Comprehensive Smoking Ban Research Articles

Effects of comprehensive smoke-free legislation on smoking behaviours and macroeconomic outcomes in Shanghai, China: a difference-in-differences analysis and modelling study

China has one of the highest levels of tobacco consumption globally, and there is no national smoke-free legislation. Although more than 20 Chinese cities have passed local smoke-free laws since 2008, evidence on their effectiveness in reducing smoking behaviours and their economic benefits is scarce. By exploiting a natural quasi-experiment, whereby a comprehensive public smoking ban was implemented in Shanghai in March, 2017, this study aims to assess the impact of the policy on individual smoking behaviours and quantify its effect on macroeconomic outcomes. In this difference-in-differences analysis and modelling study, we used data on smoking behaviours from the 2012, 2014, 2016, and 2018 waves of the China Family Panel Studies. We used a difference-in-differences approach to investigate trends in smoking prevalence in respondents in Shanghai, relative to respondents from other direct-administered municipalities, provincial capital cities, and subprovincial municipalities (control group), after the implementation of a smoking ban in 2017. All respondents aged 18 years or older were included, with the exception of people who lived in Beijing and rural areas. The primary variable of interest in the difference-in-differences analysis was self-reported smoking status. Based on the difference-in-differences estimation of reduction in smoking prevalence, we then used a health-augmented macroeconomic model to estimate the potential macroeconomic gains if such a ban was implemented across China for the period 2017-35. 14 688 respondents were included in the analysis: 5766 from Shanghai and 8922 from the control group. After the implementation of the smoking ban in Shanghai in 2017, smoking prevalence decreased by 2·2 percentage points (95% CI 2·1-2·3), equivalent to an 8·4% reduction in the number of current smokers. The smoking ban had a larger effect on men, people with a higher level of education, unmarried people, and younger people when compared with their respective counterparts. The modelling analysis showed that implementing a nationwide comprehensive public smoking ban similar to that in Shanghai would result in a 0·04-0·07% increase in the national gross domestic product in China between 2017 and 2035, outweighing the economic costs of smoking ban enforcement. The smoking ban in Shanghai shows that a comprehensive public smoking ban with strict enforcement is effective in curbing smoking behaviours. Moreover, the implementation of a comprehensive public smoking ban across China would be cost-effective. National Social Science Fund of China.

Impact of smoke-free legislation on stroke risk: A systematic review and meta-analysis.

Secondhand smoke significantly increases the risk of cerebrovascular diseases, prompting recent public smoking bans. We aimed to ascertain the effects of smoke-free legislation on stroke incidence and mortality. We systematically searched Medline, Embase, Cochrane Library, and Scopus up to August 13, 2023, for studies reporting changes in stroke incidence following partial or comprehensive smoking bans. A random-effects meta-analysis was conducted on hospital admissions and mortality for stroke, stratified based on comprehensiveness of the ban ((i) workplaces-only, (ii) workplaces and restaurants, (iii) workplaces, restaurants and bars). The effect of post-ban follow-up duration was assessed visually by a forest plot, while meta-regression was employed to evaluate for any dose-response relationship between ban comprehensiveness and stroke risk. Of 3987 records identified, 15 studies analysing bans across a median follow-up time of 24 months (range: 3-67) were included. WRB bans were associated with reductions in the rates of hospital admissions for stroke (nine studies; RR, 0.918; 95% CI, 0.872-0.967) and stroke mortality (three studies; RR, 0.987; 95% CI, 0.952-1.022), although the latter did not reach statistical significance. There was no significant difference in the risk of stroke admissions for studies with increased ban comprehensiveness and no minimum duration for significant post-ban effects to be observed. Legislative smoking bans were associated with significant reductions in stroke-related hospital admissions, providing evidence for its utility as a public health intervention.

