Changes in child exposure to environmental tobacco smoke (CHETS) study after implementation of smoke-free legislation in Scotland: national cross sectional survey

Abstract

OBJECTIVE To detect any change in exposure to secondhand smoke among primary schoolchildren after implementation of smoke-free legislation in Scotland in March 2006. DESIGN Comparison of nationally representative, cross sectional, class based surveys carried out in the same schools before and after legislation. SETTING Scotland. PARTICIPANTS 2559 primary schoolchildren (primary 7; mean age 11.4 years) surveyed in January 2006 (before smoke-free legislation) and 2424 in January 2007 (after legislation). OUTCOME MEASURES Salivary cotinine concentrations, reports of parental smoking, and exposure to tobacco smoke in public and private places before and after legislation. RESULTS The geometric mean salivary cotinine concentration in non-smoking children fell from 0.36 (95% confidence interval 0.32 to 0.40) ng/ml to 0.22 (0.19 to 0.25) ng/ml after the introduction of smoke-free legislation in Scotland-a 39% reduction. The extent of the fall in cotinine concentration varied according to the number of parent figures in the home who smoked but was statistically significant only among pupils living in households in which neither parent figure smoked (51% fall, from 0.14 (0.13 to 0.16) ng/ml to 0.07 (0.06 to 0.08) ng/ml) and among pupils living in households in which only the father figure smoked (44% fall, from 0.57 (0.47 to 0.70) ng/ml to 0.32 (0.25 to 0.42) ng/ml). Little change occurred in reported exposure to secondhand smoke in pupils' own homes or in cars, but a small decrease in exposure in other people's homes was reported. Pupils reported lower exposure in cafes and restaurants and in public transport after legislation. CONCLUSIONS The Scottish smoke-free legislation has reduced exposure to secondhand smoke among young people in Scotland, particularly among groups with lower exposure in the home. We found no evidence of increased secondhand smoke exposure in young people associated with displacement of parental smoking into the home. The Scottish smoke-free legislation has thus had a positive short term impact on young people's health, but further efforts are needed to promote both smoke-free homes and smoking cessation

Predictors of smoking in cars with nonsmokers: Findings from the 2007 Wave of the International Tobacco Control Four Country Survey

“…Our analyses were complicated by the fact that (a) some municipalities within provinces/states had their own comprehensive smoke-free laws, (b) presence/absence of comprehensive smoke-free laws was highly correlated with country of residence, and (c) states/provinces had laws in place for varying lengths of time (anywhere from at the outset of survey to more than 5 years before the survey), this weakens the strength of conclusions that can be drawn. Additionally, a 2007 longitudinal study conducted in Scotland found no changes in nonsmoking adults and children's exposure to cigarette smoke in cars after the introduction of comprehensive smoke-free legislation (Akhtar et al, 2007;Haw & Gruer, 2007). However, the utility of comprehensive smoke-free legislation for promoting smokefree cars should not be discounted; previous studies have linked comprehensive smoke-free legislation with the implementation of smoke-free homes, and our study found that smokers with smoke-free homes are less likely to smoke in cars with nonsmokers (Borland et al).…”

Effects of Enactment of Legislative (Public) Smoking Bans on Voluntary Home Smoking Restrictions: A Review

“…2,22,23,29,[34][35][36][37][38][39][40] Nevertheless, some findings suggest that smoking bans may have negative repercussions. 4,41,42 The relationships between private and public spaces with regard to smoking bans and behavior have been found to be complex and have been said to "demand[] more consideration if interventions in public areas are meant to serve as catalysts for favorable changes in primary private spaces such as homes."…”

Pragmatic Trials

“…[59][60][61] Nonrandomised designs may have to be used for studying rare adverse events, which a trial would have to be implausibly large to detect. 62 63 An example is the use of case-control methods to evaluate the impact on the incidence of sudden infant deaths of advice about sleep position and other aspects of babies' sleeping environment.…”