Making Patios Smoke‐free:
A positive step that governments can take to further
protect children, hospitality workers and thecommunity from second‐hand smoke.
Second‐hand smoke is dangerous…
Second‐hand smoke is what smokers exhale from alit cigarette. It contains over 4,000 chemicals, 69 ofwhich are known to cause cancer.1 Second‐handsmoke also causes other diseases, such as asthma,
heart disease and emphysema. Medical authorities
like the World Health Organization agree: there is nosafe level of exposure to second‐hand smoke.2, 3…even outdoors.
Some people believe that exposure to second‐handsmoke outdoors poses no health risk because thesmoke will simply go away. This belief is NOT
supported by scientific research.
• When there is no wind, cigarette smoke will rise
and then fall, and will saturate the local area withsecond‐hand smoke;• When there is a breeze, cigarette smoke will
spread in various directions, and will expose non‐smokers down‐wind.4

Smoke‐free laws prevent heart attacks
When smoke‐free laws are introduced, hospitaladmissions for heart attacks drop by one‐fifth in
the newly smoke‐free jurisdiction.
The finding of a study that pooled results fromeight studies in Europe and North America.5

California researchers monitored tobacco smoke
levels in outdoor public places where smokers werepresent, including sidewalk cafes, restaurant andpub patios. They found that being close to smokers
outdoors resulted in about the same levels of
exposure to smoke as being in a smoky tavern forthe same length of time.6 A similar study of outdoor
smoking areas in Victoria, British Columbia, foundthat smoke pollution levels were similar to indoor
smoking environments and exceeded healthstandards.7, 8• Non‐smokers can be exposed to almost as muchsecond‐hand smoke in outdoor places, likerestaurant patios, as they are in indoor
restaurants.
Nicotine blood levels of non‐smoking
bar workers in smoke‐free bars(Ireland)bars without outdoor
smoking areas
bars with outdoor
smoking areas

813

Researchers in Ireland measured the blood nicotine
levels in non‐smoking bar workers who were nototherwise exposed to second‐hand smoke. They
found that those who worked in bars with outdoor
smoking areas had much higher blood nicotine
levels, indicating that they had been exposed tomuch more second‐hand smoke.10

Physicians for a Smoke-Free Canada

1226 A Wellington Street ♦ Ottawa ♦ Ontario ♦ K1Y 3A1
Tel: 613 233 4878 ♦ Fax: 613 233‐7797 ♦ www.smoke‐free.ca ♦ psc @ smoke‐free.ca

Outdoor smoking areas are
an unfair threat to workers’ health.
Until smoke‐free indoor laws were passed,
hospitality workers were unfairly exposed tochemicals in tobacco smoke (like 4‐aminobiphenol)that were so dangerous that no level of exposure
was permitted for any other category of worker. As
long as smoking is permitted on patios and otheroutdoor workplaces, people who work in theseenvironments will continue to be unfairly exposedto these chemicals.

Outdoor smoking areas area hidden threat to public health.
People working or eating inside a smoke‐freerestaurant may not realize that they are exposed tosmoke that drifts in from the outside patio. Smokedrifts inside from the outdoors and from informal
and formal gathering places that permit smoking.
This phenomenon was measured duringexperimental studies in Waterloo, Ontario.9
A study in Ireland found that workers in bars that
had adjoining smoking areas (like patios) had levelsof exposure to tobacco smoke much higher thanworkers in bars that had no outdoor smoking
areas.10

Richard Stanwick
Chief Medical Health Officer
Vancouver Island Health Authority11

Smoking on patios measurably
worsens air quality.
Researchers in Waterloo, Ontario, conducted
experiments on the effect of as few as eightcigarettes on a typical restaurant patio that had noroof, walls, awnings or umbrellas. Experiments wererepeated 46 times in different wind conditions. They
found in each test that when cigarettes are smoked,
the quality of the air in the patio area falls
considerably. Measurements of air particulates
quadrupled. These air particulates include chemicals
that cause cancer and heart disease.12

The impact of cigarette smoking on patio air quality.
No roof or other structures; Particulate matter (PM2.5) in micrograms/m380
0 cigarettes burning708 cigarettes burning

6050403020
Very good

Ontario Ministry of the Environment Air Quality Index

poor90“With as few as three cigarettes beingsmoked, the air quality was very
similar on those patios [wheresmoking was permitted] to that whichused to be found in indoor premises
with no restrictions on smoking.”

