1
|
Sassano M, Mariani M, Pastorino R, Ricciardi W, La Vecchia C, Boccia S. Association of national smoke-free policies with per-capita cigarette consumption and acute myocardial infarction mortality in Europe. J Epidemiol Community Health 2024; 78:388-394. [PMID: 38485217 PMCID: PMC11103332 DOI: 10.1136/jech-2023-220746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 02/03/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Evidence on the association between smoke-free policies and per-capita cigarette consumption and mortality due to acute myocardial infarction (AMI) in Europe is limited. Hence, we aimed to assess this association and to evaluate which factors influence it. METHODS We performed an interrupted time series analysis, including 27 member states of the European Union and the UK, on per-capita cigarette consumption and AMI mortality.A multivariate meta-regression was used to assess the potential influence of other factors on the observed associations. RESULTS Around half of the smoke-free policies introduced were associated with a level or slope change, or both, of per-capita cigarette consumption and AMI mortality (17 of 35). As for cigarette consumption, the strongest level reduction was observed for the smoking ban issued in 2010 in Poland (rate ratio (RR): 0.47; 95% CI: 0.41, 0.53). Instead, the largest level reduction of AMI mortality was observed for the intervention introduced in 2012 in Bulgaria (RR: 0.38; 95% CI: 0.34, 0.42).Policies issued more recently or by countries with a lower human development index were found to be associated with a larger decrease in per-capita cigarette consumption. In addition, smoking bans applying to bars had a stronger inverse association with both cigarette consumption and AMI mortality. CONCLUSIONS The results of our study suggest that smoke-free policies are effective at reducing per-capita cigarette consumption and AMI mortality. It is extremely important to monitor and register data on tobacco, its prevalence and consumption to be able to tackle its health effects with concerted efforts.
Collapse
Affiliation(s)
- Michele Sassano
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Marco Mariani
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Roberta Pastorino
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Walter Ricciardi
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Carlo La Vecchia
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milano, Italy
| | - Stefania Boccia
- Section of Hygiene, University Department of Life Sciences and Public Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
2
|
Septiono W. Quasi-experimental study on the impact of local smoke-free policies on smoking among Indonesian adults: Evidence from repeated national health surveys. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104307. [PMID: 38176177 DOI: 10.1016/j.drugpo.2023.104307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Smoke-free policies (SFPs) have been effective in reducing smoking prevalence, but evidence remains limited for low- and middle-income countries. Due to decentralized governance in Indonesia, SFPs are adopted in different ways in different locations. This study aims to assess the impact of local smoke-free policies (SFPs) on current smoking among Indonesian adults. METHODS Data from national health surveys conducted in 515 districts and 34 provinces in 2007, 2013, and 2018, involving 1,599,517 adults, were analyzed. A multilevel logistic regression analysis was performed, considering variables such as survey year, SFP adoption in 2007, SFP between 2007 and 2013, SFP between 2013 and 2018, socio-demographic factors, and district characteristics. RESULTS Moderate (OR:0.94, 95%CI:0.91-0.97) and strong (OR:0.95, 95%CI:0.0.92-0.98) district-level SFPs between 2013 and 2018 were associated with decreased odds of current smoking, compared to no district-level SFP adoption. Similar results were observed for moderate (OR:0.91, 95%CI:0.86-0.96) and strong (OR:0.89, 95%CI:0.85-0.94) district-level SFPs between 2007 and 2013, compared to no district-level SFP. Compared to provinces without SFPs, individuals living in provinces with moderate SFPs between 2007 and 2013 had lower odds of current smoking (OR:0.67; 95% CI:0.63-0.71), while those in districts with moderate SFPs between 2013 and 2018 had higher odds (OR: 1.08, 95% CI: 1.05-1.11). CONCLUSIONS Local SFPs demonstrated a potential in reducing smoking persistence in Indonesia, particularly at the district level. However, the impact of province-level SFPs differed. Tailored SFPs and district-province strategies, focusing on synchronizing the top-down SFP implementation in the Indonesia's decentralized systems, are critical for lowering smoking rates.
Collapse
Affiliation(s)
- Wahyu Septiono
- Department of Biostatistics and Population Studies, Faculty of Public Health, Universitas Indonesia, Depok, West Java, Indonesia.
| |
Collapse
|
3
|
Teed JA, Robichaud MO, Duren M, Gouda HN, Kennedy RD. State of the literature discussing smoke-free policies globally: A narrative review. Tob Induc Dis 2024; 22:TID-22-03. [PMID: 38188939 PMCID: PMC10767724 DOI: 10.18332/tid/174781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 01/09/2024] Open
Abstract
Despite the success of the Framework Convention on Tobacco Control (FCTC), most jurisdictions in the world do not have policies that create 100% smoke-free environments in indoor workplaces, indoor public places, public transport, or other public places. We conducted a narrative review of articles that discuss smoke-free policies and describe the state of the current literature. A search of peer-reviewed and gray literature, published between 1 January 2004 and 30 April 2022, was conducted using PubMed and EMBASE databases. We classified articles based on the location of the policy discussed (WHO region, World Bank income classification) and the environment that was being made smoke-free. Insights related to policy development and implementation, as well as compliance and enforcement, were also identified. The search identified 4469 unique citations; 134 articles met the criteria for inclusion and underwent data extraction by two independent coders. The sample included articles published in or about jurisdictions in each WHO region, in high- and low- and mediumincome countries, and articles that discussed policies regulating smoke-free indoor workplaces, indoor public places, public transport, outdoor/quasi-outdoor environments, and other (unspecified) public places. Some important insights from the literature related to smoke-free policy implementation included tobacco industry interference, the important role of civil society, and the need for effective communication, education, and leadership. Enforcement officials' awareness and training, stakeholders' attitudes and beliefs, and understanding social norms were identified as relevant determinants of effective smoke-free policies. There continue to be challenges for implementing smoke-free policies in jurisdictions throughout the globe, in high- and low- and middle-income countries. The literature includes insights to support 100% smoke-free policies in each environment that must be made smoke-free as per the FCTC.
Collapse
Affiliation(s)
- Jacqueline A. Teed
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkings University, Baltimore, United States
| | - Meagan O. Robichaud
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkings University, Baltimore, United States
| | - Michelle Duren
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkings University, Baltimore, United States
| | - Hebe N. Gouda
- Tobacco Free Initiative, World Health Organization, Geneva, Switzerland
| | - Ryan David Kennedy
- Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| |
Collapse
|
4
|
Kulhánek A, Lukavská K, Švancarová I, Fidesová H, Gabrhelík R. Changes in tobacco use patterns and motivation to quit related to the new smoke-free legislation in the Czech Republic. J Public Health (Oxf) 2021; 43:348-354. [PMID: 31832643 DOI: 10.1093/pubmed/fdz156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/14/2019] [Accepted: 10/18/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smoke-free policy belongs to key public health instruments to promote health in populations. In 2017, new comprehensive smoke-free law prohibiting smoking in indoor public places was implemented. We aimed to measure changes in tobacco smoking patterns and changes in motivation to quit in adult smokers prior to and after the new smoke-free legislation came into force. METHODS We conducted a prospective cohort study prior to and post the implementation of Act No. 65/2017 Coll. Self-reported questionnaires were administered to 131 adult smokers by trained nurses in general practitioner offices in Prague. We analysed changes in cigarette consumption per day; ratio of cigarettes smoked in pub, street, work and home; and motivation to quit using regression modelling. RESULTS We found a statistically significant decrease in the daily consumption of cigarettes (an average of 1.7 cigarettes per day, P < 0.001, d = 0.34). Smoking in indoor public spaces decreased to almost zero, while tobacco consumption in outdoor public spaces (such as streets and squares) increased by nearly 20%. We observed statistically significant increase of motivation to quit smoking (P = 0.021, d = 0.21). CONCLUSION The study brings valuable indication of the desired public health impact related to key legislative change in the Czech Republic.