The impact of public health policies on reducing tobacco and substance abuse among the community

Public health policies have significantly impacted the reduction of tobacco and substance abuse within communities. Legislative measures, including increased taxation on tobacco products, comprehensive smoking bans, and restrictions on advertising, have been instrumental in decreasing smoking rates and protecting non-smokers from second-hand smoke. Community-based interventions, such as school-based programs and peer-led initiatives, address the root causes of substance abuse by promoting education, social support, and healthy behaviors, tailored to meet the specific needs of local populations, ensuring their relevance and effectiveness. Public awareness campaigns leveraging mass media and educational efforts play a crucial role in changing social norms and attitudes towards tobacco and substance use. Campaigns like the "truth" campaign and programs such as life skills training (LST) have shown significant success in reducing smoking and substance use among adolescents and young adults. Integrating these campaigns with other strategies enhances their impact, creating a comprehensive approach to public health. A multifaceted strategy combining legislative action, community engagement, and public education is crucial for achieving sustained reductions in tobacco and substance abuse. Continued investment in these areas is necessary to address evolving challenges and ensure long-term public health benefits. Coordinated efforts involving diverse stakeholders, including policymakers, educators, healthcare providers, and community organizations, are essential for effectively combating tobacco and substance abuse. By fostering collaboration and leveraging local resources, communities can create supportive environments that discourage harmful behaviors and promote healthier lifestyles. These comprehensive strategies demonstrate that a well-rounded approach, incorporating legislative measures, community-based interventions, and public awareness campaigns, is effective in mitigating the prevalence of tobacco and substance abuse, ultimately contributing to improved public health outcomes.

The consequences of health mandates on infant health: Evidence from a smoking-ban regulation

Low- and middle-income countries, where more than four-fifths of the world’s smokers live, are far behind in implementing comprehensive smoking bans in public places. This paper studies the infant health consequences of a highly enforced smoking-ban law in Brazil that reduced exposure to smoking for workers in hospitality occupations. Using administrative data and a difference-in-differences strategy, we show that pregnant women’s decreased exposure to smoking improved birth outcomes. Vulnerable workers who were more likely to have unintended pregnancies benefited more from the smoking ban, highlighting the regulation’s distributional consequences. Back-of-the-envelope calculations suggest that the intervention is highly cost-effective, as the infant health benefits surpass enforcement-related costs. Furthermore, we show that several behavioral changes that could offset the regulation’s intended impact are unlikely to operate in our setting.

Tobacco Policy and ENDS Policy Influences on Adolescent Vaping Across the U.S. States

Although the use of tobacco has declined among youth, ENDS has the potential to disrupt or reverse these trends. Policies for tobacco and ENDS may have an impact on adolescent ENDS use. The impacts of state-level policies were examined for both tobacco and ENDS indoor use bans, excise taxes, and age-of-purchase laws on past-month adolescent ENDS use from 2013 to 2019. This study used cohort data from the Population Assessment of Tobacco and Health study and policy data from the Americans for Nonsmokers' Rights Foundation repository-3 policies for ENDS and 2 policies for tobacco products. Policies included comprehensive indoor vaping/smoking bans, purchase-age restrictions, and excise taxes. Hybrid panel models were estimated in 2022 using data merged from the 2 longitudinal sources on past-month vaping. The analytic sample (observations=26,008) included adolescents aged 12-17 years, yielding a total of 72,684 observations. The odds of adolescent ENDS use were 21.4% lower when the state had an ENDS purchase-age restriction and 55.0% lower when the state had a comprehensive tobacco smoking ban than in the years when the state did not have the ban. During a period of significant growth in ENDS use among U.S. youth, ENDS purchase-age restrictions and smoking bans reduced the odds of past-month vaping among adolescents. Wider implementation of policies may help intervene in youth vaping.

The Impact of the Danish National Smoking Ban From 2007 on the Incidence of Eight Smoking-related Diseases: A Nationwide Register-based Interrupted Time Series Analysis.

