Primary studies included in this systematic review

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Primary study

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Hospital admissions for childhood asthma after smoke-free legislation in England.

Journal Pediatrics
Year 2013
Links Pubmed DOI PubMed Central

This article is included in 1 Broad synthesis Broad syntheses (1 reference) 2 Systematic reviews Systematic reviews (2 references)

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OBJECTIVE: To assess whether the implementation of English smoke-free legislation in July 2007 was associated with a reduction in hospital admissions for childhood asthma. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Primary study

Unclassified

The effect of a smoking ban on hospitalization rates for cardiovascular and respiratory conditions in Prince Edward Island, Canada.

Journal PloS one
Year 2013
Links Pubmed DOI PubMed Central

This article is included in 3 Systematic reviews Systematic reviews (3 references)

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BACKGROUND: This is the first study to have examined the effect of smoking bans on hospitalizations in the Atlantic Canadian socio-economic, cultural and climatic context. On June 1, 2003 Prince Edward Island (PEI) enacted a province-wide smoking ban in public places and workplaces. Changes in hospital admission rates for cardiovascular (acute myocardial infarction, angina, and stroke) and respiratory (chronic obstructive pulmonary disease and asthma) conditions were examined before and after the smoking ban. METHODS: Crude annual and monthly admission rates for the above conditions were calculated from April 1, 1995 to December 31, 2008 in all PEI acute care hospitals. Autoregressive Integrated Moving Average time series models were used to test for changes in mean and trend of monthly admission rates for study conditions, control conditions and a control province after the comprehensive smoking ban. Age- and sex-based analyses were completed. RESULTS: The mean rate of acute myocardial infarctions was reduced by 5.92 cases per 100,000 person-months (P = 0.04) immediately after the smoking ban. The trend of monthly angina admissions in men was reduced by -0.44 cases per 100,000 person-months (P = 0.01) in the 67 months after the smoking ban. All other cardiovascular and respiratory admission changes were non-significant. CONCLUSIONS: A comprehensive smoking ban in PEI reduced the overall mean number of acute myocardial infarction admissions and the trend of angina hospital admissions.

Primary study

Unclassified

Smoking ban and small-for-gestational age births in Ireland.

Authors Kabir Z , Daly S , Clarke V , Keogan S , Clancy L
Journal PloS one
Year 2013
Links Pubmed DOI PubMed Central

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: Ireland introduced a comprehensive workplace smoke-free legislation in March, 2004. Smoking-related adverse birth outcomes have both health care and societal cost implications. The main aim of this study was to determine the impact of the Irish smoke-free legislation on small-for-gestationa- age (SGA) births. METHODS AND FINDINGS: We developed a population-based birthweight (BW) percentile curve based on a recent study to compute SGA (BW <5(th) percentile) and very SGA (vSGA - BW<3(rd) percentile) for each gestational week. Monthly births born between January 1999 and December 2008 were analyzed linking with monthly maternal smoking rates from a large referral maternity university hospital. We ran individual control and CUSUM charts, with bootstrap simulations, to pinpoint the breakpoint for the impact of ban implementation ( = April 2004). Monthly SGA rates (%) before and after April 2004 was considered pre and post ban period births, respectively. Autocorrelation was tested using Durbin Watson (DW) statistic. Mixed models using a random intercept and a fixed effect were employed using SAS (v 9.2). A total of 588,997 singleton live-births born between January 1999 and December 2008 were analyzed. vSGA and SGA monthly rates declined from an average of 4.7% to 4.3% and from 6.9% to 6.6% before and after April 2004, respectively. No auto-correlation was detected (DW = ~2). Adjusted mixed models indicated a significant decline in both vSGA and SGA rates immediately after the ban [(-5.3%; 95% CI -5.43% to -5.17%, p<0.0001) and (-0.45%; 95% CI: -0.7% to -0.19%, p<0.0007)], respectively. Significant gradual effects continued post the ban periods for vSGA and SGA rates, namely, -0.6% (p<0.0001) and -0.02% (p<0.0001), respectively. CONCLUSIONS: A significant reduction in small-for-gestational birth rates both immediately and sustained over the post-ban period, reinforces the mounting evidence of the positive health effect of a successful comprehensive smoke-free legislation in a vulnerable population group as pregnant women.

Primary study

Unclassified

Impact of a stepwise introduction of smoke-free legislation on the rate of preterm births: analysis of routinely collected birth data.

