Impact of Comprehensive Smoking Bans on the Health of Infants and Children

Abstract

As evidence of the negative effects of environmental tobacco smoke (ETS) has mounted, an increasingly popular public policy response has been to impose restrictions on smoking through 100% smoke-free bans (comprehensive smoking bans). Yet sparse information exists regarding the impact these smoking bans at the state and local levels have on the health of children and infants. A rationale for expansion of smoke-free laws implicitly presumes that potential public health gains from reducing adult cigarette consumption and declines in adult ETS exposure extend to children. However, if smokers compensate by shifting their consumption of cigarettes from public venues that impose a comprehensive smoking ban to smoking at home, then these policies may have a harmful effect on children and infants. This study provides estimates of how comprehensive smoking bans impact the venue of smoking, and the health of children and infants. Using models that exploit state-and county-level changes to smoking ban legislation over time, estimates suggest that smoking bans have improved the health of both infants and children, mainly through implementation of more comprehensive bans. Further, we find no evidence of displacement among smokers (both smokers with and without children in the household), and actually find that the bans had a positive spillover effect in terms of reducing smoking inside the home-an effect which may further explain the improvement in infant and children's health. Our effect magnitudes imply that expanding comprehensive coverage from 60% (current level) to 100% of the population can prevent between approximately 1,110-1,750 low birthweight births among low-educated mothers, resulting in economic cost savings of about $71-$111 million annually. Health improvements among older children add to these economic benefits.

The effect of e‐cigarette taxes on pre‐pregnancy and prenatal smoking

“…Early studies using birth records documented that higher cigarette taxes reduce smoking among pregnant women with implied own‐tax elasticities of ‐0.7 to ‐1.0 (Colman et al., 2003; Ringel & Evans, 2001). While not estimating a prenatal smoking tax elasticity directly, McGeary and colleagues (2019) found evidence consistent with prior literature of the effect of cigarette taxes on birth outcomes using birth certificate data through 2012. Other recent studies have suggested cigarette tax‐elasticities of demand for pregnant women are lower in recent years (Adams et al., 2012; Hoehn‐Velasco et al., in press).…”

“…Infants born to women smoking in the 3 rd trimester were almost twice as likely to have experienced low birthweight, 48% more likely to have been born prematurely, and 1.5 times less likely to have survived their first year of life, compared to infants born to women who did not smoke during pregnancy. 1 Quasi-experimental evidence using policy variation in cigarette taxes supports descriptive evidence that smoking reduces birth weight (McGeary et al, 2019, Evans and Ringel, 1999, Lien and Evans, 2005, and increases risk for premature birth (McGeary et al, 2019) and infant mortality (Sen andPiérard, 2011, Markowitz, 2008).…”

“…Using policy tools to increase the direct or indirect costs of smoking, such as cigarette taxes and smoking indoor air laws, has generally been found to reduce prenatal smoking rates (Colman et al., 2003; Evans & Ringel, 1999; Lien & Evans, 2005; McGeary et al., 2019). However, there is concern that traditional tobacco control policies like cigarette taxes have less impact on smoking outcomes among pregnant women now than they did in the past (Hoehn‐Velasco et al., in press), thus increasing the importance of identifying alternative strategies to reduce prenatal smoking.…”

Impact of Comprehensive Smoking Bans on the Health of Infants and Children: Evidence from the U.S

“…By 2012, over 48% of the population was exposed to a comprehensive worksite ban, over 64% were exposed to full bans in restaurants, and over 60% were exposed to these restrictions in freestanding bars. For a fuller description of the ban exposure see the online appendices and McGeary et al (2017).…”

The effect of outdoor smoking ban: Evidence from Korea

“…Anger, Kvasnicka, and Siedler () reported that, after the implementation of state‐level public smoking ban in bars, restaurants, and dance clubs in Germany, the prevalence of smoking among people who often go out to such places fell significantly. In the United States, comprehensive indoor smoking bans effectively reduced smoking rates (Carton, Darden, Levendis, Lee, & Ricket, ) and improved the health of infants and children (McGeary, Dave, Lipton, & Roeper, ).…”