Collapse
Affiliation(s)
- Adam Kulhánek
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Kateřina Lukavská
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic.,Department of Psychology, Faculty of Education, Charles University, Czech Republic
| | - Iveta Švancarová
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Hana Fidesová
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| | - Roman Gabrhelík
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Czech Republic
| |
Collapse
|
5
|
Xiao H, Qi F, Jia X, Wang Y, Zhang H, Li S, Yang G, Wan X, Naghavi M. Impact of Qingdao's smoke-free legislation on hospitalizations and mortality from acute myocardial infarction and stroke: an interrupted time-series analysis. Addiction 2020; 115:1561-1570. [PMID: 31961014 DOI: 10.1111/add.14970] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/31/2019] [Accepted: 01/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS More than 20 cities in China have enacted local smoke-free laws that prohibit smoking in public places. Only two of these cities have examined the health impact of the law. Enacted in 2013, Qingdao's smoke free-law was stricter than most other municipal smoke-free laws because it did not allow designated smoking rooms. This study aimed to estimate the impact of Qingdao's smoke-free legislation on acute myocardial infarction (AMI) and stroke. DESIGN, SETTING AND PARTICIPANTS We used an interrupted time-series design adjusting for underlying secular trends, seasonal patterns and meteorological factors to estimate the impact of the smoke-free law on AMI and stroke events among permanent residents aged 35 years or older in Qingdao, China. The study period was from 1 January 2010 to 31 December 2015, with a post-ban follow-up of approximately 2.5 years. MEASUREMENT Outcome measures were weekly numbers of hospitalizations and deaths due to AMI/stroke. FINDINGS A total of 10 371 and 56 101 patients were hospitalized, with a principal discharge diagnosis of AMI and stroke, respectively; 32 196 AMI and 49 711 stroke deaths occurred during the study period. Following the smoke-free legislation, an incremental 20% [95% confidence interval (CI) = 14-26%] and 8% (95% CI = 3-13%) decrease per year was observed in AMI and stroke hospitalization rates, respectively. Neither the immediate nor gradual change in AMI nor stroke mortality rates associated with the law was statistically significant (P > 0.05). Post-hoc subgroup analyses indicated that statistically significant reductions in AMI hospitalizations were evident among both the 35-64 (18% per year, 95% CI = 12-27%) and 65-84 (20% per year, 95% CI = 12-27%) age groups. Statistically significant reductions in stroke hospitalization were only in the older subgroup (13% per year, 95% CI = 8-18%). CONCLUSIONS The 2013 smoke-free legislation in Qingdao, China was associated with reduction in hospitalization from acute myocardial infarction and stroke among permanent residents aged 35 years or older. There was no statistically significant reduction in mortality from acute myocardial infarctions or stroke.
Collapse
Affiliation(s)
- Hong Xiao
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Fei Qi
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Xiaorong Jia
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Yani Wang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Hua Zhang
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Shanpeng Li
- Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
| | - Gonghuan Yang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences/School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| |
Collapse
|
6
|
Azagba S, Shan L, Latham K. County Smoke-Free Laws and Cigarette Smoking Among U.S. Adults, 1995-2015. Am J Prev Med 2020; 58:97-106. [PMID: 31732322 DOI: 10.1016/j.amepre.2019.08.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 08/21/2019] [Accepted: 08/22/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Tobacco use remains the leading cause of preventable death worldwide. Though research on smoke-free policies in the U.S. exists at the state or national level, there is limited evidence on such policies at the county level. This study examined the association between changes in county-level comprehensive smoke-free laws and smoking behavior among U.S. adults. METHODS Data were used from the 1995/1996 to the 2014/2015 Tobacco Use Supplement to the Current Population Survey, analyzed in 2019. Changes in county smoke-free law population coverage over time were used as a natural experiment. Quasi-experimental analyses were performed to examine the association between changes in county-level comprehensive smoke-free laws and smoking behavior (smoking status and number of cigarettes smoked). RESULTS During the study period, current smoking prevalence decreased from 21.6% to 11.9%. Specifically, the prevalence of every day smoking decreased from 17.1% to 9.1% and some days smoking decreased from 4.4% to 2.9%. The number of cigarettes smoked per day for every day smokers decreased from 18.5 to 13.6, and from 5.9 to 4.1 for those who smoked some days. Comprehensive smoke-free legislation was associated with lower odds of cigarette smoking (AOR=0.76, 95% CI=0.74, 0.79). Adults living in counties with comprehensive smoke-free policies smoked fewer cigarettes per day both for every day smokers (β= -1.55, p<0.0001) and some days smokers (β= -0.79, p<0.0001). CONCLUSIONS County smoke-free policies in the U.S. may have contributed significantly to the reduction in smoking prevalence as well as the reduction in the number of cigarettes smoked among continuing cigarette smokers.
Collapse
Affiliation(s)
- Sunday Azagba
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah.
| | - Lingpeng Shan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Keely Latham
- Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| |
Collapse
|
7
|
Leão T, Kunst AE, Schreuders M, Lindfors P, Kuipers MA, Perelman J. Adolescents' smoking environment under weak tobacco control: A mixed methods study for Portugal. Drug Alcohol Depend 2019; 204:107566. [PMID: 31568935 DOI: 10.1016/j.drugalcdep.2019.107566] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Bans on smoking in public places and on sales to minors have been widely implemented across the globe. However, many countries have either adopted non-comprehensive (i.e., partial) bans and/or weakly enforce those bans. Little is known, from the adolescents' perspective, how this affects their smoking-related perceptions and behaviors. We studied the case of Portugal, where bans are partial and/or weakly enforced. We sought to understand how the bans affect adolescents' access to cigarettes from commercial sources, the visibility of smoking in public places, and smoking locations. MATERIAL AND METHODS We used a mixed methods design on data gathered in 2016. Quantitative, cross-sectional surveys were conducted in six schools (n = 2,444) in Coimbra, Portugal. In two of these schools, qualitative data were collected in eight single-sex focus group interviews (n = 42). RESULTS Ninety-five percent of the adolescents who tried to buy cigarettes were able to do so from commercial sources, through vending machines, or directly from the vendor. Bans on smoking on school premises and at enclosed public places did not prevent these adolescents from observing smoking outside school gates (84.0%), in cafes and restaurants (97%), or from smoking at cafes, bars, or nightclubs (72.9%). DISCUSSION Partial and/or weakly enforced policies seem to not prevent adolescents from having access to cigarettes, frequently seeing smoking, and finding ample opportunities to smoke in public places. Adopting and enforcing comprehensive policies are necessary efforts to prevent unfavorable responses and more effectively reduce adolescents' smoking behavior.
