Abstract
BackgroundComprehensive smoke-free legislation covering all enclosed public places and workplaces was implemented in England on 1 July 2007. This study examines the impact of this legislation on smoking prevalence, number of cigarettes smoked and location of smoking, controlling for secular trends through the end of 2008.Method and FindingsRepeat cross sectional survey using nationally representative data from the Health Survey for England (HSE). In total there are 54,333 respondents from 2003–2008. Logit and linear regression models were used to examine the effect of the legislation on smoking prevalence and the number of cigarettes smoked daily among continuing smokers which took the underlying trend into account. Our finding suggest that smoking prevalence (current smoker) decreased from 25% in 2003 to 21% in 2008 (AOR = 0.96 per year, 95% CI = 0.95–0.98, P<0.01) and the mean number of cigarettes consumed daily by smokers decreased from 14.1 in 2003 to 13.1 in 2008 (coefficient for time trend = −0.28±0.06 SE cig/day per year, P<0.01). After adjusting for these trends the introduction of smoke-free legislation was not associated with additional reductions in smoking prevalence (AOR = 1.02, 95% CI = 0.94–1.11, P = 0.596) or daily cigarette use in smokers (0.42±0.28 SE; P = 0.142). The percentage of respondents reporting smoking ‘at work’ and ‘inside pubs or bars’ decreased significantly from 14% to 2% (p<0.001) and from 34% to 2% (p<0.001), respectively, after the legislation. The percentage reporting smoking ‘inside restaurants, cafes, or canteens’ decreased significantly from 9% to 1% (p<0.001) and ‘inside their home’ decreased significantly from 65% to 55% (p<0.01).ConclusionThere is widespread compliance with the smoke-free legislation in England, which has led to large drops in indoor smoking in all venues, including at home. Declines in smoking prevalence and consumption continued along existing trends; they did not accelerate during the 18 months immediately following implementation.
Highlights
Comprehensive smoke-free legislation covering all enclosed public places and workplaces was implemented in England on 1 July 2007, following implementation of similar legislation in other parts of the United Kingdom (Scotland in March 2006 and Wales and Northern Ireland in April 2007)
Declines in smoking prevalence and consumption continued along existing trends; they did not accelerate during the 18 months immediately following implementation
There was a statistically significant time trend with smoking prevalence falling over time (AOR = 0.96 per year, 95% CI = 0.95–0.98, P,0.001) and number of cigarettes smoked (20.28 cigarettes/day per year, SE = 0.06, P,0.001)
Summary
Comprehensive smoke-free legislation covering all enclosed public places and workplaces was implemented in England on 1 July 2007, following implementation of similar legislation in other parts of the United Kingdom (Scotland in March 2006 and Wales and Northern Ireland in April 2007). While the primary purpose of the legislation was to reduce exposure to second hand smoke in enclosed public places a secondary objective was to ‘‘help people trying to give up smoking by providing supportive smoke-free environments’’ [12]. This objective is supported by an early systematic review which found that implementation of totally smoke-free workplaces was associated with a 3.8% reduction in smoking prevalence and lower cigarette use in continuing smokers [13]. This study examines the impact of this legislation on smoking prevalence, number of cigarettes smoked and location of smoking, controlling for secular trends through the end of 2008
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