The case for banning smoking indoors — even in your home

On Wednesday, the US Department of Housing and Urban Development announced it will ban smoking in all of the nation’s 1.2 million public housing units. HUD Secretary Julián Castro said his main concern is cutting down on the dangers of secondhand smoke: “We have a responsibility to protect public housing residents from the harmful effects of secondhand smoke, especially the elderly and children who suffer from asthma and other respiratory diseases.”

One major problem with this policy is it seems to single out low-income people for a problem that is universal — secondhand smoke can kill anyone who’s around it. While HUD’s jurisdiction is limited to public housing, the criticism is fair.

But there’s an easy solution to that: Indoor smoking should be banned everywhere — inside bars, restaurants, your home. Full stop. Smoking remains an enormous public health problem, and smoking bans actually do work to curtail the detrimental effects of one of the world’s most dangerous habits.

Although it gets considerably less press than it previously did, smoking remains a huge threat to public health. According to the Centers for Disease Control and Prevention’s most recent data, smoking kills 480,000 people each year. Secondhand smoke alone kills nearly 42,000 people. To put that in perspective, that’s around 8,000 more people than die to either car crashes or gun violence.

So we’re clearly dealing with a major public health crisis. And the research shows that smoking bans can help, particularly with eliminating exposure to secondhand smoke.

The CDC has a good rundown of the research into smoking bans, showing they work to cut down on the public harms of tobacco. A 2010 review of dozens of studies by the Task Force on Community Preventive Services, for example, found that workplace smoking bans increased the rates of workers quitting smoking by 6.4 percent and led to a 3.4 decrease in tobacco use more generally. And while a 2010 review of the research by Cochrane found a lack of evidence for bans reducing overall rates of smoking, it found that bans decreased exposure to secondhand smoke in workplaces, restaurants, pubs, and public places, and led to improvements in health outcomes after bans were put in place.

A 2011 study of two Indiana universities also showed particular promise. After Indiana University in Bloomington banned smoking on the whole campus in 2008, researchers in the school looked into the effects of the ban and compared the results with outcomes at nearby Purdue University in West Lafayette, which didn’t have a total ban. Through student surveys, they found a significant drop in smoking prevalence in Indiana University but not Purdue University, and that Indiana University students were more likely to report fewer peers smoking.

The ban in Indiana University actually wasn’t strictly enforced, but it seems its mere existence deterred smoking. “The positive changes may be attributable to increased awareness of the policy due to signage an media coverage,” researchers wrote.

While there’s no research on whether a broader indoor smoking ban would work, the body of research certainly suggests it’s worth trying. If it worked in workplaces and college campuses, after all, it could work in other places — including people’s homes. (This is one benefit to HUD’s move: It could provide strong data for how this kind of ban works in a housing setting.)

Of course, there’s a question of how far enforcement should go. Should someone lose his home because he smokes? Absolutely not. Taking away people’s homes would cause all sorts of negative side effects — especially if there are children involved. But like more typical smoking bans, a fine or the mere existence of a ban could work.

Although the US has made enormous strides in reducing smoking over the past several decades — from 42 percent among adults in 1965 to 19 percent in 2011 — it remains a huge public health crisis, killing hundreds of thousands of people each year. An indoor smoking ban would not eliminate smoking altogether, but trying to expand on existing laws certainly seems worth a shot.