
Acute coronary event (out of 
hospital deaths and hospital 
admissions) for residents aged 35-
64 years old
. Time period: 2000 
and 2004 -05 and after smoking 
ban in Jan 2005. 
(Cesaroni, Forastiere et al. 2008) 
Italy  
 
7.9% 
(95%CI 
3.4% - 12.2%) 
Acute coronary events (out of 
hospital deaths and hospital 
admissions) for residents aged 65-
74 years old
. Time period: 2000 
and 2004 -05 and after smoking 
ban in Jan 2005. 
(Barone-Adesi, Vizzini et al.  Italy  
 
0.7% 
2006) 
AMI in six months after ban 
NHS Health Scotland (NHS Scotland  
 
17% 
Health Scotland, Ludbrook et al
2005) 
Heart attacks admitted to 9 major 
Scottish hospitals one year post 
ban. (Average reduction of 3% 
per annum in the 10 years leading 
up to ban) 
Howell et al, ECTH (2007) 
Ireland  
0.10 
1.03 
 
AI coronary events (hospital 
admissions per week) 
(Redpath 2007) 
Scotland 
-4.7% (95%CI - -25.1% 
20.4% 
EN 
166  
 
E

 
4.9 to -4.5) 
(95%CI  -38.7 
Average annual change in 
 
to -8.4) 
incidence MI 
(Redpath 2007) 
Scotland 
-3.4% (95%CI - -24.9% 
21.5% 
3.6 to -3.2) 
(95%CI -41.3 
Average annual change in  MI 
to -3.8) 
(admissions) 
(Redpath 2007) 
Scotland 
-6.67% (95%CI - -17.7% 
11% 
6.94% to -6.39%  (95%CI -39.4 
Average annual change in  MI 
to -11.8) 
(deaths) 
(Spizzichino 2007) 
Italy  
 
 
7% 
AMI in 2005. AMI absolute 
numbers increased overtime 
2001-04. 
Cited in (WHO 2007) 
Italy  
 
20% 
Heart attack - Piedmont region 
Le Figaro, 22 February 2008 France  
 
15% 
National Sanitary Institute. 
Admissions to emergency wards 
for myocardial infarction since 1st 
Jan 2008 (compared to Jan and 
Feb 2006 and 2007). This is 
equivalent to reduction of 10,000 
heart attacks in 2008.  
Lemstra et al (2008) 
Canada 176.1 
cases 
per 
152.4 cases 
13% 
100,000 pop 
per 100,000 
Age standardised incidence 
(95% CI 165.3 –  pop (95% CI 
(hospital discharges) rate for 
186.8) 
135.3 – 169.3) 
acute MI from July 1 2000 to June 
30 2004) to July 1 2004 to June 
30 2005). 
Bartecchi et al (2006) 
U.S. 
  
27% 
(Colorado) 
AMI hospitalisations among 
residents in Pueblo, 18 months 
pre and post ban in licensed 
venues. 
(Samet 2006)  
Helena, 
  
40% 
Montana 
Admissions for AMI during 6  U.S.  
months of ban. Admission rose 
after public smoking ban lifted.  
 
EN 
167  
 
E

 
Dong-Chul and Torabil (2007) 
Monroe 
17 

-12 (-21.19 to -
Country 
2.81) or 71% 
Hospital admissions for AMI  (U.S.) 
among non-smoking patients in 
Monroe County [pre public 
smoking ban: August 2001 to 
May 2003 versus post: August 
2003 to May 2005).
No significance difference (17 vs 
18) pre implementation of 
smoking ban between Monroe 
Country and Delaware County. 
Delaware County (control): pre: 
18 versus post: 16. 
(Sargent, Shepard et al. 2004) 
Helena, 
 
 
RR 0.60 (95%CI 
Montana 
0.21 - 0.99) 
Hospital discharge rates for AMI 
(304 cases in study) 
Bartecchi et al (2006) 
Pueblo, 
 
 
RR 0.73 (95%CI 
Colorado 
0.63 - 0.85) 
Hospital discharge rates for AMI 
(2794 cases in study) 
(Barone-Adesi, Vizzini et al.  Piedmont, 
 
 
RR 0.89 (95%CI 
2006) 
Italy 
0.81 - 0.98) 
Hospital discharge rates for AMI 
in person under 60 (4213 cases in 
study) 
Khunder et al (2007) 
Bowling 
 
 
RR 0.61 (95%CI 
Green, 
0.55 - 0.67) 
Hospital discharge rates for Ohio 
ischemic heart disease and heart 
failure (1109 cases in study)  
Dinno & Glantz (in press) Meta 
 
 
RR 0.73 (95%CI 
Pooled estimate (random effects 
0.56 - 0.89) 
model) for above 4 studies. 
Irish Independent, 5 Sept 2007 Ireland  
 
11% 
Heart attack hospital admissions 
in the South-West Public 
hospitals, after year of ban 
NYS Dept of Health, 28 Sept  New 
  
8% 
2007. 
York, U.S. 
Hospital admissions for AMI in 
NY State in 2004 (smoking ban 
took effect July 2003) 
 
EN 
168  
 
E

 
Table 27 Respiratory symptoms 
Study  
Country 
Setting 
Before  After 

reduction 

(Allwright 2004) 
Ireland  
Bar workers 
 
 
16.7% 
Fernandez E, TSFS Spain Work 
   39.2% 
(2007) 
Ayres, TSFS (2007) 
Scotland Bar 
workers 
67% 54% 13% 
N=371 bar workers: 
baseline and one year 
after ban. 
(Semple, Maccalman et  Scotland  
73% 57% 16% 
al. 2007) 
pre (Feb 2006) and one 
year after ban (Feb 
2007) 
(Menzies, Nair et al.  Scotland Bar 
workers 
79.2% 
53.2% 
26% 
2006) 
(95%CI 
Respiratory and sensory 
13.8% to 
symptoms (one month 
38.1%) 
after ban) P<.001 
(Menzies, Nair et al.  Scotland Bar 
workers 
79.2% 
46.8 32.5 
(95% 
2006) 
19.8% to 
Respiratory and sensory 
45.2%) 
symptoms (two months 
after ban) P<.001 
Reaney (Reuters) 
Ireland 
Bar workers in    30% 

pubs  
40% 
Decrease in symptoms 
both respiratory and 
irritant. Pre and after 
one year of ban. 
(Farrelly, Nonnemaker U.S. (New Hospitality 
88% 
38% 
50% 
et al. 2005) 
York) 
workers 
(95% 
(95%CI 
From baseline to 12 
CI 
20% to 
months follow-up. 
66% to  59%) 
Sensory symptoms 
95%) 
(n=24, p<0.01). 
No change in overall 
prevalence of upper 
respiratory symptoms, 
p<0.16)   
(Eisner, Smith et al.  U.S. 
Bartenders (n=39) 
 
 
41% 
1998) 
(California) 
Respiratory symptoms 
EN 
169  
 
E

 
p<0.001 
(Eisner, Smith et al.  U.S. 
Bartenders (n=41) 
 
 
22% 
1998) 
(California) 
Sensory irritation 
 
symptoms p<0.001 
 
Table 28 Other disease  
Study  
Country 
Disease 
Before 
After 

reduction 

Cited in European 
14 countries  Incidence lung 
  30% 
Respiratory Society 
in Europe  
cancer 
(2008) 
Cited in European 
 Incidence 
asthma 
 
 
8% 
Respiratory Society 
(2008) 
(Menzies, Nair et al.  Scotland Bar 
workers 
34.3 27.4 
0.8 fold 
2006) 
ppb 
ppb 
change 
Airway inflammation in 
(95%CI 
Asthmatic bar workers 
0.67 to 
exhaled nitric oxide (one 
0.96 ppb) 
month after ban) P<.04 
 
Effects on smoking behaviour 
Table 29 Smoking prevalence in Europe 
Study  
Country 
Setting 
Before  After 

reduction 

(Fong, Hyland et al
Ireland 
Work 62% 
14% 
16% 
2006) 
Restaurants  
85% 
3% 
82% 
Bars/pubs 98% 
5% 
93% 
Shopping malls 
40% 
3% 
37% 
(Heloma, Kahkonen 
Finland  
 
 
 
5% 
et al. 2000) 
Among workers 
Gorini et al (2007) 
Norway  
27.3% 
24.5% 
2.8% 
Daily smokers aged 
EN 
170  
 
E

 
16-74 years in 2003 
vs 2006  
Braverman et al 
Norway 
Any  
 
3.6% 
(2007)  
Work  
 
6.2% 
Daily smoking. 
Baseline and 4 
months post 
implementation. No 
significant change in 
these variaggbles 
between 4 an 11 
months post 
implementation.   
 
Greiner BA, Mullally  Ireland  
24.7% 
22.9% 
1.8% 
BJ et al ECTH,  
Switzerland, 11-13 
Oct 2007 
Pre ban and post ban 
after 3 months 
(Gallus, Zuccaro et 
Italy  
 
26.2%  24.3% 
1.9% 
al. 2006) 
(2004)  (2006) 
March-April 2004 
versus same period 
in 2005 and 2006. In 
2005 prevalence 
25.6%. 
Deputy Chief 
England  
 
24% 
22% 
2% 
Medical Officer, 
Department of 
Health, England 
(Presentation)  
Adult smokers (no 
dates specified)  
Office of Tobacco 
Ireland  
26.4 
25.7 
1.4% 
Control Annual 
report (2006). 
In March 2004 
versus March 2006 
 
Table 30 Smoking prevalence outside Europe 
Study  
Country 
Setting 
Before 
After 

reduction 

Gorini et al (2007) 
California  
18.8% 
14.7% 
4.1% 
1992-3 vs 2001-02. 
% reduction in the 
EN 
171  
 
E

 
rests of U.S. was 
14%. 
Lemstra  et al 
Canada  
24.1% 
18.2% 
5.9% 
(2008) 
Saskatoon. Time 
period: 2003 (pre-
ban) to 2005 (post 
ban). Smoking 
prevalence in 
Saskatchewan 
remained 
unchanged at 
23.8%. 
(Fichtenberg and 
 Workplaces 
  3.8% 
Glantz 2002) 
(amongst 
employees) 
Meta analysis of 26 
studies 
(Brownson, 
   16% 
26.4% 
 
Hopkins et al. 2002) 
workers employed 
in smoke-free 
workplaces vs no 
smoking 
restrictions.  
(NHS Health 
Multiple  
 
 
3.8% 
to 
Scotland, Ludbrook 
20% 
et al. 2005) 
Review. 
(Fichtenberg and 
Multiple  
 
 
3.8% 
Glantz 2002) 
(2.8% to 
4.7% 
Review. Amongst 
employees. Effect 
sizes were about 
half this size in 
workplaces where 
partial restrictions 
were already 
present.  
Levy et al (2007) 
Thailand Workplace 
total 
  3% 
(with 
Review of literature 
ban 
variation 
to determine inputs 
by age 
and effect sizes for 
and 
the SimSmoke 
gender) 
model.  
  
Workplace 
partial 
 
 
2%  (with 
ban, requiring 
variation 
ventilation 
by age 
EN 
172  
 
E

 
(smoking 
and 
restricted to 
gender) 
ventilated areas in 
all indoor 
workplace) 
  
Workplace 
partial 
 
 
1%  (with 
ban limited to 
variation 
common areas 
by age 
(smoking limited 
and 
to non-ventilated 
gender) 
common area) 
  
Restaurant 
total 
  1% 
ban  
  
Restaurant 
partial 
  0.5% 
ban (ban in all 
restaurants except 
in designated 
areas) 
  
Other 
place 
bans 
  1% 
(ban in 3 of 4 
locations – malls, 
retails stores, 
public 
transportation, and 
elevators) 
U.S. study cited in 
U.S.  
 
 
5.7% 
(The Smoke free 
Partnership 2006) 
Versus 2.6% 
reduction in 
smoking prevalence 
if partial ban. 
 
Consumption 
Table 31 Individual Consumption   
Study  
Country 
Setting 
Before  After 
reduction 
in 
number of 
cigarettes smoked 

(Brownson, 
Multiple Work 
place 
 
 
1.2 (0 to -4.3) per 
Hopkins  et al
bans 
day 
2002) 
Follow up 
periods of up to 
EN 
173  
 
E

 
two years. 
Review 
(Fichtenberg and  Multiple  
Workplace bans   
 
3.1 per day 
Glantz 2002) 
Meta analysis of 
26 studies. For 
Active smokers.  
(NHS Health 
 
Workplace 
 
 
1.2 – 3.1 per day 
Scotland, 
Ludbrook  et al
2005) 
Review 
(Heloma, 
Finland  
19 
16 

Kahkonen  et al
2000) 
(Gallus, Zuccaro  Italy  
 
15.4 
13.9 
9.7% per day 
et al. 2006). In 
(2004)  (2006)
2005 smokers 
 
consumed 14.6 
cigarettes per 
day.  
Braverman  et al  Norway 
Any  
 
1.55 
(2007) 
Continuing 
At work 
 
 
1.63 
smokers. 
Baseline and 4 
months after ban. 
(Andreeva 2007) 
Ukraine  
Work (complete    3.08 
ban) 
Work (isolated   2.39 
premises) 
Office of Ireland Occasional 
 
(1-5 
  +2.2% 
Tobacco Control 
per day) 
Annual report 
(2006) 
 
Light (6-10 per    -1.2% 
2005 and 2006 
day) 
Regular (11-20    -0.3% 
per day) 
Heavy (21+ per    -0.7% 
day) 
 
EN 
174  
 
E

 
Table 32 Total consumption 
Study 
 
Country 
Before After  Reduction in tobacco 
consumption 
(Cesaroni, Forastiere 
Italy 
34.9% 30.5% 4.4% 
et al. 2008) 
20.6% 20.4% 0.2% 
Rome. Frequency of 
cigarette smoking. 
Time period: 2000-04 
and after smoking ban 
Jan 2005.  
(Fichtenberg and 
  
 
29% 
Glantz 2002) Meta 
analysis of 26 studies. 
For Active smokers. 
World Bank cited in   
 
 
4 to 10% 
(WHO 2007) 
(WHO 2007) 
Multiple  
 
29% 
Review. 
Champan et al 
U.S.   
 
 
12.7% 
Review. Time period: 
1988-1994 
Pisano M (2008) 
Italy 
 
 
8% 
Salton  et al ECTH  Spain  
 
28.4% 
(2007) 
Daily consumption.  
Greiner  et al, ECTH  Ireland 65% 
46% 
 
(2007) 
Pre and 3 months 
after ban.  
(Evans, Byrne et al.  U.S.  
 
 
10% 
2007) 
(Gallus, Zuccaro et al.  Italy  
  7.6% 
2006) 
March-April 2004 
 
 
23% (15-24 year olds) 
versus same period in 
2005. 
  10.5% 
(women) 
Survey in March 
April 2004 vs 
comparison survey in 
EN 
175  
 
E

 
2005 
 
Cessation  
Table 33 Cessation attempts 
Study 
 
Country  Increase in cessation 
attempts 
(Brownson, Hopkins et al. 2002) 
Multiple 
73% (-3.2% to 272%) 
Review. Median change or difference in cessation 
attempts (measured and self-reported) in smokers 
exposed to workplace ban vs lesser or no ban. 
NCI (Brownson, Hopkins et al. 2002) 
Multiple 
OR: 1.09 (95%CI 1.00 – 
Review 
1.18) 
(Fong, Hyland et al. 2006) 
Ireland 46% 
Survey of 640 smokers. Other findings: Amongst 
smokers who quit since ban, 80% reported ban helped 
them quit, 88% said helped stay quit, and 34% more 
likely to use NRT.  
Greiner BA, Mullally BJ et al ECTH,  Switzerland, 
 
11.6% (pre) to 9.9% 
11-13 Oct 2007 
(post) 
Proportion of heavy smokers: Pre ban and post ban 
after 3 months.  
Greiner BA, Mullally BJ et al ECTH,  Switzerland, 
Ireland  
25% (pre) to 28.3% (post) 
11-13 Oct 2007 
Proportion of light smokers: Pre ban and post ban 
after 1 year.  
Media release, August 1 2005, Quit Organisaiton. 
Australia 
27% 
Increase in calls to quit line in first month following 
(VIC) 
smoking ban July 1, 2007.  
BBC News, 22 March 2007. 
Scotland 40% 
Increase in number of people contacting smoking 
cessation services in the three months prior to the ban 
 
Table 34 Actually quit smoking  
Study  
Country 
Quitting  
(Gorini, Moshammer et al. 2007) Survey Jan-
Italy  
15% 
April 2005 among owners of 1641 bars, 
restaurants, pizzerias, and pubs in N. Italy. 
Smoking owners who quit after the ban. 
EN 
176  
 
E

 
NCI (Brownson, Hopkins et al. 2002) 
 
OR: 1.34 (95%CI 1.10 to 1.63)  
OR of being former smoker of 3 months or more. 
Review 
(Directorate for Health and Social Affairs 2005) 
 10% 
Employees (1 out of 10 employees quit smoking) 
Salto E, Valverde A et al ECTH,  Switzerland, 
Spain 9.1% 
11-13 Oct 2007 
Information Centre for Health and Social Care, 
England and 
28% 
Department of Health (2008) 
Wales 
165,000 smokers quit April – Sept 2007 
Media release, Quit 1 October 2004 
Australia (VIC) 
28% 
The percent of smokers who are “somewhat or 
very likely to quit smoking” with smokefree ban 
in pubs, clubs, and gambling venues.  
(Helakorpi, Patja et al. 2007) 
Finland  
OR: 0.83 (95% CI 0.73 – 0.94) 
OR for daily smoking after 1995 for Employed 
men. 
(Helakorpi, Patja et al. 2007) 
Finland  
OR: 0.78 (95% CI 0.68 – 0.91) 
OR for daily smoking after 1995 for employed 
women 
(Surgeon General 2006) 
U.S. 
1.3 million smokers quitting 
If U.S. workplaces implemented 100% smokefree 
policy 
 
Table 35 Uptake/Initiation of Smoking 
Study  
Country 
Setting 
Before 
After 
Uptake  
(Spizzichino 2007) Italy  
26.5% 
27.7% 
1.2% 
2003 to 2005. Males 
aged (18-19 years 
old) 
Spizzichino, L cited  Italy  
 
21.3% 
21.6%  0.3% 
in TSFS, Edin, 
Scotland 
2003 to 2005. 
Females aged (20-24 
years old) 
(Andreeva 2007) 
Ukraine  
 
 
 
OR: 
0.517  
(95%CI 
0.262 – 
1.017) 
EN 
177  
 
E

 
 
Table 36 Youth smoking behaviour  
Study  
Country 
Impact  
% Reduction 
(WHO 2007) 
 
Reduction 
in  17.2%  
prevalence amongst 
teenagers living in 
communities with 
smokefree law versus 
none 
(Farkas, Gilpin et al.  U.S.  
Ever-smoking 
26% (95%CI 12 – 38%)  
2000) 
prevalence amongst 
Based on two 
employed 15-17 year 
national surveys 
olds living in smoke 
conduction in 1993-
free home vs homes 
93 and 1996-7.  
with no smoking 
restrictions 
(Farkas, Gilpin et al.  U.S.  
Ever-smoking 
32% 
2000) 
prevalence amongst 
Based on two 
employed 15-17 year 
national surveys 
olds working in 
conduction in 1993-
smoke free 
93 and 1996-7. 
workplace versus 
workplace with no 
smoking restrictions 
 
Table 37 Domestic trickle down 
Study  
Country 
Impact  
Before 
After 
% reduction  
(Evans, Byrne et al. 
Ireland Smoking 
at 
58% 50% 5% 
2007) 
home 
Smoking at home 
(Andreeva 2007) Edin,  Ukraine  
 
 
 
1.44 (95% 1.03 
Scotland 
– 2.01) 
Chances of household 
restrictions with 
smoking restrictions to 
isolated premises at 
their work 
(Edwards, Bullen et al
  
 
20% 
2008) 
Self-reported ETS in 
New Zealand 
all households. (42% 
of household had one 
EN 
178  
 
E

 
or more smoker) 
(Fong, Hyland et al
Ireland  
 
85% 
80% 
5% 
2006) 
Smoking allowed in 
the home. 
This was similar to 
decrease from 82% to 
76% over same period 
for UK. 
 
Attitudes and social norms  
Table 38 European countries  
Author Country 
Key 
finding 
(European Commission 2007)   EU 
Most people totally or somewhat in favour of smoking bans 
Attitudes of European’s 
in offices, and other indoor workplaces (86%), and indoor 
towards tobacco” 
public space (84%), restaurants (77%) and bars or pubs 
(61%). Only 9% and 16% of people were totally opposed to 
smoking bans in restaurants and bars or pubs, respectively.  
(Gallus, Zuccaro et al. 2006) 
Italy  
In 2001, 83.3% were favourable to a smoking ban in public 
places, such as pubs or restaurants. This figure increased to 
over 90% 
Based on a survey of 3114 Italian adults interviewed in 
March-April 2005, the degree in favour of separate 
smoking areas in cafes, restaurants, and other areas open 
to the public, and smoking ban in their absence:  

All the population: Strongly in favour: 68.1%  Strongly 
against: 2.7% 
Current smokers only: Strongly in favour: 44.4%  Strongly 
against: 6.6% 
Extension to forbid smoking in every workplace, including 
private ones  

All the population: Strongly in favour: 55.5%  Strongly 
against: 2.9% 
Current smokers only: Strongly in favour: 33.5%  Strongly 
against: 8.5% 
(Directorate for Health and 
Norway  
Support for the Smokefree law increased from 47% in 
Social Affairs 2005) 
survey six month before to 58% six months after 
implementation. In different national surveys support for 
smokefree bars and restaurants increased from 54% before 
the legislation to 68% one year after. A survey in May 
2005, a year after the legislation, found that 77% though the 
EN 
179  
 
E

 
law had been a success. Among a cohort of hospitality 
industry employees (from 48% pre to 51% three months 
post implementation, with 18-22% neutral and the 
proportion opposed remaining at 30-31%. 
(Hilton, Semple et al. 2007) 
Scotland 
Bar workers agreed with the proposed legislation on 
smoking went from 69% (before) to 79% (post 
implementation, and the need to protect the health of 
workers, 80% (before) to 81% (post). 49% thought the 
legislation would harm business (before) to fewer than 20% 
(post). Legislation would encourage smokers to quit showed 
reduced support, 70% pre-implementation to 60% post 
implementation. 
Mullally BJ et al ECTH,  
Ireland 
General public agreed SHS exposure raises NS' risk of 
Switzerland, 11-13 Oct 2007 
asthma (84% to 92%), of lung cancer (86% to 94%), of HD 
(76% to 88%). Bar workers identified SHS as risk factor for 
all 3 diseases, percentage was substantially lower than GPs 
or general public. 42% of NS bar workers felt they had 
moderate risk of lung cancer. 
49% staff supported the ban before implementation and 
50% after, with no differences according to the type of 
facility. Bar staff (and customers) in affluent areas were 
more likely to support the ban both pre and post 
implementation (p<0.001). Customer complaints were more 
Richmond, L cited in TSFS, 
common in deprived areas (p<0.001) and deprived areas 
Scotland 
Edin, Scotland 
were more likely to report a decline in business, and less 
likely to report improvements (p<0.001). In the most 
affluent areas, 97% reported that customers supported the 
ban pre and post implementation. In the most deprived 
group, only 11% initially supported the ban but this 
increased to 14% after implementation.  
In 1974 85% Finnish adult population in favour prohibiting 
Hara, M cited in TSFS, Edin, 
smoking in public places. In 2005 62% (and 77% in 2007) 
Finland 
Scotland 
thought smoking should be prohibited in restaurants and 
bars. In 2007 13% were strictly against restrictions.   
Support for the Irish smoke free law among the public 
(Office of Tobacco Control 
Ireland  
increased from 67% before, to 82% four months after 
2005) 
implementation, and 93% after one year.   
Support for total bans among Irish smokers increased in all 
venues, including workplaces (43% to 67%), restaurants 
(45% to 77%), and bars/pubs (13% to 46%). Overall 83% of 
Irish smokers reported that the smoke-free law was a 
(Fong, Hyland et al. 2006) 
Ireland 
“good” or “very good” thing. 
Based on prospective cohort study of adult smokers in 
Ireland surveyed before the law (Dec 2003-Jan 2004) and 8-
9 months after the law (Dec 2004-Jan 2005).  
Percentage support among smokers for smoke-free policy: 
(Royal College of Physicians 
Pre-policy (Dec 2003-Jan 2004) to post-policy (Dec 2004-
Ireland 
2005) 
Jan 2005): 
Workplaces: 38% to 47% (UK) 
EN 
180  
 
E

 
Workplaces: 44% to 67% (Ireland) 
Restaurants: 33% to 47% (UK) 
Restaurants: 46% to 77% (Ireland) 
Bars/pubs: 6% to 12% (UK) 
6% to 48% (Ireland)  
Survey of approx 288 (pre) and 220 (post – one year after 
ban) bar workers in public houses (pubs) in three areas or 
ROI . 
Support for legislation increased from 59.5% (pre) to 76.8% 
(post). 
Support increased amongst smokers from 39.4% (pre) to 
66.7% (post) (p<0.001) 
Republic  Support increased amongst non-smokers from 66.8% (pre) 
of 
to 81.2% (post) (p=0.003) 
Pursell et al (2007) 
Ireland 
(ROI) 
Percentage agreeing that legislation would make bars more 
comfortable and was needed to protect workers’ health rose 
from 75% (pre) to over 90% (post) (p<0.001). 
Perceptions that legislation has a negative impact on 
businesses rose from 50.9% (pre) to 62.7% (post) (p=0.008) 
and that fewer people would visit pub (41.8% to 62.7%, p 
<0.001).   
Overall support for ban increased two to three-fold post 
implementation.  
Department of Health survey findings 
July 2007: 98% of the general public aware of the law. 75% 
Smokefree England (2008) 
of adults expressed their support for the law and 79% 
www.smokefreeengland.co.uk/  England 
believe new law will have a positive effect on people’s 
thefacts/latest-research.html 
health.  
August 2007: 87% of businesses thought implementation 
gone well and 78% think the legislation is a “good idea”. 
ONS survey (fieldwork Oct and Nov 2006) 
Smokefree England (2008) 
www.smokefreeengland.co.uk/  England 
Support for smoke-free law 77%: 53% of people strongly 
thefacts/latest-research.html 
support the law; 24% support the law; 15% disagree with 
the new law.  
Deputy Chief Medical Officer, 
¾ adults support the smokefree legislation  
Department of Health, 
England 
More smokers agree (47%) than disagree (37%) with the 
England (Presentation)  
legislation  
97.2% compliance with smoking regulation in the year 
(Haw 2007) 
Scotland 
following implementation. Based on 80,832 inspections of 
pubs and other workplaces.  
 