Previous research has documented the effect of comprehensive smoking bans on preventing various adverse health outcomes in the years post-ban. In 2007, Denmark implemented a national smoking ban that prohibited indoor smoking in workplaces and public settings, although only partial restrictions applied in specific premises such as small bars, one-person offices, and in psychiatric units. We tested the hypothesis that the implementation of the national smoking ban was associated with a decrease in incidence of smoking-related morbidity in the Danish population compared to the pre-ban period. Interrupted time series analyses including the entire Danish population (≥30 years) was conducted. Information of hospitalizations and cause-specific mortality due to acute myocardial infarction, heart failure, hemorrhagic stroke, ischemic stroke, chronic obstructive pulmonary disease, cancer in bronchus and lung, cancer in lip, mouth, oral cavity, and pharynx, and bladder cancer were obtained from population-based registers. Poisson regression models accounting for seasonal variations and secular trends quantified immediate changes in incidence rates occurring at the time of the smoking ban as well as changes in the post-ban trend compared to pre-ban levels. Overall, we observed no consistent declines in incidence of cardiovascular diseases, chronic obstructive pulmonary disease, or the specific types of cancer in the post-ban period compared with the pre-ban period. No consistent reduction in incidence of smoking-related diseases was observed after the smoking ban was introduced in Denmark. This probably reflects that the Danish smoking ban included several exemptions, resulting in a less comprehensive ban compared to those introduced in other countries. In this study, we found that the Danish national smoking ban from 2007 did not consistently reduced the incidence of eight smoking-related outcomes in the post-ban period compared to pre-ban levels. We argue that due to the exemptions in the smoking ban, which for example allowed smoking in specific premises of the care and nursing sector, in one-person offices, and small bars, the ban was not sufficiently comprehensive to influence smoking behavior and thereof the incidence of smoking-related morbidity. Our findings highlight the importance of introducing comprehensive legislative measures to yield largest health benefits at a population level.

Secondhand smoke exposure and its influencing factors among Chinese people aged 15 years and above in 2010 and 2018

Objective: To investigate secondhand smoke (SHS) exposure among non-current smokers aged 15 and over and its influencing factors in China in 2010 and 2018. Methods: The 2010 and 2018 China Adult Tobacco Surveys used multistage stratified cluster random sampling methods to obtain national representative samples across 31 provinces (autonomous regions and municipalities) in China. This study selected non-current smokers aged 15 and over as the research subjects to describe the general demographic characteristics, perceptions of SHS hazards, attitudes towards smoking bans in indoor areas in public places, and SHS exposure and the smoking restriction regulations in different places. The Rao-Scott χ2 test was used to compare the rates, and the unconditional logistic regression was used to analyze the influencing factors of SHS exposure. All the subjects in the analysis were weighted based on a complex sampling design. Results: Among non-current smokers aged 15 and over, from 2010 to 2018, the percentage of indoor smokers had decreased from 84.7% to 71.9%. The rates of people who saw smoking in various places declined with a statistically significant difference (P<0.001). The exposure to SHS for females, people aged 45-64, teachers, medical staff, workers in enterprises, businesses, waiters, and people who live in rural and central areas declined. The differences were statistically significant (P<0.05). In 2018, the percentage of SHS exposure for those who reported a comprehensive smoking ban in households or allowed smoking in certain areas was lower than for those who reported allowed or without a smoking ban. Among those aged 25-44, SHS exposure for those who reported complete smoking prohibition in workplaces was lower than those who reported allowed or without smoking prohibition (OR=0.65, 95%CI: 0.49-0.87). The proportion of SHS exposure for those who believe that smoking should not be allowed in indoor areas of 0-5 public places is higher than that smoking should not be allowed in the indoor spaces of 8 public places (OR=2.13, 95%CI: 1.35-3.36). Among people aged 45-64, the proportions of SHS exposure for teachers (OR=0.37, 95%CI: 0.17-0.78) and medical staff (OR=0.35, 95%CI: 0.16-0.76) and staff working in agriculture, forestry, animal husbandry, fishery, and water conservancy were lower than governmental staff (OR=0.49, 95%CI: 0.29-0.84). Conclusions: Data from the decreased exposure of Chinese non-current smokers aged 15 and over to SHS suggests the initial achievement through constructing a smoke-free environment, but continued efforts are needed. It is necessary to actively advocate for smoke-free families, strengthen publicity and education on the hazards of tobacco and SHS, and improve the skills of non-smokers in rejecting SHS exposure.

