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Smoke-free public places

Evidence level:
Best PracticePromising PracticeEmergent Practice
 
Evidence of Effectiveness:
?-0+++
Transferability:
?-0+
Enduring Impact:
?-0+
Review criteria and process

Policy category

Helping Vulnerable Children

Recommendation Pillars

Improve the responsiveness of health systems to address the needs of disadvantaged children

Countries that have implemented practice

United Kingdom

Age Groups

Middle Childhood (age 6 to 12)

Target Groups

Fathers, Mothers, Children, Parents

Years in Operation

2005  - still operating

Type of Organization Implementing Practice

National Government, State/district or Other Sub-national Government

Practice Overview

In March of 2006, Scotland introduced legislation that prohibited smoking in most enclosed public places. Enclosed public places are those that are more than 50% covered, including for example bars, restaurants, offices and sports stadiums. Businesses covered by the smoking ban were required to have a smoke-free policy and to display a non-smoking sign at the building’s entrance. The effects of this ban on smoking in public places on schildren’s secondhand smoke expoure were evaluated in two longitudinal studies. Study authors examined whether children’s secondhand smoke exposure decreased subsequent to the legislation. They also examined whether the ban was associated with a displacement of smoking from public places into the home, an effect which would have deleterious consequences for children’s secondhand smoke exposure. Authors found a reduction in secondhand smoke exposure and did not find a concomitant increase in smoking in the home.

 

Transferability

Smoking bans in public places have been implemented by many other countries, however, the effects on secondhand smoke exposure among children specifically has not been measured in these other locations. Thus, it is unclear whether these results might be duplicated if this ban were replicated elsewhere.

Evidence of Effectiveness

Evaluation 1

PC Akhtar , D B Currie, CE Currie, SJ Haw, “Changes in child exposure to environmental tobacco smoke (CHETS) study after implementation of smoke-free legislation in Scotland: national cross sectional survey”, BMJ 2007; pp. 335:545

Akhtar et al. (2007) evaluated the effects of the smoking ban in two nationally-representative surveys of primary schoolchildren in January of 2006 and 2007, before and after the smoking ban was enacted. Participating schoolchildren completed a questionnaire and were asked to provide a saliva sample in order to analyse salivary cotinine concentrations. Cotinine is a metabolite of nicotine and its concentration in saliva is a sensitive indicator of the absorption of smoke products. Pupils with a cotinine concentration indicating that they were active smokers were removed from the analyses.

Summary of Results for Evaluation 1

 

Outcome

Pre-legislation Group

Post-legislation Group

Outcomes improved (statistically significant)

Mean cotinine concentrations (ng/ml)

.35

.21

Smoking in someone else’s home (% students indicating that they had observed this yesterday)

11.6%

9.5%

Smoking in café or restaurant (% students indicating that they had observed this yesterday)

3.2%

0.9%

Smoking on bus or train (% students indicating that they had observed this yesterday)

1.5%

0.6%

Outcomes with no effect

Smoking in home  (% students indicating that they had observed this yesterday)

27.8%

27.4%

Smoking in car yesterday (% students indicating that they had observed  this yesterday)

6.7%

6.5%

Smoking in indoor leisure facility (% students indicating that they had observed this yesterday)

2.6%

1.9%

 

Evaluation 2

PC Akhtar, S J Haw, D B Currie, R Zachary, C E Currie, ”Smoking restrictions in the home and secondhand smoke exposure among primary schoolchildren before and after introduction of the Scottish smoke-free legislation”, Tobacco Control, 2009; 18:5 pp. 409-415.

This was an additional set of analyses performed on the same population described above. Authors were examining changes in the proportion of schoolchildren with partial or complete smoking bans in their home subsequent to the legislation. Authors used student responses to the question, “Is smoking allowed inside your home?” to measure smoking restrictions in the home.

Summary of Results for Evaluation 2

Outcome

Pre-legislation Group

Post-Legislation Group

Outcomes improved (statistically significant)

% of pupils with complete smoking restrictions in home

47.3%

51.8%

% of pupils with partial smoking restrictions in home

34.2%

34.0%

% of pupils with no smoking restrictions in home

18.5%

14.2%

Issues to consider

The smoke-free legislation passed in Scotland was associated with an attendant decrease in salivary cotinine concentrations among schoolchildren. For comparison, the observed annual decrease in cotinine concentration was greater than any annual change observed in two English longitudinal studies of secondhand smoke exposure. When authors examined this observed change at the sub-group level, they found that cotinine concentrations fell significantly for households in which neither parent figure smoked, as well as those households where only the father figure smoked. In households where only the mother figure smoked, no significant change in cotinine concentrations was found. Also note that the smoking legislation and related evaluations were based on a nationally-representative sample, and the effect of the program on vulnerable children in particular has not been established.

Enduring impact

Outcomes presented are from the period immediately following the smoking ban, and no longer-term follow-up studies have been conducted.

Contact Information

Name

Patricia C. Akhtar

Title

Course Secretary

Organization

University of Edinburgh · School of Biological Sciences

Address

 

Phone

 

Email

patricia.akhtar@ed.ac.uk

Website

Available Resources

Full text of the legislation can be found here: http://www.legislation.gov.uk/asp/2005/13/contents

Evaluation Details

The results from the Akhtar et al. (2007) and Akhtar et al. (2009) studies were based on the same two nationally-representative, classroom-based surveys of primary schoolchildren in Scotland. The surveys were conducted before and after the implementation of the smoking ban.  Specifically, the surveys were conducted in January of 2006 and 2007 with 2,559 and 2,424 school children participating, respectively.

Each sampled school selected one classroom in the final year of primary school to take part in the study.  Schools that declined to participate in the study (32% of 170 approached schools) were not significantly different from participating schools in terms of urban/rural, school size, % of pupils receiving free meals.  Participating schools were representative of Scottish schools with respect to these indicators.  Pupils with cotinine concentrations above 15 ng/ml, indicating that they are active smokers, were excluded from the study.  The proportion of pupils with higher cotinine concentrations was not different across study years. The mean age of pupils, their gender, the proportion of pupils in each type of family structure, and family affluence was not significantly different across years.

Pupils surveyed were administered a questionnaire on reports of parental smoking and their exposure to tobacco smoke in a variety of places.  Furthermore, they were asked to provide a saliva sample for testing for salivary cotinine concentrations.  Cotinine is a “metabolite of nicotine and a sensitive indicator of the absorption of smoke products” (Akhtar et al. 2007).

Bibliography

PC Akhtar , D B Currie, CE Currie, SJ Haw, “Changes in child exposure to environmental tobacco smoke (CHETS) study after implementation of smoke-free legislation in Scotland: national cross sectional survey”, BMJ 2007; pp. 335:545

PC Akhtar, S J Haw, D B Currie, R Zachary, C E Currie, ”Smoking restrictions in the home and secondhand smoke exposure among primary schoolchildren before and after introduction of the Scottish smoke-free legislation”, Tobacco Control, 2009; 18:5 pp. 409-415.