EN 
181  
 
E

 
Table 39 Non-European countries  
Author Country 
Main 
Results 
(Edwards, Bullen et al
By 2006 population surveys showed over 90% agreement, 
2008) 
for the right to live and work in a smokefree environment; 
2003 Smoke-free 
New 
and for indoor workers, including bar and restaurant 
Environments Amendment 
Zealand 
workers, to work in a smokefree environment. Support was 
Act (smoking ban Dec 
similar among men and women, Maori and Non-Maori and 
2004) 
all income groups. Support was less strong among smokers. 
(Edwards, Bullen et al
New 
60-70% before and at the time of implementation, rising to 
2008) 
Zealand 
75%-90% afterwards. 
According to the 2004 Field Research poll: 
-- 90% Californians said they approve of the smoke-free 
workplace law. 
-- 52% of former smokers who quit in the past 10 years said 
that having smoke-free public places made it easier for 
them to quit smoking. 
-- 69% of current smokers who attempted to quit in the past 
Cherner, Smokefree 
U.S. 
10 years said that smoke-free public places helped them 
California 
California 
reduce the number of cigarettes they smoke. 
-- Amongst people who moved to the state after the law 
went into effect, 93% approve of the law and 91% said they 
would recommend that other communities adopt a similar 
smoke-free policy. 
-- 74% Californians, including nearly half of those who 
were smokers, agreed that smoking should be prohibited in 
the outdoor dining areas of restaurants. 
Between 2004 (before) and 2005 (after) public support for 
smokefree bars rose from 56% to 69%.  
Between 2004 and 2005 support for the rights of bar 
Thomson and Wilson 
New 
workers to have smokefree workplaces rose from 81% to 
(2006) 
Zealand 
91%. 
Proportion of bar mangers who approved smokefree bars 
increased from 44% to 60% between November 2004 and 
May 2005.  
 
Table 40 Compliance 
Author Country 
Main 
Results 
(Directorate for Health and  Norway 
Before the smokefree legislation , 43% of bar and restaurant 
Social Affairs 2005) 
employees thought that many guests would refuse to obey 
the law. However , four months after implementation, only 
7% reported many guest refusing to comply.   
Smokefree (2007) 
England  
Overall compliance of premises and vehicles in December 
2007 (n=23.009) and first six months of legislation (July – 
Dec) (n=379,990): 
 - 98.7% compliant of no-smoking (no evidence of 
EN 
182  
 
E

 
management knowingly permitting smoking) and 98.2%, 
respectively. 
- 94.4% compliant in terms of signage (required no 
smoking signage being displayed prominently) and 86.6%, 
respectively.  
- Compliance rates varied little by regions 
(Office of Tobacco Control  Ireland 
Compliance (no smoking observed on the premises) with 
2005) 
the smoke free legislation is very high: 
Nine months after its introduction, compiled  inspection 
data show overall compliance in workplaces was 94% 
(ranging from 89% in pubs to 98% in restaurants). 
Compliance of office and factory workplaces in the Health 
and Safety Inspection Programme was 92%, in almost 
7,500 inspections.  
Complaints to the smokefree compliance line were 
concentrated in the first month (677 complaints, 30% of all 
calls in the first year), and then declined to around 150 per 
month over the first year and to less than 120 calls per 
month in 2005.    
- 98% people believe workplaces are healthier because of 
the smoke free law, including 94% of smokers.  
- 96% people feel smoke free law is success, including 89% 
of smokers 
- 93% people think smoke free law is a good idea, including 
80% of smokers 
(within a month of ban 97% compliance rate had been 
achieved in all workplaces, including bars).  
(Lund and Helgason 2005) 
Norway 
Better compliance with total ban vs. smoke-free areas. 75% 
of general public support ban 
(Clancy, Goodman et al
Ireland 
Compliance remains at nearly 100%.  
2007) 
Interviews with 70 bar workers, customers, and bar 
proprietors in eight bars in 3 contrasting communities in 
same local authority. Compliance varied with violations 
Eadie, D cited in TSFS, 
Scotland 
more prevalent in deprived communities. Factors 
Edin, Scotland 
influencing compliance include smoking norms, 
management competency, and management attitudes 
towards the ban.    
(Edwards, Bullen et al
Observed compliance in pubs and bars in 2005-06 close to 
2008) 
100%. Number of complaints fell rapidly after the first 
month, with less than 20% per month since October 2005. 
2003 Smoke-free 
New 
Only five complaints resulted in prosecutions. Anecdotal 
Environments Amendment 
Zealand 
reports suggest that there may be greater non-compliance in 
Act (smoking ban Dec 
licensed premised in more remote rural areas, and in 
2004) 
smaller businesses with a high proportion of smokers.  
During the first ten months of the smokefree bars policy, 
Thomson and Wilson 
New 
there were only 196 complaints to officials about smoking 
(2006) 
Zealand 
in the over 9900 licensed premises.  
Weber et al 2003 cited in 
U.S. 
Patron compliance (defined as no smoking patrons 
EN 
183  
 
E

 
(Edwards, Bullen et al
California  
observed in the venue when inspected) increased from 
2008) 
92.2% to 98.5% between 1998 and 2002 for bars with 
restaurants, and from 45.7 to 75.8% in free-standing bars.   
Three months after comprehensive smokefree regulations, a 
Skeer et al 2004 cited in 
random sample of 102 bars found only three patrons 
(Edwards, Bullen et al
U.S., Boston  smoking inside, and that complete removal of ash-trays had 
2008) 
occurred. After eight months, only six violation notices had 
been issues to free standing bars.  
McCaffrey  et al., (2007) 
Study in 39 Dublin pubs visited 7-12 months after the 
cited in (Edwards, Bullen 
Ireland  
smokefree legislation found that of over 2,500 customers, 
et al. 2008) 
none were smoking inside the pubs.  
(Gallus, Zuccaro et al
Italy  
Out of about 6000 checks by the Police and other civil 
2006) 
forces, less than 100 (1.5%) violations observed. 
(Fong, Hyland et al. 2006) 
Ireland 
At the post legislation wave (8-9 months after law 
implementation (Dec 2004 to Jan 2005), 94% of Irish 
smokers (N=640) reported that pubs were enforcing the law 
“totally”, 5% said “somewhat”, and 2% said “not at all”. 
Deputy Chief Medical 
 
Officer, Department of 
Over 98% compliance with the legislation  
Health, England 
(Presentation)  
Scotland 
97.2% compliance with smoking regulation in the year 
(Haw 2007) 
following implementation (n=80,832 inspections of pubs 
and other workplaces)  
Multiple 
Compliance in Ireland (94%), New York City (97%), New 
(Global Smokefree 
Zealand (97%), Italy (98.2%), Massachusetts (96.3%), and 
Partnership 2007) 
Scotland (95.9%).  
 
Economic effects 
Table 41 Tobacco Industry  
Study 
Country 
Setting 
% Change in Sales 
of cigarettes 

(Cesaroni, Forastiere Italy 
Work and public -5.5% ( in 2005 
et al. 2008) 
places (ban 2005) 
compared to 2004) 
(Spizzichino 2007) 
Italy 
 
-6.1% 
(in 
2005 
compared to 2004) 
Rogerson, The Herald,  Scotland Benson 

Hedges 
-3% to -4% 
March 3 2007. 
and Dunhill maker 
Gallaher (however 
firm posted a 4.9% 
rise in underlying 
profit) 
Convenience 
Store  England and Wales 
Lambert & Butler 
-4% (in 2007) 
EN 
184  
 
E

 
(Feb 11th  2008) 
Champman et al (cited  Australia  
-3.4% 
in (Royal College of 
Physicians 2005)) 
Nogues (2008) 
Spain  
-10% 
21 months after 
smoking ban in 
province of Malaga 
Smokefree public 
Ireland   
 
-8.7% (in 2004  after 
places in Ireland  
ban) 
-3.4% (in 2003) 
-1.2% (in 2002) 
Smokefree public 
Ireland   
Gallaher Tobacco 
-10.7%  (from  Jan  
places in Ireland  
2004) 
(Global Smokefree 
Ireland  
-16% 
Partnership 2007) 
In first six months 
after ban 
(Global Smokefree 
Italy  
-5.7% 
Partnership 2007) 
In first 11 months after 
ban 
(Global Smokefree 
New Zealand 
 
-1.5% 
Partnership 2007) 
In first year after ban 
(Global Smokefree 
Norway  
-14.1% 
Partnership 2007) 
In first year after ban 
Study 
Country 
% Reduction in % Change in Sales 
Demand for 

of cigarettes 
cigarettes 
Health Re
No
gulatory rthern Ireland  
4% 
-0.1% 
Impact Assessment - 
(Gallaher Ltd.) 
England 
4% 
-3% per annum 
 20% 
-15% 
(Gallus, Zuccaro et al.  Italy  
 
-8.9% 
2006) 
January-April 2004 
versus same period in 
2005. 
EN 
185  
 
E

 
Official legal sales 
(million kg of 
cigarettes) 
(Surgeon General 
U.S. 
950 million fewer  
2006) 
cigarette packs being 
If U.S. workplaces 
smoked 
implemented 100% 
smokefree policy 
Study 
Country 
Setting 
% Change in Sales 
of tobacco products 

 
Italy 
 
-6.6% per capita 
(Spizzichino 2007) 
Italy 
 
-5.9% (in 2005) 
+1.1% (in 2006, after 
6% increase in price) 
 
Table 42 Hospitality Sector 
 
% change from 
Study Country 
pre-ban to post-
ban 
Bar and pub sales 
+0.5%  
(NHS Health 
Review (n=1, 
Scotland, Ludbrook  California, not s.s.) 
(95% CI: -0.28% to  et al. 2005) 
+1.284%; mean 7.1) 
 
-4.4% (in 2004) 
(Office of Tobacco  Ireland 
Control 2005) 
-4.2% (in 2003) 
-1% 
Lund K (cited in  Norway 
TSFS, Edin, 
Scotland) 
Approx. -4% (in 1st  (Edwards, Bullen et  New Zealand 
quarter of 2005) 
al. 2008)
This effect was not 
sustained.
  
+0.6% 
Thomson and 
New Zealand 
Wilson (2006) 
Seasonally adjusted 
bar sales between 
the first three 
quarters of 2004 
(before ban) versus 
same period in 2005 
EN 
186  
 
E

 
(after ban) 
+5.8% 
 
Melia, The Irish Ireland 
Independent, Sept  
14th 2005
Annual increase 
July 2004-05 in 
sales of beer, wine 
and spirits and food 
in pubs 
-11% (drink sales) BBC News, 22 Scotland 
March 2007. 
-3% (food sales) 
Scottish Licensed 
Trade Association 
survey for Scottish 
pubs (only 1/3 
members responded 
out of total 1,500). 
-10%  
(Adda, Berlinski et  Scotland 
al. 2006).
(p=0.02, 95% CI: - Based on 1590 pubs 
19% to -2%) 
before ban (Feb 24-
Mar 10 2006) and 
after (May 3 – May 
31 2006) 
Hotel room revenues 
-0.054%  
(NHS Health 
Review 
Scotland, Ludbrook 
(95% CI: -0.128% to  et al. 2005) 
+0.02%; mean 2.43) 
 
Restaurant/licensed 
+0.25%  
Bartosch and Pope  Massachusetts, USA 
café sales 
(cited in RCP, 
(95% CI: -1.32 to  (Royal College of 
1.81) 
Physicians 2005)) 
+0.25%  
(NHS Health 
Review  (n=11, 
Scotland, Ludbrook  Australia and USA) 
(95% CI: -1.32% to  et al. 2005) 
+1.81%) 
+6% 
(Lund and Helgason  Norway 
2005) 
+9.3% Thomson 
and 
Wilson (2006) 
Seasonally adjusted 
restaurant and café 
sales between the 
New Zealand 
first three quarters 
of 2004 (before ban) 
versus same period 
in 2005 (after ban) 
EN 
187  
 
E

 
+7% Americas 
for 
Nonsmokers’ Rights 
(2005). 
Florida (U.S.) 
Effect one year after 
State smoking ban 
in 2003.  
Patronage (# 
-14%  
(Adda, Berlinski et  Scotland 
customers or tourists) 
al. 2006).
(p=0.02; 95% CI: - Based on 1590 pubs 
26% to -2%) 
before ban (Feb 24-
Mar 10 2006) and 
after (May 3 – May 
31 2006) 
9.5% higher in non- Kunzli et (2005) 
Switzerland 
smoking café  
+3.2% (in 2004 vs.  Office of Tobacco  Ireland 
2003) 
Control (2005) 
+11% (p=0.060) 
(McCaffrey, 
Ireland 
Goodman et al. 
2006) 
(n=39 public houses 
prior to ban and one 
year later) 
No change (between  (Edwards, Bullen et  New Zealand 
2003/4 and 2005/6) 
al. 2008) 
+9.6% (Gallus, 
Zuccaro 
et  Italy  
al. 2007)
Survey in March-
April 2005 and 
same period 2005 
(self-report visits to 
cafes and 
restaurants) 
-7.4% (Gallus, 
Zuccaro 
et  Italy 
al. 2007)
Survey in March-
April 2005 and 
same period 2005 
(self-report visits to 
cafes and 
restaurants) 
-16% (Fong, 
Hyland 
et al.  Ireland  
2006) 
Have you avoided 
going to pub 
EN 
188  
 
E

 
because of law 
(amongst Irish 
smokers post-
legislation (n=632) 
-18% (Fong, 
Hyland 
et al.  Ireland 
2006) 
Have you avoided 
going to restaurants 
because of law 
(amongst Irish 
smokers post-
legislation (n=640) 
-41% (Fong, 
Hyland 
et al.  Ireland 
2006) 
Survey: Irish 
smokers report 
visiting pubs less 
often than a year 
ago post legislation 
(N=640) 
+3% (Fong, 
Hyland 
et al.  Ireland 
2006) 
Survey: Irish 
smokers report 
visiting pubs more 
often than a year 
ago post legislation 
(N=640). 
NB: 57% said they 
visit the pub the 
same amount of 
time. 
 
Patronage decrease:  (Biener, Garrett et  U.S. Boston 
29.1% (control 
al. 2007)
33.1%) 
Reports (n=81) of 
No change: 36.6%  changes in Boston 
(control 45.5%) 
bars patronage 
anywhere before 
Patronage increase:  and after smoking 
34.3% (control 
ban (vs other MA 
21.3%) 
towns with no 
smoking ban). 
p=0.018 
 
+8.6% (p=0.609) 
(Alpert, Carpenter et  Massachusetts, U.S.  
al. 2007) 
Overall hospitality 
-7.3% Federation 
of 
England 
sales 
Licensed 
EN 
189  
 
E

 
Victuallers’ 
Associations and 
BII (2007) 
No change 
(Alpert, Carpenter et  Massachusetts, U.S.  
(p=0.240) 
al. 2007) 
Monthly meal tax 
collections 
U.S.$ 6.6 B (1995) Americas for 
California, U.S. 
 to  
Nonsmokers’ Rights 
U.S.$ 7.6 B (1998) (2005). 
to  
U.S.$ 9.6 B (2002) Eating 
 
establishments’s 
taxable annual sales 
for beer and wine 
1995 (smoke free 
restaurants) to 1998 
(smoke free bars) to 
2002.  
Drink Sales 
-7.4% Federation 
of 
England 
Licensed 
Victuallers’ 
Associations and 
BII (2007) 
Food Sales 
-0.6% Federation 
of 
England 
Licensed 
Victuallers’ 
Associations and 
BII (2007)
n=2708, response 
rate 15.9% 
Employment in 
-2.4% (2003 to (Office of Tobacco  Ireland 
hospitality sector 
2004) 
Control 2005) 
+0.6% (in 2004 
compared to 2002) 
-8.82% (p=1.176) 
(McCaffrey, 
Ireland 
Goodman et al. 
2006) (n=39 public 
houses prior to ban 
and one year later) 
-15% 
YLE News, Dec 17,  Finland 
(establishments) 
2007 
Percent 
establishments who 
have cut back on 
staff because of 
EN 
190  
 
E

 
sales drop 
+24% (pubs, bars  Thomson and 
and taverns)* 
Wilson (2006) 
Average 
+9% (cafes and employment in first 
restaurants)  
three quarters of 
2004 (before ban) 
New Zealand 
-8% (clubs) 
versus same period 
in 2005 (after ban) 
*Might have high 
patronage around 
major sport series.  
No change 
(Alpert, Carpenter et  Massachusetts, U.S.  
(p=0.683)  
al. 2007) 
  
Number of workers 
employed in food 
services and 
drinking places.
(Number of workers 
increased in 
 
accommodation 
industry but not 
significant, 
p=0.926) 
+19.5% Americas 
for 
California, U.S. 
Nonsmokers’ Rights 
(2005). 
Increase 19.5% 
from 1992-2000 in 
no. individuals 
employed in eating 
and drinking places 
(versus 13.5% for 
all employment 
statewide over same 
period) 
VAT from hospitality 
+5% 
Lund K (cited in  Norway 
industry 
TSFS, Edin, 
Scotland) 
In the first 16 
months after the ban 
versus the same 
interval the year 
before.  
Number of bars 
+3.5% Americas 
for 
New York 
Nonsmokers’ 
Rights (2005) 
EN 
191  
 
E

 
From April 2002 to 
May 2004 (smoke-
free law 
implemented on 
June 23, 2003) 
-7.3% (2005) 
Revenue 
Ireland 
Commissioners 
-4.7% (2006) 
Change in number 
of pub licenses in 
2005 and 2006. 
(2004 = +2.4%; 
2003 = -1.7%) 
 
Table 43 Other Sectors 
 
% change from 
Study Country 
pre-ban to post-
ban 
Gambling revenues 
-14% Lal 
et al (2008)
Australia (VIC) 
Mean level of 
monthly electronic 
gaming machine 
expenditure, July 
1998 to Dec 2005. 
-15% Rogerson, 
The 
Scotland 
Herald, March 3 
2007. Impact on 
RANK (Mecca 
Bingo and 
Grosvenor Casinos). 
One in 10 
Scotland’s  bingo 
halls has shut down 
since ban.
 
Smoking breaks at 
See note 
Jones, 
Daily  England  
work 
Express, February 
29, 2008
Three 15 minute 
smoking breaks a 
day cost employers 
195 working hours 
per annum for each 
worker.  
 
EN 
192  
 
E

 
B) FINDIGS FROM THE EVALUATION OF SCOTTISH SMOKEFREE 
LEGISLATION 

In March 2006 a comprehensive ban on smoking in public places was 
introduced. Summarised below are the preliminary finding from a 
comprehensive evaluation of the impact of the legislation. 
Improvement in Air Quality 
•  Two months post legislation, there was an 86% reduction in secondhand 
smoke in 41 pubs in 5 locations across Scotland.  
•  Immediately before the legislation was implemented measures of air quality 
(PM2.5) exceeded the US EPA threshold for a hazardous classification in 
40% of visits. 
•  Two months post legislation the majority of pubs had air quality equivalent 
to that of outdoor air.  
Compliance  
•  In the year following implementation of the legislation environmental health 
officers made 80,832 inspections of pubs and other workplaces.  They 
recorded 97.2% compliance with smoking regulations. 
•  These very high levels of compliance were consistent across Scotland and 
were maintained throughout the year.   
•  This indicates that the legislation has become self-policing. 
Reduction in SHS Exposure  
•  There was evidence of a reduction in SHS exposure in both bar workers and 
the general population. 
•  In bar workers there was an 89% reduction mean salivary cotinine – an 
indicator of SHS exposure - one year post legislation.   
•  In adults aged 16 to 74 years and 11 year old children there was a  39% 
reduction in SHS exposure (based on salivary cotinine) 
•  Post legislation reductions in SHS exposure were greatest in adults living in 
non-smoking households and in children living in households where parent 
figures were non-smokers or only the father figure smoked.   
•  The main beneficiaries of the legislation are likely to be those who have 
very little or no SHS exposure in the home. 
•  There was strong evidence from across the studies in large reductions in 
reported SHS exposure in other workplaces and on public transport, as wells 
as in bars.  
•  While, there appears was no evidence of a reduction in exposure in the 
home, there was no evidence of displacement of smoking from public 
places into the home or cars.
  
 
 
EN 
193  
 
E

 
 
Improvements in Health  
•  Post legislation, bar workers reported fewer respiratory (coughs and phlegm) 
and sensory (sore eyes and throat) symptoms one year after their work 
environments became smokefree.   
•  These improvements were seen in both non-smokers and smokers indicating 
smokefree environments have potential health benefits for smokers too.  
•  Health benefits were also observed at a population level.   
•  A prospective study of admissions to 9 Scottish hospitals found a 17% 
reduction in acute coronary syndrome (including heart attack) one year after 
implementation of the legislation.   
•  This compares with an average 3% reduction in ACS admissions in the 10 
years before the legislation was introduced.  
•  The reduction occurred in all age groups but was greatest in the under 60s 
who as a group, spend more time in public places, such as bars, and will 
therefore experience greater reductions in SHS as a result of the legislation  
•  This suggests that smoke-free legislation is effective at reducing the risk of 
AMI.   
Changes in Attitude 
•  Support for smokefree legislation increased post legislation in both Scotland 
and the rest of the UK (control) but the increase in support was much greater 
in Scotland.   
•  In Scotland support for the legislation increased most in respondents from 
middle SEGs rather than the most or least affluent groups.  
•  The change in smoker attitudes was greatest post-legislation. 
Smoking Restrictions in Private Places  
•  Post legislation there was a reduction in the proportion of households with 
no smoking restrictions or only partial smoking restriction in the home.   
•  There was also a small reduction in the proportion of children who reported 
exposure to SHS in other people’s homes.   
•  This may reflect increased awareness of the health risks associated with 
SHS; a change in the acceptability of exposing others to SHS; or both. 
Socio-cultural Changes 
•  Qualitative studies found a reduction in reported tobacco consumption post-
legislation, particularly in disadvantages communities. 
•  Smokers in both affluent and disadvantaged communities reported 
experiencing public disapproval associated with their smoking post 
legislation and this was an important factor that shaped their smoking 
behaviour. 
•  Implementation of smokefree legislation has the potential to change 
attitudes, shape beliefs and change smoking behaviour, thereby bringing 
about socio-cultural change, particularly in disadvantaged communities.   
EN 
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•  A study of the impact of smokefree legislation on smoking behaviour and 
compliance in Scottish bars showed fear of prosecution was the main motive 
in enforcing the ban. 
•  Study shows that the nature and levels of compliance vary widely and 
suggests the need for more robust, targeted surveillance methods, 
particularly supporting smokers in deprived areas. 
Publications 
Akhtar PC, Currie DB, Currie CE, Haw SJ. Changes in child exposure to 
environmental tobacco smoke (CHETS) study after implementation of smoke-free 
legislation in Scotland: national cross sectional survey. BMJ 2007;335:545-49 
Eadie D et al. A qualitative analysis of compliance with smoke-free legislation in 
community bars in Scotland (Addiction, forthcoming) 
Hastie C, Haw S, Pell J. Impact of smoking cessation on C-reactive protein, and the 
role of life-time and passive exposure: cross-sectional study of 4,072 adults. Nicotine 
and Tobacco Research
 (forthcoming) 
Haw S, Gruer L, Amos A et al. Legislation on Smoking in Enclosed Public Places: how 
will we evaluate its impact? Journal of Public Health 2006;38:24-30. 
Haw SJ, Gruer L. Changes in adult exposure to second hand smoke following 
implementation of smoke-free legislation in Scotland. BMJ 2007;335:549-52 
Hilton S, Semple S, Miller BG et al. Expectations and changing attitudes of bar 
workers before and after the implementation of smoke-free legislation in Scotland. 
BMC Public Health 2007 
Pell JP, Haw, SJ, Cobbe SM et al. Validity of self-reported smoking status: comparison 
of patients admitted to hospital with acute coronary syndrome and the general 
population. Nicotine and Tobacco Research (forthcoming). 
Petticrew M, Semple S, Hilton S et al. Covert observation in practice: Lessons from the 
evaluation of the prohibition of smoking in public places in Scotland. BMC Public 
Health
 2007 
Phillips R, Amos A, Ritchie D, Cunnigham-Burley S, Martin C. Not in front of the 
children’: Smoking in the home after the Scottish Smoke-free Legislation. BMJ 
2007;335:553-57 
Richmond L, Haw S, Pell J. Impact of socioeconomic deprivation and type of facility 
on perceptions of the Scottish smoke-free legislation (letter). Journal of Public Health 
2007. doi:10.1093/pubmed/fdm056 
Semple S, Creely KS, Naji A et al.  Second hand smoke levels in Scottish Pubs: the 
effect of smoke-free legislation. Tobacco Control 2007;16:127-32 
Semple S, MacCalman L, Atherton A et al. Bar workers’ exposure to second-hand 
smoke: The effect of Scottish smoke-free legislation on occupational exposure. Annals 
of Occupational Hygiene 
2007. 
NHS Health Scotland, March 2008 
EN 
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C) UK REGULATORY IMPACT ASSESSMENTS 
England:  
Annual benefits with full ban (£ million) 
Source: Department of Health (2007) 
Benefits (£ million) 
Health benefits  
Averted deaths 
Reduced ETS exposure 
 
Employees 
21 
Cutsomers 
350 
Smokers giving up 
 
Employees 
1,600 
Cutsomers 
180 
Reduced uptake of smoking 550 
Economic and environmental benefits 
NHS expenditure saved through reduced smoking  100 
prevalence  
Reduced Sickness Absence 
70-140 
Production gains (from reduced exposure to SHS) 
340-680 
Safety benefits (damage, fire, injuries etc.) 
63 
Reduced cleaning and maintenance costs 
100 
Total  (£ million) 
3,374 - 3,784 
Costs (£ million) 
Implementation of regulatory requirements 
0-5 
Enforcement 30 
Education and communication 

Revenue losses to the Exchequer from  Employees 859 
decline in cigarette sales 
Customers 113 
Losses to the tobacco industry and retailers 
97 
Production losses (smoking breaks) 
430 
Consumers' surplus losses to continuing smokers 
155 
Total  (£ million) 
1,685-1,690 
Net benefit (£ million) 
Total  (£ million) 
1,689-2,094 
 
EN 
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Northern Ireland 
Net present value of comprehensive smoke-free legislation (in 2006 prices (£ million) 
based on 30 year appraisal  
Source: Adjusted from Department of Health for Northern Ireland (2006)  
Benefits (£ million) 
 
Three main smoking All identified 
related diseases  (lung  smoking related 
cancer, stroke and diseases 
ischaemic heart disease)   
Health benefits 
 
 
Economic value of lives  Reduced exposure to ETS   59.2 
59.2 
saved 
Reduced active smoking 
123.06 
209.66 
 
Reduced
Morbidity savings   exposure to ETS   156.26 
156.26 
(Human Cost of ill health) 
 
Reduced active smoking 
37.26 
120.69 
Resource savings  
 
 
NHS Treatment costs  
34.67 
44.42 
Reduced Sickness Absence Savings  
6.50 
6.50 
Productivity gains as a result of reduced smoking breaks  518.66 
518.66 
Cost savings from reduced fire hazards and reduced  84.60 84.60 
cleaning and decoration costs 
Hospitality sector impacts 
-45.98 -45.98 
Implementation and enforcement costs 
 