Collapse
Affiliation(s)
- Teresa Leão
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal; Public Health Unit, Matosinhos Local Health Unit, Rua Dr. Eduardo Torres, 4464-513, Senhora da Hora, Portugal.
| | - Anton E Kunst
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Michael Schreuders
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Pirjo Lindfors
- Faculty of Social Sciences, 33014 Tampere University, Finland
| | - Mirte Ag Kuipers
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Julian Perelman
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal
| | | |
Collapse
|
8
|
Qian X, Gu H, Wang L, Wang X, Xuan Z, Zheng P, Fu C. Changes in smoking prevalence after the enforcement of smoking control regulations in urban Shanghai, China: Findings from two cross-sectional surveys. Tob Induc Dis 2018; 16:27. [PMID: 31516427 PMCID: PMC6659492 DOI: 10.18332/tid/91095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 04/09/2018] [Accepted: 05/16/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The Smoking Control Regulation in Public Places (hereafter, the ‘regulations’) has been implemented in Shanghai since 2010. This study explores the changes in smoking prevalence and its influencing factors among urban Shanghai residents. METHODS Two rounds of household investigations (the Health Status and Health Service Utilization Survey) were carried out using a multistage probability proportionate-to-size sampling method in an urbanized district in 2010 and 2015. Descriptive and logistic regression analyses were applied to the statistics. RESULTS From 2010 to 2015, the standardized current smoking rate fell from 24.8% to 19.1% (38.3% to 32.0% among men, and 1.9% to 1.4% among women). Meanwhile, the standardized smoking cessation rate increased from 18.1% to 23.3%. Smoking prevalence in respondents aged 45 to 59 years was still higher than that of other age groups. Changes in smoking prevalence and cessation rates were more obvious in respondents aged 30–44 and over 75 years. Sex, age, education, marital status, and alcohol use were influencing factors of current smoking, while sex, age and alcohol use were influencing factors of smoking cessation. CONCLUSIONS The implementation of smoking control regulations may be beneficial for reducing smoking and increasing smoking cessation, especially among middle-aged and older men. Nevertheless, tobacco control in urban Shanghai still faces huge challenges. Therefore, more targeted and comprehensive measures should be taken.
Collapse
Affiliation(s)
- Xiaolin Qian
- Department of Chronic Disease Prevention and Control, Xuhui District Center for Disease Control and Prevention, Shanghai, China
| | - Haiyan Gu
- Department of Chronic Disease Prevention and Control, Xuhui District Center for Disease Control and Prevention, Shanghai, China
| | - Lan Wang
- Department of Chronic Disease Prevention and Control, Xuhui District Center for Disease Control and Prevention, Shanghai, China
| | - Xian Wang
- Department of Chronic Disease Prevention and Control, Xuhui District Center for Disease Control and Prevention, Shanghai, China
| | - Zeliang Xuan
- Department of Chronic Disease Prevention and Control, Xuhui District Center for Disease Control and Prevention, Shanghai, China
| | - Pinpin Zheng
- School of Public Health, Fudan University, Shanghai, China
| | - Chaowei Fu
- School of Public Health, Fudan University, Shanghai, China
| |
Collapse
|
9
|
Sureda X, Fu M, Martínez-Sánchez JM, Martínez C, Ballbé M, Pérez-Ortuño R, Saltó E, Pascual JA, Fernández E. Manufactured and roll-your-own cigarettes: A changing pattern of smoking in Barcelona, Spain. ENVIRONMENTAL RESEARCH 2017; 155:167-174. [PMID: 28222364 DOI: 10.1016/j.envres.2017.02.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 02/10/2017] [Accepted: 02/14/2017] [Indexed: 06/06/2023]
Abstract
AIMS The objectives of the present study were to describe smoking prevalence and compare the smoking attributes of adult smokers according to the type of tobacco product consumed. METHODS Repeated cross-sectional surveys (2004-2005 and 2011-2012) of a representative sample of the adult (≥16 years) population in Barcelona, Spain, were used to assess self-reported tobacco consumption, smoking attributes, and salivary cotinine concentration. The survey conducted in 2004-2005 included information on 1245 subjects and the survey in 2011-2012 on 1307 individuals. RESULTS Smoking prevalence decreased over the study period (from 26.6% to 24.1% in self-reported daily smokers). The prevalence of daily smokers who reported the use of manufactured cigarettes declined from 23.7% in 2004-2005 to 17.3% in 2011-2012. The prevalence of roll-your-own cigarette users increased from 0.4% to 3.7%. According to data obtained in 2011-2012, the proportion of self-reported roll-your-own cigarette users was higher among men (19.8% vs. 9.5% of women), participants aged 16-44 years (22.9% vs. 5.8% of participants aged 45-65 years and 4.0% of participants aged ≥65 years), and participants with secondary and university education (17.7% and 18.5% vs. 7.9% of participants with less than primary and primary education). We did not observe differences in cotinine concentrations according to the type of tobacco product consumed. CONCLUSIONS Systematic collection of data on smoking prevalence and smoker attributes from representative samples of the population is necessary for policymakers to develop efficient tobacco control interventions. Considering the increase of roll-your-own cigarette users and the unclear health consequences of their use, policymakers should aim to implement tax policies to equalize the prices of different types of tobacco products.
Collapse
Affiliation(s)
- Xisca Sureda
- Social and Cardiovascular Epidemiology Research Group, School of Medicine, University of Alcalá, Crta. de Madrid-Barcelona, Km. 33,600, 28871 Alcalá de Henares, Madrid, Spain; Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain.
