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NEWS: In brief BMJ 2006; 332: 194 [Full text]

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New evidence that a partial smoking ban would worsen health inequalities across England as a whole

Geraint H. Lewis, Adrian C. Brown, David C. Osborne, Tim J.B. Crayford   (1 February 2006)

New evidence that a partial smoking ban would worsen health inequalities across England as a whole 1 February 2006
Geraint H. Lewis, Specialist Registrar in Public Health Croydon PCT, CR0 9XT, Adrian C. Brown, David C. Osborne, Tim J.B. Crayford Send response to journal: Re: New evidence that a partial smoking ban would worsen health inequalities across England as a whole	Several studies have shown that in small areas - such as across a local authority - a partial smoking ban would be likely to increase health inequalities.  We present what we believe is the first evidence that this is indeed the case across England as a whole.   Method We generated a random sample of 500 pubs from a national commercial database of 36,586 English pubs, bars and inns (The Thomson Directory), and referenced each pub's postcode to its Index of Multiple Deprivation (IMD) Score.  We telephoned each pub in our sample and asked whether or not it served hot food.   Statistical Methods Our power calculation suggested that a sample size of 500 would permit us to contrast any two quintiles of deprivation.  IMD scores for England are based on an exponential scale so we log transformed this variable for analysis.   We used a t-test to test the hypothesis that pubs serving hot food had the same deprivation scores as those not serving food, and repeated this analysis after excluding all town centre pubs (as based on the ‘Town Centre Boundaries and Statistics for England and Wales – 2002’ ). This was to address the possibility that town centre pubs may serve a wider population than their immediate vicinity.    Results We obtained a response from 483 (96.6%) of the pubs.     Table 1: Relationship of deprivation to food availability Deprivation Quintile n % serving hot food 1 (least deprived) 99 87.9 2 99 80.1 3 98 70.4 4 97 61.9 5 (most deprived) 90 45.6 All 483 69.8     Public houses that serve hot food have lower IMD scores than those that do not (t=-6.07, difference in mean log IMD score –0.35, p<0.0001, 95% confidence interval –0.47 to -0.24).  This remains significant when town centre public houses are excluded (n=382, t=-5.99, difference in mean log IMD score –0.42 p<0.0001, 95% confidence interval –0.56 to -0.28).     Discussion Our nationwide study confirms that the proposed partial smoking ban is set to exacerbate health inequalities from smoking and second-hand smoke, through a disproportionate increase in the number of smoke-free pubs in affluent areas of England.   Competing interests: None declared