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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
Competing interests:
No competing interests
01 February 2006
Geraint H. Lewis
Specialist Registrar in Public Health
Adrian C. Brown, David C. Osborne, Tim J.B. Crayford
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
Competing interests: No competing interests