Non-smoker protection and tobacco cessation

Non-smoker protection and tobacco cessation Abstract. Objective: Whereas, on the one hand, employees in child and adolescent psychiatric institutions (CAP) have to enforce smoking bans among patients, on the other hand, they have a high likelihood of being smokers themselves. Little data are available on the enforcement of smoking regulations and what cessation support is offered by CAP institutions. Method: In an online survey, n = 78 senior staff members or directors of German CAP institutions (41.9 % of all addressed CAP institutions) responded to questions on smoking regulations, exceptions, and cessation support for employees. Results: The enforcement of comprehensive smoking bans is rarely reported (<20 % of CAP institutions). Employees are exempted or allowed to smoke mostly outside of the building (e. g., in designated smoking areas: 69-78 % depending on ward type). Cessation support was offered by less than half of the CAP institutions (47%). Conclusions: The data presented point toward future areas for tobacco control in CAP care, including transparent regulations, staff training, and dissemination of support for occupational smoking cessation.

Exploring the association between school-based peer networks and smoking according to socioeconomic status and tobacco control context: a systematic review

BackgroundWhilst prevalence of youth smoking in middle and high income countries has decreased, inequality has prevailed. The introduction of legislation regulating tobacco use in public spaces varies across countries, impacting the tobacco control context. Thus reviewing our knowledge of how social networks may influence smoking differently within different contexts is required to facilitate the development of context-specific interventions.MethodsThe search, conducted on 31st May 2019, included the following smoking-related terms; schools, adolescents, peers and social networks. Inclusion and exclusion criteria were applied throughout the title and abstract screening and full text screening. Quality assessment and synthesis followed. Studies were narratively synthesised to identify changes according to legislative context. This synthesis was conducted separately for findings relating to three categories: socioeconomic status; social selection and influence; and network position.ResultsThirty studies were included. Differences in the relationship between network characteristics and smoking according to socioeconomic status were measured in five out of fifteen studies in Europe. Results varied across studies, with differences in network characteristics and their association with smoking varying both between schools of a differing and those of a similar socioeconomic composition. For studies conducted both before and after the introduction of comprehensive smoking legislation, the evidence for selection processes was more consistent than influence, which varied according to reciprocity. Findings showed that isolates were more likely to smoke and in-degree and out-degree centrality were related to smoking both before and after the introduction of legislation. The relationship between popularity and smoking was contingent on school level smoking prevalence in studies conducted before the introduction of legislation, but not after.ConclusionsOverall, effects according to socioeconomic status were underreported in the included studies and no consistent evidence of change after the introduction of a comprehensive smoking ban was observed. Further network analyses are required using more recent data to obtain a comprehensive understanding of how network processes may influence smoking differently according to socioeconomic status, and how adaptation could be used to enhance intervention effectiveness.Systematic review registrationInternational Prospective Register of Systematic Reviews (PROSPERO) registration number: CRD42019137358.

Finally a Smoking Gun? Compensating Differentials and the Introduction of Smoking Bans

Using the staggered introduction of smoking bans in the German hospitality industry over 2007–2008, I find a robust 2.4 percent decline in the daily earnings of workers in bars and restaurants associated with the most comprehensive smoking ban. This effect is unlikely to be driven by a decline in hospitality revenues or hours worked but is consistent with a simple model of compensating differentials. (JEL I12, I18, J22, J31, J81, L83)

Better air but not for all? Changes in second-hand smoke exposure at workplaces in 29 European countries over 10 years.

