Published: 02/12/2004, Volume II4, No. 5934 Page 25

Last month's public health white paper may not have gone as far as some would have wished in banning smoking in public places, but it is probably only a matter of time before it effectively disappears. Not only are the numbers of smokers declining, but the numbers who have never smoked are increasing - from 39 per cent to 45 per cent between 1996 and 2003. And attitudes to smoking are also changing.

Public health doctors and lobby groups have argued for some time for greater restrictions on smoking in public places. And with recent action in Ireland and bans in place in New York and elsewhere, there is a greater political will to intervene.

Interestingly, there is also considerable support for such intervention from people who smoke. The ONS omnibus survey has been recording attitudes to smoking for some years and the latest survey results (for 2003) were published this summer (see graphs). They show that even among smokers, between 70 and 77 per cent agree to restrictions at work, restaurants and indoor shopping centres.

Smokers' only exception is pubs, where only around a quarter would want restrictions. But this conceals the fact that nearly 50 per cent would welcome either total bans or separate smoking areas - not surprising when you consider that 70 per cent of smokers would like to quit.

Arguments from those with a vested financial interest in resisting further restrictions in pubs should note another ONS finding: asked whether they would be more or less likely to visit pubs if there were smoking restrictions, only 2 per cent of current smokers stated that they would be less likely, and 9 per cent said they would go more often - even smokers do not like other people's smoke.

Research into the impacts of restrictions and bans in other countries suggests that while restrictions can reduce alcohol sales in the short term, they recover within months. Similar effects are observed in restaurants. Moreover, bans can have a feedback effect, changing attitudes. Research into a smoking ban in California found that support for the ban among smokers increased from 24 per cent to 44 per cent over two and a half years.

But the main impact of smoking restrictions will be the extent to which they help smokers give up and the consequent longer-term impact on smoking-related deaths. A long-term prospective study in the US suggests that workplace bans help smokers give up quicker, but that relapse rates are similar to workplaces with no bans.

Bans and restrictions may help, but smokers probably need even bigger sticks and carrots to get them to quit permanently.

John Appleby is chief economist at the King's Fund.