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Did smokefree legislation in England reduce exposure to secondhand smoke among nonsmoking adults? Cotinine analysis from the Health Survey for England.

Sims M, Mindell JS, Jarvis MJ, Feyerabend C, Wardle H, Gilmore A - Environ. Health Perspect. (2011)

Bottom Line: We observed a significant fall in exposure after legislation was introduced--the odds of having undetectable cotinine were 1.5 times higher [95% confidence interval (CI): 1.3, 1.8] and geometric mean cotinine fell by 27% (95% CI: 17%, 36%) after adjusting for the prelegislative trend and potential confounders.Significant reductions were not, however, seen in those living in lower-social class households or homes where smoking occurs inside on most days.Nevertheless, some population subgroups appear not to have benefitted significantly from the legislation.

View Article: PubMed Central - PubMed

Affiliation: Department for Health, and the UK Centre for Tobacco Control Studies, University of Bath, Claverton Down, Bath, United Kingdom. m.sims@bath.ac.uk

ABSTRACT

Background: On 1 July 2007, smokefree legislation was implemented in England, which made virtually all enclosed public places and workplaces smokefree.

Objectives: We examined trends in and predictors of secondhand smoke exposure among nonsmoking adults to determine whether exposure changed after the introduction of smokefree legislation and whether these changes varied by socioeconomic status (SES) and by household smoking status.

Methods: We analyzed salivary cotinine data from the Health Survey for England that were collected in 7 of 11 annual surveys undertaken between 1998 and 2008. We conducted multivariate regression analyses to examine secondhand smoke exposure as measured by the proportion of nonsmokers with undetectable levels of cotinine and by geometric mean cotinine.

Results: Secondhand smoke exposure was higher among those exposed at home and among lower-SES groups. Exposure declined markedly from 1998 to 2008 (the proportion of participants with undetectable cotinine was 2.9 times higher in the last 6 months of 2008 compared with the first 6 months of 1998 and geometric mean cotinine declined by 80%). We observed a significant fall in exposure after legislation was introduced--the odds of having undetectable cotinine were 1.5 times higher [95% confidence interval (CI): 1.3, 1.8] and geometric mean cotinine fell by 27% (95% CI: 17%, 36%) after adjusting for the prelegislative trend and potential confounders. Significant reductions were not, however, seen in those living in lower-social class households or homes where smoking occurs inside on most days.

Conclusions: We found that the impact of England's smokefree legislation on secondhand smoke exposure was above and beyond the underlying long-term decline in secondhand smoke exposure and demonstrates the positive effect of the legislation. Nevertheless, some population subgroups appear not to have benefitted significantly from the legislation. This finding suggests that these groups should receive more support to reduce their exposure.

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Related in: MedlinePlus

Trends in SHS exposure among nonsmoking adults in England from 1998 to 2008 in 6-month time periods by household smoking status (A and B) and social class of head of household (C and D) using proportion with undetectable cotinine (A and C), geometric mean cotinine (B and D). Error bars indicate 95% CIs. SFL (smokefree legislation) indicates when the legislation was implemented.
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f2: Trends in SHS exposure among nonsmoking adults in England from 1998 to 2008 in 6-month time periods by household smoking status (A and B) and social class of head of household (C and D) using proportion with undetectable cotinine (A and C), geometric mean cotinine (B and D). Error bars indicate 95% CIs. SFL (smokefree legislation) indicates when the legislation was implemented.

Mentions: Variation in the estimated impact of the smokefree legislation by household smoking status and social class. The impacts of legislation appeared to vary by population subgroup (Table 2, Figure 2A–D). Significant impacts were observed only among those living in homes where there was no smoking inside on most days and among those from social classes I to III. For those living in homes where there was no smoking inside on most days, the odds of having undetectable cotinine were 1.6 (95% CI: 1.3, 1.9) times higher after the legislation was implemented and geometric mean cotinine fell by 31% (95% CI: 21%, 39%) after adjusting for underlying trends and potential confounders. The odds of having undetectable cotinine were 1.8 (95% CI: 1.4, 2.3) times higher among those in social classes I and II and 1.5 (95% CI: 1.1, 1.9) times higher among those in social classes III after the legislation, whereas geometric mean cotinine levels fell by 37% (95% CI: 24%, 48%) and 23% (95% CI: 6%, 37%) respectively. By contrast, no significant impact was seen in adults living in households where someone smoked inside on most days or in social classes IV and V when measured using either the OR of undetectable cotinine [0.38 (95% CI: 0.12, 1.2) and 1.00 (95% CI: 0.64, 1.6) respectively], or multiplicative change in geometric cotinine [1.5 (95% CI: 0.89, 2.5) and 1.0 (95% CI: 0.7, 1.4) respectively].