 
Costs to Northern Ireland Administration -47.36 
-47.36 
Costs to Local Authorities 
-5.91 
-5.91 
Total NPV 
788.52 
1,100.81 
 
 
 
 
 
 
EN 
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Annual benefits of comprehensive smoke-free legislation (in 2006 prices (£ million) 
based on 30 year appraisal  
Source: Adjusted from Department of Health for Northern Ireland (2006)  
Benefits (£ million) 
 
Three main smoking All identified 
related diseases  (lung  smoking related 
cancer, stroke and diseases 
ischaemic heart disease)   
Health benefits 
 
 
Economic value of lives  Reduced exposure to ETS   5.47 
5.47 
saved 
Reduced active smoking 
11.36 
19.35 
 
Reduced
Morbidity savings   exposure to ETS   14.42 
14.42 
(Human Cost of ill health) 
 
Reduced active smoking 
3.44 
11.14 
Resource savings  
 
 
NHS Treatment costs  
3.2 
4.10 
Reduced Sickness Absence Savings  
0.6 
0.6 
Productivity gains as a result of reduced smoking breaks  28.2 
28.2 
Cost savings from reduced fire hazards and reduced  4.6 4.6 
cleaning and decoration costs 
Total (£ million)  
71.29 
87.88 
Costs (£ million) 
Hospitality sector impacts 
-2.5 
-2.5 
Costs to Northern Ireland Administration 
-2.4 
-2.4 
Costs to Local Authorities 
-0.3 
-0.3 
Total (£ million) 
-5.2 -5.2 
Net benefits (£ million) 
Total (£ million) 
66.09 
82.68 
 
EN 
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Scotland:  
Annual benefits of comprehensive smoke-free legislation (£ 2003 prices million) 
Source: Adjusted from NHS Health Scotland, Ludbrook et al (2005) 
Benefits (£ million) 
Health benefits  
Value of deaths avoided 
Reduced exposure to ETS 
91.4 (range: 16.8 – 176.7) 
Reduced active smoking 
108.5 (range: 11.7 – 169.7) 
Reduced
Morbidity savings   exposure to ETS 
12.8 (range: 10.8 – 36) 
(Human Cost of ill health) 
Reduced active smoking 

Resource savings 
NHS Treatment cost
Reduced
 
 exposure to ETS 
5.3 (range: 4.5 – 11.5) 
savings  
Reduced active smoking 
2.8  (range 1.2 – 4.2) 
Reduced Sickness absence  Reduced exposure to ETS 
4.1 – 5.2 
savings 
Reduced active smoking 
0.8 (0.34 – 1.2) 
Cost savings from reduced fire hazards 
5.0 (range: 4.0 – 5.0) 
Cost savings from reduced cleaning and redecoration  11.7  (11.7 – 11.7) 
costs 
Productivity  gains as a result of reduced smoking breaks 
73.7 (0 – 73.7) 
Total  (£ million) 
311.9 (range 61.1 – 489.7) 
 
EN 
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Net present value of comprehensive smoke-free legislation (in 2005 prices (£ million) 
based on 30 year appraisal  
Source: NHS Health Scotland (2005) 
Health benefits  
Economic value of lives  Reduced exposure to ETS 
1,076 
saved 
Reduced active smoking 
1,278 
Reduced
Morbidity savings   exposure to ETS 
151 
(Human Cost of ill health) 
Reduced active smoking 

Resource savings 
NHS Treatment cost
Reduced
 
 exposure to ETS 
63 
savings  
Reduced active smoking 
33 
Reduced Sickness absence  Reduced exposure to ETS 
49 
savings 
Reduced active smoking 

Productivity gains as a result of reduced smoking breaks 
1,474 
Cost savings from reduced fire hazards 
99 
Cost savings from reduced cleaning and redecoration  234  
costs 
Hospitality sector impacts 
-28 
Implementation and enforcement costs 
 
Costs to the Scottish Administration 
-25 
Education and communication 
-25 
Total NPV 
4,387 
EN 
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Wales:  
Annual net present value of comprehensive smoke-free legislation (in 2006 prices (£ 
million) based on 30 year appraisal  
Source: Welsh Assembly Government (2007) 
Benefits (£ million) 
Health benefits  
Economic value of lives  Reduced exposure to ETS 
86.9 
saved 
Reduced active smoking 
46.8 
Morbidity savings (Human  Reduced exposure to ETS 
12.6 
Cost of ill health) 
Reduced active smoking 

Resource savings  
NHS Treatment cost
Reduced
 
 exposure to ETS 
2.9 
savings  
Reduced active smoking 
2.2 
Reduced Sickness Absence  Reduced exposure to ETS 

Savings  
Reduced active smoking 
0.47 
Cost savings from reduced fire hazards  

Cost savings from reduced cleaning and decoration costs 
7.6 
Hospitality sector impacts 
42 
Total (£ million) 
211.47 
Costs (£ million) 
Increased smoking breaks 
- 0.4 
Implementation and enforcement costs 
Costs to Welsh Assembly  Smoking cessation 
- 34.91 
Government 
Public awareness 
- 1.1 
Signage - 
0.05 
Monitoring and evaluation 
- 0.5 
Costs to local authorities 
- 37.58 
Total (£ million) 
- 74.54 
Net benefits (£ million) 
Total NPV (£ million) 
136.93 
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ANNEX VII – QUANTITATIVE ANALYSIS 
This Annex estimates the annual numbers of deaths and the medical and non-
medical costs due to ETS exposure for smoking and non-smoking staff in indoor 
workplaces/offices and bars/restaurants across the EU-27 in 2008; and the 
reduction in annual mortality for each policy option due to ETS is estimated. In 
addition, the impacts on the hospitality and tobacco industry are estimated. In 
the first section, the approach used is described followed by the results. 
Data and methods 
The approach used is based on similar approaches applied in the Impact 
Assessments regarding passive smoking in the UK ((NHS Health Scotland et 
al., 2005; Department of Health 2006; Department of Health 2007; Welsh 
Assembly Government, 2007) and Lifting the Smokescreen (Smokefree 
Partnership, 2006). It comprised five steps. First, the estimates for the 
prevalence of ETS (i.e. the number of people exposed to ETS in different 
venues) across all 27 Member States were obtained. Second, the estimates on 
the expected effect of each of the five policies on ETS prevalence were 
obtained. Third, the relative risk estimates were obtained from the literature for 
four diseases for which ETS is a known risk factor, and transferred into ETS 
attributable fractions
. Fourth, the burden of the four diseases was estimated in 
terms of mortality and costs, across all 27 MS. The fifth and final step consisted 
in calculating for each MS the burden of ETS per disease-venue combination 
under each of the five policies. Each of the steps is discussed in detail below and 
France is used as an example to further clarify the approach used. 
ETS prevalence—2006 estimate 
The most recent data (field work Oct-Nov 2006) from the Eurobarometer survey 
was used to estimate the fraction of the population exposed to ETS. This survey 
covers the population aged 15+ years across all 27 Member States and is based 
on multi-stage random sampling, with about 1,000 responses in the majority of 
countries. The data allowed to distinguish between location of exposure (indoor 
workplaces/offices; and bars/restaurants), and smoking behaviour (smoker and 
non-smoker). In addition, to be conservative, when the location of exposure was 
categorised as ‘indoor workplace /office’ or ‘bars/restaurants’, only staff 
members were included in the analysis while non-staff members were excluded 
from the calculations. Table 44 shows how different groups exposed to ETS 
were identified, using specific questions and response options from the 
Eurobarometer questionnaire. 
Table 44 Classification of different groups exposed to ETS  
Category Question 
Qualifying 
answers 
Exposed to ETS at indoor workplaces  QB31b How long are you exposed to  -  ‘1-5 hours a day’ 
tobacco smoke on a daily basis—Indoor 
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/ offices 
workplaces and offices  
- ‘more than 5 hours a day’ 
Exposed to ETS in bars and QB31b How long are you exposed to  -  ‘1-5 hours a day’ 
restaurants 
tobacco smoke on a daily basis—
Restaurants, pubs or bars 
- ‘more than 5 hours a day’ 
Smoker/tobacco user 
QB19 
- ‘Smoke packed cigarettes 
- Smoke roll-up cigarettes 
- Smoke cigars or a pipe 
- Chew tobacco or take snuff 
Non smoker 
QB19  
- Used to smoke but have stopped 
- Never smoked 
Staff (indoor workplaces / offices) 
QB31a Where do you work? 
‘Indoor workplaces or offices’ 
Staff (restaurants, pubs, or bars) 
QB31a Where do you work? 
‘Restaurants, pubs or bars’ 
For example, respondents who chose any of the response categories ‘1-5 hours a 
day’, or ‘more than 5 hours a day’ to question QB31b ‘How long are you 
exposed to tobacco smoke in indoor workplaces and offices, on a daily basis?’, 
were categorised in our analysis as being ‘exposed to ETS in indoor workplaces 
and offices’. It should be noted that respondents who chose ‘Never or almost 
never’ were not classified as being exposed to ETS. In addition, those 
responding ‘Less than 1 hour a day’ were also not classified as being exposed to 
ETS, in order to adopt a conservative approach and to avoid overstating the 
prevalence of ETS. 
For example, according to the Eurobarometer data, in France at the end of 2006, 
26 out of 1,022 respondents were non-smoking staff working in indoor 
workplaces/offices and exposed to ETS for at least one hour on a daily basis, 
leading to a fraction of 21/1,022 = 0.0205. Note that this fraction does not 
represent the prevalence of ETS exposure within non-smoking staff working in 
indoor workplaces/offices. Rather, it is the fraction of the population 
representing non-smoking staff working in indoor workplaces/offices and 
exposed to ETS for at least one hour on a daily basis. Because subsequent 
quantities of interest (i.e. costs and mortality due to diseases related to ETS) are 
typically known at the population level, it is convenient to express the fraction 
exposed to ETS at this stage also as a population-level fraction. 
ETS prevalence—2008 extrapolation 
The data discussed above relate to ETS prevalence at the end of 2006. Since 
then, various Member States have implemented either full or partial smoke-free 
legislation. As a result of this legislation, the 2008 ETS prevalence for indoor 
workplaces/offices and restaurants/bars/pubs in those MS is expected to be 
lower than the ETS prevalence reported in 2006. In order to avoid overstating 
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link to page 205  
the ETS prevalence in 2008, it was assumed that for countries introducing full 
smoke-free legislation after 2006, prevalence rates in 2008 would fall to the 
average 2006 ETS prevalence of Ireland, Italy and Sweden, countries that had 
already implemented smoke-free legislation prior to 2006. The effect of partial 
bans was assumed to have half the effect of a full ban.13   
Based on the literature, it was assumed that the countries shown in Table 45 
implemented full and partial smoking bans related to ETS exposure at indoor 
workplaces/offices and bars/restaurants between October-November 2006 and 
today. For all other countries the 2008 ETS prevalence in indoor 
workplaces/offices and restaurants/bars/pubs was assumed to be equal to 2006 
ETS prevalence.  
Table 45 Smoke-free legislation (full and partial bans) implemented after 2006 
 
Indoor workplaces / offices 
Bars / restaurants 
Full ban 
France 
Lithuania 
United Kingdom 
Estonia 
 
Finland 
Slovenia 
France 
United Kingdom 
The Netherlands 
Partial ban 
Denmark 
Germany 
Portugal 
Belgium 
Portugal 
Denmark 
Continuing the previous example, France was one of the countries that 
implemented a smoking ban after 2006. It was therefore assumed that the 2008 
prevalence of ETS among non-smoking staff working in indoor 
workplaces/offices (i.e. being exposed to ETS for at least 1 hour daily) would be 
equal to the 2006 average of Ireland, Italy and Sweden, calculated as 3.72%. 
This fraction was then multiplied by the fraction of non-smoking staff working 
in indoor workplaces/offices in the total sample14: 3.72% * 158 / 1,022 = 0.57%. 
The latter estimate represents the fraction of the French (sample) population in 
                                                 
13 Smoke-free legislation was implemented in Ireland in March 2004, in Italy in January 2005 and 
in Sweden in June 2005. The levels of ETS exposure reported in these countries for 2006 
therefore can be assumed to represent the effect of these policies within 1-2 years after 
implementation of the policy. 
14 It was assumed that the fraction of non-smoking staff working in indoor workplaces/offices 
was stayed constant between 2006 and 2008. 
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2008 who are non-smoking, working in indoor workplaces/offices and exposed 
to ETS for at least 1 hour daily. 
 
The effects of the five policy options on ETS exposure 
Based on the literature review, the results of the Green Paper consultation and 
the experience with existing EU instruments, we established a series of 
arguments supporting certain assumptions regarding the effect of the five policy 
options on ETS exposure. We then independently asked representatives from 
various stakeholder groups to give their (expert) opinion on the expected effect 
of each of the policy options on ETS exposure after explaining the problem of 
ETS and each of the proposed policy options in detail. The results from the 
latter exercise were used to validate our assumptions.  
Relative risk for selected diseases due to ETS 
The venue-specific estimates on the relative risk for lung cancer, 
cerebrovascular diseases (stroke), ischaemic heart disease, and chronic lower 
respiratory diseases (including COPD and asthma) that were applied in the 
calculations were identical to those reported by Jamrozik (The Smoke free 
Partnership 2006) and the Royal College of Physicians (2005) in the UK. They 
are based on median figures obtained through meta-review of existing literature 
and are consistent with the ranges reported in Annex V. 
Table 46 Relative risk estimates associated with ETS and specific diseases 
Disease ICD-10 
Relative risk 
Classification 
   Average 
Pub/bar/nightclub 
workplace 
Lung cancer 
C33-C34 
1.24 
1.73 
Stroke I60-I69 
1.45 
2.52 
Ischaemic heart 
I20-I25 1.2 
1.61 
disease 
Chronic lower 
J40-J47 1.25 
1.76 
respiratory disease 
In order to estimate the burden of ETS, the eight relative risk ratios (for 
workplace and pub/bar/nightclub) were converted to eight ETS attributed 
fractions. The ETS attributed fraction is defined as the part of a disease’s burden 
that can be attributed to ETS: 
 
ETS Pr evalence ∗ (Re lative Risk − )
1
ETS attributed fraction =
 
(ETS Pr evalence ∗ (Relative Risk − )
1 + )
1
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The estimates for the burden of ETS in terms of mortality as well as medical 
and non-medical costs were obtained by multiplying the number of deaths and 
costs due to each disease by the ETS attributed fractions. The sections that 
follow discuss how the estimates for the number of deaths and costs due to each 
disease were obtained. 
Because the ETS attributable fraction depends on the (Member State-specific) 
ETS prevalence, it varies by MS, venue (indoor workplaces/offices and 
bars/pubs/restaurants), and smoking status (smoker/non-smoker). Continuing 
the example for France, the ETS attributable fraction for non-smoking staff in 
indoor workplaces/offices can be calculated as:  
0083
.
0
∗ 24
.
1
(
− )
1
ETS attributed fraction =
= 00199
.
0
 
( 0083
.
0
∗ 24
.
1
(
− )
1 + )
1
Thus, 0.199% of the population-level burden of lung cancer in France can be 
attributed to ETS exposure among non-smoking staff in indoor workplaces and 
offices. By plugging in the relative risks for the other three diseases, it is 
possible to calculate the ETS attributed fractions in a similar way.  
Mortality 
For each MS, data was obtained from Eurostat on the annual number of deaths 
in the population of working age (20-64 years) caused by each of the four 
diseases discussed above. For 16 countries, the most recent estimates were 
available for 2006 or later; for eight countries, the most recent estimates were 
available for 2005. For Italy and Denmark, the most recent estimates were 
available for 2003 and 2001 respectively. For Belgium, no estimates were 
available. To estimate mortality due to ETS, the ETS attributable fraction was 
applied to the number of deaths in the population of working age (20-64 years) 
for each of the four diseases.  
For example, according to the Eurostat data, in France 12,034 people of 
working age died from lung cancer. Multiplying this by the ETS attributed 
fraction of 138% calculated above, leads to an estimated annual number of 17 
deaths in France among non-smoking staff in indoor workplaces/offices from 
lung cancer caused by ETS. 
 
Costs 
For cerebrovascular disease and ischaemic heart disease, MS-specific estimates 
for medical and non-medical cost for the year 2006 were obtained from the 
British Heart Foundation15. The method adopted by the British Heart 
Foundation relies on a ‘top-down approach’ to calculate total annual 
                                                 
15 For a detailed description of this approach, see www.heartstats.org (accessed 1/5/2008) 
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expenditure for specific diseases, using aggregate data on morbidity, mortality, 
hospital admissions, disease related costs, and other health related indicators. 
The following services were included in the estimation of medical costs: 
primary care, accident and emergency care, hospital inpatient care (including 
day cases and cardiac rehabilitation services), outpatient care, and medications. 
Categories included in the estimation of non-medical costs included informal 
care, productivity costs due to mortality, and productivity costs due to 
morbidity16.  
Using OECD Health Data the average annual percentage increase in health care 
expenditure was estimated for each of the 19 OECD EU countries over the 
period 1996-2005, and the average across these 19 countries (8.2%) was 
imputed for the remaining eight countries. To obtain estimates for the 2008 
medical cost for cerebrovascular disease and ischaemic heart disease, the 2006 
costs were extrapolated using this average annual percentage increase in health 
care expenditure for each of the Member States. The same method was applied 
for the extrapolation of the 2006 non-medical cost; however the average annual 
percentage increase in GDP was used rather than health care expenditure.17 
In the case of France, the medical costs of treating stroke were €1,427,985,446 
according to figures from the British Heart Foundation. Between 1996 and 
2005, according to OECD Health Data, overall health care expenditure in 
France rose by 5.3% per year on average, leading to an estimated 
€1,582,299,557 in medical costs for treating stroke. Applying the ETS 
attributable fraction for stroke then leads to an annual medical cost among non-
smoking staff in indoor workplaces/offices exposed to ETS of €4,080,415 in 
France. Similarly, the British Heart Foundation estimated the non-medical costs 
of stroke in France in 2006 as €1,742,987,431. Applying an average annual 
increase in GDP of 3.9%, leads to an extrapolated 2008 estimate of 
€1,880,133,401. Finally, applying the ETS attributable fraction leads to an 
annual non-medical cost among non-smoking staff in indoor workplaces/offices 
exposed to ETS of €2,507,411  in France. 
Unfortunately, detailed Member States-specific cost estimates were not readily 
available for lung cancer and chronic lower respiratory disease. The following 
indirect method of estimation was therefore used. For lung cancer, an estimate 
from the National Cancer Institute (part of the U.S. National Institutes of 
Health) was obtained for total medical spending on lung cancer in the U.S. in 
2004. Medical spending on lung cancer was then expressed as a percentage of 
health care expenditures in the U.S. in 2004, and this percentage was applied to 
                                                 
16 For a detailed description of this approach, see www.heartstats.org/eucosts (accessed 
1/5/2008) 
17 Here GDP is used, because these costs are not directly related to medical treatments. Therefore 
inflating these by an index specific to the costs of healthcare does not seem appropriate. 
Because non-medical costs include a broad range of costs, changes over time can be expected to 
track changes in GDP. 
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the (estimated) 2008 health care expenditure in each of the 27 Member States. 
In other words, it was assumed that the share of health care spending allocated 
to the treatment of lung cancer is relatively homogeneous across industrialised 
countries.18  
In order to carry out this estimation, the 2008 health care expenditure for each 
of the 27 Member States had to be calculated first. For the 19 OECD EU 
countries, the most recent available data (2005 for the majority of countries) 
was used and extrapolated to 2008 using the average annual percentage increase 
in health care expenditure over the most recent 10-year period. For all other 
countries (except for Latvia and Malta, for which no data were available) 2004 
estimates on health care expenditure obtained from Eurostat were extrapolated, 
using the average (8.2%) annual increase in health care spending across the 
other countries. In case expenditure figures were not available in Euros, the 
average exchange rate for the first half of 2008 was used to convert national 
currencies to Euros.  
A similar procedure was applied to estimate the cost of lower respiratory 
disease, and estimates on the medical cost of asthma for 1998 were obtained 
from Weiss et al, and on the medical cost of COPD for 2002 from the National 
Heart, Lung, and Blood Institute of the U.S. National Institutes of Health. 
Estimates for non-medical cost for these diseases were also obtained from the 
same sources, expressed as a percentage of the U.S. GDP (rather than health 
care expenditures) and this percentage was applied to the 2008 GDP (obtained 
from Eurostat) for each of the 27 Member States in order to estimate the non-
medical cost. Unfortunately it was not possible to obtain estimates on the non-
medical cost for lung cancer.  
Methods to estimate effects of smoke-free legislation on revenues and 
employment to the tobacco and hospitality industry 

To estimate the effect of an EU-wide smoking ban on revenues and employment 
in the tobacco industry, the estimates found in the literature (shown along with 
the non-peer reviewed literature in Table 41 and Table 42 in Annex VIA) were 
applied to the EU-wide estimated 2007 revenue and employment estimates for 
the tobacco and hospitality industry. However, applying the estimates from the 
literature directly, would assume that the entire EU would move from a scenario 
in which there is no smoking ban to a complete smoking ban. Because many 
countries already had smoking bans by 2008, a correction was applied to the 
estimates from the literature. Because many of the larger Member States such as 
France, the UK and Italy had already smoking bans, it was estimated that only 
                                                 
18 Unfortunately, it was not possible to evaluate this assumption due to a lack of data (in fact, if 
data were available to test this assumption, i.e. spending on lung cancer treatments across a 
wide range of countries, spending on lung cancer in the EU could have likely been obtained as 
well, in which case it would not be necessary to infer this spending from the US). 
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half of the entire EU-27 tobacco market would be affected by a new EU-wide 
smoking ban. 
The most recent data on tobacco industry revenues across the EU-27 are 
available for the year 2006, which were extrapolated to 2007 by Eurostat using 
short-term indices.  
It was assumed that, holding everything else constant, any reductions in revenue 
would have a proportional effect on employment in the tobacco industry in the 
longer run.  
The most recent data on MS-specific hospitality industry revenues (NACE 
categories 55.3 to 55.5, i.e. restaurants, bars, canteens and catering) across the 
EU-27 were available for the year 2006, which were extrapolated to 2007 by 
Eurostat using short-term indices.  
At the EU-level, restaurants, bars, canteens and catering represent 69.9% 
(revenue) and 75.4% (employment) of the total, whereas hotels, camping sites 
and other provision of short-stay accommodation represent the remaining (much 
smaller) share. Unfortunately, no data were available to further distinguish 
between bars and restaurants. Because no country-specific estimates were 
available, we applied these average EU percentages to each country.  
Methods to estimate effects of smoke-free legislation on the cost of fires, 
cleaning and redecoration costs 

To estimate the effect of an EU-wide smoking ban on the cost of fires, cleaning 
and decoration costs, the estimates from the Health and Regulatory Impact 
Assessment on Smoking for Northern Ireland, reported as £ 4.6 million per 
annum; the English impact assessment, reported as £163 million per annum; the 
Scottish impact assessment, reported as £16.6 million per annum; and the Welsh 
impact assessment, reported as £13.5 million per annum were summed up. To 
extrapolate this figure to an EU-wide estimate, this was expressed as a fraction 
of UK GDP and this fraction was then applied to the GDP for Member States 
that did not have smoking bans as of 2008. Summing across these Member 
States resulted in the expected EU-wide reduction in the cost of fires, cleaning 
and redecoration following a smoking ban. 
Results 
Table 47 provides a summary of the baseline estimates for 2008. This section 
will discuss these estimates in further detail, in addition to the way they are 
expected to change under each of the policies considered. 
Table 47 Summary of baseline estimates for 2008 
indoor workplaces
bars and 
 
/offices 
restaurants 
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Staff staff 
ETS exposure of over 1 hour (per 1,000) 
 
 
- non- smokers 
18.62 
2.58 
- smokers 
28.66 
2.47 
Total number of deaths 
 
 
- non- smokers 
1,714   
786 
- smokers 
2,694 
813  
Total medical cost (EUR mln) 
 
 
- non- smokers 
427 
139 
- smokers 
636 
134 
Total non-medical cost (EUR mln) 
 
 
- non smokers 
353 
124 
- smokers 
529 
119 
Throughout this chapter, a distinction is made between exposure among staff in 
indoor workplaces/offices and bars/restaurants. Exposure among staff in 
healthcare and educational facilities, as well as government buildings is not 
taken into account. The reason to exclude these latter categories is that the 
Eurobaromater survey shows very small numbers of staff exposed (about 55 for 
each of these three venues across the entire EU-27, in a sample of 28,532 
individuals), which prohibits effective use of these data in a country-level 
analysis. If the data would have allowed to include the effects of ETS exposure 
among staff in healthcare and educational facilities, and government buildings, 
the findings and conclusions would not be expected to change drastically, 
because this population is only about 13% of the size of staff exposed in indoor 
workplaces/offices. 
ETS exposure—2006  
Table 48 shows the fraction of smoking and non-smoking staff (per 1,000) 
exposed to ETS for at least one hour on a daily basis, for each of the 
combinations of categories. 
Table 48 Number of staff per 1,000 EU citizens exposed to ETS in 2006 for at least one 
hour a day on a daily basis  
 
Non-smokers Smokers 
indoor workplaces 
bars and  
indoor workplaces 
bars and 
 
/offices staff 
restaurants staff 
/offices staff 
restaurants staff 
average 
     21.27  
       4.04  
     31.95  
       4.12  
minimum 
       0.99  
          -    
       2.98  
          -    
maximum 
     51.00  
     12.67  
     99.00  
       9.87  
 
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The first row of Table 48 shows the population-weighted average for the EU-27. 
The largest category of staff exposed to ETS is smoking staff in indoor 
workplaces/offices (32 exposed per 1,000 population). The number of staff 
exposed at bars and restaurants is relatively small. The minimum and maximum 
across the EU-27 (second and third row) show that these figures can vary 
considerably across Member States.  
Note, however, that these proportions take the entire population as denominator. 
An alternative measure is to estimate the proportion of people exposed to ETS 
within each of the subgroup populations, e.g. the number of non-smoking staff 
in indoor workplaces/offices exposed to ETS divided by the number of all non-
smoking staff in indoor workplaces/offices. These estimates are shown in Table 
49 and Table 50. 

