Abstract
In this paper, we aim to present an overview of the scientific literature on the link between smoke-free legislation and early-life health outcomes. Exposure to second-hand smoke is responsible for an estimated 166 ,000 child deaths each year worldwide. To protect people from tobacco smoke, the World Health Organization recommends the implementation of comprehensive smoke-free legislation that prohibits smoking in all public indoor spaces, including workplaces, bars and restaurants. The implementation of such legislation has been found to reduce tobacco smoke exposure, encourage people to quit smoking and improve adult health outcomes. There is an increasing body of evidence that shows that children also experience health benefits after implementation of smoke-free legislation. In addition to protecting children from tobacco smoke in public, the link between smoke-free legislation and improved child health is likely to be mediated via a decline in smoking during pregnancy and reduced exposure in the home environment. Recent studies have found that the implementation of smoke-free legislation is associated with a substantial decrease in the number of perinatal deaths, preterm births and hospital attendance for respiratory tract infections and asthma in children, although such benefits are not found in each study. With over 80% of the world’s population currently unprotected by comprehensive smoke-free laws, protecting (unborn) children from the adverse impact of tobacco smoking and SHS exposure holds great potential to benefit public health and should therefore be a key priority for policymakers and health workers alike.
Highlights
Despite the fact that the adverse health effects of tobacco smoking were officially recognised over 50 years ago, smoking continues to be the leading cause of preventable death worldwide.[1]
In a systematic review published in 2014,58 we identified six studies assessing the association between smoke-free legislation and low birthweight.[41,42,44,68,69,70]
In our systematic review on smoke-free legislation and child health, we identified four studies investigating the association with preterm birth.[41,42,44,69]
Summary
Despite the fact that the adverse health effects of tobacco smoking were officially recognised over 50 years ago, smoking continues to be the leading cause of preventable death worldwide.[1]. Maternal SHS exposure during pregnancy is associated with increased risks for stillbirth, low birthweight and paediatric asthma.[1,7,8,9,10] After birth, an estimated 40–50% of the world’s children are regularly exposed to SHS, primarily by being around smoking parents and/or other household members.[6,11] As a result, children make up over a quarter of all deaths and over half of all disability-adjusted life-years associated with SHS exposure.[6] These estimates are based on the impact of SHS on respiratory tract infections (RTIs) and asthma only, and the estimated burden of death and disease is likely much larger when in addition considering other SHS-associated outcomes including adverse perinatal outcomes, sudden infant death syndrome (SIDS) and invasive meningococcal infections.[6,12,13,14]. It is important to consider the potential benefits of smoke-free legislation to child health via reducing both antenatal and postnatal SHS exposure
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