Smoke-free Legislation In England Research Articles

Children's exposure to second-hand smoke 10 years on from smoke-free legislation in England: Cotinine data from the Health Survey for England 1998-2018

SummaryBackgroundWe aimed to investigate trends in children's exposure to second-hand tobacco smoke in England from 1998 to 2018.MethodsWe used twenty-one years of data from the Health Survey for England, a yearly repeated cross-sectional population study. A total of 49,460 children participated between 1998 and 2018, of whom 17,463 were biochemically confirmed non-smokers aged 4-15. We examined changes in (i) the proportion of children living in reported smoke-free homes and (ii) second-hand smoke uptake, measured quantitatively using saliva cotinine concentration.FindingsThe percentage of children living in a home reported to be smoke-free increased from 63.0% (95% CI 60.5%-65.2%) in 1998 to 93.3% (91.8%-94.6%) in 2018. This increase was most pronounced among children with a smoker parent, rising from 17.1% (14.7%-19.8%) to 75.9% (70.8%-80.4%). Segmented regression showed that the rate of adoption of smoke-free homes accelerated leading up to the 2007 ban on smoking in public places, growing most rapidly in the four years after its entry into law. Between 1998 and 2018, there was a ten-fold decline in geometric mean cotinine among non-smoking children, from 0.50 ng/ml (0.46-0.56) to 0.05 ng/ml (0.04-0.06). A total of 65.0% (61.2%-68.6%) of children had undetectable cotinine in 2018, up from 14.3% (12.7%-16.0%) in 1998. Children living in rented accommodation were more exposed than those from owner-occupied households, but they experienced similar relative declines across years.InterpretationCotinine data show that children's exposure to second-hand smoke has fallen by some 90% since 1998, with an apparent acceleration in adoption of smoke-free homes since the 2007 ban on smoking in public places. A norm has emerged that sees smoking in the home as inappropriate, almost universally where parents are non-smokers, but also increasingly among smoking parents.FundingPublic Health England, now the Office for Health Improvement and Disparities, and Cancer Research UK.

Building on the success of ten years of comprehensive smokefree legislation in England

Building on the success of ten years of comprehensive smokefree legislation in England

Protective Effects of Smoke-free Legislation on Birth Outcomes in England: A Regression Discontinuity Design.

Environmental tobacco smoke has an adverse association with preterm birth and birth weight. England introduced a new law to make virtually all enclosed public places and workplaces smoke free on July 1, 2007. We investigated the effect of smoke-free legislation on birth outcomes in England using Hospital Episode Statistics (HES) maternity data. We used regression discontinuity, a quasi-experimental study design, which can facilitate valid causal inference, to analyze short-term effects of smoke-free legislation on birth weight, low birth weight, gestational age, preterm birth, and small for gestational age. We analyzed 1,800,906 pregnancies resulting in singleton live-births in England between 1 January 2005 and 31 December 2009. In the 1 to 5 months following the introduction of the smoke-free legislation, for those entering their third trimester, the risk of low birth weight decreased by between 8% (95% confidence interval [CI]: 4%, 12%) and 14% (95% CI: 5%, 23%), very low birth weight between 28% (95% CI: 19%, 36%) and 32% (95% CI: 21%, 41%), preterm birth between 4% (95% CI: 1%, 8%) and 9% (95% CI: 2%, 16%), and small for gestational age between 5% (95% CI: 2%, 8%) and 9% (95% CI: 2%, 15%). The estimated impact of the smoke-free legislation varied by maternal age, deprivation, ethnicity, and region. The introduction of smoke-free legislation in England had an immediate estimated beneficial impact on birth outcomes overall, although we did not observe improvements across all age, ethnic, or deprivation groups.See video abstract at http://links.lww.com/EDE/B85.

Smoke-free legislation and the incidence of paediatric respiratory infections and wheezing/asthma: interrupted time series analyses in the four UK nations.

