Abstract
Background Smoke-free legislation has the potential to reduce the substantive disease burden associated with second-hand smoke exposure, particularly in children. We investigated the effect of smoke-free legislation on perinatal and child health.Methods We searched 14 online databases from January, 1975 to May, 2013, with no language restrictions, for published studies, and the WHO International Clinical Trials Registry Platform for unpublished studies. Citations and reference lists of articles of interest were screened and an international expert panel was contacted to identify additional studies. We included studies undertaken with designs approved by the Cochrane Effective Practice and Organisation of Care that reported associations between smoking bans in workplaces, public places, or both, and one or more predefined early-life health indicator. The primary outcomes were preterm birth, low birthweight, and hospital attendances for asthma. Effect estimates were pooled with random-effects meta-analysis. This study is registered with PROSPERO, number CRD42013003522.Findings We identified 11 eligible studies (published 2008-13), involving more than 2.5 million births and 247 168 asthma exacerbations. All studies used interrupted time-series designs. Five North American studies described local bans and six European studies described national bans. Risk of bias was high for one study, moderate for six studies, and low for four studies. Smoke-free legislation was associated with reductions in preterm birth (four studies, 1 366 862 individuals; -10.4% [95% CI -18.8 to -2.0]; p=0.016) and hospital attendances for asthma (three studies, 225 753 events: -10.1% [95% CI -15.2 to -5.0]; p=0.0001). No significant effect on low birthweight was identified (six studies, >1.9 million individuals: -1.7% [95% CI -5.1 to 1.6]; p=0.31).Interpretation Smoke-free legislation is associated with substantial reductions in preterm births and hospital attendance for asthma. Together with the health benefits in adults, this study provides strong support for WHO recommendations to create smoke-free environments.
| Original language | English |
|---|---|
| Pages (from-to) | 1549-1560 |
| Number of pages | 12 |
| Journal | The Lancet |
| Volume | 383 |
| Issue number | 9928 |
| DOIs | |
| Publication status | Published - 3 May 2014 |
| Externally published | Yes |
Bibliographical note
Funding Information:This work was supported by the Thrasher Research Fund Early Career Award NR-0166 (JVB); the Lung Foundation Netherlands Long Term Fellowship 3·4.12·128FE (JVB), a Maastricht University Medical Centre Kootstra Talent Fellowship (JVB), and the International Paediatric Research Foundation Young Investigator Exchange Program (JVB). BC is supported by the Flemish Scientific Fund (FWO; G.0873.11.N.10), and TSN is supported by a European Research Council starting grant. AS is supported by The Commonwealth Fund, a private independent foundation based in New York City. The views presented here are those of the author and not necessarily those of The Commonwealth Fund, its directors, officers, or staff. We thank Marshall Dozier for assistance in preparing the search strategy, members of the expert panel for providing advice, Michelle Amaral, Marina Bianchi, Connie Cheverie, Katherine Gaudreau, Julian Johnsen, Zubair Kabir, John Tayu Lee, Katrine Løken, Daniel Mackay, Carol McClure, Chris Millett, Jill Pell, and Anita Ravelli for providing additional data on their studies.