Journal BMJ (Clinical research ed.)
Year 2013
Links Pubmed PubMed Central

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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OBJECTIVE: To investigate the incidence of preterm delivery in the Belgian population after implementation of smoke-free legislation in three phases (in public places and most workplaces January 2006, in restaurants January 2007, and in bars serving food January 2010). DESIGN: Logistic regression analyses on routinely collected birth data from January 2002 to December 2011. SETTING: Flanders, Belgium. POPULATION: All live born singleton births delivered at 24-44 weeks of gestation (n = 606,877, with n = 448,520 spontaneous deliveries). MAIN OUTCOME MEASURES: Preterm birth (gestational age <37 weeks). RESULTS: We found reductions in the risk of preterm birth after the introduction of each phase of the smoking ban. No decreasing trend was evident in the years or months before the bans. We observed a step change in the risk of spontaneous preterm delivery of -3.13% (95% CI -4.37% to -1.87%; P<0.01) on 1 January 2007 (ban on smoking in restaurants), and an annual slope change of -2.65% (-5.11% to -0.13%; P=0.04) after 1 January 2010 (ban on smoking in bars serving food). The analysis for all births gave similar results: a step change of -3.18% (-5.38% to -0.94%; P<0.01) on 1 January 2007, and an annual slope change of -3.50% (-6.35% to -0.57%; P=0.02) after 1 January 2010. These changes could not be explained by personal factors (infant sex, maternal age, parity, socioeconomic status, national origin, level of urbanisation); time related factors (underlying trends, month of the year, day of the week); or population related factors (public holidays, influenza epidemics, and short term changes in apparent temperature and particulate air pollution). CONCLUSION: Our study shows a consistent pattern of reduction in the risk of preterm delivery with successive population interventions to restrict smoking. This finding is not definitive but it supports the notion that smoking bans have public health benefits from early life.

Primary study

Unclassified

A citywide smoking ban reduced maternal smoking and risk for preterm births: a Colorado natural experiment.

Authors Page RL , Slejko JF , Libby AM
Journal Journal of women's health (2002)
Year 2012
Links Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: Few reports exist on the association of a public smoking ban with fetal outcomes and maternal smoking in the United States. We sought to evaluate the effect of a citywide smoking ban in comparison to a like municipality with no such ban in Colorado on maternal smoking and subsequent fetal birth outcomes. METHODS: A citywide smoking ban in Colorado provided a natural experiment. The experimental citywide smoking ban site was implemented in Pueblo, Colorado. A comparison community was chosen that had no smoking ban, El Paso County, with similar characteristics of population, size, and geography. The two sites served as their own controls, as each had a preban and postban retrospective observation period: preban was April 1, 2001, to July 1, 2003; postban was April 1, 2004, to July 1, 2006. Outcomes were maternal smoking (self-report), low birth weight (LBW) (defined as <2500 g or as <3000 g), and preterm births (<37 weeks gestation) in singleton births from mothers residing in these cities and reported to the State Department of Public Health. A difference-in-differences estimator was used to account for site and temporal trends in multivariate models. RESULTS: Compared to El Paso County preban, the odds of maternal smoking and preterm births were, respectively, 38% (p<0.05) and 23% (p<0.05) lower in Pueblo. The odds for LBW births decreased by 8% for <3000 g and increased by 8.4% for <2500 g; however, neither was significant. CONCLUSIONS: This is the first evidence in the United States that population-level intervention using a smoking ban improved maternal and fetal outcomes, measured as maternal smoking and preterm births.

Primary study

Unclassified

Impact of Scotland's smoke-free legislation on pregnancy complications: retrospective cohort study.

Authors Mackay DF , Nelson SM , Haw SJ , Pell JP
Journal PLoS medicine
Year 2012
Links Pubmed DOI PubMed Central

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: Both active smoking and environmental tobacco smoke exposure are associated with pregnancy complications. In March 2006, Scotland implemented legislation prohibiting smoking in all wholly or partially enclosed public spaces. The aim of this study was to determine the impact of this legislation on preterm delivery and small for gestational age. METHODS AND FINDINGS: We conducted logistic regression analyses using national administrative pregnancy data covering the whole of Scotland. Of the two breakpoints tested, 1 January 2006 produced a better fit than the date when the legislation came into force (26 March 2006), suggesting an anticipatory effect. Among the 716,941 eligible women who conceived between August 1995 and February 2009 and subsequently delivered a live-born, singleton infant between 24 and 44 wk gestation, the prevalence of current smoking fell from 25.4% before legislation to 18.8% after legislation (p<0.001). Three months prior to the legislation, there were significant decreases in small for gestational age (-4.52%, 95% CI -8.28, -0.60, p = 0.024), overall preterm delivery (-11.72%, 95% CI -15.87, -7.35, p<0.001), and spontaneous preterm labour (-11.35%, 95% CI -17.20, -5.09, p = 0.001). In sub-group analyses, significant reductions were observed among both current and never smokers. CONCLUSIONS: Reductions were observed in the risk of preterm delivery and small for gestational age 3 mo prior to the introduction of legislation, although the former reversed partially following the legislation. There is growing evidence of the potential for tobacco control legislation to have a positive impact on health.

