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Evidence summaries

Legislative Smoking Bans for Reducing Secondhand Smoke Exposure and Smoking Prevalence

Legislative smoking ban appears to reduce exposure to passive smoking, and admissions for acute coronary syndrome. Level of evidence: "B"

The certainty of evidence is upgraded by large magnitude of effect.

A Cochrane review [Abstract] 1 included 77 studies (repeated before and after cross-sectional and cohort studies).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.

A longitudinal study 2 in random population samples (European Community Respiratory Health Survey) in 1990-1995, with follow-up interviews in 1998-2003 and 2010-2014 investigated whether smoking bans influence passive smoking. Passive smoking at work was reported by 31.9% in 1990-1995, 17.5% in 1998-2003, and 2.5% in 2010-2014. Concurrently, passive smoking at home decreased from 28.9% to 18.2% and 8.8%. When controlling for sex, age, education, smoking status, and ECHRS wave, the odds of passive smoking at work was markedly reduced after global smoking bans (OR = 0.45, 95% CI 0.25-0.81), particularly among non-smokers.

    References

    • Frazer K, Callinan JE, McHugh J et al. Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst Rev 2016;(2):CD005992. [PubMed]
    • Olivieri M, Murgia N, Carsin AE et al. Effects of smoking bans on passive smoking exposure at work and at home. The European Community respiratory health survey. Indoor Air 2019;29(4):670-679.[PubMed]

Primary/Secondary Keywords