We investigated the association between introduction of smoke-free legislation in the UK (March 2006 for Scotland, April 2007 for Wales and Northern Ireland, and July 2007 for England) and the incidence of respiratory diseases among children. We extracted monthly counts of new diagnoses of wheezing/asthma and RTIs among children aged 0–12 years from all general practices in the Clinical Practice Research Datalink during 1997–2012. Interrupted time series analyses were performed using generalised additive mixed models, adjusting for underlying incidence trends, population size changes, seasonal factors, and pandemic influenza, as appropriate. 366,642 new wheezing/asthma diagnoses and 4,324,789 RTIs were observed over 9,536,003 patient-years. There was no statistically significant change in the incidence of wheezing/asthma after introduction of smoke-free legislation in England (incidence rate ratio (IRR) 0.94, 95% CI 0.81–1.09) or any other UK country (Scotland: IRR 0.99, 95% CI 0.83–1.19; Wales: IRR 1.09, 95% CI 0.89–1.35; Northern Ireland: IRR 0.96, 95% CI 0.76–1.22). Similarly no statistically significant changes in RTI incidence were demonstrated (England: IRR 0.95, 95% CI 0.86–1.06; Scotland: IRR 0.96, 95% CI 0.83–1.11; Wales: IRR 0.97, 95% CI 0.86–1.09; Northern Ireland: IRR 0.90, 95% CI 0.79–1.03). There were no demonstrable reductions in the incidence of paediatric wheezing/asthma or RTIs following introduction of smoke-free legislation in the UK.

Impact of smoke-free legislation on perinatal and infant mortality: a national quasi-experimental study.

Smoke-free legislation is associated with improved early-life outcomes; however its impact on perinatal survival is unclear. We linked individual-level data with death certificates for all registered singletons births in England (1995–2011). We used interrupted time series logistic regression analysis to study changes in key adverse perinatal events following the July 2007 national, comprehensive smoke-free legislation. We studied 52,163 stillbirths and 10,238,950 live-births. Smoke-free legislation was associated with an immediate 7.8% (95%CI 3.5–11.8; p < 0.001) reduction in stillbirth, a 3.9% (95%CI 2.6–5.1; p < 0.001) reduction in low birth weight, and a 7.6% (95%CI 3.4–11.7; p = 0.001) reduction in neonatal mortality. No significant impact on SIDS was observed. Using a counterfactual scenario, we estimated that in the first four years following smoke-free legislation, 991 stillbirths, 5,470 cases of low birth weight, and 430 neonatal deaths were prevented. In conclusion, smoke-free legislation in England was associated with clinically important reductions in severe adverse perinatal outcomes.

Smoke-free legislation and childhood hospitalisations for respiratory tract infections.

Second-hand smoke exposure is a major risk factor for respiratory tract infections (RTIs). Although evidence suggests important early-life health benefits of smoke-free public environments, the impact on childhood RTIs is unclear. We investigated the association between England's smoke-free legislation and childhood RTI hospitalisations.We used the Hospital Episode Statistics database to obtain nationwide data on hospital admissions for acute RTIs among children (<15 years of age) from 2001 to 2012. Hospitalisation counts were disaggregated by month, age group, sex and small-area level, and linked to urbanisation, region, deprivation index and corresponding population estimates. Negative binomial regression analyses were adjusted for confounders, seasonal variation, temporal autocorrelation, population-size changes and underlying incidence trends. Models allowed for sudden and gradual changes following the smoke-free legislation. We performed sensitivity and subgroup analyses, and estimated number of events prevented.We analysed 1 651 675 hospital admissions. Introduction of smoke-free legislation was followed by an immediate reduction in RTI admissions (-3.5%, 95% CI -4.7- -2.3%), this mainly being attributable to a decrease in lower RTI admissions (-13.8%, 95% CI -15.6- -12.0%). The reductions in admissions for upper RTI were more incremental.The introduction of national smoke-free legislation in England was associated with ∼11 000 fewer hospital admissions per year for RTIs in children.