Table 49 Percentage of staff exposed to ETS in 2006 for at least one hour a day on a 
daily basis within each subpopulation for at least 1 hour a day 
 
Non-smokers Smokers 
indoor workplaces 
bars and  
indoor workplaces 
bars and 
 
/offices staff 
restaurants staff 
/offices staff 
restaurants staff 
average 
13% 46% 31% 48% 
 
Table 50 Percentage of staff exposed to ETS in 2006 for at least one hour a day on a 
daily basis within each subpopulation (with smokers and non-smokers 
combined) for at least 1 hour a day 
 
indoor workplaces /offices staff 
bars and restaurants staff 
average 20% 
47% 
 
ETS exposure—2008 
Using the approach outlined in previous section, the 2006 ETS prevalence 
estimates were updated for 2008, taking into account that various Member 
States have implemented smoke-free legislation since 2006. For each quantity 
of interest, a high and low estimate is shown, depending on the assumed effect 
of partial bans implemented between 2006 and 2008. The high estimate assumes 
the effect of a partial ban is equal to the effect of no ban while the low estimate 
assumes the effect equals the effect of a full ban. Table 51 updates the 2006 
estimates shown in Table 48 to 2008, and Figure 1 shows the entire range of 
ETS prevalence estimates under different assumptions regarding the 
effectiveness of partial bans. Note that the high and low estimates in Table 51 
correspond to the 0% and 100% estimates in Figure 1 (extreme left and right 
ends of the lines).  
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Table 51 Estimated number of staff per 1,000 EU citizens exposed to ETS in 2008 for at 
least one hour a day on a daily basis 
Estimate Non-smokers 
Smokers 
indoor workplaces 
bars and  
indoor workplaces  
bars and 
 
/offices staff 
restaurants staff 
/offices staff 
restaurants staff 
High 
 18.86 
 2.93  
 28.90 
 2.91  
Low 
 18.37 
 2.22  
 28.41  
 2.03  
 
Figure 1 
Expected 2008 ETS prevalence (per 1,000 citizens) as a function of the assumed effectiveness of 
partial smoking bans implemented after 2006
35.00
 
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00
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o

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i
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ce
n
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al
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 prev
Smokers - bars / restaurants
d
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e

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x

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E
-
0
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Assumed effectiveness of partial smoking ban as % of full smoking ban
 
Similarly, Table 52 updates Table 49 to 2008, with the full range of ETS 
estimates under different assumptions of the effect of partial bans shown in 
Figure 2. Comparing Figure 1 to Figure 2 provides more insight into the impact 
of the uncertainty around the effect of partial bans: While the effect of partial 
bans can have a large impact on the average ETS prevalence within staff in bars 
and restaurants
, the eventual impact of ETS exposure across the entire 
population
 is much smaller. The reason for this is that only a small fraction of 
the population is employed as staff in bars and restaurants.  
Table 52 Estimated percentage of staff exposed to ETS in 2008 within each 
subpopulation for at least 1 hour a day 
Estimate Non-smokers 
Smokers 
indoor workplaces 
bars and  
indoor workplaces 
bars and 
 
/offices staff 
restaurants staff 
/offices staff 
restaurants staff 
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High 
11.13 
 31.47  
 27.53 
 35.73  
Low 
 10.76 
 18.05  
 26.66 
 20.86  
 
Figure 2 
Expected 2008 ETS prevalence (within subgroups, per 100 staff) as a function of the assumed 
effectiveness of partial smoking bans implemented after 2006
40.00
ch 
 ea

35.00
i
n
t
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wi
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30.00
T
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25.00
pos
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20.00
t
af
 s

ubgr
s

%
 (
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Non-smokers - indoor workplaces / offices
15.00
Non-smokers - bars / restaurants
l
enc

Smokers - indoor workplaces / offices
eva
10.00
Smokers - bars / restaurants
ed pr
ct
pe
x

5.00
E
-
0
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Assumed effectiveness of partial smoking ban as % of full smoking ban
 
Finally, Table 53 updates Table 50 to 2008, showing expected ETS prevalence 
within indoor workplaces/offices staff and staff in bars/restaurants (with 
smokers and non-smokers combined). 
Table 53 Percentage of staff exposed to ETS in 2008 for at least one hour a day on a 
daily basis within each subpopulation (with smokers and non-smokers 
combined) for at least 1 hour a day 
 
indoor workplaces /offices staff 
bars and restaurants staff 
High 
 17.26 
 33.96  
Low  
16.75  
 19.32  
In the remainder of this report, it is assumed partial bans have half the effect of 
a full ban, and hence our baseline estimates for 2008 fall in the middle of the 
high and low estimates shown above. 
ETS exposure under five alternative policies—2013 
After showing 2006 and 2008 baseline estimates in the previous two sections, 
this section considers ETS prevalence in 2013, under each of the five policies.  
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The table below summarises the qualitative analysis of the policy options across 
various parameters carried out in section 6.1 of this IA, assuming that the level 
of bindingness is the most important factor, followed by scope and timing. 
Table 54 Summary of the analysis of the policy options across 5 main parameters 
Score of 
Degree of 
 VA 
Timing 
Scope 
Risks 
the 
"bindingness" 
option 
PO1 4 1 1  1  0 
1,10 
PO2 5 2 3  4  1 
3,40 
PO3 6 6 6  2  2 
3,80 
PO4 6 5 6  4  2 
4,70 
PO3+ 7 5  6  4  2 
4,75 
PO4+ 7 4  6  5  2 
5,15 
PO5 7 2 5  7  1 
5,60 
relative weight 
of parameter 
5% 10% 30%  50%  5% 100% 
in final scoring 
 
 
 
 
 
 
 
--- 0 
 
+ 4  
 
-- 1 
 
++ 5   
 
- 2 
 
+++ 6   
 
+/- 3 
 
++++ 7   
 
It should be noted that the final scoring indicates the ranking of options in terms 
of their potential impact on ETS prevalence rather than the magnitude of 
impacts. For instance, policy option 5 has been assigned +++ for the degree of 
bindingess as compared to ++ for options 2 and 4 even though an EU Directive 
would be several times more binding than the other two policy options.  
Based on the above considerations, the experience with existing EU instruments 
and developments and national level, the following proportional reductions were 
applied to the ETS prevalence ratios
• 
Policy 1: 6% reduction 
• 
Policies 2, 3, 3+, 4 and 4+: between 13% and up to 26% reduction, with  
Policies 2 and 3 being closer to the lower bound and Policy 4 closer to the 
upper bound. 
• 
Policy 5: under the most optimistic scenario, prevalence rates for all MS 
become equal to Ireland (a 100% reduction for bars/restaurants and 87-
89% reduction in indoor workplaces/offices), corrected for the fact that 
policy 5 is somewhat narrower in scope than the Irish ban and will not 
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affect businesses that are entirely run by self-employed or family workers. 
For the hospitality industry, on average 15.4% of the workforce is self-
employed or a family worker (based on Eurostat data from the labour 
force survey), and in the general workforce it is 12.3%. As a result, after 
this correction, the reduction in prevalence under policy 5 is equal to an 
85% reduction in ETS prevalence among staff in bars/restaurants and 76-
78% reduction in indoor workplaces/offices. 
The assumed 6% reduction in prevalence ratios for policy 1 takes into account 
the fact that several Member States are expected to implement smoke-free 
legislation over the next 5 years, even if the EC would take no further action. It 
is therefore useful to examine proposed legislation across the EU-27, and 
simulate how implementation of this legislation would affect the 2013 ETS 
prevalence under policy 1. Member States with smoke-free legislation proposals 
were therefore categorised into 3 categories, where category 3 represents 
legislation that is most likely to be implemented and category 1 represents 
legislation that is least likely to be implemented. 
Category 1: 
Category 1 assumes that by 2013 Romania will have a full ban in indoor 
workplaces/offices and a partial ban in bars/restaurants. In January 2008, the 
government adopted an emergency ordinance setting out a full ban in 
workplaces and a partial ban in hospitality sector (exemption for venues smaller 
than 100 m2 as of Jan.2009). The ordinance has already been approved by one 
chamber of the parliament (senate) but still has to be approved by the other 
chamber (deputies). 
In Austria, a partial ban in hospitality venues (below 80m2) can be expected as 
of January 2009, agreed on by the government in April 2008. However, the draft 
law now has to be approved by the parliament. Because there have been long 
negotiations on the proposed changes, chances have increased that the 
amendment will be accepted in the parliament. 
In addition, the Latvian parliament adopted in April 2008 a bill introducing a 
total ban on smoking in all enclosed public places including hospitality venues 
as of April 2010. Because ETS prevalence among staff in bars/restaurants is 
already very low according to the most recent Eurobarometer survey and 
smoking is currently allowed in ventilated smoking rooms, the adoption of this 
law is unlikely to significantly change ETS exposure among staff in 
bars/restaurants in 2013.  
Category 2: 
Category 2 assumes by 2013, the Czech Republic will have banned smoking in 
indoor workplaces/offices and bars/restaurants. In the Czech Republic a 
parliamentary initiative to ban smoking in all public places passed the health 
committee of the parliament but was watered down in the second reading with a 
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partial ban alternatives. However, it needs one more reading in the lower 
chamber and one in the senate. A number of similar initiatives failed in the past 
though. 
Category 3: 
Category 3 assumes that by 2013, Greece, Poland, Slovakia and Hungary have 
banned smoking in indoor workplaces/offices and bars/restaurants. Greece and 
Bulgaria currently have proposals for comprehensive smoking bans in all indoor 
public places and workplaces submitted to the Parliament. In Poland, a 
parliamentary initiative to ban smoking in all public places and workplaces 
passed the health committee of the parliament in March 2008. It needs two more 
readings in the lower chamber and one in the senate. In Hungary, the health 
ministry drafted a proposal for a comprehensive smoking ban covering all 
indoor workplaces, including bars and restaurants. However, there was a change 
at the post of the health minister and it is not yet certain that the new minister 
will take up the initiative. In Slovakia, the health ministry drafted a proposal for 
a partial ban in the hospitality sector (with an exemption for venues below 
200m2). Still, it has to be approved by the cabinet, before it is sent to the 
parliament. 
Table 54 shows the resulting reduction in ETS prevalence ratios compared to 
the 2008 baseline under the assumptions made for each of the three categories. 
Partial bans are assumed to have half the effect of full bans. The latter table 
reveals that the 6% reduction assumed for policy 1 would be largely consistent 
with a situation in which the countries in category 1 and 2 would have 
implemented their proposed smoke-free policies by 2013. The table also shows 
that ETS prevalence in the EU would have reduced substantially by 2013 if all 
category 3 countries would also become successful in implementing the 
proposed legislation.  As has been argued above, there are many uncertainties 
around these policies though, and one cannot simply assume that they will all be 
implemented.  
Table 54 Percentage reduction compared to baseline 
 indoor 
workplaces 

bars and 
offices staff 
restaurants staff 
Policy 1, Cat 1, 2013 
-5.64% 
-5.1% 
Policy 1, Cat 1 + 2, 2013 
-5.64% 
-8.2% 
Policy 1, Cat 1 + 2 + 3, 2013 
-23.3% 
-23% 
Policy 1 would therefore be equivalent to Member States in categories 1 and 2 
adopting smoke-free legislation by 2013 while all other countries remain on the 
same ETS prevalence level.  
To give an idea about the size of the assumed reductions, it is useful to express 
them as a (hypothetical) equivalent of member states going entirely smoke-free. 
For example, a 6% reduction in EU-wide ETS prevalence (policy 1) among 
non-smoking staff in indoor workplaces/offices, would be equal to Spain 
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reducing ETS exposure in this category to zero. Or, for another example, a 26% 
reduction EU-wide (policy 4) among non-smoking staff in bars/restaurants 
would be equal to Belgium, Denmark, Greece, Luxembourg, Austria, Portugal, 
Bulgaria and Hungary reducing ETS exposure in this category to zero. 
As explained in the methods section, these were validated estimates against the 
expert opinion of members of 15 stakeholder organisations. Their average 
ratings are shown in Table 55.  
Table 55: Stakeholder ratings on percent reduction in ETS prevalence ratio compared to 
baseline 
Stakeholders ratings on percent reduction in ETS prevalence ratio compared to 
Venue 
baseline 
Policy 2 
Policy 3 
Policy 4 
Policy 1 
Policy 5 
Open method 
Commission 
Council 
No change 
Binding 
of 
recommendati
recommendati
status quo 
legislation 
 
coordination 
on 
on 
overall exposure - indoor 
workplaces and offices 
0% 
-1% 
-2% 
-66% 
-81% 
overall exposure - bars and 
restaurants 
-1% -2% -5% -70% -89% 
workers' exposure - indoor 
workplaces and offices 
0% -1% -1% -66% 
-89% 
workers' exposure - bars 
and restaurants 
0% -1% -2% -75% 
-94% 
exposure at home 
0% 
-1% 
-3% 
-12% 
-20% 
 
These ratings reveal that the estimates applied in this report are slightly larger 
for policy 1-3, and substantially more conservative for policy 4.  
Table 56 shows the estimated number of staff exposed to ETS for at least one 
hour a day per 1,000 EU citizens under each of the 5 policies in 2013.  
 
Table 56 Estimated number of people per 1,000 EU citizens exposed to ETS for at least 
one hour a day on a daily basis 
 Non-smokers 
Smokers 
indoor workplaces /
bars and 
indoor workplaces / 
bars and 
 
offices staff 
restaurants staff 
offices staff 
restaurants staff 
                    
2.58 
2.47 
Baseline 2008 
18.62  
                              28.66 
Policy 1  
                    
2.41 
2.31 
No change from status quo 
17.41  
                              26.80 
Policy 2-3 
                    
2.24 
2.15 
Open Method 
16.20  
of Coordination 
                              24.94 
                    
1.91 
                              21.21 
1.83 
Policy 4 
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Council Recommendation 
13.78  
Policy 5 
                    
0.40 
0.38 
Binding legislation 
2.53  
                                7.28 
 
Estimated reductions in ETS-related mortality under each of the policies 

This section shows—separately for non-smokers and smokers—the EU-27 wide 
mortality and cost estimates for the 2008 baseline and each of the five policy 
alternatives. These estimates were obtained following the approach described in 
the previous chapter. A summary of the estimated mortality due to ETS 
exposure among smoking and non-smoking staff in the EU-27 is shown at the 
end of this section (table 62). 
In all tables that follow we show figures for the different venues (indoor 
workplaces/offices and bars/restaurants) separately, in addition to the total. In 
some cases, the total shown differs slightly from the sum of the separate 
estimates due to rounding of the separate estimates (while the totals have been 
calculated using the un-rounded estimates). 
Non-smokers 
Table 57 shows an estimate for the total number of annual deaths to ETS in 
2008 among non-smoking staff as 2,500. Note that this is a very conservative 
estimate, as it does not include non-staff members visiting bars, restaurants and 
pubs.  
Table 57 Estimated EU-wide mortality due to ETS exposure among non-smokers in 
2008  
 Baseline 2008 
Non-smokers 
Indoor workplaces
Bars and 
  
/offices staff 
restaurants staff 
Total 
                   
                    
Lung cancer 
 156  
387  
542  
                   
                    
Stroke 
 160  
378  
538  
                   
                    
Heart disease 
 138  
384  
522  
Chronic lower 
                   
                    
 332  
respiratory disease 
565  
897  
                   
                    
Total 
 786  
1,714  
2,500  
Table 58 shows the expected reduction in annual deaths in 2013 under each of 
the 5 policies. Whereas reductions for the first four policies are only modest, a 
large reduction (up to 1,487 deaths among non- smoking staff in indoor 
workplaces/office, and 664 deaths among non-smoking staff in 
bars/restaurants). 
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Table 58 Estimated annual reductions in mortality due to ETS exposure among non-
smokers for each of the policies 
 
 
Non-smokers 
 
Bars and  
Indoor workplaces/  
restaurants 
 
 
offices staff 
staff 
Total 
 
 
 
 
 
                     
               
          
Policy 1 
Lung cancer 
25  
10  
35  
                     
               
          
 
Stroke 
24  
10  
35  
                     
               
          
 
Heart disease 
25  
9  
34  
Chronic lower 
                     
               
          
 
respiratory disease 
36  
21  
58  
                     
               
          
 
Total 
110  
51  
161  
 
 
 
 
 
                      
               
          
Policy 2/3 
Lung cancer 
50  
20  
70  
                     
               
          
 
Stroke 
49  
21  
69  
                     
               
          
 
Heart disease 
50  
18  
67  
Chronic lower 
                     
               
          
 
respiratory disease 
73  
43  
116  
                     
               
          
 
Total 
221  
101  
323  
Policy3+/
                     
               
          
4 
Lung cancer 
50-100 
20-40 
70-140 
 
Stroke 
                     
 
          
 
Heart disease 
                     
               
          
Chronic lower 
 
respiratory disease 
                     
               
          
 
Total 
                     
                
          
 
 
 
 
 
                     
               
          
Policy 4+ 
Lung cancer 
100  
40  
140  
                     
               
          
 
Stroke 
97  
41  
139  
                     
                
          
 
Heart disease 
99  
36  
135  
Chronic lower 
                     
               
          
 
respiratory disease 
146  
86  
232  
 
Total 
                     
               
          
EN 
219  
 
E

link to page 219 link to page 221 link to page 222  
443  
203  
646  
 
 
 
 
 
                     
               
          
Policy 5 
Lung cancer 
335  
132  
466  
                     
               
          
 
Stroke 
327  
135  
463  
                     
               
          
 
Heart disease 
333  
116  
449  
Chronic lower 
                     
               
          
 
respiratory disease 
492  
280  
773  
                     
               
          
 
Total 
1,487  
664  
2,151  
Policy 1 = No change form status quo; Policy 2 = Open method of coordination; Policy 3 = 
Commission recommendation; Policy 4 = Council recommendation; Policy 5 = Binding 
legislation 
 
Smokers 
Table 35 shows a separate set of estimates for the annual number of deaths due 
to ETS among smokers, based on the assumption that regular ETS exposure 
adds to the risk from smoking itself. A noticeable difference between Table 57 
and Table 59 is that mortality from ETS exposure in indoor workplaces/offices 
is much higher among smokers compared to non smokers. This reflects the 
baseline prevalence numbers (i.e. the number of smokers exposed to ETS at 
indoor workplaces/offices is much larger than the number of non smokers 
exposed to ETS at indoor workplaces/offices).  
Table 59 Estimated EU-wide mortality due to ETS exposure among smokers in 2008  
Indoor 
workplaces / 
Bars and 
 
offices 
restaurants Total 
Disease Staff 
Staff  
 
               
              
            
Lung cancer 
600  
161  
761  
               
              
             
Stroke 
601  
197  
798  
               
              
            
Heart disease 
612  
159  
771  
Chronic lower 
respiratory 
               
              
            
disease 
881  
296  
1,176  
               
              
            
Total 
2,694  
813  
3,507  
Table 60 shows estimated reductions in mortality under each of the policies. 
EN 
220  
 
E

 
Table 60 Estimated annual reductions in mortality due to ETS exposure among smokers 
for each of the policies 
Indoor 
workplaces / 
Bars and 
 
 
offices 
restaurants 
Total 
 
Disease 
Staff 
Staff 
 
           
Policy 1 
Lung cancer 
              39  
              10  
49  
           
 
Stroke 
              38  
              13  
51  
           
 
Heart disease 
              39  
              10  
50  
Chronic lower respiratory 
           
 
disease 
              57  
              19  
76  
           
 
Total 
            173  
              53  
225  
 
 
 
 
 
           
Policy 2/3 
Lung cancer 
              77  
              21  
98  
           
 
Stroke 
              77  
              25  
102  
           
 
Heart disease 
              79  
              21  
100  
Chronic lower respiratory 
           
 
disease 
            113  
              38  
151  
           
 
Total 
            346  
            105  
451  
 
 
 
 
 
                 
             
           
Policy3+/4 
Lung cancer 
50-100 
20-40 
70-140 
 
Stroke 
                 
 
           
 
Heart disease 
                  
             
           
Chronic lower respiratory 
 
disease 
                 
             
           
 
Total 
                 
             
           
           
Policy 4+ 
Lung cancer 
            155  
              42  
196  
           
 
Stroke 
            154  
              51  
205  
           
 
Heart disease 
            158  
              41  
199  
Chronic lower respiratory 
           
 
disease 
            227  
              76  
303  
           
 
Total 
            693  
            210  
904  
EN 
221  
 
E

 
 
 
 
 
 
           
Policy 5 
Lung cancer 
            449  
            136  
586  
           
 
Stroke 
            456  
            166  
622  
           
 
Heart disease 
            464  
            135  
598  
Chronic lower respiratory 
           
 
disease 
            677  
            250  
927  
         
 
Total 
         2,046  
            687  
2,733  
Policy 1 = No change form status quo; Policy 2 = Open method of coordination; Policy 3 = 
Commission recommendation; Policy 4 = Council recommendation; Policy 5 = Binding 
legislation 
It should be noted that these impacts might not materialize immediately. For 
example, for the current cohort of people that would not be exposed to ETS due 
to any of the proposed policies, a reduction in lung cancer mortality would only 
become apparent after several years. For other diseases, such as heart disease 
the effect might be more immediate though. Thus, the effects on mortality 
should be regarded as annual deaths prevented in the longer run. 
Even though these effects will not fully materialise until a certain number of 
years has passed, the earlier a policy could be implemented, the larger the total 
benefits (i.e. over a series of years) will be.  
Summary 
Table 62 shows a summary of the estimated mortality in 2008 and reduction in 
mortality for each policy option due to ETS exposure among smoking and non-
smoking staff in the EU-27. 
Table 61: Summary of estimated mortality in 2008 and annual reduction in mortality for 
each policy option due to ETS exposure among smoking and non-smoking 
staff in EU-27 
 
Smokers 
Non-smokers 
Smokers 
and Non-
Smokers 
 
Indoor 
Indoor 
Bars and 
Bars and 
workplaces 
Total 
workplaces/
Total 
Total 
restaurants 
restaurants 
/offices 
offices 
Baseline 
1,714  
786  
2,500 
2,694 
813 
3,507 
2008* 
6,007 
(25%)  
(16%)  
(41%)  
(42%)  
(17%)  
(59%)  
Policy 1 
110  
51  
161  
173  
53  
225  
386 
Policy 
221  
101  
323  
346  
105  
451  
774 
EN 
222  
 
E

link to page 225 link to page 225  
2/3 
Policy 
221 -443 
101 - 203 
323-646 
346-693 
105-210 
451-904 
774-1,550 
3+/4 
Policy 
443 
203  
646  
693  
210  
904  
1,550 
4+ 
Policy 5 
1,487  
664  
2,151  
2,046  
687  
2,733  
4,884 
* The percentage of total (smokers and non-smokers) is shown in brackets 
Policy 1 = No change form status quo; Policy 2 = Open method of coordination; Policy 3 = Commission 
recommendation; Policy 4 = Council recommendation; Policy 5 = Binding legislation 
 
Medical Cost 
This section shows—separately for non-smokers and smokers—the EU-27 wide 
annual medical cost estimates for the 2008 baseline and each of the five policy 
alternatives. A summary of the estimated annual medical cost due to ETS 
exposure among smoking and non-smoking staff in the EU-27 is shown at the 
end of this section (table 67). 
Non- smokers 
This section shows the estimated annual medical cost due to ETS exposure 
across the EU-27, which total to €566 million and are highest for the treatment 
of stroke (€242 million) and heart disease (€149 million). 
Table 62 Estimated EU-wide medical cost (EUR millions) due to ETS exposure among 
non-smokers in 2008  
indoor workplaces / 
bars and 
  
offices staff 
restaurants staff 
Total 
Lung cancer 
29 11 
41 
Stroke 
185 58 
242 
Heart disease 
116 34 
149 
Chronic lower respiratory 
disease 
97 37 
134 
Total 427 
139 
566 
 
Table 63 shows that large reductions in medical cost are possible, up to 85% 
among staff in bars and restaurants under policy 5. Although policy 3 and 4 are 
assumed to have lower effectiveness than policy 5, they could still save between 
73 million euro (policy 2/3) and 146 million euro (policy 4) annually. 
EN 
223  
 
E

 
 
Table 63 Estimated  annual reductions in medical cost (EUR millions) due to ETS 
exposure among non-smokers for each of the policies 
Indoor 
workplaces / 
Bars and 
 
 
offices 
restaurants 
Total 
 
Disease 
Staff 
Staff 
 
               
             
         
Policy 1 
Lung cancer 
2  
1  
3  
                
             
         
 
Stroke 
12  
4  
16  
               
             
         
 
Heart disease 
7  
2  
10  
Chronic lower 
               
             
         
 
respiratory disease 
6  
2  
9  
               
             
         
 
Total 
27  
9  
36  
 
 
 
 
 
Policy 
               
              
         
2/3 
Lung cancer 
4  
1  
5  
               
             
         
 
Stroke 
24  
7  
31  
               
             
         
 
Heart disease 
15  
4  
19  
Chronic lower 
               
             
         
 
respiratory disease 
13  
5  
17  
               
             
         
 
Total 
55  
18  
73  
 
 
 
 
 
Policy 
             
         
3+/4 
Lung cancer 
      4-8           
1 -3 
5-11  
               
             
         
 
Stroke 
24 -47 
7 -15 
31 -62 
               
             
         
 
Heart disease 
15 -30 
4 -9 
19 -39 
Chronic lower 
               
             
         
 
respiratory disease 
13 -25 
5 -10 
17 -35 
               
             
         
 
Total 
55 -110 
18 -36 
73 -146 
 
 
 
 
 
               
             
         
Policy 4+ 
Lung cancer 
8  
3  
11  
               
             
         
 
Stroke 
47  
15  
62  
               
             
         
 
Heart disease 
30  
9  
39  
EN 
224  
 
E

link to page 226 link to page 226  
Chronic lower 
               
             
         
 
respiratory disease 
25  
10  
35  
               
             
          
 
Total 
110  
36  
146  
 
 
 
 
 
               
             
         
Policy 5 
Lung cancer 
25  
9  
35  
               
             
         
 
Stroke 
159  
49  
208  
               
             
          
 
Heart disease 
100  
28  
129  
Chronic lower 
               
             
         
 
respiratory disease 
84  
31  
115  
                
             
         
 
Total 
369  
118  
486  
Policy 1 = No change form status quo; Policy 2 = Open method of coordination; 
Policy 3 = Commission recommendation; Policy 4 = Council recommendation; 
Policy 5 = Binding legislation 
 
Smokers 
Table 64 and Table 65 show similar results for the medical cost due to ETS 
among smokers. 
Table 64: Estimated EU-wide medical cost (EUR millions) due to ETS exposure among 
smokers in 2008  
Indoor 
workplaces / 
Bars and 
 
offices 
restaurants 
Total 
Disease staff 
staff 
 
Lung cancer 
45 
10 
55 
Stroke 274 
56 
330 
Heart disease 
170 
33 
203 
Chronic lower respiratory disease 
147 
34 
181 
Total 636 
134 
770 
 
Table 65 Estimated reductions in annual medical cost (EUR millions) due to ETS 
exposure among smokers for each of the policies 
Indoor 
workplaces / 
Bars and 
 
 
offices 
restaurants 
Total 
 
Disease 
staff 
staff 
 
           
Policy 1 
Lung cancer 
                3  
                1  
4  
EN 
225  
 
E

 
           