As the largest study of its kind to date, this article aims to describe the scope, trends over time, socio-demographic risk groups and the association with different progressive regulations relating to workplace second-hand smoke (SHS) exposure in 29 European countries during a period of high regulatory action. Three waves of the European Working Conditions Surveys (2005, 2010 and 2015) were evaluated, including a total of 95718 workers. The samples are representative for all employed residents of the 29 countries included. All interviews were conducted face-to-face at respondents' homes (computer-assisted personal interviews). SHS exposure among the overall working population of 29 countries-including smokers-was examined. Workplace regimes were grouped corresponding to the sub-scale 'workplace' as used in the Tobacco Control Scale. Between 2005 and 2015, SHS exposure in the European countries declined from around 19.0% (95% CI 16.1-22.0) to 9.9% (8.3-11.5). High SHS-exposure was reported by workers with the lowest level of education [11.5% (9.7-13.2)], among high-skilled manual labourers [14.3% (12.1-16.4)] and among those without a standard employment contract [11.2% (9.3-13.1)]. The highest exposure was reported by workers in the food service industry [19.7% (16.8-22.6)]. Countries with less workplace-related smoking prevention regulations were found to have the highest overall levels of exposure. This multinational series of cross-sectional surveys on the trends in passive smoking in the workplace have shown that countries with more comprehensive workplace smoking bans overall report lower levels of SHS exposure among their work force as compared with slow progressing countries.

Exposure of second hand smoke in women and children: A narrative review.

Second-hand smoke is a neglected public health issue. Every year 1.2 million people die due to this exposure. Second-hand smoke is also related to various other diseases like cardiovascular diseases, lung diseases, low birth weight, maternal depression, etc. The purpose of this review is to look over various studies and to gain an understanding of existing research about second-hand smoke and its adverse effects. In addition, we tried to identify the barriers behind creating a smoke-free environment at home and successful strategies employed and suggestion given in various studies. A comprehensive search of the recent literature related to Second-hand smoke was undertaken using electronic databases like MEDLINE, PUBMED, Google Scholar, and Research gate. Keyword searches were conducted for publications published since 2004 or later on Second-hand smoke exposure in pregnant women. Prevalence of SHS among pregnant women ranged from 24% 92%. Lack of knowledge, absence of comprehensive smoking ban, low status of women was among the main contributing factors. Community awareness and counseling by primary health-care physician was found to be successful strategies. There are various cultural and social barriers behind a smoke-free home for pregnant women. Interventional approaches like focused counseling by primary care physicians can help to overcome this issue. There is a need for behavioral interventions and community awareness to be done in this aspect.

Burden of disease from exposure to secondhand smoke in children in Europe.

Secondhand smoke (SHS) exposure at home and fetal SHS exposure during pregnancy are a major cause of disease among children. The aim of this study is quantifying the burden of disease due to SHS exposure in children and in pregnancy in 2006-2017 for the 28 European Union (EU) countries. Exposure to SHS was estimated using a multiple imputation procedure based on the Eurobarometer surveys, and SHS exposure burden was estimated with the comparative risk assessment method using meta-analytical relative risks. Data on deaths and disability-adjusted life years (DALYs) were collected from National statistics and from the Global Burden of Disease Study. Exposure to SHS and its attributable burden stalled in 2006-2017; in pregnant women, SHS exposure was 19.8% in 2006, 19.1% in 2010, and 21.0% in 2017; in children it was 10.1% in 2006, 9.6% in 2010, and 12.1% in 2017. In 2017, 35,633 DALYs among children were attributable to SHS exposure in the EU, mainly due to low birth weight. Comprehensive smoking bans up to 2010 contributed to reduce SHS exposure and its burden in children immediately after their implementation; however, SHS exposure still occurs, and in 2017, its burden in children was still relevant. Exposure to secondhand smoke at home and in pregnancy is a major cause of disease among children. Smoking legislation produced the adoption of voluntary smoking bans in homes; however, secondhand smoke exposure at home still occurs and its burden is substantial. In 2017, the number of deaths and disability-adjusted life years in children attributable to exposure to secondhand smoke in the European Union countries were, respectively, 335 and 35,633. Low birth weight caused by secondhand smoke exposure in pregnancy showed the largest burden. Eastern European Union countries showed the highest burden.

From Smoking-Permitted to Smokefree Prisons: A 3-Year Evaluation of the Changes in Occupational Exposure to Second-Hand Smoke Across a National Prison System.

