Researchers and activists are calling for the smoking ban to be extended to all public spaces, writes Erin Golden.
By most accounts, Ireland's three-year-old workplace smoking ban has been an unprecedented success, dramatically reducing indoor second-hand smoke levels and laying the groundwork for other countries looking to develop their own smoking control policies.
But some researchers, activists and policy leaders believe Ireland - and the rest of the European Union - can and should do more to block smokers from public places. A European Commission Green Paper launched in January includes a recommendation that would ban smoking in all enclosed and partially enclosed public spaces, including doorways, sheltered restaurant patios and bus stops.
The Commission has not yet taken any action on the proposal, but in Ireland, some have called for a similar extension, citing the potential respiratory and cardiovascular health risks created by smokers who step outside to light up, but then cluster, creating clouds of smoke in doorways and outdoor dining areas.
Maurice Mulcahy, the HSE West's principal environmental health officer, says Ireland's near-100 per cent compliance with the current smoking ban has resulted in a major improvement in air quality inside most workplaces. But in his air quality studies of pubs in Galway, Mulcahy found dangerous levels of smoke-related chemicals in the air inside - even when smokers had moved outdoors.
"It's understandable that the EU is looking at smoking bans because they know that indoor smoking is extremely unhealthy," he says. "We've found that bars with outdoor smoking areas, places where they have created these waist-high barriers to congregate smokers, had higher indoor nicotine levels."
The Department of Health and Children has not yet moved to extend the current ban but, according to a department spokeswoman, "Ireland supports a total ban on smoking in all enclosed or substantially enclosed workplaces and public places - including the hospitality sector and means of public transport."
Last year, 34 cases of non-compliance with the ban were successfully prosecuted under the Public Health (Tobacco) Acts, according to the Office of Tobacco Control.
But for publicans and policy makers, legal questions surrounding outdoor and semi-enclosed smoking areas - public spaces that are workplaces for some, but not yet no-go areas for smokers - remain a grey area. Some activists, including Prof Luke Clancy of the anti-smoking group Ash, say the flexible rules surrounding near-workplace smoking should be revisited to make the ban work as it was intended.
"I'm not happy with the way that side [ outdoor smoking] of the legislation is being run or interpreted," he says. "Irish publicans have tested the water in many ways there, and the worry is that to get around the law or to test it, they've found ways of glamorising smoking and we think that's bad for society."
For Clancy, however, the issue is less about the health risks of passive smoking and more of a missed opportunity to make smoking less of a publicly accepted habit.
"If the EU was to extend the ban it would not be on a health basis because the health evidence doesn't exist - what is obvious is that it's a dirty habit and inconsiderate and some people are intimidated trying to get through these big groups of people smoking outdoors," he says. "I think [ smoking near workplaces] is aesthetically unacceptable but not bad medically."
But Mulcahy disagrees, noting that for some workers in hotels, outdoor restaurants and other exempted spaces, exposure to second-hand smoke has become more of an issue since the ban pushed smokers out of other areas.
"It doesn't take much smoke to have a cardiovascular impact," he says. "It's about where you spend your time - if you're the guy on the front door of the bar, you're getting more smoke after the ban than before the ban."
The likelihood of major policy changes seems to weigh on the level of acceptance of findings by Mulcahy and other researchers studying the links between outdoor smoking and health as well as an evolving definition of the workplace.
According to the Department of Health and Children's spokeswoman, "scientific evidence shows that 100 per cent smoke-free environments are the only proven way to adequately protect the health of all people from the devastating effects of second-hand tobacco smoke".
Clancy thinks the Commission is far from making a blanket recommendation on outdoor smoking, as many European countries have yet to implement an indoor ban of any kind. He says Ireland should focus its own efforts on maintaining and improving current legislation with added attention to smoking cessation services.
"The ban is successful and we must preserve it and see that compliance is high," he says. "The big things in tobacco control are price, advertising, sponsorship, cessation services and mass media campaigns . . . you need a comprehensive programme to combat smoking."
And while Mulcahy is still working to determine the outdoor health effects of smoking, he is also looking into the anti-tobacco lobby's next big challenge: urging Irish people to cut down on smoking in their own homes and cars.
"The big issue for tobacco and second-hand smoke is in the home, where 40-50 per cent of Irish children have someone in their home that smokes," he explains. "In California, the Environmental Protection Agency has said that second-hand smoke can cause asthma and we know that sudden infant death syndrome [ SIDS] is associated with second-hand smoke as well."
And though turning attention to private spaces is sure to draw fire from many smokers, Mulcahy says Ireland's record as a leader in the whole area will continue with further policy and education campaigns.
"We're on a learning curve," he says. "Ireland's smoking ban is one of the greatest public health initiatives in Europe, and we want to continue to have legislation that's even across the board and proportionate to the risk."