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Report of the Tobacco Policy Research Study Group on Smoke-Free Indoor Air Policies
  1. David M Burns,
  2. Robert Axelrad,
  3. Dileep Bal,
  4. Julia Carol,
  5. Ronald M Davis,
  6. Matthew L Myers,
  7. John M Pinney,
  8. Nancy A Rigotti,
  9. Donald R Shopland
  1. University of California, San Diego, UCSD Medical Center, San Diego, California
  2. Environmental Protection Agency, Washington, DC
  3. California State Department of Health, Los Angeles, California
  4. Americans for Nonsmokers’ Rights, Berkeley, California
  5. Michigan Department of Public Health, Lansing, Michigan
  6. Asbill, Junkin, and Myers, Chtd, and the Coalition on Smoking or Health, Washington, DC
  7. Corporate Health Policies Group, Washington, DC
  8. Harvard Medical School, Boston, Massachusetts
  9. National Cancer Institute, Bethesda, Maryland
  1. Correspondence to Dr David M Burns, University of California, UCSD Medical Center, 225 Dickenson Street, San Diego, California 92102-1990 USA.

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The rationale for policies that restrict the locations where smoking is permitted reflects three major issues:

  • Environmental tobacco smoke (ETS) is annoying and irritating to most non-smokers

  • ETS can cause acute and chronic illness in non-smokers

  • Restricting the locations where smoking is allowed may increase the number of smokers who attempt to stop smoking ; may reduce the frequency of relapse by those who attempt to stop ; and may reduce the number of cigarettes smoked by those who continue to smoke.

This paper reviews the evidence that ETS requires restrictive public policies, and discusses the various mechanisms used to accomplish this. It provides background on the many laws, regulations, and ordinances implemented in the United States to date and draws attention to issues requiring further research to strengthen public policy in this area.


The existing research base clearly establishes that many non-smokers are annoyed and physically irritated by exposure to ETS at levels that occur when smoking is allowed. ‘ It is also clear that ETS produces acute and chronic illnesses, most notably lung cancer and heart disease in adults2,3 and respiratory illness in children.4 The precise magnitude of these effects and the range of diseases that are produced by exposure to ETS are issues of current scientific interest. For purposes of public policy, however, there is conclusive scientific proof that both short term and long term exposure to ETS produce significant adverse health outcomes at levels that substantially exceed those of other agents currently restricted and regulated in the United States and several other countries.

Further research on health outcomes will be important in defining the mechanisms by which tobacco smoke causes disease and the extent of the disease burden, but it is not required to define or support the need for public health …

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