ObjectivesPrisons in Scotland were one of the few workplaces exempt from the 2006 comprehensive smoking ban in indoor public places, excluding the prison workforce from the health benefits of smokefree workplaces. The November 2018 introduction of comprehensive restrictions on smoking in Scottish prisons aimed to protect prison staff and people in custody from the harmful impacts of second-hand smoke (SHS) exposure. This study presents SHS exposure data gathered after smokefree policy implementation and compares these with data gathered during and before policy development.MethodsDylos DC1700 monitors were used to measure concentrations of fine particulate matter (PM2.5) derived from SHS across Scotland’s 15 prisons. Six days of fixed-site monitoring (09.00 22 May 2019 to 09.00 28 May 2019) were conducted in residential halls in each prison 6 months post-smokefree policy implementation. Prison staff task-based measurements were conducted to assess concentrations of SHS in various locations (e.g. gyms and workshops) and during specific activities (e.g. cell searches, maintenance, and meal service). Utilizing the fixed-site monitoring data, typical daily PM2.5 exposure profiles were constructed for the prison service and time-weighted average (TWA) exposure concentrations were estimated for the typical shift patterns of residential staff pre- and post-smokefree policy implementation. Staff perceptions of changes to SHS exposure were assessed using online surveys.ResultsAnalysis of both fixed-site and mobile task-based PM2.5 measurements showed the smokefree policy implementation was successful in reducing SHS exposures across the Scottish prison estate. Measured PM2.5 in residential halls declined markedly; median fixed-site concentrations reduced by more than 91% compared with measures in 2016 before policy announcement. The changes in the TWA concentrations across shifts (over 90% decrease across all shifts) and task-based measurements (89% average decrease for high-exposure tasks) provide evidence that prison staff exposure to SHS has significantly reduced. Following smokefree policy implementation, the majority of staff reported no longer being exposed to SHS at work.ConclusionsTo our knowledge, this is the first comprehensive international study to objectively measure SHS levels before, during, and after implementation of a smokefree policy across a country’s prison system. The findings confirm that such a policy change can be successfully implemented to eliminate occupational exposures to SHS. The results are highly relevant for other jurisdictions considering changes to prison smoking legislation.

What are the effects on respiratory and cardiovascular outcomes of comprehensive legislative smoking bans for reducing harm from secondhand smoke exposure, smoking prevalence, and tobacco consumption?

Moderate‐certainty evidence shows that comprehensive legislative smoking bans probably improve overall cardiovascular health. Results for the impact of such bans on respiratory health are less certain.

Impact of the 2005 and 2010 Spanish smoking laws on hospital admissions for tobacco-related diseases in Valencia, Spain

ObjectivesThis study aimed to assess the impact of the latest smoke-free legislation on hospital admission rates due to smoking-related diseases in Spain. Study designA retrospective cohort study was conducted to evaluate changes in hospital admission rates for cardiovascular, respiratory diseases, and smoking-related cancer in Valencia, Spain, during the period 1995–2013. Law 28/2005 and then law 42/2010 prohibited smoking in bars and restaurants as well as playgrounds and access points to schools and hospitals. MethodsGeneral population data by age and sex were obtained from the National Institute of Statistics census. Data on hospital admissions were obtained from the Minimum Basic Data Set. Diagnoses were codified according to the International Classification of Diseases-9th revision. Data from all hospitals of the Valencian Community from 1995 to 2013 were analysed. Trend analyses in the periods before and after the approval of the 2005 law were conducted using least-squares linear regression models. ResultsAdjusted hospital admission rates per 100,000 inhabitants for cardiovascular diseases significantly decreased after the 2005 Law (from 550.0/100,000 in 2005 to 500.5/100,000 in 2007), with a further decrease (to 434.6/100,000) in 2013, after the 2010 Law. Reductions in hospital admissions were seen in men and women, although declining trends were more marked in men. Hospital admission rates for respiratory diseases showed a reduction of a lower magnitude, whereas for smoking-related cancer admissions there was a slight decline only among men. ConclusionsThe Spanish comprehensive smoking ban resulted in a remarkable reduction of the adjusted rate of hospital admissions mainly associated to cardiovascular diseases. The decrease in the number of persons requiring in-patient care is relevant and may be viewed as an improvement of the public's health.