 
Stroke 
              17  
                4  
21  
           
 
Heart disease 
              11  
                2  
13  
Chronic lower 
           
 
respiratory disease 
                9  
                2  
12  
           
 
Total 
              41  
                9  
49  
 
 
 
 
 
Policy 
           
2/3 
Lung cancer 
                6  
                1  
7  
           
 
Stroke 
              35  
                7  
42  
           
 
Heart disease 
              22  
                4  
26  
Chronic lower 
           
 
respiratory disease 
              19  
                4  
23  
           
 
Total 
              81  
              17  
99  
 
 
 
 
 
Policy 
           
3+/4 
Lung cancer 
                6 -11 
                1 -3 
7-14  
           
 
Stroke 
              35 -70 
                7 -15 
42 -85 
           
 
Heart disease 
              22 -44 
                4 -9 
26-52  
Chronic lower 
           
 
respiratory disease 
              19 -38 
                4 -9 
23 -47 
 
Total 
              81-163  
              17 -35 
99 -198     
 
 
 
 
 
           
Policy 4+ 
Lung cancer 
              11  
                3  
14  
           
 
Stroke 
              70  
              15  
85  
           
 
Heart disease 
              44  
                9  
52  
Chronic lower 
           
 
respiratory disease 
              38  
                9  
47  
           
 
Total 
            163  
              35  
198  
 
 
 
 
 
           
Policy 5 
Lung cancer 
              33  
                9  
42  
           
 
Stroke 
            203  
              48  
251  
 
Heart disease 
            129  
              28  
           
EN 
226  
 
E

 
156  
Chronic lower 
           
 
respiratory disease 
            108  
              29  
138  
           
 
Total 
            473  
            113  
587  
Policy 1 = No change form status quo; Policy 2 = Open method of coordination; Policy 
3
 = Commission recommendation; Policy 4 = Council recommendation; Policy 5 = 
Binding legislation 
 
Summary 
Table 67 shows a summary of the estimated medical costs in 2008 and annual 
reduction in medical costs for each policy option due to ETS exposure among 
smoking and non-smoking staff in the EU-27 (in € millions). 
Table 66: Summary of estimated medical costs in 2008 and annual reduction in medical 
costs for each policy option due to ETS exposure among smoking and non-
smoking staff in EU-27 (in € millions) 
 
Smokers 
and 
Non-smokers 
Smokers 
Non-
Smokers 
 
Indoor 
Indoor 
Bars and 
Bars and 
workplaces 
Total 
workplaces/ 
Total 
Total 
restaurants 
restaurants 
/offices 
offices 
Baseline 
427 
139 
566 
636 
134 
770 
1336 
2008* 
(27%) 
(15%) 
(41%) 
(44%) 
(15%) 
(59%) 
Policy 1 
 27 
 9  
 36  
 41  
 9  
 49  
85 
Policy 
 55  
 18  
 73  
 81  
 17  
 99  
172 
2/3 
Policy 
 55 -110 
 18-36  
 73-146 
 81-163 
 17 -35 
 99 -198 
172-344 
3+/4 
Policy 4 
 110  
 36  
 146  
 163  
 35  
 198  
344 
Policy 5 
 369 
 118  
 486  
 113  
 113  
 587  
1073 
* The percentage of total (smokers and non-smokers) is shown in brackets 
Policy 1 = No change form status quo; Policy 2 = Open method of coordination; Policy 3 = Commission 
recommendation; Policy 4 = Council recommendation; Policy 5 = Binding legislation 
EN 
227  
 
E

 
 
Non-Medical Cost 
This section shows—separately for non-smokers and smokers—the EU-27 wide 
annual non-medical cost estimates for the 2008 baseline and each of the five 
policy alternatives. A summary of the estimated annual non-medical cost due to 
ETS exposure among smoking and non-smoking staff in the EU-27 is shown at 
the end of this section (table 72). 
Non-smokers 
This section shows the non-medical cost due to ETS, including productivity 
losses due to premature death and morbidity. Excluding the cost of lung cancer 
(for which no recent and reliable estimates were available), the non-medical cost 
due to ETS for non-smoking staff are slightly less than the medical costs, 
totalling an estimated €347 million in 2008. Potential savings are estimated at 
€61 million, €123 million and €407 million for policy 2/3, 4 and 5 respectively.. 
Table 67 Estimated EU-wide non-medical cost (EUR millions) due to ETS exposure 
among non- smokers in 2008  
Indoor workplaces / 
Bars and 
 
offices 
restaurants 
Total 
Disease Staff 
Staff 
 
 
Lung cancer 
n/a 
n/a 
n/a 
Stroke 154 
54  208 
Heart disease 
102 
31 
134 
Chronic lower 
respiratory disease 
96 
38 
135 
Total 
353 
124 
477 
 
Table 68: Estimated annual reductions in non-medical cost (EUR millions) due to ETS 
exposure among non-smokers for each of the policies 
Indoor workplaces / 
Bars and 
 
 
offices 
restaurants 
Total 
 Disease 
Staff 
Staff 
 
Policy 1 
Lung cancer 
n/a    
n/a    
 -    
                   
             
            
 
Stroke 
10  
3  
13  
                    
             
            
 
Heart disease 
7  
2  
9  
Chronic lower respiratory 
                   
             
            
 
disease 
6  
2  
9  
                   
             
            
 Total 
23  
8  
31  
EN 
228  
 
E

 
 
 
 
 
 
Policy 
                   
             
            
2/3 
Lung cancer 
-    
-    
-    
                   
              
            
 
Stroke 
20  
7  
27  
                   
             
            
 
Heart disease 
13  
4  
17  
Chronic lower respiratory 
                   
             
            
 
disease 
12  
5  
17  
                   
             
            
 Total 
45  
16  
61  
 
 
 
 
 
Policy 
                   
             
            
3+/4 
Lung cancer 
-    
-    
-    
                   
             
            
 
Stroke 
20 -40 
7 -14 
27 -54 
                    
             
            
 
Heart disease 
13 -26 
4-8  
17 -35 
Chronic lower respiratory 
                   
             
            
 
disease 
12 -25 
5 -10 
17 -35 
                   
             
            
 Total 
45 -91 
16 -32 
61 -123 
 
 
 
 
 
                   
             
            
Policy 4+ 
Lung cancer 
-    
-    
-    
                   
             
            
 
Stroke 
40  
14  
54  
                   
             
            
 
Heart disease 
26  
8  
35  
Chronic lower respiratory 
                   
             
            
 
disease 
25  
10  
35  
                   
             
            
 Total 
91  
32  
123  
 
 
 
 
 
                   
             
            
Policy 5 
Lung cancer 
-    
-    
-    
                   
             
            
 Stroke 
131  
46  
177  
                   
             
            
 Heart 
disease 
88  
27  
115  
Chronic lower respiratory 
                   
             
            
 
disease 
83  
33  
115  
                   
             
            
 Total 
302  
105  
407  
Policy 1 = No change form status quo; Policy 2 = Open method of coordination; Policy 3 = 
Commission recommendation; Policy 4 = Council recommendation; Policy 5 = Binding 
legislation 
EN 
229  
 
E

link to page 231 link to page 231  
 
Smokers 
Finally, estimates for the non-medical cost due to ETS among smokers is shown 
in Table 69 and Table 70. 
Table 69: Estimated EU-wide non-medical cost (EUR millions) due to ETS exposure 
among smokers in 2008  
Indoor workplaces 
Bars and 
 
/ offices 
restaurants 
Total 
Disease staff 
staff   
Lung cancer 
n/a 
n/a 
n/a 
Stroke 231 
52 284 
Heart disease 
152 
31 
183 
Chronic lower respiratory disease 
145 
35 
180 
Total 529 
119 647 
 
Table 70: Estimated annual reductions in non-medical cost (EUR millions) due to ETS 
exposure among smokers for each of the policies 
Indoor 
workplaces / 
Bars and 
 
 
offices 
restaurants 
Total 
 
Disease Staff 
Staff   
Policy 1 
Lung cancer 
n/a    
n/a    
 -    
           
 
Stroke 
              15  
                3  
18  
           
 
Heart disease 
              10  
                2  
12  
Chronic lower respiratory 
           
 
disease 
                9  
                2  
12  
           
 
Total 
              34  
                8  
42  
 
 
 
 
 
Policy 
           
2/3 
Lung cancer 
               -    
               -   
-    
           
 
Stroke 
              30  
                7  
36  
           
 
Heart disease 
              20  
                4  
24  
Chronic lower respiratory 
           
 
disease 
              19  
                5  
23  
           
 
Total 
              68  
              15  
83  
EN 
230  
 
E

 
 
 
 
 
 
Policy 
           
3+/4 
Lung cancer 
               -    
               -   
-    
           
 
Stroke 
              30 -59 
           7-14 
36 -73 
           
 
Heart disease 
              20 -39 
            4 -8 
24 -47 
Chronic lower respiratory 
           
 
disease 
              19 -37 
              5-9 
23 -47 
           
 
Total 
              68 -136 
          15-31 
83 -167 
 
 
 
 
 
Policy 
           
4+ 
Lung cancer 
               -    
               -   
-    
           
 
Stroke 
              59  
              14  
73  
           
 
Heart disease 
              39  
                8  
47  
Chronic lower respiratory 
           
 
disease 
              37  
                9  
47  
           
 
Total 
            136  
              31  
167  
 
 
 
 
 
           
Policy 5 
Lung cancer 
               -    
               -   
-    
           
 
Stroke 
            166  
              44  
211  
           
 
Heart disease 
            112  
              26  
139  
Chronic lower respiratory 
           
 
disease 
            107  
              30  
137  
           
 
Total 
            385  
            100  
486  
Policy 1 = No change form status quo; Policy 2 = Open method of coordination; Policy 3 = 
Commission recommendation; Policy 4 = Council recommendation; Policy 5 = Binding 
legislation 
 
Summary 
Table 72 shows a summary of the estimated non-medical costs in 2008 and 
annual reduction in non-medical costs for each policy option due to ETS 
exposure among smoking and non-smoking staff in the EU-27 (in € millions). 
EN 
231  
 
E

 
Table 71: Summary of estimated non-medical costs in 2008 and annual reduction in 
non-medical costs for each policy option due to ETS exposure among 
smoking and non-smoking staff in EU-27 (in € millions) 
 
Smokers 
and 
Non-smokers 
Smokers 
Non-
Smokers 
 
Indoor 
Indoor 
Bars and 
Bars and 
workplaces 
Total 
workplaces/ 
Total 
Total 
restaurants 
restaurants 
/offices 
offices 
Baseline 
353 
124 
477 
529 
119 
647 
1124 
2008* 
(27%) 
(15%) 
(42%) 
(44%) 
(15%) 
(58%) 
Policy 1 
23  
 8  
 31  
34  
 8  
 42  
73 
Policy 
 45  
 16  
 61  
 68  
 15  
83  
144 
2/3 
Policy 
 45 -91 
 16 -32 
 61-123 
 68 -136 
 15 -32 
83-167  
144-290 
3+/4 
Policy 
 91  
 32  
123  
 136  
 32  
 167  
290 
4+ 
Policy 5 
 302  
 105  
 407  
 385  
 100 
486  
893 
* The percentage of total (smokers and non-smokers) is shown in brackets 
Policy 1 = No change form status quo; Policy 2 = Open method of coordination; Policy 3 = Commission 
recommendation; Policy 4 = Council recommendation; Policy 5 = Binding legislation 
 
Results industry revenues and employment 
Tobacco industry revenues 
The 2007 revenues across the entire EU-27 tobacco industry were estimated 
from Eurostat data as €67,089 million. According to the literature (shown in 
Table 41, Annex VI A) the effect of a smoking ban on tobacco revenues ranges 
from a reduction of 5.5% (Cesaroni et al, 2008) to 14% (Directorate for Health 
and Social Affairs, 2005). As discussed in the methods section, one could 
expect to see about half of this effect if an EU-wide smoking ban would be 
implemented, because various countries already have smoking bans in place. 
For the entire EU-27, the expected loss in revenue is within a range from €1,844 
million to to €4,696 million.  
EN 
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link to page 234 link to page 234 link to page 234  
 
Table 72 Estimated lost revenues (million EUR) in tobacco sales and jobs due to EU-wide 
smoking ban 
Lost revenues and jobs due to smoking 
 
 
ban 
 
2007 estimate 
Lower bound 
Upper bound 
  
2.75% 
7% 
EU-27 revenues 
67,089 1,844 
4,696 
EU-27 jobs 
53,521 1,472 
3,746 
 
Tobacco industry employment 
Table 72 shows the estimated number of people employed in the tobacco 
industry (NACE code 160) across the entire EU in 2007. Assuming the ratio of 
employment/revenue to be constant in the longer run, an EU-wide smoking ban 
would lead to a loss within a range from 1,472 to 3,746 jobs in the tobacco 
industry in the longer run. Note that this is not an annual loss (as the other 
figures are), but rather an overall shrinkage of the tobacco industry workforce. 
Considering that the current EU-27 labour force contains 218 million workers, 
even the upper bound estimate on jobs lost would represent less than 0.002% of 
the entire EU-27 labour force. 
Hospitality industry revenues 
Although the comprehensive Scollo and Lal (2008) review concluded that 
smoking bans did not have a negative effect on the hospitality industry, it may 
still be informative to extrapolate the range of effects reported in the literature to 
an EU-wide estimate. Table 73 shows for countries with no smoking ban for 
bars/pubs and restaurants, the 2008 estimated revenues and expected change in 
revenues due to an EU-wide smoking ban. The upper and lower bound in the 
table reflect the large range of effect estimates reported in the literature, varying 
from a reduction in revenues of 10% (Adda, Berlinski et al. 2006) to an increase 
in revenues by 9% (Thomson and Wilson, 2006). As a result, the estimated 
change in revenues varies between -€11 billion and +€10 billion annually.  
Table 73 Estimated annual changes in revenues in restaurants/pubs/bars sales due to 
EU-wide smoking ban (in EUR millions) 
Change in revenue due to 
Comprehensive smoke-free 
smoking ban 
Country 
2007 revenues 
legislation present 
Lower bound 
Upper bound 
 
 
 
- 10% 
9.3% 
EN 
233  
 
E

 
Belgium  
 
 8,557  
-855.7  
 795.8  
Denmark  
 
 4,042  
-404.2  
 375.9  
Greece  
 
 
 
Spain 
 
 42,110  
-4,211.0  
 3,916.3  
Finland Yes 
 
 
 
France Yes 
 
 
 
Ireland Yes 
 
 
 
Italy Yes 
 
 
 
Luxembourg 
 
 790  
-79.0  
 73.5  
Netherlands Yes   
  
Austria 
 
 6,944  
-694.4  
 645.8  
Portugal 
 
 6,936  
-693.6  
 645.1  
Sweden Yes 
 
 
 
Germany West 
 
 27,000  
-2,700.0  
 2,511.0  
United Kingdom 
Yes 
 
 
 
Bulgaria 
 
 726  
-72.6  
 67.5  
Cyprus 
 
 980  
-98.0  
 91.2  
Czech Republic 
 
 2,783  
-278.3  
 258.8  
Estonia Yes 
 
 
 
Hungary 
 
 1,909  
-190.9  
 177.5  
Latvia Yes 
 
 
 
 
Lithuania Yes   
 
 
Malta Yes 
 
 
 
Poland  
 3,461  
-346.1  
 321.9  
Romania 
 
 1,345  
-134.5  
 125.0  
Slovakia 
 
 860  
-86.0  
 80.0  
Slovenia Yes  
 
 
 
 
 
-10,758.2  
 10,005.1  
The expected effect on hotel revenues (-0.054%, as reported by NHS Health 
Scotland, 2005) is much smaller compared with the effect on 
restaurants/pubs/bars. Given that hotel revenues represent 30% of total revenues 
in the hospitality sector, the expected loss from an EU-wide smoking ban is 
estimated at €17.6 million annually.  
EN 
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link to page 236  
Hospitality industry employment 
Table 74 shows the expected change in employment (in 1,000 workers) due an 
EU-wide smoking ban. Following the range of effect estimates reported in the 
literature (McCaffrey, Goodman et al. 2006 reported a 8.82% reduction while 
Thomson and Wilson reported a 9% increase), the resulting (one-time) change is 
in the range of 265,000 jobs lost to 271,000 jobs gained. 
Table 74 Estimated changes in employment (1,000 workers) in 
restaurants/pubs/bars sales due to EU-wide smoking ban 
Change in employment due to smoking 
Comprehensive 
2007 
ban 
Country 
smoke-free 
Employment 
legislation present 
Lower bound 
Upper bound 
 
 
 
- 8.82% 
+9% 
Belgium  
 
 140  
-12.4  
 12.6  
Denmark  
 
 81  
-7.1  
 7.3  
Greece  
 
 
 
Spain 
 
 981  
-86.6  
 88.3  
Finland Yes 
 
   
France Yes 
 
  
Ireland Yes 
 
   
Italy Yes 
 
 
 
Luxembourg 
 
 12  
-1.1  
 1.1  
Netherlands Yes  
 
 
Austria 
 
 144  
-12.7  
 12.9  
Portugal 
 
 235  
-20.7  
 21.1  
Sweden Yes 
    
Germany West 
 
 809  
-71.4  
 72.8  
United Kingdom 
Yes 
 
 
 
Bulgaria 
 
 87  
-7.6  
 7.8  
Cyprus 
 
 19  
-1.7  
 1.7  
Czech Republic 
 
 122  
-10.7  
 11.0  
Estonia Yes 
 
   
 
Hungary 
 
 105  
-9.3  
 9.5  
Latvia 
Yes 
  
 
  
Lithuania Yes 
   
 
Malta Yes 
 
  
Poland 
 
 177  
-15.6  
 15.9  
EN 
235  
 
E

 
Romania 
 
 99  
-8.7  
 8.9  
Slovakia 
 
 22  
-1.9  
 2.0  
Slovenia Yes 
    
 
 
 
-265.4  
 270.9  
Estimated effects of smoke-free legislation on the cost of fires, cleaning and 
redecoration costs 

The total savings related to the cost of fires, cleaning and redecoration resulting 
from a smoking ban estimated in the four impact assessments for the UK, added 
up to GBP 197 million, or 0.015% of the 2006 UK GDP. Applying this fraction 
to the GDP of member states that did not have a full smoking ban by 2008, led 
to an extrapolated figure for annual EU-wide savings from a smoking ban (i.e. 
policy 5) of €965 million.    
Summary of potential costs and benefits of EU initiative 
To give an indication of the overall economic impact of an EU smoke-free 
initiative, the table below summarises the monetary benefits and costs of option 
5 for which the most elaborate estimates are available. The magnitude of the 
impacts would be proportionately smaller under options 1-4+. 
An economic value was placed on the following impacts of the initiative: 
-  economic value of lives saved as a result of reduced staff exposure to ETS in 
indoor workplaces/offices and bar/restaurants;  
-  reduced medical costs as a result of reduced exposure staff exposure to ETS; 
-  reduced non-medical (productivity) costs as a result of reduced staff 
exposure to ETS; 
-  Cost savings from reduced fire hazards and reduced cleaning and decorating 
costs; 
-  Impact on jobs and revenue in the tobacco industry. 
It should be noted that the benefits category is very conservative as it does not 
include the economic value of lives saved and the resource savings resulting 
from reduced exposure to ETS in non-staff members and reduced levels of 
active smoking, which are expected to bring substantial additional benefits.  
The costs category does not include reduced revenues from tobacco taxes and 
the implementation costs. However, these costs are expected to be relatively 
small. 
Even with a very incomplete list of benefits an EU smoke-free initiative would 
clearly result in a positive net economic impact.   
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Summary of costs and benefits of option 5 (binding EU legislation) 
Benefits (€ ) 
Costs (€ ) 
Social impacts 
Reduction in annual mortality due to  - 4,884 
ETS exposure among staff19 
deaths averted 
= €4.9 billion 
 
  
 
to €9.7 billion  
Reduction in morbidity due to ETS 
 
 
exposure 
Reduction in mortality from reduced 
 
 
active smoking 
non-
Reduction in morbidity from reduced  quantifiable 
 
 
active smoking 
Reduction of ETS at home 
 
 
Reduction in socio-economic 
 
 
inequalities 
Economic impacts 
Reduction in annual medical costs due  -€1073 million   
 
to reduced ETS exposure among staff  
Reduction in annual non-medical costs 
due to reduced ETS exposure among 
-€893 million 
 
 
staff  
  
Reduced 
tax 
revenues 
 
from tobacco sales20 
Annual lost revenues in 
 
 
€1.8 to 4.7 billion 
tobacco industry21 
Lost  jobs in tobacco  1,472 to 3,746 
 
 
industry22 
jobs less  
Impact on sales and revenues in hospitality sector is reported in the literature to range from minus 10 % to 
plus 9 %. Hence could range from – 11000 to 10000 million Euro.  
Impact on jobs in hospitality sector is reported by the literature to vary between 8.8 % reduction to 9 % 
increase. Hence could vary between 265.000 jobs lost to 271.000 jobs gained.   
Reduced costs of fires, cleaning and  €965  
 
 
redecoration for bar owners 
  
Enforcement 
and 
 
implementation costs  
Environmental impacts 
Reduction in indoor air pollution: 
Non-
 
 
83%-93% particular matter reduction  monetiseable   
reported in the literature for smoking 
 
 
bans  
Increased street litter and use of air  non 
 
 
heaters 
quantifiable 
Conclusion: Health benefits to be gained clearly outweigh costs.  
                                                 
19 The lives saved from reduced passive smoking were converted into an economic impact by 
assuming the value of a statistical life at € 1 – 2 million.   
20 These have not been quantified as this would have been exceeded the scope of this IA but 
reference is made to TAXUD IA. However in the majority of MS, tobacco taxes are less than 
5% of total tax revenues.  
21 It could be expected that money not spent on tobacco products would be spent on other goods 
and services, hence resulting in a re distribution of revenues from one sector to another.  
22 The loss of jobs is not annual but represents the overall shrinkage of the workforce.  
 
EN 
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Discussion and conclusion 
The analysis has shown that the current burden of ETS is substantial. Even 
under conservative assumptions (i.e. the requirement of being exposed for at 
least an hour on a daily basis), 2,500 non-smoking EU citizens of working age 
die each year due to ETS exposure at the place where they work. More than 
1,700 of these are due to exposure in indoor workplaces and offices, equal to an 
average of more than 7 deaths per regular business-day.  
The total annual costs among non-smoking and smoking staff combined, 
estimated at almost €2.5 billion, are substantial. At the same time, the evidence 
from countries (e.g. Ireland) with smoke-free legislation that exposure levels 
can drop considerably and approach zero if a ban on smoking at specific venues 
is implemented and enforced. It is reasonable to expect a similar reduction 
would be possible in other countries as well, in case EU-wide smoke-free 
legislation (policy option 5) would be implemented. As our analysis shows, up 
to 85% of deaths due to ETS among employees in the workplace could be 
prevented. Given that not only staff but also non-staff members are being 
exposed to ETS in workplaces, bars and restaurants, the number of 
(preventable) deaths due to ETS in the entire population is likely even larger. 
Under less stringent smoke-free policies compared to option 5, e.g. a 
Commission or Council Recommendation, the number of prevented deaths and 
savings from (non-)medical costs is still considerable, but substantially less than 
under option 5. 
It is interesting to compare the results of this IA with the most recent reported 
estimates in the literature, in particular those by Jamrozik (Smokefree 
Partnership, 2006). Jamrozik estimated 2,799 non-smokers across the EU-25 
died in 2002 due to ETS exposure at workplaces (including the hospitality 
industry). This estimate is remarkably close to this IA's estimate of 2,500 deaths 
due to ETS (combined for non-smoking staff in indoor workplaces/offices and 
restaurants/bars). However, this IA's estimates for the number of deaths among 
non-smoking staff in bars/restaurants (786) is much higher than what Jamrozik 
reports for the hospitality industry (89). No recent comprehensive direct 
estimates have been reported for the medical and non-medical cost of ETS, 
which makes it difficult to compare this IA's findings in this area to existing 
work.    
The method underlying this analysis is similar in many respects to various 
country-specific impact assessments on smoke-free legislation. For example, the 
impact assessments for Northern Ireland and Scotland applied a population 
attributable risk factor to the incidence of lung cancer, ischaemic heart disease 
and stroke to estimate the annual number of deaths caused by ETS, in addition 
to the costs resulting from morbidity due to these diseases and attributable to 
ETS.  
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It should be noted that the estimates only consider (changes in) exposure to ETS 
among staff members in indoor workplaces and offices, bars, pubs and 
restaurants. However, visitors of these places will likely be exposed to ETS as 
well, in case staff members report to be exposed. It is expected that the policies 
considered examined in this IA would not only affect exposure among staff but 
also among these visitors. It is difficult to estimate the effect on non-staff 
members, because reliable data on ETS prevalence in this group are not 
currently available. All that can be said is that most likely the population of non-
staff members in bars, pubs and restaurants is substantially larger than the 
population of staff-members (e.g. a restaurant with 10 staff will likely serve 
many more than 10 guests during one evening), and hence the absolute number 
exposed to ETS is much larger for non-staff members. At the same time, the 
time of exposure (e.g. in hours per day) is likely lower for non-staff compared to 
staff, making it difficult to compare the risk of exposure and resulting burden. 
Likewise, a (relatively small) number of people are exposed to ETS in other 
work places and (fairly substantial) number at home. For the latter category, 
reliable prevalence estimates were not available from the Eurobarometer 
dataset, and hence albeit was not possible to estimate the burden due to ETS 
exposure at home. However, it should be also noted that the policies considered 
in this IA do not directly aim to reduce ETS exposure at home.     
As discussed in the methods chapter, it was not possible to obtain reliable and 
recent estimates on the costs of lung cancer, asthma and COPD, neither for 
individual member states, nor for the EU as a whole. Although the European 
Lung White Book contains estimates on the costs of these diseases, they are of 
limited value as they are not very recent (i.e., estimates for the year 2000) and 
apply to the EU-15, in addition to Norway and Switzerland, rather than the EU-
27. Based on the preference to use estimates published in the peer-reviewed 
literature, a different method was chosen instead based on US cost figures 
published in the peer-reviewed literature, and expressed as a ratio of total US 
health care costs. It is useful to compare this IA's estimates to those reported in 
the European Lung White Book. 
For lung cancer (i.e. the total cost of lung cancer, both resulting from ETS and 
from other causes), the direct medical costs estimated in this IA were €9.6 
billion, whereas the European Lung White Book estimated these as €2 billion in 
2000, which would be €3.8 billion in 2008 (assuming an average 8% annual 
increase in health care expenditures, based on calculations we made using 
OECD Health data). Given that the latter estimate applies to only 15 member 
states, the estimate of this IA does not diverge by an order of magnitude from 
the European Lung Whitebook. Performing the same exercise for COPD, the 
estimate of this IA was €18 billion, whereas the 2008 extrapolated European 
Lung Whitebook estimate would be €18,914 million. Finally, for asthma these 
figures would compare as €6.1 billion (ours) and €14.6 billion (European 
Respiratory Society 2003).       
EN 
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E

 
It might be useful to compare this IA's medical cost estimates to (extrapolated) 
estimates from the UK impact assessments (NHS Health Scotland et al., 2005; 
Department of Health 2006; Department of Health 2007; Welsh Assembly 
Government, 2007). Potential savings in treatment costs under a complete 
smoking ban were estimated at £110.818 million at 2003 prices (Northern 
Ireland £2.6 million; England £100 million; Scotland £5.318 million; and Wales 
£2.9 million), or 0.13% of the UK’s 2003 expenditure on health care (£86,529 
million in 2003 according to OECD Health data). Applying this percentage to 
the predicted 2008 expenditure on health care in all EU-27 countries that did not 
have a smoking ban in 2008, and half the percentage to all EU-27 countries that 
had a partial smoking ban would result in savings from a total smoking ban 
(policy 5) at €682 million. This is higher than this IA's estimated savings under 
policy option 5 for non-smoking staff (€486 million) and lower than the 
estimated savings under that same policy option for non-smoking and smoking 
staff combined (€1073 million).  
Table 75: Estimated number of deaths attributable to passive smoking among non-
smoking staff in the EU-25 in 2002 and EU-27 in 2008  
 
Non-smokers 
 
Indoor workplaces/offices 
Bars and restaurants 
Disease 
EU-25 2002 
EU-27 
EU-25 2002 
EU-27 
2008 
2008 
Lung cancer  521 
 387  
16 
 156  
Ischaemic 
1481 
 384  
48 
 160  
heart 
disease  
Stroke 
596 
 378  
19 
 138  
Chronic 
201 
 565 

 332  
lower 
respiratory 
disease 
Total 
2799 
 1,714 
89 
 786  
The literature suggests that smoke-free policies can have substantial effects on 
industry revenues, in particular those of the tobacco and hospitality sector. The 
extrapolations made in this IAshow that such losses can amount to €1.9 billion 
annually for the tobacco industry under EU binding legislation (policy 5). 
However, this estimate is very sensitive to the exact effect assumed, making it 
difficult to provide an exact quantification across the policy options. This is 
even more the case for the effects on the hospitality industry, where the 
literature reports contradictory evidence: i.e. both positive and negative effects 
on revenue, leading to extrapolated increases and reduction in revenues due to 
EU-wide smoke-free legislation (policy 5) in the order of €10 billion annually. 
EN 
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Further research would be necessary to obtain a more conclusive estimate than 
is currently available from the literature. 
 