| | - Marcela Fu
- Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Ctra. Feixa llarga s/n., 08907 L'Hospitalet del Llobregat (Barcelona), Spain
| | - Jose M Martínez-Sánchez
- Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain; Biostatistic Unit, Department of Basic Science, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Carrer Josep Trueta s/n., 08915 Sant Cugat del Valles, Spain
| | - Cristina Martínez
- Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain; Department of Nursing, School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Carrer Josep Trueta s/n., 08915 Sant Cugat del Valles, Spain
| | - Montse Ballbé
- Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain; Addictions Unit, Psychiatry Department, Institute of Neurosciences, Hospital Clínic de Barcelona, C. Villarroel 170, 08036 Barcelona, Spain
| | - Raúl Pérez-Ortuño
- Group of Integrative Pharmacology and Systems Neuroscience, Programme of Neurosciences, IMIM-Hospital del Mar Medical Research Institute, Barcelona Biomedical Research Park, Barcelona, Spain
| | - Esteve Saltó
- Direcció General de Planificació i Recerca en Salut,Salut, Generalitat de Catalunya, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; Department of Public Health, School of Medicine, Universitat de Barcelona, Carrer Casanova 143, 08036 Barcelona, Spain
| | - José A Pascual
- Group of Integrative Pharmacology and Systems Neuroscience, Programme of Neurosciences, IMIM-Hospital del Mar Medical Research Institute, Barcelona Biomedical Research Park, Barcelona, Spain; Department of Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Esteve Fernández
- Tobacco Control Unit, Cancer Prevention and Control Programme, Institut Català d'Oncologia-ICO, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain; Cancer Control and Prevention Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, Av. Granvia de L'Hospitalet 199-203, 08908 L'Hospitalet de Llobregat (Barcelona), Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Ctra. Feixa llarga s/n., 08907 L'Hospitalet del Llobregat (Barcelona), Spain
| |
Collapse
|
10
|
León-Gómez BB, Colell E, Villalbí JR, Barrio G, Domingo-Salvany A. Impact of smoke-free regulations on smoking prevalence trends in Spain. Eur J Public Health 2017; 27:123-128. [PMID: 28177493 DOI: 10.1093/eurpub/ckw151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Esther Colell
- IMIM, Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain
| | | | - Gregorio Barrio
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain
| | | |
Collapse
|
11
|
Zheng ZL, Deng HY, Wu CP, Lam WL, Kuok WS, Liang WJ, Wang HL. Secondhand smoke exposure of children at home and prevalence of parental smoking following implementation of the new tobacco control law in Macao. Public Health 2017; 144:57-63. [PMID: 28274385 DOI: 10.1016/j.puhe.2016.11.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 09/19/2016] [Accepted: 11/24/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate secondhand smoke exposure (SHS) of children at home and the prevalence of parental smoking after implementation of the new tobacco control law in Macao. This study explored whether the smoking ban in public places in Macao has decreased the prevalence of smoking or led to increased SHS exposure of children at home. As smokers cannot smoke in public places any more, they may smoke at home more frequently; a displacement effect of smoke-free legislation. STUDY DESIGN Cross-sectional survey. METHODS This study surveyed 337 fathers and 538 mothers. Questions from a subset of key questions from the Global Adult Tobacco Survey (2nd edition) were applied to assess the SHS exposure of children and the prevalence of parental smoking since the smoking ban. A classification tree analysis was used to analyse the factors increasing SHS exposure of children. RESULTS The prevalence of SHS exposure in children at home was 41.3%. The prevalence rates of paternal and maternal smoking were 43.7% and 3.8%, respectively. Compared with data reported by the Health Bureau of Macao SAR in 2011, the prevalence of parental smoking and the prevalence of SHS exposure of children at home have not decreased since the smoking ban. Analysis of the factors increasing the prevalence of SHS exposure of children indicated that fathers with an education level below high school were more likely to contribute to this increase, compared with fathers with a high school education or more (48.2% vs 32.4%, respectively). In addition, fathers represented the majority of smokers at home, accounting for 92.0% of 415 smoking parents. The prevalence of paternal smoking (82.0%) in the group of children with SHS exposure was much higher than that in the unexposed group (16.7%, Chi-squared test = 367.199, P = 0.000). The SHS exposure of children increased consistently with the decrease in paternal education level. This was consistent with the increasing prevalence of paternal smoking as paternal education level decreased. SHS exposure was most common among children whose fathers had an education level below high school and whose mothers were aged ≤29 years (75.0%). CONCLUSIONS This study did not find any decline in the prevalence of parental smoking after the smoking ban. These parents were more likely to smoke at home after the ban, leading to more frequent SHS exposure for their children.
Collapse
Affiliation(s)
- Z L Zheng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - H Y Deng
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| | - C P Wu
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China.
| | - W L Lam
- Health Bureau of Macao SAR, Macao, China
| | - W S Kuok
- Health Bureau of Macao SAR, Macao, China
| | - W J Liang
- Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - H L Wang
- Department of Public Health and Preventive Medicine, School of Medicine, Jinan University, Guangzhou, China
| |
Collapse
|
12
|
Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev 2016; 2:CD005992. [PMID: 26842828 PMCID: PMC6486282 DOI: 10.1002/14651858.cd005992.pub3] [Citation(s) in RCA: 155] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Smoking bans have been implemented in a variety of settings, as well as being part of policy in many jurisdictions to protect the public and employees from the harmful effects of secondhand smoke (SHS). They also offer the potential to influence social norms and the smoking behaviour of those populations they affect. Since the first version of this review in 2010, more countries have introduced national smoking legislation banning indoor smoking. OBJECTIVES To assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption. SEARCH METHODS We searched the Cochrane Tobacco Addiction Group Specialised Register, MEDLINE, EMBASE, PsycINFO, CINAHL and reference lists of included studies. We also checked websites of various organisations. Date of most recent search; February 2015. SELECTION CRITERIA We considered studies that reported legislative smoking bans affecting populations. The minimum standard was having an indoor smoking ban explicitly in the study and a minimum of six months follow-up for measures of smoking behaviour. Our search included a broad range of research designs including: randomized controlled trials, quasi-experimental studies (i.e. non-randomized controlled studies), controlled before-and-after studies, interrupted time series as defined by the Cochrane Effective Practice and Organisation of Care Group, and uncontrolled pre- and post-ban data. DATA COLLECTION AND ANALYSIS One author extracted characteristics and content of the interventions, participants, outcomes and methods of the included studies and a second author checked the details. We extracted health and smoking behaviour outcomes. We did not attempt a meta-analysis due to the heterogeneity in design and content of the studies included. We evaluated the studies using qualitative narrative synthesis. MAIN RESULTS There are 77 studies included in this updated review. We retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes randomized controlled trials. Thirty-six studies used an interrupted time series study design, 23 studies use a controlled before-and-after design and 18 studies are before-and-after studies with no control group; six of these studies use a cohort design. Seventy-two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking-related diseases. A number of the studies report multiple health outcomes. There is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking-related illnesses. Effects on respiratory and perinatal health were less consistent. We found 24 studies evaluating the impact of national smoke-free legislation on smoking behaviour. Evidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long-term change in existing trends in prevalence. AUTHORS' CONCLUSIONS Since the first version of this review was published, the current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in SHS for countries and their populations. The clearest evidence is observed in reduced admissions for acute coronary syndrome. There is evidence of reduced mortality from smoking-related illnesses at a national level. There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption.