Primary study

Unclassified

Smoking Bans, Maternal Smoking and Birth Outcomes

blocked
Report IZA Discussion Paper No. 7006
Year 2012
Links papers.ssrn.com

This article is included in 1 Systematic review Systematic reviews (1 reference)

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An important externality of smoking is the harm it might cause to those who do not smoke. This paper examines the impact on birth outcomes of children of female workers who are affected by smoking bans in the workplace. Analyzing a 2004 law change in Norway that extended smoking restrictions to bars and restaurants, we find that children of female workers in restaurants and bars born after the law change saw significantly lower rates of being born below the very low birth weight (VLBW) threshold and were less likely to be born pre-term. Using detailed data on smoking status during pregnancy, we find that relative to the control group, most of the benefits arise from changes in smoking behavior of the mother; the effect of second hand smoke exposure on birth outcomes in this formulation appears to be quite small. However, we find suggestive evidence of substituting behavior, i.e. a greater likelihood of smoking at home among fathers, since children born to male workers in restaurants and bars after this law change appear to have slightly worse outcomes. Using individual tax data, we find that the law change did not result in changes in earnings or employment opportunities for those affected, thus suggesting that the effects seen are likely a direct result of changes in smoke exposure in utero. Using a twins based analysis, we link very low birth weight status to adult labor force participation and suggest that via the improvements in birth weight alone, the smoking restriction law in Norway could result in a 0.2 percentage point increase in full time employment by age 28.

Primary study

Unclassified

Analysis of the association between birth outcomes and the Ohio tobacco ban

blocked
Authors Hade, E
Book In: Analyses of the impact of the Ohio smoke-free workplace act. Columbus: Ohio Department of Health
Year 2011
Links www.odh.ohio.gov

This article is included in 1 Systematic review Systematic reviews (1 reference)

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There is little evidence in the vital statistics data compiled between January 2006 and December 2009, that the enforcement of the tobacco ban had a substantial effect on poor birth outcomes. These trends may be more apparent with increased pre and post ban data.

Primary study

Unclassified

Smoke-free legislation and hospitalizations for childhood asthma.

Journal The New England journal of medicine
Year 2010
Links Pubmed DOI

This article is included in 2 Systematic reviews Systematic reviews (2 references)

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BACKGROUND: Previous studies have shown that after the adoption of comprehensive smoke-free legislation, there is a reduction in respiratory symptoms among workers in bars. However, it is not known whether respiratory disease is also reduced among people who do not have occupational exposure to environmental tobacco smoke. The aim of our study was to determine whether the ban on smoking in public places in Scotland, which was initiated in March 2006, influenced the rate of hospital admissions for childhood asthma. METHODS: Routine hospital administrative data were used to identify all hospital admissions for asthma in Scotland from January 2000 through October 2009 among children younger than 15 years of age. A negative binomial regression model was fitted, with adjustment for age group, sex, quintile of socioeconomic status, urban or rural residence, month, and year. Tests for interactions were also performed. RESULTS: Before the legislation was implemented, admissions for asthma were increasing at a mean rate of 5.2% per year (95% confidence interval [CI], 3.9 to 6.6). After implementation of the legislation, there was a mean reduction in the rate of admissions of 18.2% per year relative to the rate on March 26, 2006 (95% CI, 14.7 to 21.8; P<0.001). The reduction was apparent among both preschool and school-age children. There were no significant interactions between hospital admissions for asthma and age group, sex, urban or rural residence, region, or quintile of socioeconomic status. CONCLUSIONS: In Scotland, passage of smoke-free legislation in 2006 was associated with a subsequent reduction in the rate of respiratory disease in populations other than those with occupational exposure to environmental tobacco smoke. (Funded by NHS Health Scotland.)

Primary study

Unclassified

The eff ect of local smoking ordinances on fetal development: evidence from California

blocked
Authors Amaral, M
Thesis Department of Economics, University of the Pacific
Year 2009
Links 138.9.110.12

This article is included in 1 Systematic review Systematic reviews (1 reference)

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Smoking restrictions in workplaces have been shown to reduce the demand for cigarettes but little is known of their downstream effect on individual well-being. In this paper, I examine the impact of local workplace smoking restrictions on birth outcomes. It is known that maternal and passive smoking during pregnancy reduce birth weight and that low birth weight infants are more likely to experience acute health and developmental difficulties that inflict significant costs on society. I use variation in the timing of local smoking ordinances in California between 1988 and 2004 in combination with a large sample of birth certificates to identify the effects of these ordinances on birth weight. The results indicate that the state workplace ordinance decreases the average city birth weight. While the results show no effect on birth outcomes from local ordinances and only small effects from the state ordinance, the point estimates consistently suggest the opposite of what is expected. This detrimental outcome, while seemingly counterintuitive, supports Adda and Cornaglia (2006b).