Smoke-Free Legislation and Adverse Pregnancy Outcomes in England

Background: There is a wide array of evidence on the morbidity and mortality associated with smoking and second-hand-smoke on both adults and children. In response to these findings and following the Health Act, 2006, England introduced a new law to make virtually all enclosed public places and workplaces smoke free on July 1, 2007. Aim: To investigate the effect of smoking-free legislation on adverse pregnancy outcomes in England. Methods: A retrospective observational study design is used to analyse routinely collected national Hospital Episode Statistics (HES) maternity data covering the whole of England. All mothers who delivered singleton live-births between 24 to 44 weeks of gestation between January 1, 2005 to December 31, 2009 are included in the analyses (N=1,819,633). Regression discontinuity (RD) model, which is a quasi-experimental model, was employed to analyse the effects of the 2007 UK smoke-free legislation on pregnancy outcomes on birth weight, preterm and small for gestational age. Results: Preliminary results show that in the six months following the smoking-free legislation, low birth weight rates decreased by 5 to 7%, preterm deliveries decreased by 4 to 5%, and small for gestational age rates decreased by 6 to 7%. An overall increase in pregnancies gestational age and babies birth weights was also observed in the same time period. Most of the effects of the legislation on low birth weight, preterm delivery and small for gestational age were most pronounced in babies delivered by women aged 20-29, women living in less deprived areas in the east and south of England. Conclusions: Smoke-free legislation in England is likely to have positively influenced pregnant women's environment with respect to smoke and second hand some exposure. Our analyses are consistent with beneficial effects on pregnancy outcomes apparent within six months of the introduction of this legislation.

Short-term Impact of the Smokefree Legislation in England on Emergency Hospital Admissions for Asthma Among Adults: A Population Based Study: Sims M, Maxwell R, Gilmore A. Thorax 2013;68:619–24.

Short-term Impact of the Smokefree Legislation in England on Emergency Hospital Admissions for Asthma Among Adults: A Population Based Study: Sims M, Maxwell R, Gilmore A. Thorax 2013;68:619–24.

Short-term impact of the smokefree legislation in England on emergency hospital admissions for asthma among adults

Short-term impact of the smokefree legislation in England on emergency hospital admissions for asthma among adults

Short-term impact of the smokefree legislation in England on emergency hospital admissions for asthma among adults: a population-based study

BackgroundComprehensive smokefree laws have now been introduced in several jurisdictions. Few studies have examined the association between smokefree laws and asthma in adults and these have limitations, such as lacking...

Good public health practice

British Journal of School NursingVol. 8, No. 1 EditorialGood public health practiceEmma CroghanEmma CroghanSearch for more papers by this authorEmma CroghanPublished Online:16 Aug 2013https://doi.org/10.12968/bjsn.2013.8.1.5AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References British Medical Association (2013) BMA seeks HPV vaccination for gay men. http://bma.org.uk/news-views-analysis/news/2013/january/bma-seeks-hpv-vaccination-for-gay-men (accessed 1 February 2013) Google ScholarEllwood P, Asher MI, García-Marcos L et al. (2013) Do fast foods cause asthma, rhinoconjunctivitis and eczema? Global findings from the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three. Thorax [Epub ahead of print] Crossref, Google ScholarMillett C, Lee JT, Laverty AA, Glantz SA, Majeed A (2013) Hospital admissions for childhood asthma after smoke-free legislation in England. Pediatrics [Epub ahead of print] Crossref, Google Scholar FiguresReferencesRelatedDetails 1 February 2013Volume 8Issue 1ISSN (print): 1752-2803ISSN (online): 2052-2827 Metrics History Published online 16 August 2013 Published in print 1 February 2013 Information© MA Healthcare LimitedPDF download

Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England

To assess whether the implementation of English smoke-free legislation in July 2007 was associated with a reduction in hospital admissions for childhood asthma. Interrupted time series study using Hospital Episodes Statistics data from April 2002 to November 2010. Sample consisted of all children (aged ≤14 years) having an emergency hospital admission with a principle diagnosis of asthma. Before the implementation of the legislation, the admission rate for childhood asthma was increasing by 2.2% per year (adjusted rate ratio 1.02; 95% confidence interval [CI]: 1.02-1.03). After implementation of the legislation, there was a significant immediate change in the admission rate of -8.9% (adjusted rate ratio 0.91; 95% CI: 0.89-0.93) and change in time trend of -3.4% per year (adjusted rate ratio 0.97; 95% CI: 0.96-0.98). This change was equivalent to 6802 fewer hospital admissions in the first 3 years after implementation. There were similar reductions in asthma admission rates among children from different age, gender, and socioeconomic status groups and among those residing in urban and rural locations. These findings confirm those from a small number of previous studies suggesting that the well-documented population health benefits of comprehensive smoke-free legislation appear to extend to reducing hospital admissions for childhood asthma.

Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England

Hospital Admissions for Childhood Asthma After Smoke-Free Legislation in England

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

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.

OP54 Short-Term Impact of the Smokefree Legislation in England on Hospital Admissions for Asthma Among Adults

BackgroundComprehensive smokefree laws prohibiting smoking in enclosed public places and workplaces have now been introduced in several jurisdictions and there is a growing body of evidence documenting the immediate health...

OP53 Defining the Long-Term Trend in a Public Health Intervention Study: A Cautionary Tale

BackgroundNumerous studies have reported on the impact of comprehensive smoke-free laws on population health. Many early studies have ignored the potential effect of the long-term trend of the health outcome,...

Stop Smoking Service Clients’ Views Following the Introduction of Smoke-Free Legislation in England

This study aimed to explore smoker's perspectives of continued smoking and smoking cessation following the introduction of smoke-free legislation in England. Seventeen semi-structured interviews were conducted with smokers who were making a quit attempt with the support of stop smoking services delivered by the National Health Service. Interviews explored opinions of smoke-free legislation before it was implemented in July 2007, as well as attitudes towards the legislation, beliefs about the influence of legislation on smoking behaviours, as well as changes to public attitudes about smoking. Framework analysis highlighted five key themes: attitudes towards smoke-free legislation prior to its introduction, support for smoke-free legislation following implementation, smoke-free legislation and smoking behaviour, stigma, and returning to smoking. Overall, smokers were positive about smoke-free legislation and reported reductions in smoking and an increase in quit attempts after introduction of the legislation. Change in attitudes towards smoking and smokers were noted, which at times could transpire to stigmatisation felt by the participants. Few quitters expressed a wish to return to smoking if the legislation was reversed.

The impact of the introduction of smoke‐free legislation on prescribing of stop‐smoking medications in England

To investigate whether there were changes in the rate of prescribing of smoking cessation medications in the months leading up to, and after, the introduction of smoke-free legislation in England. Interrupted time-series analysis of prescribing rates using Autoregressive Integrated Moving Average (ARIMA) models. A total of 350 general practices in England who contribute data to The Health Improvement Network (THIN) database. Patients in THIN aged 16+ identified from their medical records as smokers. Monthly rates of prescribing of nicotine replacement therapy (NRT), bupropion and varenicline were calculated from THIN from 2000 to 2009 for all smokers and for subgroups defined by patient sex, age group, history of chronic disease and quintile of the Townsend Index of Deprivation. ARIMA models were built to assess whether there were changes in prescribing before or after the introduction of smoke-free legislation over and above any long-term and seasonal trends. There was a 6.4% (0.7-12.1) increase in prescribing of all smoking cessation medications in the 9 months before the introduction of smoke-free legislation and a 6.4% (1.1-11.7) reduction in the 9-month period afterwards. A 6.2% (1.4-11.0) increase in NRT prescribing and a 13.2% (4.3-22.2) increase in bupropion prescribing occurred in the 6- and 3-month periods, respectively, before smoke-free legislation was introduced, and a 5.5% (2.3-8.7) decline in NRT prescribing and a 13.7% (4.6-22.8) decline in bupropion prescribing in the 9 months post-legislation. The patterns of change in prescribing did not vary with patient demographics. Numbers of primary care prescriptions for smoking cessation medications increased prior to the introduction of smoke-free legislation but decreased afterwards, suggesting a temporal displacement in prescribing activity rather than a change in the overall volume of prescribing. Effects observed were consistent across all population subgroups, suggesting that the changes in prescribing will neither widen nor reduce smoking-related health inequalities.

Effect of Smoke-Free Legislation on Adult Smoking Behaviour in England in the 18 Months following Implementation

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.

Quit attempts in response to smoke-free legislation in England

ObjectivesTo determine whether England's smoke-free legislation, introduced on 1 July 2007, influenced intentions and attempts to stop smoking.Design and settingNational household surveys conducted in England between January 2007 and December...