Collapse
Affiliation(s)
- Kate Frazer
- University College DublinSchool of Nursing, Midwifery & Health SystemsHealth Sciences CentreBelfieldDublin 4Ireland
| | - Joanne E Callinan
- Milford Care CentreLibrary & Information Service, Education, Research & Quality DepartmentPlassey Park RoadCastletroyLimerickIreland000
| | - Jack McHugh
- University College DublinSchool of Public Health, Physiotherapy and Sports ScienceBelfieldDublin 4Ireland
| | - Susan van Baarsel
- University College DublinSchool of Medicine and Medical ScienceDublinIreland
| | - Anna Clarke
- National Immunisation OfficeManor StreetDublin 7Ireland
| | - Kirsten Doherty
- Education and Research CentreDepartment of Preventive Medicine and Health PromotionSt Vincent's University HospitalElm ParkDublin 4Ireland
| | - Cecily Kelleher
- University College DublinSchool of Public Health, Physiotherapy and Sports ScienceBelfieldDublin 4Ireland
| | | |
Collapse
|
13
|
Estimating the Smoking Ban Effects on Smoking Prevalence, Quitting and Cigarette Consumption in a Population Study of Apprentices in Italy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:9523-35. [PMID: 26287220 PMCID: PMC4555295 DOI: 10.3390/ijerph120809523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 08/05/2015] [Accepted: 08/06/2015] [Indexed: 11/24/2022]
Abstract
Objectives: We evaluated the effects of the Italian 2005 smoking ban in public places on the prevalence of smoking, quitting and cigarette consumption of young workers. Data and Methods: The dataset was obtained from non-computerized registers of medical examinations for a population of workers with apprenticeship contracts residing in the province of Viterbo, Italy, in the period 1996–2007. To estimate the effects of the ban, a segmented regression approach was used, exploiting the discontinuity introduced by the application of the law on apprentices’ smoking behavior. Results: It is estimated that the Italian smoking ban generally had no effect on smoking prevalence, quitting ratio, or cigarette consumption of apprentices. However, when the estimates were applied to subpopulations, significant effects were found: −1% in smoking prevalence, +2% in quitting, and −3% in smoking intensity of apprentices with at least a diploma.
Collapse
|
14
|
Tsai YW, Chang HC, Chiou ST. The impact of multipolicy tobacco control legislation on smoking behavior. Public Health 2015; 129:1003-6. [PMID: 26116932 DOI: 10.1016/j.puhe.2015.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 01/30/2015] [Accepted: 05/13/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Y-W Tsai
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - H-C Chang
- Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan
| | - S-T Chiou
- Health Promotion Administration, Ministry of Health and Welfare, New Taipei City, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
| |
Collapse
|
15
|
de Goeij MCM, Veldhuizen EM, Buster MCA, Kunst AE. The impact of extended closing times of alcohol outlets on alcohol-related injuries in the nightlife areas of Amsterdam: a controlled before-and-after evaluation. Addiction 2015; 110:955-64. [PMID: 25689068 DOI: 10.1111/add.12886] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/04/2014] [Accepted: 02/11/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS The municipality of Amsterdam implemented a new alcohol policy allowing alcohol outlets in two of the five nightlife areas to extend their closing times from 1 April 2009 onwards. We investigated how levels and trends of alcohol-related injuries changed after implementation of this alcohol policy, by comparing areas with extended closing times to those without. DESIGN A controlled before-and-after evaluation to compare changes in alcohol-related injuries between intervention and control areas. SETTING Central district of Amsterdam, The Netherlands. PARTICIPANTS Alcohol-related ambulance attendances for control and intervention areas between 1 April 2006 and 1 April 2009 (respectively, n = 544 and n = 499) and between 1 April 2009 and 1 April 2011 (respectively, n = 357 and n = 480). MEASUREMENTS Alcohol-related injuries were defined as ambulance attendances for people who suffered from direct or indirect consequences of alcohol consumption. Injuries were counted per month in two intervention and three control nightlife areas. We used Poisson regression to assess changes in injuries. FINDINGS After 1 April 2009, intervention areas showed a larger change in the level of alcohol-related injuries than control areas [incidence rate ratio 1.34, 95% confidence interval (CI) = 1.12, 1.61], but trends remained stable in all areas. This increase was only statistically significant for the following subgroups: 2.00-5.59 a.m., weekend days, men, individuals aged 25-34 years, and people transported to a hospital. However, the increase did not differ between subgroups with statistical significance. CONCLUSIONS A 1-hour extension of alcohol outlet closing times in some of Amsterdam's nightlife areas was associated with 34% more alcohol-related injuries.
Collapse
Affiliation(s)
- Moniek C M de Goeij
- Department of Public Health, Academic Medical Center (AMC) - University of Amsterdam, Amsterdam, The Netherlands
| | - Eleonore M Veldhuizen
- Department of Human Geography, Planning and International Development Studies, Faculty of Social and Behavioural Sciences, University of Amsterdam, Amsterdam, The Netherlands
| | - Marcel C A Buster
- Department of Epidemiology and Health Promotion, Public Health Service, Amsterdam, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center (AMC) - University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
16
|
Chan SSC, Cheung YTD, Leung DYP, Mak YW, Leung GM, Lam TH. Secondhand smoke exposure and maternal action to protect children from secondhand smoke: pre- and post-smokefree legislation in Hong Kong. PLoS One 2014; 9:e105781. [PMID: 25166507 PMCID: PMC4148325 DOI: 10.1371/journal.pone.0105781] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Accepted: 07/17/2014] [Indexed: 11/19/2022] Open
Abstract
Background Smokefree legislation may protect children from secondhand smoke (SHS) in the home from smoking parent(s). We examined the effect of the 2007 smokefree legislation on children’s exposure to SHS in the home and maternal action to protect children from SHS exposure in Hong Kong. Methods Families with a smoking father and a non-smoking mother were recruited from public clinics before (2005–2006, n = 333) and after the legislation (2007–2008, n = 742) which led to a major extension of smokefree places in Hong Kong. Main outcomes included children’s SHS exposure in the home, nicotine level in mothers’ and children’s hair and home environment, mothers’ action to protect children from SHS, and their support to the fathers to quit. Results Fewer mothers post-legislation reported children’s SHS exposure in the home (87.2% versus 29.3%, p<0.01), which was consistent with their hair nicotine levels (0.36ng/mg versus 0.04ng/mg, p<0.01). More mothers post-legislation in the last month took their children away from cigarette smoke (6.3% versus 92.2%; p<0.01) and advised fathers to quit over 3 times (8.3% versus 33.8%; p<0.01). No significant change was found in the content of smoking cessation advice and the proportion of mothers who took specific action to support the fathers to quit. Conclusions SHS exposure in the home decreased and maternal action to protect children from SHS increased after the 2007 smokefree legislation. Maternal support to fathers to quit showed moderate improvement. Cessation services for smokers and specific interventions for smoking families should be expanded together with smokefree legislation.
Collapse
Affiliation(s)
| | | | - Doris Yin Ping Leung
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Gabriel M. Leung
- School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Tai Hing Lam
- School of Public Health, The University of Hong Kong, Hong Kong, China
| |
Collapse
|
17
|
Langley T, Szatkowski L, Lewis S, McNeill A, Gilmore AB, Salway R, Sims M. The freeze on mass media campaigns in England: a natural experiment of the impact of tobacco control campaigns on quitting behaviour. Addiction 2014; 109:995-1002. [PMID: 24325617 DOI: 10.1111/add.12448] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/14/2013] [Accepted: 12/03/2013] [Indexed: 11/29/2022]
Abstract
AIMS To measure the impact of the suspension of tobacco control mass media campaigns in England in April 2010 on measures of smoking cessation behaviour. DESIGN Interrupted time series design using routinely collected population-level data. Analysis of use of a range of types of smoking cessation support using segmented negative binomial regression. SETTING England. MEASUREMENTS Use of non-intensive support: monthly calls to the National Health Service (NHS) quitline (April 2005-September 2011), text requests for quit support packs (December 2007-10) and web hits on the national smoking cessation website (January 2009-March 2011). Use of intensive cessation support: quarterly data on the number of people setting a quit date and 4-week quitters at the NHS Stop Smoking Services (SSS) (quarter 1, 2001 and quarter 3, 2011). FINDINGS During the suspension of tobacco control mass media spending, literature requests fell by 98% [95% confidence interval (CI) = 96-99], and quitline calls and web hits fell by 65% (95% CI = 43-79) and 34% (95% CI: 11-50), respectively. The number of people setting a quit date and 4-week quitters at the SSS increased throughout the study period. CONCLUSIONS The suspension of tobacco control mass media campaigns in England in 2012 appeared to markedly reduce the use of smoking cessation literature, quitline calls and hits on the national smoking cessation website, but did not affect attendance at the Stop Smoking Services. Within a comprehensive tobacco control programme, mass media campaigns can play an important role in maximizing quitting activity.
