Smoke-free legislation and childhood hospitalisations for respiratory tract infections

Abstract

Second-hand smoke exposure is a major risk factor for respiratory tract infections (RTIs). Although evidence suggests important early-life health benefits of smoke-free public environments, the impact on childhood RTIs is unclear. We investigated the association between England's smoke-free legislation and childhood RTI hospitalisations.We used the Hospital Episode Statistics database to obtain nationwide data on hospital admissions for acute RTIs among children (<15 years of age) from 2001 to 2012. Hospitalisation counts were disaggregated by month, age group, sex and small-area level, and linked to urbanisation, region, deprivation index and corresponding population estimates. Negative binomial regression analyses were adjusted for confounders, seasonal variation, temporal autocorrelation, population-size changes and underlying incidence trends. Models allowed for sudden and gradual changes following the smoke-free legislation. We performed sensitivity and subgroup analyses, and estimated number of events prevented.We analysed 1 651 675 hospital admissions. Introduction of smoke-free legislation was followed by an immediate reduction in RTI admissions (−3.5%, 95% CI −4.7-−2.3%), this mainly being attributable to a decrease in lower RTI admissions (−13.8%, 95% CI −15.6-−12.0%). The reductions in admissions for upper RTI were more incremental.The introduction of national smoke-free legislation in England was associated with ∼11 000 fewer hospital admissions per year for RTIs in children. @ERSpublications Smoke-free legislation in England was associated with a drop in paediatric respiratory infection admissions

The independent role of prenatal and postnatal exposure to active and passive smoking on the development of early wheeze in children

“…These findings further stress the importance of protecting pregnant women and infants from passive smoke exposure, in both public and private areas. [22] Exposure to passive smoking in public places has been substantially regulated over the past decade with significant health gains for children [23,24]. While increased population awareness and the adoption of smoke free environments have been found to reduce exposure inside the house [25], further action is needed to reduce exposure in other private areas that have been identified to contribute significantly to overall passive smoke exposure during the gestational period, such as exposure within the family car [26].…”

“…The independent role of prenatal and postnatal exposure to active and passive smoking on the development of early wheeze in children Vardavas CI (1,2) , Hohmann C (3,4) , Patelarou E (1,5) , Martinez D (6,7,8) , Henderson AJ (9) , Granell R (9) , Sunyer J (6,7,8,10) , Torrent M (6,11) , Fantini MP (12) , Gori D (12) , AnnesiMaesano I (13,14) , Slama R (15) , Duijts L (16) , de Jongste JC (17) , Aurrekoetxea JJ (18,19,20) , Basterrechea M (7,19,20) , Morales E (6,7,21) , Ballester F (7,22) , Murcia M (7,22) , Thijs C (23) , Mommers M (23) , Kuehni CE (24) , Gaillard EA (25) , Tischer C (26) , Heinrich J (26,27,) , Pizzi C…”

Reduction in emergency department visits for children's asthma, ear infections, and respiratory infections after the introduction of state smoke-free legislation

“…However, methodological limitations include the lack of a control group, (Mackay et al, 2010;Millett et al, 2013;Herman and Walsh, 2011;Rayens et al, 2008) not accounting for other tobacco control policies, (Mackay et al, 2010;Millett et al, 2013;Naiman et al, 2010;Herman and Walsh, 2011;Rayens et al, 2008) or not distinguishing state from local policies (Herman and Walsh, 2011;Shetty et al, 2011). More recent studies have found reductions in hospitalizations for children's respiratory tract infections, primarily attributed to decreases in lower respiratory infections, after the introduction of country-wide smoke-free legislation (Been et al, 2015;Lee et al, 2016). Despite plausible mechanisms, (US Department of Health and Human Services, 2006) we are not aware of any studies that have examined the effects of secondhand smoke exposure on children's hospital admissions or ED visits for ear infections.…”

Protecting children from second-hand smoke

“…In this issue, BEEN et al [1] present the first study on smoke-free law and hospitalisation for RTIs in children. They analysed hospital episode statistics to investigate the association between smoke-free legislation introduced in England on July 1, 2007, and hospitalisation trends for upper and lower RTIs from 2001 to 2012 in children <15 years of age.…”

“…The claim by SCHROEDER AND WARNER [36] that "at a time when all eyes are focused on health care reform, escalating medical costs, and childhood obesity, cigarette smoking remains by far the most common cause of preventable death and disability," is still true and also applies to Europe. BEEN et al [1] give us even more evidence that child health can be improved easily, effectively and cheaply, if we want.…”