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Second and thirdhand smoke have significant negative impacts on people’s health by causing acute and chronic diseases. Individuals including many non-smokers exposed to these risks are often captive and vulnerable because they have little choice but to share homes, offices, schools, workplaces, and/or other public facilities. Perhaps the most appalling challenge is children who have little ability to protect themselves in settings where there is smoking. People who are allowed to smoke in public and workplaces impose costs on the non-smokers who often become sick from these exposures. In addition to the direct health implications, exposure to secondhand smoke makes it more difficult for smokers to stop smoking and can promote smoking initiation and consumption among children and adolescents.

To protect people from second and thirdhand smoke, several types of smoke-free legislation have been promoted and implemented around the world. The gold standard is a comprehensive ban that covers without exception all public places and workplaces. Governments have successfully implemented such bans despite the concern—typically raised by the tobacco industry and/or its allies—that smoke-free laws harm the economy of bars, restaurants, and hotels. The research shows clearly that this is not true. In fact, in many countries, restaurant sales have increased since a smoke-free law was implemented.

There is large variability in the existence of and compliance with smoke-free laws. According to the World Health Organization, only 25 countries, which corresponds to approximately 7% of the global population, reach a very high compliance grade of regulations on smoke-free environments. On the other hand, 127 countries have a low grade (<6) or do not provide information on compliance, which corresponds to nearly 59% of the world’s population. Moreover, considering the Human Development Index (HDI), barely 12% of people who live in countries with low HDI score a high grade (>=6) of overall compliance with smoke-free regulations. These differences between countries exacerbate health inequities since poor people are more likely be exposed to second and thirdhand smoke particularly at home, in their workplaces, and on public transportation.

Implementing effective smoke-free regulations in educational facilities is an easy first step for countries and more difficult to argue against because it clearly protects children and youth from second and thirdhand smoke. Furthermore, it makes smoking less desirable and changes cultural norms about smoking in ways that promote public health. Yet, this simple policy step remains a struggle in many countries. In the Western Pacific Region (WPR), only about 20% of the population lives in countries with complete smoking bans in universities. In comparison, nearly 100% of the population in the South-East Asian Region (SEAR) lives in countries with complete smoking bans in universities.

Almost 68% of the world’s population lives in countries with complete smoking bans in health care facilities, 58% in government facilities, 49% in indoor offices, 30% in restaurants, 28% in pubs and bars, and 75% on public transport. Some countries are taking further action and implementing bans on smoking in cars containing children and publicly-subsidized housing, often with expressed goals of lessening inequities.

Despite the progress achieved, there is considerable room for improvement implementing new and more strict legislation to protect non-smokers—especially children and youth—and smokers, which in turn will lessen the burden of disease and related economic healthcare and productivity costs.


Byron M, Cohen J, Frattaroli S, Gittelsohn J, Drope J, Jernigan D. Implementing smoke-free policies in low- and middle-incomecountries: A brief review and research agenda. Tob Induc Dis [Internet]. 2019 Aug 5 [cited 2021 Oct 18];17(August). Available from:,110007,0,2.html

WHO report on the global tobacco epidemic, 2023: protect people from tobacco smoke. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO.

Faber T, Been JV, Reiss IK, Mackenbach JP, Sheikh A. Smoke-free legislation and child health. npj Prim Care Resp Med. 2016 Dec;26(1):16067.

Myers V, Lev E, Guttman N, Tillinger E, Rosen L. “I can’t stand it…but I do it sometimes” parental smoking around children: practices, beliefs, and conflicts – a qualitative study. BMC Public Health. 2020 Dec;20(1):693.

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