EN 
241  
 
E

 
ANNEX VIII – MONITORING AND EVALUATION 
 
European Health Interview Survey (EHIS) Questionnaire 
SK.1 
Do you smoke at all nowadays? 
• 
Yes, 
daily 
      1  
• 
Yes, 
occasionally 
     2 → GO TO SK.4 
• 
Not 
at 
all 
      3 → GO TO SK.4 
 
 
SK.2 
What tobacco product do you smoke each day? 
More answers are possible 
• Manufactured 
cigarettes 
 
 1 
• Hand-rolled 
cigarettes 
 
 2 
• 
Cigars      3 
•  Pipefuls of tobacco   
 4 
• 
Other 
     5 
 
 

SK.3 
On average, how many cigarettes, cigars or pipefuls do you smoke each 
day? 

 
 
 
 
Manufactured cigarettes 
└─┴─┘ 
 
Hand-rolled cigarettes 
└─┴─┘ 
 
Cigars 
└─┴─┘ 
→ GO TO SK.5 
 
Pipefuls of tobacco 
└─┴─┘ 
 
Other 
└─┴─┘ 
 
 
SK.4 
Have you ever smoked (cigarettes, cigars, pipes) daily, or almost daily, 
for at least one year? 

EN 
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•  Yes   
 
 
 
 
 1  
•  No   
 
 
 
 
 2 → GO TO SK.6 
 
SK.5 
For how many years have you smoked daily? Count all separate periods 
of smoking daily. If you don't remember the exact number of years, 
please give an estimate. 

 
 
└─┴─┘years  
 
 
SK.6 
How often are you exposed to tobacco smoke indoors at home? 
•  Never or almost never 
 
 
 1  
•  Less than 1 hour per day 
 
 
 2  
•  1-5 hours a day 
 
 
 
 3 
•  More than 5 hours a day 
 
 
 4 
 
 
 

SK.7 
How often are you exposed to tobacco smoke indoors in public places 
and transport (bars, restaurants, shopping malls, arenas, bingo halls, 
bowling alleys, trains, metro, bus)? 

•  Never or almost never 
 
 
 1  
•  Less than 1 hour per day 
 
 
 2  
•  1-5 hours a day 
 
 
 
 3 
•  More than 5 hours a day 
 
 
 4 
 
 
SK.8 
How often are you exposed to tobacco smoke indoors at your workplace? 
•  Never or almost never 
 
 
 
 1  
•  Less than 1 hour per day 
 
 
 
 2  
•  1-5 hours a day 
 
 
 
 
 3 
•  More than 5 hours a day 
 
 
 
 4 
•  Not relevant (don't work or don't  work indoors) 
 5 
 
 
Full questionnaire available at  
EN 
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E

 
 
 
European System of Household Survey Modules (EHS) 
Updated List of variables/questions to be included in the 2008 pilot data 
collection 
 
HIS043 
      
Do you smoke at all nowadays? 

Yes, daily 

Yes, occasionally 

Not at all 
HIS044 
      
How often are you exposed to tobacco smoke 
 
indoors in public places and transport (bars, 
restaurants, shopping malls, arenas, bingo halls, 
 
bowling alleys, trains, metro, bus)? 

Never or almost never 

Less than 1 hour per day 

1-5 hours a day 

More than 5 hours a day 
HIS045 
  
How often are you exposed to tobacco smoke 
 
indoors at your workplace? 

Never or almost never 

Less than 1 hour per day 

1-5 hours a day 

More than 5 hours a day 

Not relevant (don't work or don't work indoors) 
 
EN 
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ANNEX IX– TECHNOLOGICAL APPROACHES TO CONTROLLING ETS 
This Annex provides an overview of technological strategies and their 
effectivenss for controlling second-hand smoke, specifically the segregation of 
smokers and non-smokers. This may include designated smoking rooms 
equipped with ventilation systems; designated smoking areas with ventilation 
(i.e. not separated by walls); and smoking stations and cabins. We draw upon 
evidence from the peer reviewed and grey literature. A literature search was 
performed on PubMed using the terms “tobacco smoke pollution,” “ventilation” 
and “designated smoking rooms”.23 The grey literature, including reports of 
government agencies, international organisations and scientific associations was 
searched for relevant material accessible on the Internet. Several reports and 
peer reviewed articles were also obtained through the stakeholder consultation 
on the Commission's smoke-free initiative on 19th March 2008. For example, 
material was obtained from the manufacturers of air treatment systems. A 
summary of the types of articles that were examined are presented below.  
Table 76: Summary of articles obtained from the peer reviewed and grey 
literature 
Type of article 
Number  
Type of article 
Number 
Peer reviewed journal article  
11 
Industry sponsored report 

International agency  

Charity 

Professional associations 

Independent 

Scientific association 

Non profit association  

Government/Government agency 
3 Partnership 
organisation 

Government sponsored report 

Conference proceeding 

Industry 2 
Foundation 

  
Professional 
society 

  
Total 
29 
                                                 
23 A search was carried out using PubMed’s MeSH database, which is the U.S. National Library 
of Medicine's controlled vocabulary used for indexing articles. The search term used 
was “tobacco smoke pollution” and “ventilation.” A total of 84 articles were identified. 
Another PubMed search was carried out using the search term “designated smoking 
rooms.” A total of 10 articles were identified. The title and abstract for each article was 
reviewed to determine whether or not the article was relevant for the current 
assignment. Full articles were obtained for all those abstracts we deemed to be relevant 
(i.e. articles focussed on the effectiveness of designated smoking rooms, designated 
smoking areas with ventilation and/or smoking stations and cabins).     
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Table 72 at the end of this section lists and summarises the studies that have 
been incorporated into this chapter. Each study was summarised across the 
following dimensions: sample size, year of data collection, location, setting, 
study design, outcome measures, and technology considered to control 
secondhand smoke. 
Most of the studies examining the effectiveness of technological strategies for 
controlling second hand smoke have relied on observational designs, comparing 
concentrations of ETS in non smoking and smoking sections of restaurants, bars 
or other venues (such as airports). Most of the studies also obtain concentrations 
at a control site, such as a non-smoking office building. The number of venues 
included in the studies varied from one to more than fifty over multiple cities. 
We did not come across any randomised control trial designs. 
ETS concentrations (such as nicotine and particulate matter) are typically 
measured using personal air sampling equipment work by wait staff or 
volunteers, and/or through air quality monitoring. Furthermore, concentrations 
are typically measured over a specified time period (e.g. 4 hours or one day) and 
are taken from more than one sampling point in a venue.  In several cases we 
could not summarise the study across the dimensions listed above since this 
information was not cited.  
Types of air treatment systems 
Ventilation and filtration are the two main methods of air treatment used to 
reduce indoor air pollution. Box 1 defines common terms cited in the literature 
(Smokefree Northern Ireland. Health Promotion Agency; Surgeon General 
2006). Source control may also be used to eliminate or reduce individual 
sources of pollutants. The tobacco industry as well as other interest groups, such 
as manufacturers of air treatment systems, have promoted the installation and 
use of ventilation systems and equipment in an attempt to accommodate 
smokers and non-smokers in the same indoor enclosed spaces (Bialous and 
Glantz 2002; Drope, Bialous et al. 2004; Pilkington and Gilmore 2004). The 
case is also made that if ventilation is complemented with improved filtration of 
the returned air, it may be possible to achieve greater reductions of some 
second-hand smoke constituents beyond what dilution alone can accomplish. 
This may help avoid the establishment of strict smoking bans (Surgeon General 
2006; WHO 2007).  
Box 1: Description of different types of air treatment systems  
Positive output ventilation systems exhaust air from an enclosed space at a rate 
that completely replaces the air in the room. 
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link to page 248  
Dilution ventilation is the introduction and mixing of ventilation air with air 
already present in the space. For example, 80-90% of air may be re-circulated, 
10-20% fresh air brought in from outside, and 10-20% of the stale air expelled. 
Displacement ventilation involves the introduction of ventilated air generally at 
or near floor level in a directional pattern with little or no mixing to force air out 
from or near the ceiling. Displacement ventilation is often considered a design 
option for the separation strategy of smokers and non-smokers.   
Filtration systems (sometimes called air cleaners) pump the air through very fine 
filters to remove particles of smoke and dust before the air is re-circulated. 
Table 77 presents six technologies used in air cleaning systems. Air cleaners are 
typically classified by the method employed to remove particles of various sizes 
from the air. Neither air filtration (cleaning) nor air conditioning is ventilation 
because neither process introduces air into or moves air through an enclosed 
space. The Environmental Protection Agency (2008) states there are three 
general types of air cleaners: mechanical filters, electronic air cleaners, and ion 
generators. Hybrid units, using two or more of these removal methods, are also 
available. Further, air cleaners may be in-duct units (installed in the central 
heating and/or air conditions systems) or stand-alone portable units. The 
effectiveness of these devices will be assessed by the volume of air processed 
and the removal efficiency of various constituents. The product of these two 
values is compared to the dilution rate achieved by the overall ventilation of the 
air delivered to the conditioned space. Field and laboratory investigations have 
evaluated the second-hand smoke controls strategies discussed above. In the 
next sections we review the effectiveness of various second-hand smoke control 
strategies. 
Table 77. Comparison of air-cleaning systems 
Source: (Surgeon General 2006) 
Technology 
Characteristic Electrostatic Solid media  Gas-phase filtration 
Ozone  (O3) 
Catalytic 
Bipolar air 
precipitation 
filtration 
generation 
oxidation 
ionization 
Function Electronic 
Physical 
Physico-chemical  
Electronic 
Physico-
Electronic 
chemical  
Principle High-voltage 
Flat, pleated,  Sorption and reaction 
Sparking 
Solid 
Dielectric 
wire and 
or high 
discharge 
catalyst 
barrier 
plate 
efficiency 
with or 
discharge 
particulate 
without 
air media 
ultraviolet  
Process Charging 
of 
Collection of  Sorption and reaction 
O3 
Catalytic 
Positive and 
particulate 
porous 
generation 
oxidation 
negative ion 
matter 
media 
generation 
Active species 
Charged 
High surface  Sorption and reaction  O3 Reactive 
Reactive 
particles 
area 
sites 
oxygen 
oxygen and 
species 
charged 
species  
By-products O3  if  not Spent 
filters; Spent media with Significant  Exhausted Some 
O3 
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cleaned 
contaminants contaminants 
Oy, 
or fouled 
regularly 
atmospheric  catalyst, 
reactants 
some 
VOCs 
VOCs Sorption 
of 
NA Adsorption/absorption 
Chemical 
Chemical 
Chemical 
VOCs on 
oxidation 
oxidation 
oxidation 
PMx 
PMx Collection 
on 
Impact, 
Collection on media 
NA 
NA 
Agglomeration 
plates 
settling, and 
diffusion  
VOCs = Volatile Organic Compounds 
PM = particulate matter 
NA = Not applicable 
SOURCE: (Surgeon General, 2006) 
Separating smokers and non-smokers 
This section reviews studies in the peer reviewed and grey literature which have 
examined whether second-hand smoking can be controlled by separating 
smokers from non smokers, through means such as designated smoking rooms 
equipped with ventilation system (as allowed in Italy, France, and Sweden); 
designated smoking areas with ventilation (i.e. not separated by walls); and 
smoking stations or cabins. 
Ventilation and designated smoking areas with ventilation systems 
A number of studies examined whether second-hand smoking can be controlled 
by the use of ventilation or separating smokers from non smokers with 
designated smoking areas (i.e. not separated by walls) with ventilation systems.  
A panel of ventilation experts assembled by the Federal Occupational Safety 
and Health Administration (OSHA) and the American Conference of 
Governmental Industrial Hygienists (ACGIH) in June 2000 found that dilution 
ventilation used in virtually all mechanically ventilated buildings, will not 
control second-hand smoke in the hospitality industry. Displacement ventilation 
was estimated to offer the potential for up to 90% reductions in ETS levels. 
However, this assertion was based on professional judgement rather than on 
measured data. Air cleaning was judged to be somewhere between dilution and 
displacement, depending on the level of maintenance. Panelists also observed 
that building ventilation codes are not routinely enforced. The panel concluded 
that dilution ventilation, air cleaning, or displacement ventilation technology 
(even under moderate smoking conditions) cannot control ETS risk to 
“acceptable”24 levels for workers or patrons in hospitality venues without 
substantially impractical increases in ventilation. Moreover, smoking bans 
                                                 
24 The WHO state there is no “safe” level of ETS exposure. Hence the only “acceptable” level 
means zero.  
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remained the only viable control measure to ensure workers and patrons of the 
hospitality industry are protected from exposure to toxic wastes from tobacco 
combustion (Repace 2000). 
Dutch government commissioned a study from the Netherlands Organisation for 
Applied Scientific Research - TNO (Building and Construction) and the 
National Institute for Public Health and the Environment (RIVM) to review the 
literature on ventilation and air cleaning technologies that could be used in the 
hospitality industry, and ascertaining to what extent these technologies may help 
to limit exposure to ETS. The review found that the dilution application is the 
usual application in the hospitality industry. With this technique, several tens of 
percent of exposure reduction can be achieved. Possibilities to increase the air 
exchange rate are limited because of the comfort that would otherwise be lost at 
high air exchange rates. Ventilation systems based on replacement and not 
dilution may provide better results (about 90% reductions under the most 
favourable conditions) because much higher air exchange rates can be used 
without losing comfort. However, these estimates are based on measurements 
carried out under laboratory conditions. In practice, disturbances (objects and 
undesired air flows due to movements of persons, doors etc) may make the 
systems significantly less effective. In addition, installation and maintenance of 
these systems are much more expensive than for traditional dilution systems. 
The report estimated the cost of the purchasing and installation of full-
displacement ventilation at around one thousand euro per square metre (as 
compared with the annual turnover of slightly less than €1,000 per square metre 
in cafés and bars, and approximately €2,700 in restaurants). This did not take 
into account the operating and maintenance costs (de Gids and Opperhuizen 
2004).  
Several studies have found traditional systems based on dilution ventilation and 
air filtration to be ineffective at reducing levels of SHS. A study of second-hand 
smoke exposure in 60 randomly selected bars in Greater Manchester, UK 
undertaken in 2003, found that complete separation of smokers from non 
smokers reduced the concentrations of various SHS markers (e.g. respirable 
suspended particulate matter, ultraviolet light-absorbing particulate matter, and 
nicotine) by about 50% compared to smoking and non-smoking sections. 
However, compared with other settings (homes and other workplaces) with 
unrestricted smoking, mean ETS levels were high throughout all areas of the 
pubs regardless of ventilation systems in place, which included mechanical 
ventilation and extractor fans The authors note that better ventilation designs 
might have further reduced second-hand smoke (Carrington, Watson et al. 
2003).   
In a study of 75 restaurants in 26 cities, Hammond (2002) also found no 
evidence that an increase in ventilation had any effect. Results indicated that, in 
spatially separated strategies where half or more of the seating area was non 
smoking, SHS smoke levels in the non smoking section were reduced, but levels 
remained high (Surgeon General 2006). 
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The limited potential of traditional dilution ventilation has been confirmed by 
the results of two series of experiments that were carried out by the Commission 
of the European Union, Joint Research Centre, Institute for Health and 
Consumer Protection, Ispra to test the impact of ventilation rates on ETS 
components also indicate that chemicals such as volatile hydrocarbons, 
carbonyls, poly aromatic hydrocarbons, inorganic gases and particles etc cannot 
be rapidly and substantially eliminated from the indoor air atmosphere, even 
when high air exchange rates are applied. Further, diffusion of the emitted 
compounds and burning products is relatively slow, so dilution via mixing with 
new incoming fresh air is not very effective as a control measure. Only “wind 
tunnel” rates or other high rates of ventilation would be required to achieve 
pollutant levels close to ambient air limit values (Kotzias, Geiss et al. 2006). 
These findings were comparable to results obtained from U.S. studies carried 
out at different hospitality venues. In addition, the WHO (2007) argues that 
while increasing the ventilation rate reduces the concentration of indoor 
pollutants, including tobacco smoke; ventilation rates more than 100 times 
above common standards would be required just to control odour. Even higher 
ventilation rates would be required to eliminate toxins, which is the only safe 
option for health. Indeed, the WHO state that eliminating toxins in the air would 
require many air exchanges that it would be impractical, uncomfortable and, 
most critically, unaffordable. 
A report prepared by Theodor Sterling Associates (2007) assessed the indoor air 
quality and the performance of ventilation systems in three hospitality venues 
throughout the UK in December 2006. The study concluded that dilution 
ventilation when operated effectively, can achieve levels of particles and gases 
in an indoor environment where smoking occurs that are comparable to levels of 
particles and gasses in the outdoor environment. In one hospitality venue PM2.5 
levels reached 27.6 µg/m3 compared to 41.3 µg/m3 outdoors. In the two other 
venues indoor measurements of the particles and gases were higher than outdoor 
measurements. Other studies measuring PM2.5 levels after smoking bans have 
been enforced have shown that PM2.5 levels can be reduced to, for example 16 
µg/m3   in Scotland (Semple, Maccalman et al. 2007), and 5 µg/m3 in Ireland 
(Office of Tobacco Control 2005). This suggests that smoking bans are more 
effective at reducing levels of particles and gases than dilution ventilation 
(Theodor Sterling Associates 2007). The study by Theodor Sterling Associates 
(2007) has been linked to the tobacco industry.  
There have been a few published studies in the peer reviewed and grey literature 
which have concluded that displacement ventilation technology for 
restaurants/pubs with separate smoking and non smoking areas are capable of 
achieving non-smoking area or outside air ETS concentrations (Jenkins, Finn et 
al. 2001; Theodor Sterling Associates 2007). For example, a Canadian study by 
Jenkins  et  al (2001) tested the concentration of ETS components in a small 
restaurant/pub with separate smoking and non-smoking areas (a facility outfitted 
with a heat-recovery ventilation system and directional airflow). The results 
indicated that ETS of the non-smoking section of the restaurant/bar were not 
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statistically different (P < 0.05) from those measured in similar facilities where 
smoking is prohibited. This study only examined the issue of non-smoking 
patron exposure to ETS, and did not examine the issue of employees exposure 
to ETS (Jenkins, Finn et al. 2001). This study has also been linked to the 
tobacco industry (Drope, Bialous et al. 2004). Furthermore, this study has been 
criticised on methodological grounds (Surgeon General 2006) and its results 
were undermined more recently by Repace and Johnson (2006) who examined 
whether displacement ventilation could control second-hand smoke. Results 
showed that displacement ventilation was not a viable substitute for smoking 
bans in controlling ETS exposure in contiguous designated non-smoking areas 
sharing the same space volume. Furthermore, a study in Ontario found leakage 
of ETS from a restaurant with a designated smoking area to other areas of the 
establishment. Again, these finding reinforces the EPA concept of atmospheric 
“spill-over” effect (Stantec Consulting 2004) 
Another study commissioned by the tobacco industry into the effectiveness of 
displacement ventilation in the day-to-day operations of three types of 
hospitality businesses indicated that exposure to ETS in the hospitality industry 
can be reduced significantly, up to 92-99% in the non-smoking areas (de Gids 
and Jacobs 2006). However, the assessment of the study performed for the 
Dutch government by the National Institute of Public Health and Environment 
RIVM showed that the reported high levels of reduction were due to an 
incorrect calculation approach. Based on the same data, RIVM calculated that 
the reductions are lower (between 50 and 79%) for the three hospitality venues 
(National Institute for Public Health and the Environment 2006)  
Separate smoking and non-smoking areas may not protect employees from SHS. 
For example, a study by Stantec Consulting (2004) showed that based on data 
from personal air samplers work by staff, servers based in the non-smoking 
sections experienced higher levels of some ETS markers than were present in 
the non-smoking sections, which was probably because staff entered the 
smoking section to obtain drinks.  
A recent review on ventilation performance for spaces where smoking is 
permitted also identified conflicting views. The authors acknowledge where 
attention has been paid to ensuring that the ventilation system being tested is 
adequate and working correctly, significant improvements in indoor air quality 
can be made, but such solutions need to be scientifically and critically evaluated 
(Geens, Snelson et al. 2006). Previously, pro-technological studies have been 
criticised for applying an incorrect method of calculation and as a result 
reporting excessively high reduction percentages in ETS (see for example  
National Institute for Public Health and the Environment (2006) and Piha 
(2006)). 
Because some particulate matter in smoke is visible, ventilation and filtration 
systems can give the non smoker the impression that they are safe from 
exposure to ETS by diluting the larger particles (ASH Scotland 2004). 
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However, the WHO (2007) argue that these systems can not eliminate the 
carcinogens present in SHS, and cannot therefore be considered an adequate 
solution to eliminating the health risks associated with ETS. Further, many 
particles are inhaled or deposited on clothing, furniture, walls, and ceilings 
before they can be ventilated. As ventilation systems may increase comfort 
levels, many people under-estimate the extent to which they are exposed to ETS 
(not surprisingly given that carcinogens have no smell). In one U.S. study, for 
example, 40% of people questioned reported exposure to ETS. However, the 
U.S. Centre for Disease Control measured cotinine (a nicotine by-product in the 
body) in the blood of 88% of the non smoking population (Pirkle and et al 
1996). The twin criteria of health and comfort should not be confused. 
Advanced technology solutions often require regular maintenance and ongoing 
monitoring to ensure effective operation (Broadbent 2005). A commentary on 
ventilation by the New Zealand Health Select Committee reported many 
proprietors leave their ventilation systems switched off, as they find the running 
costs too high.25 The US Environmental Protection Agency (2008) has stated there 
are major costs for air cleaners including the initial purchase of the unit, 
maintenance costs (i.e., cleaning and/or replacement of filters and other parts), 
and operating costs (e.g. costs for electricity) (Environmental Protection Agency 
2008). Moreover, the most effective units are also the most costly. Other 
considerations (apart from cost, installation, use and need for maintenance) 
include the noise of the unit, soiling of walls and other surfaces, and the air 
cleaners ability to remove odours (Environmental Protection Agency 2008). 
Designated smoking rooms equipped with ventilation systems 
Several researchers have investigated the use of designated smoking rooms to 
control second hand smoke and whether they can protect non-smokers from 
exposure to second hand smoke.    
Studies evaluated for the Surgeon General’s (2006) report showed that 
designated smoking rooms do not prevent persons outside these areas being 
exposed to second-hand smoke. There is usually a “spillover” effect into 
adjacent areas to the designated smoking room (Pion and Givel 2004). The 
strategy may require complicated engineering and a careful assessment of 
relevant building characteristics. A study by Wagner et al (2004) which 
examined ETS leakage from a simulated smoking room found it essential to 
maintain the smoking room at a negative pressure with respect to adjacent areas 
to ensure that the tobacco smoke did not move out of the room into the 
surrounding air. They also found the amount of ETS pumped out by a smoking 
room door when it is open and closed can be reduced significantly by 
                                                 
25 Report of the New Zealand Health Select Committee Commentary on ventilation, 2003, cited 
in Smokefree Northern Ireland. Health Promotion Agency Factsheet: Second-hand 
smoke and ventilation. Belfast. 
 
