In the workplace it is usually the building managers, safety staff, and personnel officers who are responsible for devising the policy. While a smoking ban may seem the simple option, they have other factors to consider. If no provision is made for smokers, is there a risk that they will smoke anyway, and in places where, for obvious safety reasons, they should not? Is there the manpower to police all internal and external areas to ensure that no-one is smoking? What does one do if the ban is breached -- suspend the member of staff, refuse future entry to a visitor, risk losing a client?

Hospitals, which led the race toward prohibition in the mid-80s, are now spearheading the return to designated smoking areas. For them prohibition produced three major problems.

The first to emerge was the difficulty in keeping track of staff, patients and visitors. they would no longer in the usual places, preferring instead to seek out those where they could smoke. This usually meant the grounds, or away from hospital premises altogether. One NHS Trust was forced to reconsider its policy when the staff canteen's revenues slumped following a smoking ban. The second, and perhaps most serious consequence, was the creation of fire risks that had hitherto not existed. Finally, there was the problem of public image. Expelling staff and patients outside to smoke simply did not look good. And contractual obligations requiring staff not to smoke when in uniform but off-duty only served to fuel resentment.

These problems are not unique.Other workplaces that follow the prohibitionist route, or have a poorly devised system of designating smoking areas, are facing similar consequences.

Designated smoking areas are often poorly ventilated, too small for the numbers of people wishing to use them, or located in the most inconvenient parts of the building. The result is that people seek out other areas (usually the front doorstep), or are absent from their work stations for long periods.

Although no formal studies have been conducted on the effects these policies have on the morale and stress levels of smokers, there is plenty of anecdotal evidence to suggest that there is some effect. This may be reflected in the unwillingness of smokers to work overtime or beyond the basic requirements of their contract of employment. If potential personality clashes already exist between staff. any between smokers and non-smokers are more likely to manifest themselves. The result is an undermining of working relationships and smooth running of the establishment.

Popular Misconceptions

The first is that most smokers want to give up smoking, a view encouraged by various surveys. What people tell a pollster they want, and what they actually do want, may be two entirely different things.

This leads to the second misconception: that smokers need "help" because they are "addicted". Apart from the fact that tobacco does not fulfil the strict medical definition of an addictive substance, the decline of smoking rates from over 50% of adults in the 1970s to less than 30% today, and the rise of the "social smoker" makes the claim questionable. Indeed, telling a smoker that he is "addicted" and needs "help" can have negative consequences: either reinforcing resentment of anti-smokers or deterring smokers from embarking on a course of action they are told will be difficult.

The third misconception concerns Environmental Tobacco Smoke (ETS). The argument runs that if active smoking presents a risk to the smoker, then the residual smoke must surely present a risk to anyone within its vicinity. Such logic ignores the fact that none of the illnesses classified as "smoking-related" are either exclusive to smokers, or illnesses where smoking is the only or even the prime factor involved. It also ignores the fact that the chemical properties of ETS differ from those of the smoke drawn in by the smoker, and that everything in ETS is already in the air anyway.

Most of the epidemiological studies on ETS have been on non-smokers married to smokers and have failed to measure exposure to ETS, the respondents or their families' medical histories for hereditary factors, or consider socio-economic circumstances, or other confounding factors such as diet. The latest metanalysis of ETS studies, conducted by the American Environmental Agency (EPA), considered only 11 out of a possible 30 studies, ignored all those conducted in workplace scenarios, and departed from recognized statistical practice in order to conclude that non-smokers had between a 19-28% increase in risk of contracting lung cancer compared with people who never came into contact with ETS. As a general guide epidemiologists only take seriously risk factors over 200%. On this basis, and apart from the questions over the conduct of the research, the claim that ETS represents a health risk (as opposed to an inconvenience) to non-smokers does not stand up to scrutiny. It should also be noted that EPA is now being sued over its report.

Thus there is not only a misunderstanding of smokers, there is also a misunderstanding of science, and it is these factors that have culminated in the implementation of bad smoking policies, and the consequences that are now beginning to emerge.

The key to devising a smoking policy is to apply the same management tools that would be used in devising any other policy within the workplace. At the most elementary level this requires that the manager identifies the problem; defines the objective of the policy; draws up a list of solutions and considers their impact; consults with staff; implements the policy.

Common Problems

Two hospitals with which FOREST has worked indicate the conflicts and problems that may arise. With the first, several smoking areas existed within the hospital. However, the hospital described itself as a "no-smoking establishment", and no information was provided either in pre-admission literature for patients and relatives, or as signage within the hospital, indicating the location of the smoking areas. As a result few used them (because they did not know they existed), resorting instead to the entrances of the buildings, thereby creating an "image" problem for the hospital.

In the second entrance, information was provided, and signage within the hospital was excellent. the problem lay in the actual facilities provided: old and broken furniture, rubbish bins instead of proper ashtrays, no ventilation system, and a broken heater. The rooms could not have been more unwelcoming or demoralising. The means of disposing of tobacco materials actually presented a fire hazard, while the lack of ventilation made not only an unpleasant atmospherewithin the rooms, it contributed to the drift of tobacco smoke into the corridor. Among the recommendations were that proper ashtrays should be immediately provided ( a safety-ashtray is now available on the market, further reducing any fire risk), the installation of an air filtration unit investigated, and, among the various leaflets on display, the inclusion of material on relaxation and smoking cessation courses discreetly inserted.

Making provision for smokers, and advising people of the policy, should not be construed as promoting or endorsing the activity. It is a sensible response to the fact that nearly 30% of all adults smoke. A designated smoking area means that you know where your smokers are. How you make use of this opportunity is then up to you.

For further information about smoking in the workplace and details of the FOREST Workplace Consultancy Service contact: Marjorie Nicholson, Workplace Consultancy Service, 2 Grosvenor Gardens, London SW1W ODH, England. FOREST provides a list of British hospitals that have reversed their smoking bans or stated that they will not remove existing designated smoking areas since 1984.