Changes in exposure of adult non-smokers to secondhand smoke after implementation of smoke-free legislation in Scotland: national cross sectional survey

Abstract

OBJECTIVE To measure change in adult non-smokers' exposure to secondhand smoke in public and private places after smoke-free legislation was implemented in Scotland. DESIGN Repeat cross sectional survey. SETTING Scotland. PARTICIPANTS Scottish adults, aged 18 to 74 years, recruited and interviewed in their homes. INTERVENTION Comprehensive smoke-free legislation that prohibits smoking in virtually all enclosed public places and workplaces, including bars, restaurants, and cafes. OUTCOME MEASURES Salivary cotinine, self reported exposure to smoke in public and private places, and self reported smoking restriction in homes and in cars. RESULTS Overall, geometric mean cotinine concentrations in adult non-smokers fell by 39% (95% confidence interval 29% to 47%), from 0.43 ng/ml at baseline to 0.26 ng/ml after legislation (P<0.001). In non-smokers from non-smoking households, geometric mean cotinine concentrations fell by 49% (40% to 56%), from 0.35 ng/ml to 0.18 ng/ml (P<0.001). The 16% fall in cotinine concentrations in non-smokers from smoking households was not statistically significant. Reduction in exposure to secondhand smoke was associated with a reduction after legislation in reported exposure to secondhand smoke in public places (pubs, other workplaces, and public transport) but not in homes and cars. We found no evidence of displacement of smoking from public places into the home. CONCLUSIONS Implementation of Scotland's smoke-free legislation has been accompanied within one year by a large reduction in exposure to secondhand smoke, which has been greatest in non-smokers living in non-smoking households. Non-smokers living in smoking households continue to have high levels of exposure to secondhand smoke

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."…”

“…26 A second, somewhat more pessimistic, theoretical model is that of displacement or last refuge which posits that smoking bans in public places will displace smoking behaviors to private places, like homes, and will produce undesired effects such as increased SHS exposure for nonsmoking family members. 3,29 This is especially concerning for children, who are more vulnerable to the effects of SHS. 5,30,31 In the United States, in 2010, approximately 98% of children living with a smoker, compared to 40% not living with a smoker, had cotinine levels (a metabolite of nicotine which has a longer half-life than nicotine) above .05 ng/mL, indicating SHS exposure.…”

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.…”