 
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substituting a sliding door for the standard swing-type door. Another study in 
Ontario also found that designated smoking rooms prevented a substantial 
amount of ETS moving to adjacent smoking sections by physical separation and 
ventilation and by maintaining the designated smoking rooms under negative 
pressure compared with the non smoking section. There was a fifty-fold 
reduction in nicotine levels observed in non-smoking sections compared with 
the smoking sections in two restaurants (Stantec Consulting 2004). 
Moreover, a U.S. study found levels of airborne ETS-related contaminants were 
significantly lower in the control environments (non-smoking buildings) than in 
the non-smoking dining rooms which were located within or adjacent to 
smoking dining rooms. Levels of ETS pollutants were also lower in the non-
smoking dining rooms and smoking dining rooms (Akbar-Khanzadeh 2003). 
The authors recommend that if non-smoking employees or patrons are to be 
fully protected, designated smoking dining rooms should be completely 
separated from smoking dining rooms and both rooms should be equipped with 
separate ventilation systems.  
Furthermore, designated smoking rooms may adversely affect the health of 
workers by exposing them to highly concentrated levels of second-hand smoke 
and would also subject any staff who enter these high concentration areas 
(Surgeon General 2006; German Cancer Research Center (DKFZ) 2007). For 
example one study showed smokers using the designated room were themselves 
subject to levels that were 1,800 times higher than typical office nicotine levels 
before the new smoking policy took effect (Vaughan and Hammond 1990). A 
more recent U.S. study compared the mean levels of carbon dioxide and 
ultrafine particles in a smoke free restaurant and a restaurant with a dedicated 
smoking room. The mean level in the smoking room was up to 43 times higher 
than at the smoke-free restaurant (Milz, Akbar-Khanzadeh et al. 2007).  
A Dutch study investigated the effectiveness and costs for a decentralised 
smoke extraction using recirculation and filtration in a designated smoke room. 
The concept was based on the extraction of air from a room by being blown in 
slowly, just above floor level. The cost of using the technology was estimated in 
area of €5,000 to €10,000. Readings were taken in a smoking room with and 
without the air purifier, and in a smoke free room. While the study found a 
potential exposure reduction for catering/hospitality staff of 40% for aldehydes, 
69% for VOCs, 81% for fine particulate matter and about 90% for nicotine in 
the smoking room, the absolute concentrations of the toxic substances were 
higher than in the smoke-free venue (Jacobs, de Jong et al. 2006). Moreover, 
workplaces need to be completely smoke-free in order to protect employees 
from second-hand smoke. Employees may not have the same option as patrons 
to avoid SHS exposure if they have to enter designated smoking areas (German 
Cancer Research Center (DKFZ) 2007). 
Regarding the costs of designated smoking rooms, laws which allow designated 
smoking rooms have been overturned in Ottawa, Canada  because they create 
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unfair competition. Large businesses can afford to install them, but smaller 
businesses often cannot.26  
Smoking stations and cabins 
Manufacturers smoking stations and cabins claim that these systems create an 
interior environment that is completely free of smoke and odour, in places 
where smoking is permitted through capturing the smoke before it spreads and 
purifying the smoke by filtration and releasing purified air. We were not able to 
identify evaluations in the peer reviewed publications of such technological 
solutions, but evidence has been reported by manufactures in reply to the 
Commission's stakeholder consultation on the Impact Assessment.   
The manufacturers cite studies by public research institutes in a umber of 
European countries. For instance, the SP Swedish National Testing Research 
Institute found that smoking cabins can reduce the investigated tobacco smoke 
compounds close to 100%. The study was conducted in accordance with the EN 
ISO 16017-1 test method for “indoor, ambient and workplace air” and showed 
that 99.6% of pyridine and pyrrole gases were filtered away; 3-vinyl pyridine 
was filtered away in 99.7% of cases; and 99.9% of nicotine was filtered away. 
Another test showed that 99.99966% of particles, ranging from 0.10 - 0.45 µm, 
and 100% of larger particles, were filtered away.       
There have also been evaluations to investigate whether smoking stations 
prevent smoking spreading to adjacent rooms (on the basis that they are used 
according to instructions). A study by the Labour Inspectorate in Finland found 
that nicotine and 3-ethyle pyridine were below the detection level (<0.05 µ) in 
the surrounding room. Measurements were taken from three air samples on a 
normal working day from 8:45am – 4:10pm, and a total of 43 cigarettes were 
smoked in the smoking station during the measurement period.  
In 2007, the German BG-Institute for Occupational Health and Safety (BGIA), 
launchedand published a standard procedure of certification for smoking cabins 
to be installed at workplaces (Institute for Occupational Health and Safety 
2007). This procedure, which in its test methodology makes use of numerous 
European norms (EN, CEN standards), was developed by an international group 
of health and safety experts, representatives of independent test laboratories and 
manufacturers of smoking cabins themselves. To pass a test procedure, it is 
required that a smoking cabin produces an air quality that contains no detectable 
levels of nicotine, TVOCs, carbon monoxide, formaldehyde or acetaldehyde. 
The manufacturers are now working to prepare the ground for a European 
certification process for smoking cabins at the European Institute for 
Standardisation (CEN). 
 
                                                 
26 http://www.smokefreeottawa.com/english/article-e20.htm (accessed 29 May 2008) 
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Manufactures emphasise a number of economic benefits of smoking stations or 
cabins in the workplace. First, they claim that smoking stations in the immediate 
workplace vicinity will keep smoking breaks short and reduce the likelihood of 
people leaving their work station to smoke outside. This helps avoid losses in 
productivity and also helps protect non smokers from outdoor tobacco smoke. 
Another claim is that, a total indoor smoking ban may create ‘security 
problems.’ For example industrial companies might ban smoking outdoors 
because of the presence and/or proximity of explosive and inflammable 
materials. More over it is argued that if working people are not allowed to 
smoke in close proximity to their workstation they tend to lose concentration 
and become less motivated.27 Consequently, the social and working climate 
between smokers and non smokers could suffer. Promoters also claim that 
smoking cabins ensure that neither ash nor cigarette ends are deposited in the 
front of office blocks. Evaluations of such claims in peer reviewed publications 
were not identified. We came across limited information on the cost of 
purchasing a smoking station or cabins. A German website cites the commercial 
price of smoking stations as between €2,500 and €9,500, and smoking cabins 
for rent at a cost of €100-€400 per month.  
Conclusions 
There are various studies which have examined the effectiveness of 
technological strategies for controlling second hand smoke, including smoking 
stations and cabins, enclosed smoking rooms, designated smoking areas or 
floors, or by implementing both strategies, separating smokers from non 
smokers and increasing ventilation. The WHO (2007) states that there is no 
evidence for a safe ETS exposure level and recommends that only 100% smoke-
free environments protect the public from exposure to SHS and ventilation and 
smoking areas. It is argued ventilation systems cannot remove all particulate 
matter produced by ETS and certainly not toxic gases (i.e. carcinogens) (WHO 
2007). Moreover, in 2006, the U.S. Surgeon General’s report concluded that 
“establishing smoke-free workplaces is the only effective way to ensure that 
second-hand smoke exposure does not occur in the workplace; and exposures of 
non smokers to second-hand smoke cannot be controlled by air cleaning or 
mechanical air exchange” (Surgeon General 2006). In 2005 the American 
Society of Heating, Refrigeration and Air Conditioning Engineers, the leading 
standard setting body in ventilation and air conditioning also concluded that 
ventilation and other air filtration technologies cannot eliminate the health risks 
caused by SHS exposure, and that the most effective option is to make indoor 
place smoke-free (American Society of Heating and Air Conditioning 
Engineers, 2005).   
                                                 
27 This argument could be undermined by confounding factors, such as nicotine withdraw which 
is known to have similar effects.  
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There are considerable uncertainties surrounding current knowledge on 
technological solutions to control ETS. In particular, there are very few 
published peer-reviewed studies on the effectiveness of the new engineering 
approaches in real settings.  
The studies reviewed in this chapter suggest that technological solutions based 
on mixed occupancy of smokers and non-smokers as well as designated 
smoking areas not physically isolated from non-smoking sections cannot 
adequately control non-smokers' exposure to ETS. The types of ventilation 
systems currently used in the hospitality sector and in workplaces (based on 
mixing and dilution) have been proved to have a limited impact on the levels of 
ETS pollutants. Of new technologies, displacement ventilation has been 
identified as potentially more effective. However, the figures for ETS reduction 
are never close to 100%, even with the most modern equipment. 
Allowing smoking only in separate and isolated rooms can potentially control 
ETS exposure in non-smoking spaces in the same building. In order to prevent 
ETS leakage, it is essential that the smoking rooms be equipped with a separate 
ventilation system from non-smoking areas and maintained at a negative 
pressure with respect to adjacent areas. This approach, however, cannot control 
the adverse health effects for the occupants of the smoking rooms and the staff.  
Evidence reported by manufacturers of smoking cabins and stations seems to 
suggest that such technological solutions can reduce the investigated tobacco 
smoke compounds close to 100%, levels comparable to those of ambient air 
pollution. However the scientific quality of such evidence must be demonstrated 
before the effectiveness of technological strategies for controlling second-hand 
smoke are proven.   
It should also be highlighted that modern ventilation systems are relatively 
expensive to install and maintain. This could create an uneven playing field. 
Large scale operators can afford to install sophisticated engineering systems, 
while smaller operators cannot. In addition, possible reductions in ETS exposure 
can only be achieved if equipment is properly used and maintained, which 
might require extensive inspection and monitoring infrastructure. 
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Table 78: List of selected studies on technological strategies for controlling second hand smoke (in alphabetical order)   
Reference 
Type of article  
Sample size 
Year of data 
Location 
Setting 
Study design 
Outcome measure 
Technology 
collection 
considered 
Akbar-Khanzadeh, 
Peer reviewed 
8 restaurants and 
 
Metropolitan 
8 restaurants (6 
Observational 
Air contaminants: Personal 
Designated 
F. (2003) 
journal article  
97 nonsmoking 
Toledo, Ohio.   restaurants with a 
comparison study 
and area samples for 
smoking areas with 
subjects (40 
bar and 2 without). 
(with control 
fluorescent particulate 
ventilation 
restaurant 
group): non-
matter, nicotine, respirable 
employees, 37 
15 designated non- 
smoking and 
suspended particles, 
patrons, and 20 
smoking rooms, 14 
smoking dining 
solanesol, and ultraviolet 
referents)  
designated smoking 
rooms 
particulate matter, CO (8 
dining rooms, and 7 
hours) 
bars. 
Urinary cotinine and 
 
nicotine (pre work, post 
work and 18hr post 
exposure).  
ASH Scotland 
Charity 
report 
 
   
Not 
applicable 
 
 
 
(2004) 
Bialous, S. and S.  Peer reviewed 
 
Jan 2001 – 
  
Literature 
review: 
 Ventilation 
Glantz (2002) 
journal article  
March 2002 
Review of tobacco 
approaches 
industry documents 
available on the 
Internet 
Broadbent, C. 
Independent 
 
   
Not 
applicable 
 
 
 
(2005) 
report 
Carrington, J., A.  Peer reviewed 
Total number of 
 Greater 
Bars Random 
selection 
Min, max and median 
Electrostatic 
F. R. Watson, et al.  journal article 
sample locations 
Manchester, 
of bars. 
secondhand smoke markers: 
precipitators and 
(2003)* 
for 60 pubs include 
UK 
Respirable suspended 
extractor fans 
683 smoking ares 
Observational 
particulate matter, Ultrviolet 
EN 
257  
  EN

 
and 112 non-
comparison study. 
light-absorbing particulate 
smoking areas.   
matter, fluorescent 
particulate matter, Solanesol 
 
particulate matter 
De Gids and Government 
111 articles 
Articles 
n/a 
Hospitality industry  
Literature review  
Whether or not ventilation 
Ventilation and air 
Opperhuizen 
sponsored report 
included in review 
published 
and air cleaning can 
cleaning 
(2004) 
from 1975 to 
contribute to the reduction of  technologies 
2004) 
exposure to ETS 
Drope, J., S. A.  Peer reviewed 
 
 
U.S.  
 
Literature review: 
 Ventilation 
Bialous, et al. journal article 
tobacco industry 
approaches 
(2004) 
documents  
Environmental 
Scientific 
 
 
 
 
Not applicable  
 
Air cleaning 
Protection Agency  Association 
devices 
(2008) 
report 
Geens, A., D. Peer reviewed 
 
   
Review 
 
 
 
Snelson, et al. journal article 
(2006) 
German Cancer 
Foundation 
report 
 
   
Not 
applicable 
 
 
Research Center 
(DKFZ) (2007) 
Hammond (2002)* 
Conference 
75 restaurants 
Not cited 
26 cities  
Restaurants 
Not cited  
Mean nicotine levels 
Designated 
proceeding 
smoking areas with 
ventilation  
Jacobs, P., P. de  Industry 
 30th January 
Haarlem Jacobus 
Pieck  Case study: Smoke 
Aldehydes, volatile organic 
Designated 
Jong, et al. (2006) 
sponsored report 
2006 
restaurant  
room with and 
compounds, and nicotine 
smoking rooms 
without an air 
with a 
purifier, and in a 
decentralised 
smoke free room  
smoke 
EN 
258  
  EN

 
displacement 
system using 
recirculation and 
filtration. 
Jenkins, R., D. Peer reviewed 

restaurant/pub 
 
  Restaurant/pub 
Case study  
ETS components 
Designated 
Finn, et al. (2001) 
journal article 
smoking areas with 
heat-recovery 
ventilation system 
Kotzias and Geiss  Not-for-profit, 
INDOORTRON 
Not cited 
Not cited 
INDOORTRON 
Two series of 
ETS components (VOCs, 
Ventilation rates in 
et al (2006) 
international 
facility, a 30m3 
facility, a 30m3 
experiments to test 
carbonyl compounds, 
indoor 
medical 
walk-in type 
walk-in type 
the impact of 
inorganic gases) 
environmental 
organisation 
environmental 
environmental 
ventilation rates on 
chamber 
chamber 
chamber 
ETS components 
Milz, S., F. Akbar-
Peer reviewed 
4 restaurants. 
 
Two cities in 
Restaurants Observational 
Carbon dioxide  
Smoking rooms 
Khanzadeh, et al.  journal article 
Norwest 
comparison study: 
Ultrafine particle 
(2007) 
2 restaurants 
Ohio, Toledo 
with and without 
concentrations  
smokefree 
and Bowling 
smoking rooms 
restaurants and 2 
Green  
(with control site)  
restaurants with 
dedicated smoking 
 
rooms. 
Smokefree office 
(reference site).   
Piha, T. (2006) 
Government 
 
   
Not 
applicable 
 
 
report 
Pilkington, P. and  Peer reviewed 
 
   
Literature 
review: 
 Ventilation 
A. Gilmore (2004) 
journal article 
Web-based search 
approaches 
of tobacco industry 
documents made 
public through 
EN 
259  
  EN

 
litigation 
Pion, M. and M. S.  Peer reviewed 
Lambert airport – 
1997-98, and 
Lambert 
Airport smoking 
Repeated 
Average nicotine vapour 
Smoking rooms 
Givel (2004) 
journal article 
2 tests  
again in 2002 
Airport – near  room 
observational 
concentrations (air 
smoking 
design 
monitoring) 
room 4C (15 
Dec 1997 – 
26 Feb 1 
1998). 
Sea-Tac 
airport – 
indoor bar 
remote from 
entrances. 
Lambert 
Airport – near 
smoking 
room 4C (26 
Sept 2002) 
Pirkle, J. L. and et  Peer reviewed 
Persons aged 2 
October 25th, 
U.S. National 
  Nationally Serum cotinine levels in 
Not applicable  
al (1996) 
journal article 
months and older 
1988 to 
representative 
non-tobacco users 
(n=16818) and 
October 21 
cross-sectional 
measurements of 
1991 
survey  
serum cotinine 
from persons aged 
4 years and older 
(n=10642) 
Repace, J. (2000) 
Government 
 
   
Workshop 
on 
 Ventilation 
sponsored report 
Ventilation 
approaches  
Engineering 
Controls for ETS in 
the hospitality 
industry, attended 
by ventilation 
EN 
260  
  EN

 
experts 
Repace, J. and K.  Professional 
One Pub 
December 13 
Near Toronto 
The Black Dog Pub 
Observational 
Respirable Suspended 
Designated 
C. Johnson (2006) 
society article  
2002 and 
design comparing 
Particles and carcinogenic 
smoking areas with 
December 10 
pre and post 
particulate polycyclic 
displacement 
2002 
voluntary smoking 
aromatic hydrocarbons, 
ventilation 
ban in smoking and 
carbon dioxide 
Two pubs 
March 6 2003 
Mesa, 
TGI Fridays pubs 
non smoking areas 
 
Arizona 
and Macaroni Grill 
of pub 
pub 
 
Six pubs 
December  12 
Ottawa Pubs 
(Smoke-free) Observational 
2002, 6pm – 
design 
12 mindnight 
Smoke Free 
Industry report 
3 sampling points 
Feb 1 2001 at 
Library on the  Workplace - Library   Case study 
Nicotine 
Smoking station 
Systems (2001) 
(including one 
8:45am – 
8th floor of 
3-ethyle pyridine 
control) across 8 
4:10pm 
Uusimaa 
TVOC 
hour day 
Industrial 
Safety 
District 
Building 
Smokefree 
Government 
 
   
Not 
applicable 
 
 
 
Northern Ireland 
agency report 
Stantec Consulting  Non-profit 
3 food and 
3 day testing 
Ontario, 
Restaurants and bars 
Comparison 
Nicotine and 3-ethenyl 
Designated 
(2004) 
association 
beverage 
at each 
Canada 
observational 
pyridine and ultraviolet-
smoking rooms 
sponsored  report 
establishments 
location 
design smoking 
absorbing particulate matter, 
ventilated by an 
with both smoking 
during 
sections  versus 
fluorescing particulate 
energy/heat 
and non smoking 
February 
non-smoking 
matter, and solanesol. 
recovery or 
sections Also one 
2004 
sections 
designated 
control non-
Personal air samples from 
smoking area 
smoking location. 
one non-smoking and one 
In each location  
smoking section staff. 
3 area samples in 
EN 
261  
  EN

 
both non-smoking 
and smoking 
sections (2 
locations had DSR 
and 1 location 
DSA). 
Surgeon General Government 
 
   
Review 
 
 
(2006) 
report 
Theodor Sterling Industry 
12 hospitality 
November 
Cardiff, 
Hospitality Comparison 
of 
Carbon dioxide, nitrogen 
Ventilation 
Associates (2007) 
sponsored report 
venues where 
2006 
Wales and 
indoor and outdoor 
dioxide, carbon monoxide, 
systems using 
smoking is allowed 
London 
air quality 
respirable suspended 
dilution ventilation 
(3 indoor samples 
measurements 
particles, particulate matter 
principles  
in each venue and 
(PM2.5 and PM10) 
1 outdoor location) 
Vaughan, W. M.  Professional 
 
  Office 
buildings 
Before 
and 
after 
Nicotine measurements  
Designated 
and S. K. 
Association 
observational 
smoking room 
Hammond (1990)* 
Journal  
design: smoking 
restriction to a 
snack bar on one 
floor   
Wagner, J., D. Peer reviewed 
27 laboratory 
  Simulated 
smoking 
Laboratory 
Rates of ETS leakage to a 
Designated 
Sullivan, et al. journal article 
experiments  
room 
experiments 
nonsmoking area 
smoking room 
(2004) 
WHO (2007) 
International 
 
   
Not 
applicable 
 
 
organisation 
report  
*Cited in Surgeon   
 
 
 
 
 
 
 
General (2006) 
EN 
262  
  EN

 
ANNEX X– COST-EFFECTIVENESS OF SMOKING CESSATION INTERVENTION 
Table 81 at the end of this section shows examples of country-level and meta-analysis 
level economic evaluations we retrieved on the cost-effectiveness (or cost-
consequences, or cost-savings) of different smoking cessation interventions 
(programmes or policies). Results are limited to evidence published since the turn of 
the millennium for European countries in the English language as well as for other 
countries such as Australia and the U.S.  
The number of studies published on the economic impact of smoking cessation is 
substantial (n=39 for Europe and meta-analyses; n=50 for outside Europe), with the 
majority of studies including pharmacotherapies as one component of smoking 
cessation interventions such as booklets, courses or counselling (n=18 for European 
studies, n=34 for non-European studies). Of these evaluations, specific comparison of 
the effectiveness of pharmacotherapies alone in stopping smoking occurred in eight of 
the European studies (20% of the total) and eight of the non-European studies (10% of 
the total).  
We also found thirteen European or meta-analysis studies (including European 
studies) and thirteen non-European studies evaluating the cost-effectiveness of some 
form of counselling/advice or behavioural support alone in stopping smoking (33% of 
the total and 26% of the total, respectively). Finally, there were nine European and 
meta-analysis studies evaluating broader smoking cessation strategies such as nation- 
or community-wide smoking cessation programmes/policies (e.g. taxes and 
advertising bans in Estonia) or TV campaigns, and three studies evaluating only 
financial incentive-based smoking cessation (e.g. Quit and Win contest). A similar 
number of non-European studies were found: five investigated broader state- or 
community-wide smoking cessation programmes/policies (e.g. smoke-free 
workplaces versus free nicotine replacement therapy, or NRT) and four investigated 
incentive-based smoking cessation interventions such as Quit and Win contests or full 
insurance coverage of tobacco treatment. In addition, there were two U.S. studies 
evaluating the cost-effectiveness of legal interventions: minimal legal purchase age 
(Ahmad 2005) and enforcement to halt the sale of tobacco to youths (DiFranza et al
2001). 
Smoking cessation strategies: evidence of cost-effectiveness, especially when targeted to 
sub-groups 
In general, smoking cessation interventions are highly cost-effective and compare 
favourably with other treatment modalities (Song et al., 2002, Ronckers et al. 2005; 
Cornuz et al. 2006; Quist-Paulsen et al. 2006). For example, the cost-effectiveness of 
operating English smoking cessation services was well below the National Institute 
for Health and Clinical Excellence (NICE) benchmark of 20,000 GBP per quality 
adjusted life year (QALY) (Godfrey et al. 2006). 
EN 
263  
 
EN

link to page 265  
The European Respiratory Society found smoking cessation treatment is cost effective 
even when delivered through smoking cessation specialists; and the cost per year 
saved is four-times greater than that of other well-established preventative 
interventions for hypertension or breast cancer or hypercholesterolemia 
(Loddenkemper 2003). Table 79 shows the cost effectiveness of various smoking 
cessation programmes. A U.S. study also found that an enforcement programme to 
halt the sale of tobacco to youths could save 10 times as many lives as the same 
amount spent on mammography or screening for colorectal carcinoma (DiFranza et 
al
. 2001). 
Table 79: Cost effectiveness of smoking cessation programmes 
Intervention 
Cost per life-year saved € 
Brief advice 
354 
Brief advice with self-help 
426 
Advice plus self-help plus advice to purchase  1162 
NRT 
Advice etc with specialist services 
1458 
Source: Loddenkemper (2003). 
Some authors suggest that resources allocated to smoking cessation (e.g. physician 
advice) should be increased by 124% (Lofroth et al. 2006). However, different factors 
influence the economic impact of smoking cessation services on sub-populations and 
performance targets for smoking cessation services should reflect population 
differences (Godfrey et al. 2006). For example, Denmark’s smoking cessation 
strategies were more cost-effective when offered to men, older persons and light 
smokers than when offered to women, younger smokers and heavy smokers (Olsen et 
al
. 2006). Another European study showed that women have less success at quitting 
than men, regardless of whether they are treated with pharmacotherapy (bupropion) 
(Scharf and Shiffman 2004). Nevertheless, analysis of gender-by-treatment interaction 
suggested that men and women benefited equally from slow-release bupropion 
(OR=1.01) (Scharf and Shiffman 2004). Finally, although there is limited cost-
effectiveness evidence, a review of the literature shows that pregnancy-related 
smoking cessation and relapse prevention programmes yield favourable cost-benefit 
ratios, suggesting that the return on investment will far outweigh the costs for this 
critical population (Ruger, Weinstein et al. 2007). 
Pharmacotherapies are the most cost-effective for individual smoking cessation 
Pharmacotherapies for smoking cessation are considered favourable compared with 
other accepted public health interventions (Song et al 2002).  Studies in England and 
internationally have shown that using NRT/bupropion in smoking cessation 
interventions significantly increases the cost-effectiveness of smoking cessation 
services (Godfrey, Parrott et al. 2006).  
EN 
264  
 
EN

 
A U.S. randomised controlled trial of mixed smoking cessation strategies indicated 
that the pharmacotherapy alone group consistently showed the lowest costs per 
participant and lowest costs for achieving each of the major study outcomes (Halpin, 
McMenamin  et al. 2006). Moreover, compared to no intervention, programmes that 
offer free NRT are effective in the U.S., with a 1-week supply of nicotine patches 
representing the most cost-effective strategy (Cummings et al. 2006). 
Among the possible pharmacotherapies, earlier studies had given only some 
indication of the greater incremental cost-effectiveness of buproprion in comparison 
with NRT (NICE 2002, Song et al 2002). But now, there is strong evidence from 
more recent European data (Sweden, France, Spain, Switzerland, UK) and non-
European data (Canada, Australia, U.S.) that bupropion is the most cost-effective 
pharmacotherapy (Nielsen and Fiore, 2000; Antonanzas and Portillo, 2003; Scharf 
and Shiffman, 2004; Bolin et al., 2006; Cornuz et al., 2006; and Shearer and 
Shanahan, 2006).  
For pharmacological treatment, the marginal cost-effectiveness ratios are €1768-5879 
for men and €2146-8799 for women, depending on age group. The average cost per 
life year saved is about £750 (£500-1,500), with €1,000-2,399 for NRT, €639-1,492 
for bupropion slow-releasing, and €890-1,969 for NRT/bupropion. Finally, there is a 
wide range of incremental cost-effectiveness ratios for each type of pharmacotherapy 
(nicotine gum, patch, spray, inhaler, and bupropion) across a variety of European and 
non-European countries (Cornuz et al. 2006).  
However, newer evidence suggests that a novel pharmacotherapy, varenicline, may be 
of more cost-benefit than the currently available pharmacologic alternatives (i.e. 
buproprion, nortiptyline or NRT). A 2008 European study found that treatment with 
varenicline for smoking cessation is cost-effective compared with nortriptyline and 
unaided cessation, and even cost-saving compared with bupropion and NRT 
(Hoogendoorn et al. 2008). These findings confirm an earlier US study showing the 
cost benefit of varenicline to employers: savings for the employer, per non-smoking 
employee, were $540.60 for varenicline, $269.80 for bupropion SR generic, $150.80 
for bupropion SR brand, and $81.80 for placebo (Jackson et al. 2007).  
Financial incentives and support for smoking cessation: social prizes, full insurance 
coverage and free vouchers 
A number of studies have demonstrated how the use of financial incentives could 
increase the quit rate among smokers for a relatively modest investment of resources. 
Most notably, the Swedish Quit and Win contest was associated with cost-savings and 
health gains among women, amounting to €3,550 per female quitter (Johansson et al
2005). An earlier study showed the contest cost $188-222 per life-year gained. In New 
York, a Quit and Win contest, offering the chance to win a cash prize (usually $1,000) 
for successfully stopping smoking for at least 1 month, revealed the cost per 
attributable quit was $301-954 (Tillgren et al. 1993). More recently, O’Connor et al. 
(2006) reveal that evidence from 11 Quit and Win contests shows that for a relatively 
EN 
265  
 
