From tobacco control research to policy: the example of smoke-free legislation in England

Abstract

BackgroundTobacco control policies, such as legislation to make all enclosed public places and workplaces smoke free, are often highly contested. Despite growing evidence that smoke-free laws are effective in reducing secondhand smoke exposure and provide early health benefits, efforts to contest evidence for secondhand smoke and the effects of legislation are widespread. The Tobacco Control Research Group at Bath, UK, has produced a wide range of work assessing various effects of smoke-free legislation introduced on July 1, 2007, in England. We use our assessment of whether the legislation reduced hospital admissions for heart attacks as an example of our research. When this assessment was published in the British Medical Journal in 2010, several studies showing a decrease in admissions for heart attack after the introduction of smoke-free laws in other countries had already been published. In view of efforts to contest these findings by pro-tobacco bloggers, media articles questioning the credibility of tobacco control research, and spurious coverage of our work in national newspapers before it was published, we had two aims: to build on existing research by taking into account long-term trends; and to ensure the findings, when published, were accurately reported in the media and to policy makers. MethodsWe investigated the short-term effect of the English smoke-free legislation with numbers of emergency hospital admissions per week coded with a primary diagnosis of a myocardial infarction from July 1, 2002, to Sept 30, 2008, in all patients aged 18 years and older. The analysis was done with a segmented Poisson regression analysis that adjusted for long-term trends and other potential confounders. Cost savings to the NHS were calculated in collaboration with the London Health Observatory. For the media strategy, we prepared simple but accurate media briefings, which we disseminated to ten key parties that were likely to be contacted by the media. We held a press briefing at the Science Media Centre (London), and worked closely with them, Bath University press office, and the British Medical Journal. FindingsSmoke-free legislation was association with a 2·4% (95% CI −4·06 to −0·66) reduction in the number of emergency admissions for myocardial infarction. This reduction equates to 1200 fewer emergency admissions for myocardial infarction in the first year after legislation. The London Health Observatory estimated that £8·4 million has been saved in emergency hospital care for heart attacks in the first year since smoke-free legislation was introduced. The research received wide reaching, positive coverage in both print and broadcast media, featuring on the BBC, BBC Radio 4's Today programme, BBC Radio 5 Live, and local BBC radio stations. National newspapers that featured the story included The Times, Financial Times, Independent, and Daily Mail. Internationally, the research was reported by media in several countries, including the USA, Canada, and New Zealand. Our efforts to ensure that coverage was accurate were successful, despite later efforts by pro-tobacco bloggers to undermine it. InterpretationThis study adds to the growing evidence that smoke-free legislation leads to reductions in myocardial infarctions and builds on previous work by showing that such decreases are noted even when underlying reductions in admissions and other potential confounders are controlled for. With careful planning and communication, public health research in a contested field can be effectively and accurately disseminated. The research has subsequently contributed to the present government's tobacco control strategy. FundingDepartment of Health's Policy Research Programme.