Collapse
Affiliation(s)
- Tessa Langley
- UK Centre for Tobacco and Alcohol Studies, Nottingham, UK; Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK
| | | | | | | | | | | | | |
Collapse
|
18
|
Wakefield MA, Coomber K, Durkin SJ, Scollo M, Bayly M, Spittal MJ, Simpson JA, Hill D. Time series analysis of the impact of tobacco control policies on smoking prevalence among Australian adults, 2001-2011. Bull World Health Organ 2014; 92:413-22. [PMID: 24940015 PMCID: PMC4047797 DOI: 10.2471/blt.13.118448] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 12/08/2013] [Accepted: 12/15/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To determine the impact of tobacco control policies and mass media campaigns on smoking prevalence in Australian adults. METHODS Data for calculating the average monthly prevalence of smoking between January 2001 and June 2011 were obtained via structured interviews of randomly sampled adults aged 18 years or older from Australia's five largest capital cities (monthly mean number of adults interviewed: 2375). The influence on smoking prevalence was estimated for increased tobacco taxes; strengthened smoke-free laws; increased monthly population exposure to televised tobacco control mass media campaigns and pharmaceutical company advertising for nicotine replacement therapy (NRT), using gross ratings points; monthly sales of NRT, bupropion and varenicline; and introduction of graphic health warnings on cigarette packs. Autoregressive integrated moving average (ARIMA) models were used to examine the influence of these interventions on smoking prevalence. FINDINGS The mean smoking prevalence for the study period was 19.9% (standard deviation: 2.0%), with a drop from 23.6% (in January 2001) to 17.3% (in June 2011). The best-fitting model showed that stronger smoke-free laws, tobacco price increases and greater exposure to mass media campaigns independently explained 76% of the decrease in smoking prevalence from February 2002 to June 2011. CONCLUSION Increased tobacco taxation, more comprehensive smoke-free laws and increased investment in mass media campaigns played a substantial role in reducing smoking prevalence among Australian adults between 2001 and 2011.
Collapse
Affiliation(s)
- Melanie A Wakefield
- Behavioural Science Division, Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Kerri Coomber
- Behavioural Science Division, Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Sarah J Durkin
- Behavioural Science Division, Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Michelle Scollo
- Behavioural Science Division, Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Megan Bayly
- Behavioural Science Division, Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia
| | - Matthew J Spittal
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne, Australia
| | - Julie A Simpson
- Centre for Health Policy, University of Melbourne, Melbourne, Australia
| | - David Hill
- Behavioural Science Division, Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, Victoria 3004, Australia
| |
Collapse
|
19
|
Klein EG, Liu ST, Conrey EJ. Comprehensive smoke-free policies: a tool for improving preconception health? Matern Child Health J 2014; 18:146-152. [PMID: 23467844 PMCID: PMC10961990 DOI: 10.1007/s10995-013-1247-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Lower income women are at higher risk for preconception and prenatal smoking, are less likely to spontaneously quit smoking during pregnancy, and have higher prenatal relapse rates than women in higher income groups. Policies prohibiting tobacco smoking in public places are intended to reduce exposure to secondhand smoke; additionally, since these policies promote a smoke-free norm, there have been associations between smoke-free policies and reduced smoking prevalence. Given the public health burden of smoking, particularly among women who become pregnant, our objective was to assess the impact of smoke-free policies on the odds of preconception smoking among low-income women. We estimated the odds of preconception smoking among low-income women in Ohio between 2002 and 2009 using data from repeated cross-sectional samples of women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). A logistic spline regression was applied fitting a knot at the point of enforcement of the Ohio Smoke-free Workplace Act to evaluate whether this policy was associated with changes in the odds of smoking. After adjusting for individual- and environmental-level factors, the Ohio Smoke-free Workplace Act was associated with a small, but statistically significant reduction in the odds of preconception smoking in WIC participants. Comprehensive smoke-free policies prohibiting smoking in public places and workplaces may also be associated with reductions in smoking among low-income women. This type of policy or environmental change strategy may promote a tobacco-free norm and improve preconception health among a population at risk for smoking.
Collapse
Affiliation(s)
- Elizabeth G Klein
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, OH, USA.
| | - Sherry T Liu
- Division of Health Behavior and Health Promotion, The Ohio State University College of Public Health, Columbus, OH, USA
| | - Elizabeth J Conrey
- State Epidemiology Office, Ohio Department of Health, Columbus, OH, USA
- Division of Reproductive Health, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta, GA, USA
| |
Collapse
|
20
|
Prugger C, Wellmann J, Heidrich J, De Bacquer D, Perier MC, Empana JP, Reiner Ž, Fras Z, Jennings C, Kotseva K, Wood D, Keil U. Passive smoking and smoking cessation among patients with coronary heart disease across Europe: results from the EUROASPIRE III survey. Eur Heart J 2013; 35:590-8. [DOI: 10.1093/eurheartj/eht538] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Christof Prugger
- Paris Cardiovascular Research Centre, University Paris Descartes, Sorbonne Paris Cité, UMR-S970, 56 rue Leblanc, 75015 Paris, France
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Jürgen Wellmann
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Jan Heidrich
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Dirk De Bacquer
- Department of Public Health, University of Ghent, Ghent, Belgium
| | - Marie-Cécile Perier
- Paris Cardiovascular Research Centre, University Paris Descartes, Sorbonne Paris Cité, UMR-S970, 56 rue Leblanc, 75015 Paris, France
| | - Jean-Philippe Empana
- Paris Cardiovascular Research Centre, University Paris Descartes, Sorbonne Paris Cité, UMR-S970, 56 rue Leblanc, 75015 Paris, France
| | - Željko Reiner
- Department of Internal Medicine, University Hospital Centre, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Zlatko Fras
- Department of Vascular Medicine, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Internal Medicine, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Catriona Jennings
- Cardiovascular Medicine, Imperial College London, London, United Kingdom
| | - Kornelia Kotseva
- Cardiovascular Medicine, Imperial College London, London, United Kingdom
| | - David Wood
- Cardiovascular Medicine, Imperial College London, London, United Kingdom
| | - Ulrich Keil
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | | |
Collapse
|
21
|
Azagba S, Asbridge M. The association between smoking bans and nicotine dependence: a longitudinal analysis of current smokers in Canada. Addict Behav 2013; 38:2817-20. [PMID: 24018223 DOI: 10.1016/j.addbeh.2013.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 07/16/2013] [Accepted: 08/06/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND While a substantial body of research has examined the effects of smoking bans on smoking behavior, little is known about the relationship between smoking bans and nicotine dependence. The objective of this study was to examine whether home and workplace smoking bans are associated with reduced nicotine dependence among continuing smokers. METHODS We used longitudinal data of 1073 adult daily smokers from the Canadian National Population Health Survey (2004-2010). Generalized estimating equations were used to examine the association between smoking bans and nicotine dependence. RESULTS Smokers living in homes where smoking is restricted were less likely to be nicotine dependent (OR=0.40, 95% CI=0.32-0.50) than smokers living in homes with no such smoking restriction. Workplace smoking policies had no significant association with nicotine dependence (complete ban: OR=0.79, 95% CI=0.56-1.11; partial ban: OR=0.82, 95% CI=0.57-1.16). There was some evidence that workplace smoking bans were significantly associated with nicotine dependence when single items of the Fagerstrom test were considered. CONCLUSIONS This paper demonstrates that the presence of a home smoking ban was associated with lower nicotine dependence among continuing smokers. The relationship of workplace bans with nicotine dependence was less clear and was contingent on the measure of nicotine dependence employed. These findings further confirm the importance of bans on smoking in the home, workplace, and other public places on reducing tobacco-related harms.