100

Paired tests – 0 cigarettes and 8 cigarettes on uncovered patio (Waterloo, summers 2007/2008)2

Smoke‐free policies do more than protect people fromtobacco smoke.
They also help smokers quit.

They protect kids from starting.

Dozens of studies have shown that smoke‐freeworkplaces increase the number of smokers who try
to quit, increase the number who successfully quitand decrease the number of cigarettes smoked bythose who are not successful in quitting.13, 14 After
Ireland went smoke‐free, about half of Irish smokers
reported that the law had made them more likely toquit.15 Among Irish smokers who quit after the law
went into effect, 80% said that the law had helped
them quit, and 88% said the law helped them stayquit.16

Tragically, tobacco companies continue to recruit
new smokers among Canadian youth (currently, one
in five Canadians aged 15‐19 smokes).17 Youngpeople who see smoking in public places are more
likely to consider smoking to be socially acceptableand ‘normal.’18 Conversely, smoking restrictions
reduce youths’ positive attitudes towards smoking
and likely reduce the number who experiment withand become addicted to tobacco.19 That’s why
smoking bans are seen as a powerful way to reduceteen smoking in countries like Canada.20

Public support for smoke‐free patios is already high, and will
only get higher…
Two‐thirds of Ontarians already support
smoke‐free patios.21
Across North America and around the world,
communities are demanding that smoking bans be
extended to outdoor public places. 22 Communities
know that this will:• Increase protection from second‐hand smoke• Establish good smoke‐free role models for youth• Reduce opportunities for youth smoking• Reduce litter
Experience around the world has found that
communities quickly welcome smoke‐freeregulations. Even those who may not initially
support a smoke‐free policy soon appreciate thebenefits. 23
Volunteer measures don’t work. A phone survey of
hospitality venues across Ontario showed that thenumber of restaurants and bars that had
implemented smoke‐free patios grew from 5% to
25% in the year following the province‐wide ban onindoor smoking. However, most establishments,
including family restaurants, still permitted smoking
on their patio.24

Canadian jurisdictions that have bannedsmoking on restaurant and/or bar patios 25
Municipalities
1. Capital Regional District,(Victoria), B.C.
2. Delta, B.C. (restaurants)
3. Pitt Meadows, B.C.
(restaurants)
4. Port Coquitlam, B.C.
(restaurants)
5. Port Moody, B.C.
6. Richmond, B.C.
7. Squamish, B.C.
9. Surrey, B.C.
9. Vancouver, B.C.
10. West Vancouver, B.C.

11. Whistler, B.C.
12. White Rock, B.C.
13. Saskatoon, Sask.
14. Brighton, Ont.
15. Burpee & Mills, Ont.
16. Huron Shores, Ont.
17. Kingston, Ont.
18. Tehkummah, Ont.
19. Thunder Bay, Ont.
20. Woodstock, Ont. (ondowntown sidewalkcafés)Provinces/Territories
1. Newfoundland and Labrador (July 1, 2005)
2. Nova Scotia (Dec. 1, 2006)
3. Yukon Territory (May 15, 2008)
4. Alberta (January 1, 2008)
5. Prince Edward Island (September 15, 2009) (smokingon patios banned until 10:00 pm)

3References
1.

2.

3.

National Cancer Institute. (2001) Monograph 13, Risks
Associated with Smoking Cigarettes with Low‐Machine
Measured Yields of Tar and Nicotine. U.S. Departmentof Health Human Services. October 2001.
http://cancercontrol.cancer.gov/tcrb/monographs/13/
m13_complete.pdf.
World Health Organization. Protection from exposure
to second‐hand tobacco smoke.
http://www.who.int/tobacco/resources/publications/w
ntd/2007/who_protection_exposure_final_25June2007.pdf.
U.S. Department of Health and Human Services (2006)
The Health Consequences of Involuntary Exposure toTobacco Smoke: A Report of the Surgeon General.
Atlanta, GA.

4.

Repace, J. 2000. Banning outdoor smoking isscientifically justifiable. Tobacco Control, 9, 98.

5.

Glantz S. Meta‐analysis of the effects of smokefree lawson acute myocardial infarction: An update. Preventive
Medicine 2008: 47(4); 452‐453

6.

