1. Is Lithuania a success story? Aurelijus Veryga, MD, PhD Lithuanian National Tobacco and Alcohol Control Coalition Kaunas University of Medicine Bratislava, 16/04/2007

2. Lithuania has banned smoking in bars, restaurants, cafés, clubs since January 1 st 2007 Bratislava, 16/04/2007

3. Law of Tobacco control Article 19. Restrictions on the Consumption of Tobacco Products 1. It shall be prohibited to smoke (consume tobacco products) in the Republic of Lithuania: 1) in all educational establishments, health care facilities, Internet cafes (Internet clubs, etc.), and also in premises where sport competitions and other events take place; 2) at indoor workplaces. Special premises (places) may be set aside in undertakings, institutions and organisations where smoking shall be permitted. The requirements for fitting out and operating smoking premises (places) shall be set forth by the Government of the Republic of Lithuania or an institution authorised by it. 3) in common-use residential and other public premises where non-smokers may be forced to breathe tobacco smoke-polluted air; 4) in all types of public transport, except for long-distance trains where individual cars must be designated for smokers and non-smokers and also on aircraft where separate places shall be designated for non-smokers and smokers; 5) in restaurants, coffee shops, bars and other mass caterers, clubs, and discotheques, except for cigar or pipe clubs specially fitted out for this purpose. The procedure and conditions of establishing cigar and pipe clubs shall be set forth by the Government of the Republic of Lithuania or an institution authorised by it. 2. In restaurants, cafes, bars and other premises designated to provide services for people, where smoking is not prohibited, separate premises (places) must be set aside for smokers. Premises where smoking is not prohibited must be fitted out to protect clients (visitors) and staff members from tobacco smoke. The requirements for fitting out and operating such premises (places) shall be set forth by the Government of the Republic of Lithuania or an institution authorised by it. Paragraph 2 of Article 19 has been repealed. 6) Municipal councils shall have the right to prohibit smoking in public places (parks, squares, etc.) and other public places falling within the scope of their competence. 7) The administrative bodies of a legal person must ensure that its personnel, clients and visitors are not forced to breathe tobacco smoke-polluted air; they must also ensure that non-smoking warnings or signs are displayed in visible locations and special premises (places) be set aside and fitted out for smoking with notices or signs indicating their location.

4. Background Total ban of tobacco advertisement (2000) Ratification of FCTC (2004) Joining EU – new excise taxation policy (2004) Change of tobacco products labeling (2004) Smoking ban in bars, restaurants, cafes, clubs (January 2007) Inclusion of tobacco and alcohol control issues into National Drug prevention program (2005) National vide public awareness campaigns (I am born a non smoker) competitions (Quit and win, Smoke-free class competition) Bratislava, 16/04/2007

5. Smoking prevalence (adults) (regular smokers aged 20 – 64 years) * p<0.05 comparing with year 1994 FINBALT study % Bratislava, 16/04/2007

6. School children smoking prevalence year 1993-1994 (HBSC) Girls Boys Bratislava, 16/04/2007

7. School children smoking prevalence year 2001-2002 (HBSC) Girls Boys Bratislava, 16/04/2007

8. School children smoking prevalence year 1994-2006 (HBSC) GirlsBoys years Bratislava, 16/04/2007

9. Positive external factors Smoke – free policies in other European countries (Ireland, Italy, Malta etc.) Evidence from other countries that ban does not damages business FCTC

10. Positive internal factors Active position of minister of health (professor of public health) Strong NGO movement (Lithuanian National Tobacco and Alcohol Control Coalition - member of ENSP) European Commission project HELP – for a life without tobacco in place Existing ban of tobacco advertisement Already high public awareness about smoking harm

11. Lessons we have learned

12. First voting in Parliament (ban introduced by one parliamentarian) was unsuccessful Main reasons: No strategy Strong opposition from industry coming from industry supported NGOs

13. Second proposal from the Ministry of Health Common strategy of MoH and NGOs was developed Minister meetings with all Parliament comities (evidence based information and facts for lobbying prepared by tobacco control advocates) NGO coalition meetings with other NGOs and petitions writing campaign development Public opinion survey Youth manifesto (EC HELP campaign) Large public relation campaign

14. Public opinion survey Public opinion survey (age 18-74) (should smoking be banned in bars, restaurants and other hospitality places?) RAIT, 2006 Bratislava, 16/04/2007

15. Public opinion survey Public opinion survey (age 18-74) (should smoking be banned in bars, restaurants and other hospitality places?) RAIT, 2006 Bratislava, 16/04/2007

16. Very strong message: people want to have smoking ban in place

17. Public relation campaign Main messages generated: Constitutional right of workers to safe and health working place Protection of customers from passive smoking Positive influence to children (making smoking socially unacceptable) Intensive use of evidence Ventilation does not work Smoking ban does not damage business Smoking ban can improve hospitality workers and customers health

18. Main elements of public relation campaign Special section in MoH website Articles in newspapers Participation in TV and radio debates Press conferences

24. Youth manifesto (presenting opinion of hundreds NGOs, presented to Parliament speaker, asking to ban smoking in bars, restaurants etc.

25. Tobacco industry opposition Mainly done by industry supported NGOs Main arguments used: Already made big investments to ventilation systems Smoking ban will cause financial problems for hospitality industry Rights of smokers should be respected and there should be separate rooms for smokers Partially successful work (inclusion of exception to law for pipes and cigars clubs)

28. Changes after Some initiatives to discredit smoking ban Increased public awareness (especially about smoking in common-use residential and other public premises) Smoking ban is respected and implemented without problems

29. Thank you! WNTD celebration I am born a non smoker