EN

 
modest investment of resources (median expenditures of $25,928 for promoting 
contests, ranging from $4,345 to 91,441), thousands of smokers can be recruited to 
make a serious quit attempt, with many remaining smoke-free months later. 
Other forms of financial incentives to quit smoking include providing partial or full 
financial benefit for smoking cessation treatment. A recent meta-analysis revealed that 
when full benefit was compared with a partial or no benefit, the costs per quitter 
varied between $260 and $2330 (Kaper et al. 2005). The authors also found that when 
smokers are offered full benefit, there is an increase in self-reported prolonged 
abstinence rates at relatively low costs compared with a partial or no benefit. This 
study reinforced the findings from a previous U.S. study that full coverage of tobacco 
dependence treatment benefit with no patient cost-sharing is an effective strategy for 
increasing quit rates and quit attempts at low cost with employer-based insurance 
(Schauffler  et al. 2001). When smoking cessation benefit is provided, cost of 
healthcare in the U.S. decreased by $7.9 to $8.8 million (Barone-Adesi et al. 2006).  
In evaluating a number of different benefit strategies in New York, Bauer et al (2006) 
found that offering a free two-week voucher for NRT was a cost-effective strategy for 
enhancing calls to quitlines in order to improve smoking quit rates in the U.S.. 
Finally, Kaper et al. (2006) also assessed whether reimbursing the costs of smoking 
cessation treatment is a cost-effective intervention from the Dutch societal 
perspective; if Dutch society is willing to pay €10,000 for an additional quitter or 
€18,000 for a QALY, then reimbursement of smoking cessation treatment would be 
cost-effective.  
However, the use of financial incentives for smoking cessation programmes should be 
carefully chosen when deciding public health priority in this area. Another U.S. study 
found that a free NRT programme was 15 times more expensive than the smoke-free 
workplace programme, suggesting that smoke-free workplace programmes should be 
a public health priority. The average cost per QALY was $4,440 with the free NRT 
programme, whereas the average cost per QALY with the smoke-free workplace 
programme was $506 (Ong and Glantz 2005). Other studies have shown smoke-free 
environments can be more cost effective than programmes targeted at smoking 
cessation. One study showed that smoke-free environments are nine times more cost 
effective per new non smoker than providing smokers with nicotine replacement 
therapy (WHO 2007). Hence, Ong and Glantz (2005) concluded that smoke-free 
workplace policies should be a public health funding priority, even when the primary 
goal is to promote individual smoking cessation.  
Finally, financial support for pharmacotherapy alone may not always prove the most 
cost-effective. Indeed, among a mix of U.S. tobacco control policies which included 
pharmacotherapy, flexible coverage was the most effective and, specifically, coverage 
of behavioural therapy alone was the most cost-effective (incremental cost per quitter 
was $2,500.94), compared with brief intervention alone ($3,381.03) and to 
prescription pharmacotherapy alone ($7,185.15) (Levy and Friend 2002). 
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266  
 
EN

 
“Behavioural support”: health professional advice/counselling, quitlines, and intensive 
face-to-face interventions 
There is a growing body of evidence showing the cost-effectiveness of supportive 
advice or counselling for smoking cessation. A number of different strategies include 
brief advice from physicians, nurses or other healthcare professionals, delivery of 
booklets by specially trained healthcare professionals, quitlines or telecounselling, 
motivational interviewing, intensive interventions such as behavioural therapy or 
nurse home visits, etc. Notably, cost-effectiveness ratios range widely depending on 
the type of supportive intervention and the country of implementation (Silagy and 
Stead, 2004; Godfrey et al., 2006; Lofrothe et al., 2006; and NICE, 2006). 
Some important conclusions from the various studies are as follows: 
1.  In Norway, a programme of delivering booklets by cardiac nurses with special 
training in smoking cessation remained highly cost-effective even if the cost of 
the programme increased (Quist-Paulsen et al. 2006).  
2.  The Dutch SmokeStop Therapy was found to be more cost-effective compared 
to minimal intervention, with a higher number of quitters (20 compared with 
9) at lower total costs (Christenhusz et al. 2007). However, an earlier study 
showed that minimal counselling dominated all other interventions (such as. 
physician or specialised counsellors) for every implementation period and, 
more importantly, minimal GP counselling was event cost saving (Feenstra et 
al
. 2005). 
3.  A meta-analysis of brief physician advice concluded that costs of providing 
counselling are usually low if provided as a by-product of medical 
consultation (Silagy and Stead, 2004). Notably, in Switzerland, the training of 
primary care physicians in smoking cessation counselling is a very cost-
effective intervention and may be more efficient than currently accepted 
tobacco control interventions (Pinget et al. 2007). 
4.  Quitlines were a cost-effective strategy for smoking cessation in Sweden and 
compared favourably with other smoking cessation policies. In Australia, 
telecounselling was shown to dominate brief GP advice and remained cost 
effective across most scenarios after sensitivity analysis (Shearer and 
Shanahan 2006). In the U.S., access to telephone counselling almost doubled 
the maintained quit rates over one year, with only $1,300 of direct costs for 
each case of one year’s cessations attributable to counselling availability 
(McAlister et al. 2004). 
5.  Peer-delivered counselling compared with self-help doubled smoking 
cessation rates with incremental cost-effectiveness of $5,371 per additional 
quit at 12 months (Emmons et al. 2005) 
6.  The addition of supportive mailings of booklets and letters to prevent smoking 
relapse from typical smoking cessation therapies in the U.S. were highly cost-
effective because they reduced the incremental cost-utility ratio more than the 
prevention intervention cost (Chirikos et al. 2004) 
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267  
 
EN

 
7.  The cost-effectiveness of community-based smoking cessation interventions 
compare favourably with other tobacco control interventions in the U.S. This 
is true for the multi-faceted community intervention (Full Court Press project) 
designed to reduce youth tobacco use by changing the key environmental, 
personal and behavioural factors (Ross et al. 2006), as well as for the Breathe 
Easy intervention to help women quit smoking in four U.S. counties (Secker-
Walker et al. 2005). 
Some exceptions in the literature 
There are four studies among the several dozen evaluating the economic impact of 
smoking cessation interventions that show either neutral or unclear results. First, 
Grenard  et al (2006) found in the U.S. that motivational interviewing might be 
effective among adolescents and young adults with drug-related problems, including 
tobacco dependence, but the key components of a successful intervention have yet to 
be identified. However, according to the DARE Database, the study’s methods were 
not sufficiently robust to confirm the reliability of the conclusion.26 Yet, in a particular 
socio-economic group, another study found that motivational interviewing was cost-
effective for preventing smoking relapse among low-income pregnant women and 
may be cost-saving when net medical cost savings are considered; whereas for 
smoking cessation, motivational interviewing cost more and provided no additional 
benefit compared to usual care, although it might offer benefits at costs comparable to 
other clinical preventive interventions if 8-10% of smokers are induced to quit (Ruger 
et al. 2007). Third, Hill (2006) examined four NRT and three antidepressants for 
smoking cessation in the U.S. and concluded that the value for money of Zyban 
(antidepressant) was unclear due to the uncertain nature of the clinical data. The cost-
effectiveness of the other two antidepressant drugs could not be fully assessed 
because they have significant side effects. Hill (2006) also found that nicotine gum 
appears to be the most cost-effective strategy for the general population (Hill 2006), a 
conclusion that contradicts the findings from Cornuz et al (2006), whose meta-
analysis showing nicotine patches to be the second most cost-effective 
pharmacotherapy after bupropion. Fourth and finally, in a meta-analysis of opioid 
antagonists for pharmacotherapy of smoking cessation, David et al (2006) could 
neither confirm nor refute whether naltrexone helps smokers quit; four trials failed to 
detect a significant difference in quit rates between naltrexone and placebo. 
EN 
268  
 
EN

 
Table 80 Cost-effectiveness of Public Policies for Smoking Cessation 
 
Intervention 
Country 
Author, Year 
Cost Results 
Inpatient SC therapy 
Austria (Schoberberger 
(health impact) 
Therapy
(behaviour 
and Zeidler 2007) 
up. Heal
modification and 
diseases
NRT) 
Standard SC (trained 
Denmark (Kjaer, 
Evald 
et 
(health impact) 
1 in 6 sm
in interviewing and 
al. 2007) 
continue
advising with a 
influenc
manual) 
depende
Nation-wide 
UK (Low, 
Unsworth 
(social impact - Distributional issues) 
Smoking
Treatment Service 
et al. 2007) 
than dis
Service 
number 
inequali
wards in
SmokeStop Therapy 
Netherlands 
(Christenhusz, 
Over 12 months, avg patient receiving SST generated EUR 581 
Finding
Pieterse et al
in health care costs, including the costs of the SC programme, 
After 1 y
2007) 
vs.EUR 595 in the minimal intervention group. 
cost-sav
The SST is also associated with a lower average number of 
hospital
exacerbations (0.38 vs. 0.60) and hospital days (0.39 vs. 1) per 
patient, and a higher number of quitters (20 vs. 9) at lower total 
costs. 
Quitline (with work 
Ireland (Flannery 
and 
(health impact) 
Smoker
legislation) 
Cronin 2007) 
At 6 mo
attempte
remaine
significa
Brief interventions in  UK 
(NICE 2006) 
Costs are estimated to be £5.4 million. 
  
Primary care 
Extrapolated data from the cost of treating acute MI and stoke 
(£1.5 billion per year, 1998) indicates that cost savings of £20.7 
million over 11 years for avoided events possible. 
EN 
269  
 
EN

 
Bupropion vs. NRT 
Sweden 
(Bolin, Lindgren 
Total health care costs averted with bupropion vs nicotine 
Direct c
et al. 2006) 
pateches was SEK 50,073,220 (EUR 5,419,424.601) for men 
represen
and SEK 72,727,847 (EUR 7,871,334.881) for women. Indirect 
producti
costs accounted for a saving of SEK 122,305,699 (EUR 
Use of b
13,237,145.8) for men, and SEK 11,956,131 (EUR 
1073 ad
12,117,012.06) for women. 
Compar
Compared with nicotine gum, bupropion results in health care 
addition
savings of SEK 59,177,442 (EUR 6,404,774.55) for men and 
women.
SEK 85,962,911 (EUR 9,303,765.858) for women. The indirect 
Stochast
costs averted were SEK 144,543,099 (EUR 15,643,899.6) for 
chance o
men and SEK 132,311,792 (EUR 14,320,105.25) for women. 
nicotine
The incremental saving of bupropion compared with nicotine 
Bupropi
patches including indirect costs was SEK 23,400 (EUR 
or nicoti
2,532.582) for men and SEK 16,600 (EUR 1,796.62) for 
women. Incremental saving of bupropion compared with 
nicotine gum including indirect costs was SEK 33,300 (EUR 
3,604.1) for men and SEK 26,500 (EUR 2,868.1) for women. 
Booklet delivered by  Norway (Quist-Paulsen, 
Total additonal costs associated with SC programme over usual 
Direct c
cardiac nurses with 
Lydersen et al
care were NOK 510 (EUR 63) per patient. 
telephon
special training in SC 
2006) 
In the low-risk group (patients with stable CHS), the ICER 
not sign
associated with the SC programme over usual care was NOK 
due to fu
42,500 (EUR 5,230) at 5 yrs and NOK 2,300 (EUR 280) in the 
characte
lifetime perspective. 
In the high-risk group (patients after MI),  the ICER associated 
with SC over usual care was NOK 9,800 (EUR 1,200) at 5 yrs 
and NOK 900 (EUR 110) in lifetime perspective. 
The SC programme remained highly CE even if the cost of the 
programme were increased. It compared favourably with other 
treatment modalities. 
Specialist services  
UK 
(Godfrey, Parrott 
Average cost per LYG was £684 (95%CI: 557-811), falling to 
Finding
(England) 
et al. 2006) 
£438 when savings in future healthcare costs were counted. 
smoking
With worst case assumptions, the estimate CE rose to £2,693 
below th
per LYG saved (£2,293 including future healthcare costs) and 
NICE.
fell to £227 (£102) under the most favourable assumptions. 
Differen
indicatin
perform
EN 
270  
 
EN

 
Specialist services + 
U.K. 
(Godfrey, Parrott 
Total mean smoking cessation services costs were GBP 254,400  Direct c
NRT + bupropion 
(England) 
et al. 2006) 
(95% CI: 557.2 to 811.3). Median cost was GBP 214,900. 
costs, sp
When only smoking cessaiton costs were included, the cost per 
facilities
LYG was GBP 684.2 (95%CI: 557.2 to 811.3; median GBP 
 
544.2). 
Results 
When both costs of service and health care cost-savings were 
behavio
included, the cost per LYG was GBP 437.7 (95%CI: 311.2 to 
services
564.2; median 292.6). 
support 
After combining the worst case assumption, the net cost per 
setting q
LYG was GBP 2,293 (95% CI: 536 to 4,050). 
increase
 
In 2000/
services
QALY u
Pharmacotherapies 
Canada, 
(Cornuz, Pinget et  The cost per LYG with cessation counselling only compared 
Estimate
(bupropion, nicotine 
France, 
al. 2006) 
with no treatmetn was, for 45 yr old men and women 
analyses
patch, gum, spray, 
Spain, 
respectively was: $190 and $288 in Spain, $375 and $567 in 
15 prim
inhaler) vs. GP 
Switzerland, 
Switzerland, $389 and $588 in Canada, $479 and $724 in 
Direct c
counselling alone vs.  UK, and U.S. 
France, $623 and $941 in the U.S. and $773 and $1,168 in UK. 
discount
no treatment 
The min. and max. ICERS for each pharmacotherapy in persons   
aged 45 were:  
In each 
$2,230 for men in Spain and $7,643 for women in the USA for 
CE treat
nicotine gum; 
would b
$1,758 for men in Spain and $5,131 for women in UK for 
several o
nicotine patch; 
$1,935 for men in Spain and $7, 969 for women in the USA for 
nicotine spray; 
$3,480 for men in Switzerland and $8,700 for women in France 
for nicotine inhaler, and 
$792 for men in Canada and $2,922 for women in USA for 
bupropion 
Advice from GP 
Sweden 
(Lofroth, 
The CE ratios ranged from EUR 3,653 per QALY gained 
Study co
Lindholm et al
(including cost of productivity lossses, at a discount rate of 3% 
Health c
2006) 
and at any duration of treatment) to EUR 4,410 (excluding cost 
consulta
of productivity losses, at a discount rate of 5% and at any 
drugs an
duration of treatment). 
Value o
annual g
general 
The sma
smoking
serum ch
of 139 m
Authors
should b
EN 
271  
 
EN

 
Group courses, 
Denmark (Olsen, 
Bilde 
et 
Incremental CE ratios for SC strategies over no intervention 
Direct c
individual courses, 
al. 2006) 
was EUR 1,358 (95%CI: 1320 to 1396) in whole sample, EUR 
instructo
quick interventions, 
1090 (95%CI: 1065 to 1116) for men, EUR 1361 (95%CI: 1326  Regress
NRT 
to 1395) for women, EUR 1114 (95%CI: 1090 to 1137) for light  moderat
smokers, EUR 1362 (95%CI: 1325 to 1400) for heavy smokers, 
than ind
EUR 1361 (95%CI: 1326 to 1396) in a pharmacy setting, EUR 
chearper
1058 (95%CI: 1036 to 1081) in a hospital setting, EUR 9651 in 
individu
age group 25 to 34 yrs, EUR 1984 (95% CI: 1907 to 2060) in 
The extr
age group 35 to 54 yrs, EUR 673 (95% CI: 664 to 681) in those 
interven
aged 55+. 
EUR 45
Probabilistic sensitivity analysis showed that probability of 
heavy sm
being CE at different thresholds was higher for men, light 
hospital
smokers and participants at hospitals compared with women, 
in age g
heavy smokers and participants in pharmacies. 
SC strat
younges
differen
more CE
Opiod antagonists 
Meta-
David S, 
4 trials of naltrexone failed to detect a significant difference in 
Not pos
(naltrexone) vs. 
analysis 
Lancaster T, Stead  quit rates between naltrexone and placebo. 
smokers
placebo or vs. 
LF, Evins AE; 
alternative 
2006 
therapeutic control 
for SC 
5 face-to-face SC 
Netherlands (Feenstra, 
For 75 yr implementation, net value of the intervention at 2000 
Health s
interventions by GP 
Hamberg-van 
level prices was EUR 1.7 x10^9 for telecounselling, EUR 
help ma
or specialised 
Reenen et al
0.52x10^9 for minimal counselling, EUR 3.8x10^9 for minimal 
cancer t
counsellors 
2005) 
counselling+NRT, EUR 7.8x10^9 for intensive 
of assist
counselling_NRT, EUR 7.3x10^9 for intensive 
Minima
counselling+bupropion. 
every im
For 75 yr implementation, cost per LYG was EUR 1400 for TC,  the MC 
EUR 1,800 for MC+NRT, EUR 6,200 for IC+NRT, and EUR 
QALYs
4,300 for IC+Bupr. 
cost-sav
Cost per QALY gained was EUR 1,100 for TC, EUR 1,400 for 
million)
MC+NRT, EUR 4,900 for IC+NRT, and EUR 3,400 for 
Sensitiv
IC+Bupr. 
in resou
smokers
as the di
All 5 SC
practice
Finance incentives 
Meta-
(Kaper, Wagena 
When a full benefit was compared with a partial or no benefit, 
There is
for SC treatment 
analysis 
et al. 2005) 
the costs per quitte varied between $260 and $2330. 
directed
increase
relativel
benefit.
EN 
272  
 
EN

 
"Quit and Win" 
Sweden (Johansson,  Total costs for a female smoker was estimated between SEK 
Direct c
contest 
Tillgren et al
100,000 (EUR 11,834.32) and SEK 180,000 (21,301.78), 
costs, an
2005) 
depending on age group. For a quitter, these costs were between  death an
SEK 80,000 (EUR 9,467.45) and SEK 150,000 (EUR 
consider
17,751.48). 
and mor
Savings associated with SC amounted to about SEK 30,000 
attnedin
(EUR 3,550.3) per female quitter. If disease-related morbidity 
out at 3%
productivity costs were excluded, the savings per quitter were 
The Qui
about SEK 20,000 (EUR 2,366.86). 
health g
Intervention costs were SEK 267,000 (EUR 31,597.63), the cost  of tobac
per participant was SEK 1,100 (EUR 130.178) and the cost per 
of a wid
quitter was SEK 7,850 (EUR 928.99). The cost per 
undiscounted LYG was SEK 4,100 (EUR 485.21). 
The "Quit Smoking Gals" intervention led to societal cost-
savings of SEK 830,000 (EUR 98,224.85). These savings 
ranged from SEK 2,620,000 (EUR 310,059.17) to SEK 420,000 
(EUR 49,704.14) according to discount rate. 
Quitline Sweden 
Toomson 
T, 
Total costs of quitline were $699.243 ($475,095 for personnel, 
Discoun
Helgason AR, 
$23,766 for materials, and $200,382 for services) 
Quitline
Gilijam H; 2004 
Incremental cost per quitter was $1,052 using the conservative 
Sweden
approach of 7% spontaneous smokers, and $1,360 when 
policies
assuming a 31% quit rate. Teh incremental cost per LYG ranged 
from $311 (7%) to $401 (31%). 
When no discount rate for the benefits were considered, the cost 
per LYG was $29 when using a 31% quit rate. 
Mass TV campaign 
UK 
(Parrott and 
Campaing cost U.S. 18 million per year and resulted in 2.5% 
  
Godfrey 2004) 
quit rate, costing U.S.$10-20 per life-year saved. 
Brief Advice 
Meta-
Silagy C, Stead 
Brief advice from a physician in UK costs about £469 (US750) 
Costs of
analysis 
LF; 2004 
per life-year saved. A U.S. study found that costs of physician 
of medic
counselling were between $705 and $988 per life-year for men, 
and $1,204 to $2,058 per life-year for women. 
Bupropion vs. 
Meta-
(Scharf and 
  
Twleve 
placebo 
analysis 
Shiffman 2004) 
Bupropi
Howeve
regardle
placebo
that men
(OR=1.0
EN 
273  
 
EN

 
3 different 
Spain (Antonanzas 
and 
Total costs at 20 yrs were EUR 44,033,192 for S-I, EUR 57, 
Strategy
pharmacotherapy 
Portillo 2003) 
623,558 for S-II, and EUR 58,877,069 for S-III. Costs avoided 
patches,
mixes 
during this period for each strategy when compared to current 
Strategy
situation were: EUR 128,211,567 for S-I, EUR 84,558,581 for 
1% gum
S-II, and EUR 32,270,939 for S-III. 
Strategy
There was a net cost saving of EUR 28,166 per avoided death, 
and 1% 
and EUR 3,265 per year of life saved with S-I, and EUR 13,665  Compar
per avoided death and EUR 1,584 per year of life saved with S-
willpow
II, when compared to current situation. 
1% use 
S-III resulted in positive ICERs, equal to EUR 35,369 per each 
Six prev
additional avoided death, and EUR 4,099 per each additional 
Direct c
year of life gainsed, when compared to current situation. 
therapie
diseases
CONCL
bupropio
therapie
Community 
Meta-
(Blenkinsopp, 
For SC RCTs: cost of using intensive rather than standard 
Interven
pharmacy-based 
analysis 
Anderson et al
pharceutical support was GBP 83 per life-year saved in the 
factors f
2003) 
Scottish trial, while the cost per life-year saved in the 
counsell
intervention arm ranged from GBP 197 to GBP 351 for men and  the SC s
GBP 181 to GBP 722 for women in the Northern Ireland trial. 
Evidence supports teh wider provision of smoking cessation and 
lipid management through community pharmacies. 
4 NRT therapies 
Switzerland 
Cornuz J, Pinget 
Counselling: cost per LYS ranges from EUR 385 (45-49 yrs) to 
Changes
(gum patch, spray, 
et al; 2003 
EUR 622 ( age 65-69) for men, and EUR 468 (age 50-54) to 
CE. 
inhaler) and 
Eur 796 (age 25-29) for women. 
Upper a
buproprion as 
Pharmacological treatment: the marginal CER ranges from EUR  patch ( 4
adjunct to GP advice 
1768 to 5879 for men and from EUR 2146 to EUR 8799 for 
2298) an
women. 
OTC NRT, placebo, 
Meta-
Hughes JR, 
  
Seven R
prescription NRT 
analysis 
Shiffman S, 
informa
Callas P, Zhang J; 
produce
2003 
prescrip
Stage-based 
Meta-
(Riemsma, 
One RCT estimated the marginal cost per person who quitted as  Interven
interventions to 
analysis 
Pattenden et al
GBP 450.65, which could fall to an extreme of GBP 265 with 
program
change smoking 
2003) 
increased use. 
program
behaviour 
A second study reported an incremental CE ratio for the 
interven
intervention as GBP 300 per person who quitted. 
program
contact, 
systems
35 unna
included
EN 
274  
 
EN

 
NRT vs. Bupropion 
U.K. 
NICE, 2002 
Incremental cost per LYS is about GBP 1,000-2.399 for NRT, 
Accordi
(England & 
GBP 639-1,492 for bupropion SR, and GBP 890-1,969 for NRT  BSR is g
Wales) 
+ BSR. 
interpret
Estimated cost of SC programme to the NHS in E&W would be  relative 
about GBP 67-202 million per year. Consequently, about 
45,000-135,000 smokers will quit, and about 90,000-270,000 
life-yeras saved. The average cost per LYS is about GBP 750 
(range: GBP 500-1,500). 
Comprehensive 
U.K. Stevens 
W, 
Estimated program costs were 56,987 GBP. (alternative of no 
Targeted
Community 
Thorogood M, 
programme was zero). 
Costs in
Programs 
Kayaikki S; 2002 
Incremental cost per life-year gained was 105 GBP (95%CI: 33-
overhea
391 GBP), with a modal value of 90 GBP.  
The incremental cost per one-year quitter was 825 GBP 
(95%CI: 300-3,500). 
Advice or 
U.K. 
Song F, Raffery J,  Cost per attempt was: $5.08 with advice only; $108.72 with 
Direct c
counselling: only, or 
Aveyard P, Hyde 
advice + NRT; $109.56 with advice + bupr sustained release; $ 
NRT 
+ NRT, or + bupr, or 
C, Barton P, 
207.23 with all three;  
All SC s
+ NRT & bupr 
Woolacott N; 
Cost per attempt was: $50.76 with counselling only; $ 148.44 
health c
20027 
with counselling + NRT; $ 149.27 with counselling + BSR; and  pessimis
$ 246.95 with all three. 
slightly 
In comparison with advice or counselling alone, the average 
with cau
incremental cost per LYG was: $ 3,455 (range: 2,107 to 16,726)  those fo
with advice + NRT; $ 2,150 (range: 1,182 to 14,535) with 
advice + BSR; $ 2,836 (range: 1,268 to 26,245) with advice + 
NRT + BSR; $ 1,441 (range: 439 to 8,044) with counselling + 
NRT; $920 (range: 306 to 7,052) with counselling + BSR; and 
$1,282 (range: 507 to 11,817) with counselling + NRT + BSR. 
Incremental cost per QALY was: $ 2,559 or $ 1,067 for NRT 
relative to advice or counselling, respectively; 1,593 or $681 for 
BSR over advice or counselling, respectively; and $2,101 or 
$950 for NRT + BSR relative to advice or counselling, 
respectively. 
In comparison with advice or counselling + NRT, the average 
incremental cost per LYS was $2,391 (range: 952 to 80,558) 
with advice, NRT & BSR, and $1,156 (range: 538 to 33,170) 
with counselling, NRT and BSR 
In comparison with advice or counselling + BSR, the average 
incremental cost per LYS was $ 4,322 (range: 1,385 to 288,612) 
with advice, NRT & BSR, and $2,123 (range: 825 to 115,445) 
with counselling, NRT & BSR. 
Non-tailored letters 
Scotland 
Lennox A et al
CER = 89£ per additional quitter, under optimistic assumptions 
Patients
2001 
the CER is £37/quitter. Using a 5% discount rate gives a cost 
included
per LY of 50 to 122£. 
Behavioural support 
UK (Cruse, 
Forster 
et 
(Social impact) 
At 12 m
(trained occupational 
al. 2001) 
GlaxoSmithKline implemented a voluntary programme for its 
had not 
health advisor) + 
employees. 
relapsed
access to NRT 
themselv
52% of 
monitor
smoking
promoti
EN 
275  
 
EN

 
Unspecified U.K. (Naidoo, Stevens 
Target Group 1 (reduce smoking rate from 28% in 1996 to 26% 
The sav
(England) 
et al. 2000) 
by 2005 and 24% by 2010): undiscounted cost saving was £524 
program
M, 6% discounted cost saving was £320M 
immedia
Target Group 2 (reduce smoking rate from  28% in 1996 to 22%  the utilis
in 2005 and 17% in 2010): undiscounted cost saving was £1.14 
Costs w
B, 6% discounted cost saving was £680 M. 
events o
Community wide SC  UK 
Parrott S, Godfrey  Costs of £107-3622 per life-year saved ($171-5800). 
  
1998 
Pharmacy-based 
N. Ireland 
(Crealey, 
Cost per life-year saved was between $326.62 and $583.41 for 
  
cessation program 
McElnay et al
men and $301.04 to $1,281.72 for women. 
1998) 
Individual Treatment  UK (Buck, 
Godfrey 
et 
Program cost £2370 (U.S.$3800) per life-year saved. 
  
+ brief advice + 
al. 1997) 
nicotine gum 
Quit & Win 
Sweden 
(Tillgren, Rosen 
Contest cost from $188 to $1,222 per life-year gained. 
  
et al. 1993) 
 
EN 
276  
 
EN

Document Outline