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In 2003, the World Health Organization ratified its first international public health treaty—the Framework Convention on Tobacco Control (FCTC). The FCTC sets out a legislative framework for tobacco control and has been adopted by 164 countries to date. In July 2007, the Conference of Parties adopted guidelines for implementation of Article 8 of the FCTC on “Protection from exposure to tobacco smoke.” This article set out recommendations for the development, implementation and enforcement of national, comprehensive smoke-free legislation. The first national, comprehensive legislation was introduced in the Republic of Ireland in 2004, followed by Norway and New Zealand. Their experience of introducing comprehensive legislation informed Article 8 of the FCTC. National legislation that is in accordance with, or closely aligned to, Article 8 has now been introduced in many other jurisdictions including Italy, France and the United Kingdom, as well as a growing number of US states and Canadian provinces.
Since adoption of Article 8 of the FCTC, the evidence of benefit from smoke-free legislation has become even more compelling. There is consistent evidence that workplace smoking restrictions reduce occupational exposure to secondhand smoke, with the most effective restrictions being those introduced as part of comprehensive smoke-free legislation, as recommended in the FCTC. Most occupational studies have focused on exposure among bar workers using air markers, such as particulate matter <2.5 μm in diameter (PM2.5), or biomarkers, such as cotinine. These studies have reported reductions in secondhand smoke exposure of between 80% and 90%, resulting in air quality equivalent to ambient outdoor air. Following the introduction of legislation in the Republic of Ireland, salivary cotinine concentrations in bar workers fell from 29.0 nmol/l to 5.1 nmol/l.1 This contrasted with a much smaller reduction from 25.3 nmol/l to 20.4 nmol/l in Northern Ireland where legislation had not yet been …