Association between a comprehensive smoking ban and hospitalization for acute myocardial infarction: An observational study in the Autonomous Community of Valencia, Spain

ObjectiveTo assess the association between a comprehensive smoking ban and hospitalization rates for acute myocardial infarction (AMI). MethodsAn observational study was conducted to assess changes in hospital admission rates for AMI in the Autonomous Community of Valencia, Spain (population 5 million), during the period 1995-2013. Law 28/2005 prohibited smoking in all enclosed spaces (public and private), and Law 42/2010 extended the ban to bars and restaurants as well as children's playgrounds and access areas of schools and hospitals. Data on hospital admissions were obtained from the Hospital Discharge Database (CMBD) of the Autonomous Community. Annual hospital admission rates per 100000 population for AMI (ICD-9-CM code 410) for men and women were calculated. ResultsAdjusted hospital admission rates per 100000 population for AMI decreased markedly from 141.1 in 2005 to 119.2 in 2007, with a further reduction to 102.9 in 2013. Reductions in hospital admission were recorded in both men and women, but the downward trends were stronger in women. ConclusionThe Spanish comprehensive smoking ban was associated with a marked reduction in the adjusted rate of hospital admissions due to AMI in the Autonomous Community of Valencia. This decrease in the number of persons requiring in-patient care due to AMI is important from both a health care and a societal perspective.

Association between a comprehensive smoking ban and hospitalization for acute myocardial infarction: An observational study in the Autonomous Community of Valencia, Spain

Association between a comprehensive smoking ban and hospitalization for acute myocardial infarction: An observational study in the Autonomous Community of Valencia, Spain

'[…] the situation in the schools still remains the Achilles heel.' Barriers to the implementation of school tobacco policies-a qualitative study from local stakeholder's perspective in seven European cities.

School tobacco policies (STPs) are a crucial strategy to reduce adolescents smoking. Existing studies have investigated STPs predominantly from a school-related 'insider' view. Yet, little is known about barriers that are not identified from the 'schools' perspective', such as perceptions of local stakeholders. Forty-six expert interviews from seven European cities with stakeholders at the local level (e.g. representatives of regional health departments, youth protection and the field of addiction prevention) were included. The analysis of the expert interviews revealed different barriers that should be considered during the implementation of STPs. These barriers can be subsumed under the following: (i) Barriers regarding STP legislature (e.g. inconsistencies, partial bans), (ii) collaboration and cooperation problems between institutions and schools, (iii) low priority of smoking prevention and school smoking bans, (iv) insufficient human resources and (v) resistance among smoking students and students from disadvantaged backgrounds. Our findings on the expert's perspective indicate a need to enhance and implement comprehensive school smoking bans. Furthermore, collaboration and cooperation between schools and external institutions should be fostered and strengthened, and adequate human resources should be provided.

Impact of Comprehensive Smoking Bans on the Health of Infants and Children

As evidence of the negative effects of environmental tobacco smoke (ETS) has mounted, an increasingly popular public policy response has been to impose restrictions on smoking through 100% smoke-free bans (comprehensive smoking bans). Yet sparse information exists regarding the impact these smoking bans at the state and local levels have on the health of children and infants. A rationale for expansion of smoke-free laws implicitly presumes that potential public health gains from reducing adult cigarette consumption and declines in adult ETS exposure extend to children. However, if smokers compensate by shifting their consumption of cigarettes from public venues that impose a comprehensive smoking ban to smoking at home, then these policies may have a harmful effect on children and infants. This study provides estimates of how comprehensive smoking bans impact the venue of smoking, and the health of children and infants. Using models that exploit state- and county-level changes to smoking ban legislation over time, estimates suggest that smoking bans have improved the health of both infants and children, mainly through implementation of more comprehensive bans. Further, we find no evidence of displacement among smokers (both smokers with and without children in the household), and actually find that the bans had a positive spillover effect in terms of reducing smoking inside the home – an effect which may further explain the improvement in infant and children’s health. Our effect magnitudes imply that expanding comprehensive coverage from 60% (current level) to 100% of the population can prevent between approximately 1,110 – 1,750 low birthweight births among low-educated mothers, resulting in economic cost savings of about $71 – $111 million annually. Health improvements among older children add to these economic benefits.