Collapse
Affiliation(s)
- Sunday Azagba
- Department of Community Health and Epidemiology, Dalhousie University, 5790 University Avenue, Halifax, NS B3H 1V7, Canada.
| | | |
Collapse
|
22
|
Verbiest MEA, Chavannes NH, Crone MR, Nielen MMJ, Segaar D, Korevaar JC, Assendelft WJJ. An increase in primary care prescriptions of stop-smoking medication as a result of health insurance coverage in the Netherlands: population based study. Addiction 2013; 108:2183-92. [PMID: 23819654 DOI: 10.1111/add.12289] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 02/07/2013] [Accepted: 06/25/2013] [Indexed: 10/26/2022]
Abstract
AIMS To examine the impact of two national tobacco control interventions in the past decade on (dispensed) prescriptions of stop-smoking medication. DESIGN Ecological study with interrupted time-series analyses of quarterly data points of three nation-wide representative databases. SETTING The Netherlands 2001-2012, with the introduction of the guideline for smoking cessation care for general practitioners (GP) in 2007 and full insurance coverage for smoking cessation treatment in 2011. PARTICIPANTS GPs, pharmacists and people in the general population aged 15 years and older. MEASUREMENTS Time-series plots were inspected visually and segmented regression analyses were performed to estimate the change in level and slope of (dispensed) prescriptions of stop-smoking medication and smoking prevalence in the years preceding and after the tobacco control interventions. FINDINGS No measurable effects of the GP guideline on (dispensed) prescriptions were observed. Shortly after the start of health insurance coverage, an estimated increase in primary care prescriptions of 6.3 per 1000 smokers [95% confidence interval (CI) = 2.9-9.8; P = 0.001] and 17.3 dispensed items per 1000 smokers (95% CI = 12.5-22.0; P < 0.000) was accompanied by a sudden drop in smoking prevalence of 2.9% (95% CI = 4.6-1.1; P = 0.002) in the first quarter of 2011. Immediately after the coverage abolition, smoking prevalence increased by 1.2% (95% CI = 0.5-2.8; P = 0.156) and dispensed prescription rates decreased with 21.6 per 1000 smokers (95% CI = 26.0-17.2; P < 0.000). CONCLUSIONS Full health insurance coverage for smoking cessation treatment in the Netherlands was accompanied by a significant increase in the number of (dispensed) prescriptions of stop-smoking medication and a decrease in smoking prevalence.
Collapse
Affiliation(s)
- Marjolein E A Verbiest
- Leiden University Medical Centre, Department of Public Health and Primary Care, Leiden, the Netherlands
| | | | | | | | | | | | | |
Collapse
|
23
|
Abstract
Smoking is prevalent across Europe, but the severity and stage of the smoking epidemic, and policy responses to it, vary substantially between countries. Much progress is now being made in prohibition of paid-for advertising and in promotion of smoke-free policies, but mass media campaigns are widely underused, provision of services for smokers trying to quit is generally poor, and price policies are undermined by licit and illicit cheap supplies. Monitoring of prevalence is inadequate in many countries, as is investment in research and capacity to address this largest avoidable cause of death and disability across Europe. However, grounds for optimism are provided by progress in implementation of the WHO Framework Convention on Tobacco Control, and in the development of a new generation of nicotine-containing devices that could enable more widespread adoption of harm-reduction strategies. The effect of commercial vested interests has been and remains a major barrier to progress.
Collapse
Affiliation(s)
- John Britton
- UK Centre for Tobacco Control Studies, Division of Epidemiology and Public Health, University of Nottingham, Nottingham, UK.
| | | |
Collapse
|
24
|
Halonen JI, Kivimäki M, Kouvonen A, Pentti J, Kawachi I, Subramanian SV, Vahtera J. Proximity to a tobacco store and smoking cessation: a cohort study. Tob Control 2013; 23:146-51. [PMID: 23436138 DOI: 10.1136/tobaccocontrol-2012-050726] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND It is not clear whether the availability of tobacco affects the likelihood of smoking cessation. We examined whether the proximity to a tobacco store and the number of stores were associated with smoking cessation, and compared results for proximity variables based on walking and straight-line (as the crow flies) distance. METHODS The study population consisted of 8751 baseline smokers from the Finnish Public Sector study in 1997-2005. Smoking intensity (cigarettes/day) was determined at baseline and smoking cessation was determined from a follow-up survey in 2008-2009. Proximity was measured using straight-line and walking distance from home to the nearest tobacco store, and another exposure variable was the number of stores within 0.50 km from home. We calculated associations with log-binomial regression models, adjusting for individual-level and area-level confounders. RESULTS Of the participants, 3482 (39.8%) quit smoking during the follow-up (mean follow-up 5.5 years, SD 2.3 years). Among men who were moderate/heavy smokers at baseline and lived <0.50 km walking distance from the nearest tobacco store, the likelihood of smoking cessation was 27% (95% CI 12% to 40%) lower compared with those living ≥0.50 km from a store. Having even one store within 0.50 km walking distance from home decreased cessation in men who were moderate/heavy smokers by 37% (95% CI 19% to 51%). No decrease was found for men who were light smokers at baseline or for women. CONCLUSIONS Living within walking distance of a tobacco store reduced the likelihood of smoking cessation among men who were moderate/heavy smokers.
