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Child admissions for lower respiratory tract infections fall after smoking ban

BMJ 2017; 358 doi: (Published 05 September 2017) Cite this as: BMJ 2017;358:j4154
  1. Ingrid Torjesen

Hospital admissions of children with lower respiratory tract infections have fallen by 18.5% since the public smoking ban and 9.8% fewer children have attended hospital for severe asthma exacerbations, research published in the Lancet Public Health shows.1

The results also showed a 3.7% reduction in preterm births after the ban’s implementation.

Researchers from the University of Edinburgh, UK, and the Erasmus University Medical Centre in the Netherlands identified studies assessing the impact of World Health Organization tobacco control policies on perinatal and child health since their introduction.

They identified 41 studies where tobacco control policies had been introduced: 24 from North America, 16 from Europe, and one from China. Overall, the studies included data on more than 57 million births and 2.7 million hospital admissions.

Ten studies involving 27.5 million people were included in the meta-analysis and looked at the effects of smoke-free legislation on preterm births, finding a 3.77% fall in rates (95% confidence interval –6.37% to –1.16%).

Combining data from five studies including 684 826 events showed that rates of hospital attendance for asthma exacerbations fell by 9.83% (–16.62% to –3.04%), while two studies, including 1 681 020 events, showed that hospital attendance rates for all respiratory tract infections fell by 3.45% (–4.64% to –2.25%).

And three studies, including 887 414 events, indicated that admissions for lower respiratory tract infections fell by 18.48% (–32.79% to –4.17%). These associations seemed stronger when comprehensive rather than partial smoke-free laws were implemented.

Two studies assessed the association between smoke-free legislation and perinatal mortality: one showed notable reductions in stillbirth and neonatal mortality but did not report the overall effect on perinatal mortality, while the other showed no change in perinatal mortality.

Raising taxes on tobacco products may also have improved child health, the researchers said, but these findings were less conclusive.

Aziz Sheikh, director of the University of Edinburgh’s Usher Institute and the Asthma UK Centre for Applied Research, said, “Our evaluation provides compelling evidence of the considerable impact of tobacco control policies on child health. This work should spur governments to take action to implement tried and tested policies—strongly advocated by the World Health Organization—to reduce secondhand smoke exposure and improve a range of important health outcomes in infants and children.”

In an accompanying editorial,2 John Britton, director of the UK Centre for Tobacco and Alcohol Studies at the University of Nottingham, said, “One of the arguments advanced against comprehensive smoke-free legislation, articulated even by the then UK health minister in evidence to the House of Commons Select Committee on Health in 2005, was that prohibiting smoking in pubs, bars, and restaurants would displace smoking into the home, and hence increase exposure of (and harm to) children and other household members.

“In fact, in the UK the opposite happened: exposure of both children and non-smoking adults fell after smoke-free legislation was introduced.”


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