Did smokefree legislation in England reduce exposure to secondhand smoke among nonsmoking adults? Cotinine analysis from the Health Survey for England.

Sims M, Mindell JS, Jarvis MJ, Feyerabend C, Wardle H, Gilmore A - Environ. Health Perspect. (2011)

Trends in SHS exposure among nonsmoking adults in England from 1998 to 2008 in 6-month time periods by household smoking status (A and B) and social class of head of household (C and D) using proportion with undetectable cotinine (A and C), geometric mean cotinine (B and D). Error bars indicate 95% CIs. SFL (smokefree legislation) indicates when the legislation was implemented.
© Copyright Policy - public-domain
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3295343&req=5

f2: Trends in SHS exposure among nonsmoking adults in England from 1998 to 2008 in 6-month time periods by household smoking status (A and B) and social class of head of household (C and D) using proportion with undetectable cotinine (A and C), geometric mean cotinine (B and D). Error bars indicate 95% CIs. SFL (smokefree legislation) indicates when the legislation was implemented.
Mentions: Variation in the estimated impact of the smokefree legislation by household smoking status and social class. The impacts of legislation appeared to vary by population subgroup (Table 2, Figure 2A–D). Significant impacts were observed only among those living in homes where there was no smoking inside on most days and among those from social classes I to III. For those living in homes where there was no smoking inside on most days, the odds of having undetectable cotinine were 1.6 (95% CI: 1.3, 1.9) times higher after the legislation was implemented and geometric mean cotinine fell by 31% (95% CI: 21%, 39%) after adjusting for underlying trends and potential confounders. The odds of having undetectable cotinine were 1.8 (95% CI: 1.4, 2.3) times higher among those in social classes I and II and 1.5 (95% CI: 1.1, 1.9) times higher among those in social classes III after the legislation, whereas geometric mean cotinine levels fell by 37% (95% CI: 24%, 48%) and 23% (95% CI: 6%, 37%) respectively. By contrast, no significant impact was seen in adults living in households where someone smoked inside on most days or in social classes IV and V when measured using either the OR of undetectable cotinine [0.38 (95% CI: 0.12, 1.2) and 1.00 (95% CI: 0.64, 1.6) respectively], or multiplicative change in geometric cotinine [1.5 (95% CI: 0.89, 2.5) and 1.0 (95% CI: 0.7, 1.4) respectively].

Bottom Line: We observed a significant fall in exposure after legislation was introduced--the odds of having undetectable cotinine were 1.5 times higher [95% confidence interval (CI): 1.3, 1.8] and geometric mean cotinine fell by 27% (95% CI: 17%, 36%) after adjusting for the prelegislative trend and potential confounders.Significant reductions were not, however, seen in those living in lower-social class households or homes where smoking occurs inside on most days.Nevertheless, some population subgroups appear not to have benefitted significantly from the legislation.

View Article: PubMed Central - PubMed

Affiliation: Department for Health, and the UK Centre for Tobacco Control Studies, University of Bath, Claverton Down, Bath, United Kingdom. m.sims@bath.ac.uk

ABSTRACT

Background: On 1 July 2007, smokefree legislation was implemented in England, which made virtually all enclosed public places and workplaces smokefree.

Objectives: We examined trends in and predictors of secondhand smoke exposure among nonsmoking adults to determine whether exposure changed after the introduction of smokefree legislation and whether these changes varied by socioeconomic status (SES) and by household smoking status.

Methods: We analyzed salivary cotinine data from the Health Survey for England that were collected in 7 of 11 annual surveys undertaken between 1998 and 2008. We conducted multivariate regression analyses to examine secondhand smoke exposure as measured by the proportion of nonsmokers with undetectable levels of cotinine and by geometric mean cotinine.

Results: Secondhand smoke exposure was higher among those exposed at home and among lower-SES groups. Exposure declined markedly from 1998 to 2008 (the proportion of participants with undetectable cotinine was 2.9 times higher in the last 6 months of 2008 compared with the first 6 months of 1998 and geometric mean cotinine declined by 80%). We observed a significant fall in exposure after legislation was introduced--the odds of having undetectable cotinine were 1.5 times higher [95% confidence interval (CI): 1.3, 1.8] and geometric mean cotinine fell by 27% (95% CI: 17%, 36%) after adjusting for the prelegislative trend and potential confounders. Significant reductions were not, however, seen in those living in lower-social class households or homes where smoking occurs inside on most days.

Conclusions: We found that the impact of England's smokefree legislation on secondhand smoke exposure was above and beyond the underlying long-term decline in secondhand smoke exposure and demonstrates the positive effect of the legislation. Nevertheless, some population subgroups appear not to have benefitted significantly from the legislation. This finding suggests that these groups should receive more support to reduce their exposure.

Show MeSH
Related in: MedlinePlus