Evidence continues to mount for national smoke-free initiatives

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As the article below describes, it’s not just the long-term risk reduction for developing cancer, but also the immediate effect of reducing heart attacks that helps make the case for nationwide smoke-free initiatives in all public places. In light of the growing healthcare crisis in the U.S., how long will we be able to ignore the data on how our nation’s health would benefit, both in the short and long-term, from increasing the number of smoke-free public places? The overall health of our nation, the way we fight cancer, and our moral will to control tobacco, it is becoming increasing clear that the three are inextricably linked.

NHS Health Scotland, the national health improvement agency, has found a 17% fall in admissions for heart attacks just one year after a national smoking ban[1] came into force.

Undertaken by the University of Glasgow, this study is one of the most robust of its kind, and was commissioned as part of a national evaluation of the impact of Scotland’s smoke-free legislation. Published this week in the New England Journal of Medicine, the results from a study of nine Scottish hospitals[2] demonstrate the positive impact going smoke-free can have on the health of the population.

The evaluation of Scotland’s smoke-free law found that after the legislation came into force there was:

a 17% reduction in heart attack admissions to nine Scottish hospitals. This compares with an annual reduction in Scottish admissions for heart attack of 3% per year in the decade before the ban;

an 86% reduction in second-hand smoke in bars;

a 39% reduction in second-hand smoke exposure in 11-year-olds and in adult non-smokers;

an increase in the proportion of homes with smoking restrictions;

no evidence of smoking shifting from public places into the home; and

considerable public support for the legislation even among smokers, whose support increased once the legislation was in place.

Professor Jill Pell, University of Glasgow who conducted the study said: “Previous analyses of routine hospital admission data from the US and Italy have reported reductions in heart attacks following the introduction of smoking bans. However, our Scottish study, is the first to examine the impact of the legislation on smokers and non-smokers separately.

“We have been able to demonstrate that two-thirds of the observed reduction in heart attack has occurred in non-smokers and the results of the blood tests confirmed a reduction in exposure to second-hand smoke among non-smokers. We believe that most of the reduction can be attributed to the introduction of the Scottish smoking ban.”

Sally Haw, Principal Public Health Adviser at NHS Health Scotland, co-ordinated the research programme: “This evaluation of impact of smoke-free legislation is the most comprehensive yet conducted and the findings have exceeded our greatest expectations. As well as the dramatic 17% reduction in heart attacks, we found clear evidence of: improvements in the respiratory health of bar workers; reductions in second-hand exposure in bar workers, and adults and children the general population; and changing socio-cultural norms about smoking and the acceptability of exposing others to SHS.

“The findings from the Scottish study of heart attacks are of worldwide importance and the combined results from the evaluation provide a compelling case for other countries to implement a comprehensive ban on smoking in public places as soon as possible, thereby reducing the harm caused by second-hand smoke. However, it is essential that smoke-free legislation is set within the context of wider tobacco control activity as outlined in the WHO Framework Convention on Tobacco Control an international treaty designed to reduce both the demand for and the supply of tobacco products.” [3]

Deputy Chief Medical Officer Professor Peter Donnelly said: “This raft of research demonstrates the significant public health benefits that the smoking ban is already having in Scotland. It provides evidence that the legislation is improving the health of everyone in Scotland , including smokers, non-smokers, children and barworkers. One of the most important findings is the reduction in heart attacks. We believe that the smoking ban was a large contributory factor to this drop and I am confident that we will continue to see the positive effects of the ban in years to come.”

The publication of this study comes together with other good news internationally; Mayor Michael Bloomberg and Bill Gates announced in New York last week a further $375 million investment ($250 million from the Bloomberg Family Foundation and $125 million from the Bill & Melinda Gates Foundation) in tobacco control activity in developing countries; while China has made the forthcoming Olympics a smoke-free event when it takes the world stage in August.

Notes

1. The Smoking, Health and Social Care (Scotland) Act came into force in Scotland on 26th March 2006 and prohibits smoking in virtually all enclosed public places including bars restaurants and cafes.

2. The heart attack admissions to the nine study hospitals account for 63% of all Scottish admissions for heart attack.

3. WHO Framework Convention on Tobacco Control : www.who.int/fctc/en/

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