Letter to the Editor
Towards a 100% smoke-free Portugal: No more delays
Para um Portugal 100% livre de tabaco: Sem mais demoras
S.B. Ravaraa,b,c,, , , N. Mirandac,d, , J.M. Calheirosa,b,
a Health Sciences Research Center, Faculty of Health Sciences, University of Beira Interior, Av. Infante D. Henrique, 6200-506 Covilha, Portugal
b CHCB University Hospital, Quinta do Alvito, 6200-251 Covilha, Portugal
c Portuguese NGOs Tobacco Control Movement, Portugal
d National Institute of Health Dr. Ricardo Jorge, Avenida Padre Cruz, Lisbon, Portugal

We read with the greatest of interest the study by Paradela et al., 2013 assessing self-reported exposure (e) to second-hand smoke (SHS) in private/public enclosed settings.1 Although only a regional survey, it is one of the few that has assessed post-ban perception about the change in SHSe. The main findings are:

  • Exposure to SHS is high, significantly higher in public leisure settings where vulnerable populations such as young people should be protected by law.

  • Young adults are highly exposed.

  • Perceived exposure in the home and workplaces is similar to the pre-ban period.1

In 2013, a similar survey conducted in Covilhã observed the same trends. Furthermore, several studies have reported: (1) high SHSe in restaurants/casinos/bars/discos/mental health services; (2) patchy compliance with the ban, specially in settings which allow exemptions; (3) poor ban enforcement2 (non-published research: Calheiros et al., 2010; Ravara et al., 2012; Reis et al., 2011). Moreover, Portuguese children's exposure to SHS is high3; one of the highest in the EU (non-published research: Reis et al., Democophes 2012), several studies have reported low motivation to quit, few attempts at giving up, and an increasing prevalence among youth and females.4 These indicators mirror the failure of tobacco control policies enacted by successive governments/legislators. At the moment, the Portuguese government is about to revise the smoke-free policy (SFP). The government has publicly announced its intention to pass a 100% SFP. However, an 8 years moratorium has been proposed for hospitality venues, allowing smoking and ventilation systems, in order to “compensate for the investment made”.

While governments and legislators are elected to promote the health and well-being of all Portuguese citizens, they have mostly protected tobacco industry and other “vested interests”. The consequence of this is a major toll of death, disability, and suffering and it promotes health and social inequalities and threatens the country economy and welfare.5 WHO clearly emphasises that only 100% SFPs protect against SHSe5 and stresses that exemptions, such as the moratorium presented by the current Portuguese government, are common tactics of the tobacco industry to block SFP implementation.5 Moreover, an eminent Portuguese constitutionalist has stated that SFP exemptions are unconstitutional: while failing to protect all citizens, they violate the general principle of health protection of Portuguese law.2 The Portuguese public health community should publicly denounce the interference of the tobacco industry in policy-making, accordingly to article 5.3 of WHO-FCTC treaty5; and demand a 100% smoke-free Portugal without any exemptions or delays; as part of a comprehensive, adequately funded and enforced tobacco control programme.4,5 This would comply with the Portuguese government's obligation following the WHO-FCTC ratification in 2005.5

References
1
C. Paradela,M. Pérez-Ríos,A. Ruano-Ravina,J.M. Barros-Dios
Exposure to environmental tobacco smoke in Chaves after the implementation of the law 37/2007. A cross-sectional study in two healthcare settings
Rev Port Pneumol, 19 (2013), pp. 168-174 http://dx.doi.org/10.1016/j.rppneu.2013.02.003
2
S.B. Ravara,M. Castelo-Branco,P. Aguiar,J.M. Calheiros
Compliance and enforcement of a partial smoking ban in Lisbon taxis: an exploratory cross-sectional study
BMC Public Health, 13 (2013), pp. 134 http://dx.doi.org/10.1186/1471-2458-13-134
3
J. Precioso,A.C. Araújo,J. Machado,C. Samorinha,E. Becoña,S. Ravara
Protecting children from exposure to environmental tobacco smoke: towards health education
Educ Soc Cult, 38 (2013), pp. 13-29
4
Direcção Geral Da Saúde. Direcção de Serviços de Informação e Análise. Portugal. Prevenção e Controlo do Tabagismo em números-2013. Programa Nacional para a Prevenção e Controlo do Tabagismo. Retrieved from: http://www.dgs.pt/estatisticas-de-saude/estatisticas-de-saude/publicacoes/portugal-prevencao-e-controlo-do-tabagismo-em-numeros-2013.aspx [assessed 10.06.14].
5
World Health Organization (WHO)
WHO Report on the Global Tobacco Epidemic, 2009: implementing smoke-free environments
WHO, (2009)

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