Klepeis NE, Ott WR, & Switzer P. 2007. Real‐timemeasurement of outdoor tobacco smoke particles.
Journal of Air & Waste Management Association, 57,522‐534.

7.

8.

9.

Travers MJ, Higbee C, & Hyland A. 2007. Vancouver
Island Outdoor Smoking Area Air Monitoring Study
2007. Roswell Park Cancer Institute.
http://www.tobaccofreeair.org/documents/VancouverIslandOSAReport4‐10‐07.pdf
Millar J, Drasic L, Copes R, & Rekart J. 2006.
Environmental Tobacco Smoke in Indoor and Outdoor
Public Places. British Columbia Provincial HealthServices Authority.
http://www.phsa.ca/NR/rdonlyres/76D687CF‐6596‐
46FE‐AA9A‐
A536D61FB038/18447/EnvironmentalTobaccoSmokeinI
ndoorandOutdoorPlacesJ.pdf
Kennedy, RD, Hyland, A, Travers, M, & Fong, GT.
February 2008. Tobacco Smoke Pollution on Outdoor
Patios ‐‐ An Experimental Evaluation of the Smoke‐Free
Ontario Act. SRNT 14th Annual Conference, Portland
Oregon.

10. Mulcahy M, Evans DS, Hammond SK, Repace JL, &Byrne M. 2005. Secondhand smoke exposure and risk
following the Irish smoking ban: an assessment ofsalivary cotinine concentrations in hotel workers and air
nicotine levels in bars. Tobacco Control, 14, 384‐388.
11. Globe and Mail. Victoria Smokers told to get their butts
off the patios New rules ban smoking both inside and in
outdoor areas of bars and restaurants. July 3, 2007.

12. Kennedy et al, op cit.
13. Fichtenberg CM, & Glantz SA. 2002. Effect of smoke‐
free workplaces on smoking behaviour: Systematicreview. BMJ, 325, 188‐195.
14. Farkas AJ, Gilpin EA, Distefan JM, & Pierce JP. 1999. The
effects of household and workplace smoking
restrictions on quitting behaviours. Tobacco Control, 8,261–265.
15. Ibid.
16. Ibid.
17. Health Canada. CTUMS, 2008 (prevalence of smoking
either cigarettes or cigars).
18. Alesci NL, Forster JL, & Blaine T. 2003. Smoking
visibility, perceived acceptability, and frequency invarious locations among youth and adults. Preventive
Medicine, 36, 272‐281.
19. Wakefield MA, Chaloupka FJ, Kaufman NJ, Orleans CT,Barker DC, & Ruel EE. 2000. Effect of restrictions on
smoking at home, at school, and in public places on
teenage smoking: Cross sectional study. BMJ, 321, 333‐337.
20. Reid DJ, McNeill AD, & Glynn TJ. 1995. Reducing theprevalence of smoking in youth in Western Countries:
An international review. Tobacco Control, 4, 266‐277.
21. Ontario Tobacco Research Unit. (2007). The Tobacco
Control Environment: Ontario and Beyond. [SpecialReports: Monitoring and Evaluation Series, 2006‐2007(Vol. 13, No. 1)]. Fact Sheet 1.6: Protection from
Secondhand Smoke. Toronto.
22. Thomson G, Wilson N, & Edwards R. 2009. At thefrontier of tobacco control: A brief review of public
attitudes toward smoke‐free outdoor places. Nicotine &Tobacco Research, in press.
23. Global Smokefree Partnerships: In their own words:
public support for smokefree laws.
http://tobaccofreecenter.org/files/pdfs/en/SF_own_w
ords_en.pdf
24. Kennedy RD, Elton‐Marshall T, Mutti S, Dubray J, Fong
GT. (October 2007). Understanding the Impact of theSmoke‐Free Ontario Act on Hospitality Establishments’Outdoor Environments: A Survey of Restaurants andBars. Canadian Conference on Tobacco Control,
Edmonton Alberta.
25. Non‐Smokers’ Rights Association – Smoking and HealthAction Foundation. (Summer 2010) Compendium of
Smoke‐free Workplace and Public Place Bylaws.
http://www.nsra‐
adnf.ca/cms/file/Compendium_Summer_2010.pdf.

This fact sheet was prepared by Ryan Kennedy and Carla Parkinson‐McCracken
for Physicians for a Smoke‐Free Canada, May 2009. Updated by Janice Forsythe, August 2010.

4