Advocacy

Clean Indoor Air Policy

Adoption Date:
October 1, 2008

Public Policy Statement on Clean Indoor Air Policy

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Background

Much progress has been made in Clean Indoor Air policy since ASAM decreed -- two decades after the Surgeon General’s Report on Tobacco and Health of 1964 -- that there would be no smoking or tobacco use allowed during sessions of the annual ASAM Medical-Scientific Conference.

As we near the 50th Anniversary of that Surgeon General’s Report, virtually all hotels, convention centers, and publicly-owned buildings in North America are ‘smoke-free’--except, ironically, for some health care facilities (nursing homes or psychiatric or addiction units of hospitals). The dangers of tobacco use to persons actively addicted to tobacco are universally known and accepted. The health aspects of passive exposure to environmental tobacco smoke are also known and widely accepted, and have led city councils to establish clean indoor air standards for cities, and legislatures to consider such standards for entire states. Many major cities in Europe and some entire nations have adopted clean indoor air laws that apply to all publicly and privately owned structures where the public may consort, including restaurants, taverns, and at times open-air stadiums and public parks.

But resistance remains in some areas to universal prohibition of smoking outside of private homes and privately-owned vehicles. This resistance is often presented by advocacy groups that are covertly funded by tobacco manufacturers. Exceptions proposed include taverns, restaurants, and even addiction and psychiatric units of hospital-based or residential treatment facilities. Such exceptions fail to respect the health of employees of such facilities as well as clientele.

When local jurisdictions adopt prohibitions against smoking and neighboring ones do not, it is argued that clientele may cross jurisdictional lines in order to continue to use tobacco products, for instance while dining or drinking. One of the arguments used against adoption of local anti-smoking ordinances is the creation of competitive disadvantages for local business or the creation of a patchwork of jurisdictional differences.

ASAM affirms that regular tobacco use usually occurs in the context of the chronic disease of nicotine addiction, which frequently causes serious morbidity and mortality among those who use tobacco, as well as those who are exposed to environmental smoke from its use. Tobacco smoke is harmful in that it causes symptoms, illnesses, and death, and it affects healing from other health conditions. Smoke-free and tobacco-free environments provide people who would like to quit with an opportunity to practice not smoking and not using other forms of tobacco. Tobacco smoke is a Class A carcinogen, and removal of tobacco smoke from all workplaces, including those in the food service and hospitality industries, is an important step in promoting occupational health.

Recommendations

The American Society of Addiction Medicine recommends:

1. that all states, commonwealths, provinces, districts and territories of the United States and Canada should adopt area-wide bans on smoking in public places so that ideally there are no municipal differences in regulations within a state/province, and no differences from one jurisdiction to another in such regulations. When state-wide or comparable reforms have not yet been adopted, counties should not be dissuaded from adopting bans on smoking in public places; when county-wide reforms have not yet been adopted, localities should not be dissuaded from adopting bans on smoking in public places;

2. that bans on smoking in commercial establishments should make no exceptions for restaurants or taverns;

3. that bans on smoking in health care facilities should make no exception for inpatient, outpatient, or residential addiction or psychiatric treatment facilities; and

4. that environmental tobacco smoke should be subject to regulation by federal agencies such as the Environmental Protection Agency, the Occupational Safety and Health Administration, the Food and Drug Administration, the Indian Health Service, and the Department of Veterans Affairs.

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