Collapse
Affiliation(s)
- Jaana I Halonen
- Finnish Institute of Occupational Health, , Kuopio, Turku and Helsinki, Finland
| | | | | | | | | | | | | |
Collapse
|
25
|
Nieuwlaat R, Schwalm JD, Khatib R, Yusuf S. Why are we failing to implement effective therapies in cardiovascular disease? Eur Heart J 2013; 34:1262-9. [DOI: 10.1093/eurheartj/ehs481] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
|
26
|
Federico B, Mackenbach JP, Eikemo TA, Kunst AE. Impact of the 2005 smoke-free policy in Italy on prevalence, cessation and intensity of smoking in the overall population and by educational group. Addiction 2012; 107:1677-86. [PMID: 22360495 DOI: 10.1111/j.1360-0443.2012.03853.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To estimate the immediate as well as the longer-term impact of the 2005 smoke-free law on smoking prevalence, cessation and intensity both in the overall population and separately by educational level. DESIGN Interrupted time-series analyses of 11 cross-sectional nationally representative surveys. SETTING Italy, 1999-2010. PARTICIPANTS Adults aged 20-64 years. MEASUREMENTS For each year we computed the prevalence of current smoking, the quit ratio and the mean number of cigarettes smoked per day. All measures were standardized by age. Segmented linear regression analyses were performed for each smoking variable separately by sex. FINDINGS Among males, smoking prevalence decreased by 2.6% (P = 0.002) and smoking cessation increased by 3.3% (P = 0.006) shortly after the ban, but both measures tended to return to pre-ban values in the following years. This occurred among both highly and low-educated males. Among low-educated females, the ban was followed by a 1.6% decrease (P = 0.120) in smoking prevalence and a 4.5% increase in quit ratios (P < 0.001). However, these favourable trends reversed over the following years. Among highly educated females, trends in smoking prevalence and cessation were not altered by the ban. Among both males and females, long-term trends in the daily number of cigarettes, which were already declining well before the implementation of the policy, changed to a minor extent. CONCLUSION The impact of the Italian smoke-free policy on smoking and inequalities in smoking was short-term. Smoke-free policies may not achieve the secondary effect of reducing smoking prevalence in the long term, and they may have limited effects on inequalities in smoking.
Collapse
Affiliation(s)
- Bruno Federico
- Department of Health and Sport Sciences, University of Cassino, Cassino, Italy.
| | | | | | | |
Collapse
|
27
|
Nagelhout GE, de Vries H, Fong GT, Candel MJJM, Thrasher JF, van den Putte B, Thompson ME, Cummings KM, Willemsen MC. Pathways of change explaining the effect of smoke-free legislation on smoking cessation in The Netherlands. An application of the international tobacco control conceptual model. Nicotine Tob Res 2012; 14:1474-82. [PMID: 22491892 DOI: 10.1093/ntr/nts081] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION This study aims to test the pathways of change from individual exposure to smoke-free legislation on smoking cessation, as hypothesized in the International Tobacco Control (ITC) Conceptual Model. METHODS A nationally representative sample of Dutch smokers aged 15 years and older was surveyed during 4 consecutive annual surveys. Of the 1,820 baseline smokers, 1,012 participated in the fourth survey. Structural Equation Modeling was employed to test a model of the effects of individual exposure to smoke-free legislation through policy-specific variables (support for smoke-free legislation and awareness of the harm of [secondhand] smoking) and psychosocial mediators (attitudes, subjective norm, self-efficacy, and intention to quit) on quit attempts and quit success. RESULTS The effect of individual exposure to smoke-free legislation on smoking cessation was mediated by 1 pathway via support for smoke-free legislation, attitudes about quitting, and intention to quit smoking. Exposure to smoke-free legislation also influenced awareness of the harm of (secondhand) smoking, which in turn influenced the subjective norm about quitting. However, only attitudes about quitting were significantly associated with intention to quit smoking, whereas subjective norm and self-efficacy for quitting were not. Intention to quit predicted quit attempts and quit success, and self-efficacy for quitting predicted quit success. CONCLUSIONS Our findings support the ITC Conceptual Model, which hypothesized that policies influence smoking cessation through policy-specific variables and psychosocial mediators. Smoke-free legislation may increase smoking cessation, provided that it succeeds in influencing support for the legislation.
Collapse
Affiliation(s)
- Gera E Nagelhout
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Kennedy RD, Behm I, Craig L, Thompson ME, Fong GT, Guignard R, Beck F. Smoking cessation interventions from health care providers before and after the national smoke-free law in France. Eur J Public Health 2012; 22 Suppl 1:23-8. [PMID: 22294781 PMCID: PMC3269298 DOI: 10.1093/eurpub/ckr209] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Smoking cessation advice from health care providers (HCP) is well-known to be associated with increased quitting. This study sought to understand the extent to which smokers in France who visited a HCP around the time of the implementation of the national ban on smoking received encouragement to quit from a HCP and what kinds of intervention were provided. HCP may have a unique opportunity during the implementation phase of smoke-free laws to address their patients' smoking behaviours to increase the likelihood of success at a time when smokers' readiness and interest in quitting may be higher. METHODS Telephone interviews were conducted among adult smokers (n = 1067) before and after the two-phase (2007 and 2008) national ban on indoor smoking as part of the International Tobacco Control (ITC) France Survey. In the survey, smokers were asked whether they had visited a HCP in the past 6 months and, if so, whether they had received cessation encouragement, and/or other interventions to support quitting such as prescriptions for stop-smoking medication. RESULTS Most smokers (61%) reported visiting a HCP in the 6 months prior to the first phase of the national smoke-free ban, and 58% after the time of the hospitality ban. Of these, most reported they did not receive any assistance from a HCP before (54%) or after (64%) the smoke-free law. Among those who reported an intervention, the most common were only encouragement to quit (58% in Wave 1 and 49% in Wave 2), or receiving both encouragement and a pamphlet (31% in both Wave 1 and 2). The combination of prescriptions for stop-smoking medicine and encouragement to quit increased from 8% in 2007 to 22% in 2008. The smokers who received an intervention were more likely (OR 1.9, 95% CI: 1.2-2.9) to report that they were thinking about quitting. DISCUSSION This study demonstrates that HCP in France are well positioned to provide smoking cessation encouragement and other interventions to a majority of smokers and thus the importance of taking measures to increase their involvement, particularly when population-level tobacco control policies, such as smoke-free laws, are being implemented.
Collapse
|
29
|
McNeill A, Craig L, Willemsen MC, Fong GT. Tobacco control in Europe: a deadly lack of progress. Eur J Public Health 2012; 22 Suppl 1:1-3. [PMID: 22275516 DOI: 10.1093/eurpub/ckr201] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Ann McNeill
- UK Centre for Tobacco Control Studies, Division of Epidemiology and Public Health, University of Nottingham, UK.
| | | | | | | |
Collapse
|
30
|
Lee JT, Glantz SA, Millett C. Effect of smoke-free legislation on adult smoking behaviour in England in the 18 months following implementation. PLoS One 2011; 6:e20933. [PMID: 21698295 PMCID: PMC3115957 DOI: 10.1371/journal.pone.0020933] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 05/13/2011] [Indexed: 11/26/2022] Open
Abstract
Background Comprehensive 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 Findings Repeat 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). Conclusion There 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.
Collapse
Affiliation(s)
- John Tayu Lee
- Department of Primary Care and Public Health, Imperial College London, London, United Kingdom.
| | | | | |
Collapse
|