National evaluation of Scotland's smoke-free legislation

A study of nine Scottish hospitals found a 17 per cent fall in admissions for heart attacks in the first year after the smoking ban came into force.  The research is part of a national evaluation of the impact of Scotland's smoke-free legislation which shows that the smoking ban has had an overwhelmingly positive effect.

The evaluation found that after the legislation came into force there was:

  • a reduction in the rate of child asthma admissions of 18% per year compared to an increase of 5% per year in the years preceding it
  • a 17 per cent reduction in heart attack admissions to nine Scottish hospitals. This compares with an annual reduction in Scottish admissions for heart attack of 3 per cent per year in the decade before the ban
  • a 39 per cent reduction in second-hand smoke exposure in 11-year-olds and in adult non-smokers
  • an 86 per cent reduction in second-hand smoke in bars
  • an increase in the proportion of homes with smoking restrictions
  • no evidence of smoking shifting from public places into the home
  • high public support for the legislation even among smokers, whose support increased once the legislation was in place.

Methodology

Legislation on smoking in enclosed public places in Scotland: how will we evaluate the impact?
Sally J. Haw, Laurence Gruer OBE, Amanda Amos, Candace Currie,
Colin Fischbacher, Geoffrey T. Fong, Gerard Hastings, Sally Malam,
Jill Pell, Calum Scott and Sean Semple
Journal of Public Health, Volume 28, Number 1, March 2006 , pp. 24-30(7)
http://jpubhealth.oxfordjournals.org/cgi/content/abstract/28/1/24

Covert observation in practice: lessons from the evaluation of the prohibition of smoking in public places in Scotland
 Mark P Petticrew, Sean Semple, Shona Hilton, Karen S Creely, Douglas Eadie, Deborah Ritchie, Catherine Ferrell, Yvette Christopher and Fintan Hurley
BMC Public Health 2007, 7:204 doi:10.1186/1471-2458-7-204
http://www.biomedcentral.com/1471-2458/7/204/abstract

Acronyms:
(CHETS) Changes in child exposure to environmental tobacco smoke study
(BHETSE) The bar workers' health and ETS (environmental tobacco smoke) exposure study
(STOPIT) Study of public place interventions on tobacco exposure
(HEPS) Health education population study

Papers published to date

Volunteered, negotiated, enforced: family politics and the regulation of home smoking
Jude Robinson, Deborah Ritchie, Amanda Amos, Sarah Cunningham-Burley and Lorraine Greaves.
Sociology of Health and Illness. Vol. 33(1): 66-80. January 2011.
http://onlinelibrary.wiley.com/doi/10.1111/j.1467-9566.2010.01273.x/abstract

'Waiting until they got home': Gender, smoking and tobacco exposure in households in Scotland
Jude Robinson, Deborah Ritchie, Amanda Amos, Sarah Cunningham-Burley, Lorraine Greaves and Claudia Martin.
Social Science and Medicine, 71 (5), pp. 884-890. 2010.
www.ncbi.nlm.nih.gov/pubmed/20580143

'But it just has that sort of feel about it, a leper'—Stigma, smoke-free legislation and public health
Deborah Ritchie, Amanda Amos and Claudia Martin.
Nicotine and Tobacco Research, 2010.  12 (6): 622-629.
http://ntr.oxfordjournals.org/content/12/6/622.abstract

Smoke-free legislation and hospitalizations for childhood asthma
Daniel Mackay, Ph.D., Sally Haw, B.Sc., Jon G. Ayres, M.D., Colin Fischbacher, M.B., Ch.B., and Jill P. Pell, M.D. New England Journal of Medicine, 2010; 363:1139-1145.  September 16, 2010
www.nejm.org/doi/full/10.1056/NEJMoa1002861

Responding to change: how did bar workers adapt to the smoke-free legislation in Scotland?
Douglas R. Eadie, Susan G. MacAskill, Derek Heim, Gerard B. Hastings
International Journal of Environmental Health Research, Volume 20, Issue 1 February 2010 , pages 13 - 26
www.informaworld.com/smpp/1180142532-79223417/content~content=a918839169

UK Smoke-Free Legislation: Changes in PM2.5 Concentrations in Bars in Scotland, England, and Wales
Sean Semple1, Martie Van Tongeren, Karen S. Galea,  Laura Maccalman, Ivan Gee, Odette Parry,  Audrey Naji, and Jon G. Ayres
Annals of Occupational Hygiene (published online 19 February 2010)
Abstract or full text available at: http://annhyg.oxfordjournals.org/cgi/content/abstract/mep094v1

Are there health benefits associated with comprehensive smoke-free laws?
P G Goodman, S Haw, Z Kabir, L Clancy
Int J Public Health. 2009;54(6):365-6. (published online October 2009)
www.ncbi.nlm.nih.gov/pubmed/19882106

Public health or social impacts? A qualitative analysis of attitudes toward the smoke-free legislation in Scotland
 D Heim,  A Ross,  D Eadie, S MacAskill, J B Davies,  G Hastings, and S Haw
Nicotine and Tobacco Research.  (published online on 29 October 2009)
http://www.ncbi.nlm.nih.gov/pubmed/19875764

Socioeconomic differences in second-hand smoke exposure among children in Scotland after introduction of the smoke-free legislation
Patricia C Akhtar, Sally J Haw,  Kate A Levin, Dorothy B Currie,  Rachel Zachary,  Candace E Currie
J Epidemiol Community Health  2010;64:341-346   doi:10.1136/jech.2008.084178  (published online 13 August 2009)
jech.bmj.com/content/64/4/341.abstract (CHETS)

Smoking restrictions in the home and secondhand smoke exposure among primary schoolchildren before and after introduction of the Scottish smoke-free legislation
Patricia C Akhtar, Sally J Haw, Dorothy B Currie, Rachel Zachary, Candace E Currie
Tob Control   doi:10.1136/tc.2009.030627   (published online 10 August 2009)
tobaccocontrol.bmj.com/content/early/2009/08/10/tc.2009.030627.abstract (CHETS)

The triumph of national smoke-free legislation (featured editorial)
Jill P Pell and Sally Haw
Heart  2009;95:1377-1379   doi:10.1136/hrt.2009.176230 (published online 07 June 2009)
heart.bmj.com/content/95/17/1377.extract?sid=f68d2c12-f112-4107-8104-d93280cd2eea (STOPIT)

Action to achieve smoke-free homes- an exploration of experts' views
Deborah Ritchie, Amanda Amos, Richard Phillips, Sarah Cunningham-Burley and Claudia Martin
BMC Public Health 2009, 9:112doi:10.1186/1471-2458-9-112
www.biomedcentral.com/1471-2458/9/112

Secondhand smoke exposure and survival following acute coronary syndrome: prospective cohort study of 1261 consecutive admissions among never-smokers
J P Pell, S Haw, S Cobbe, D E Newby, A C H Pell, C Fischbacher, S Pringle, D Murdoch, F Dunn, K Oldroyd, P MacIntyre, B O'Rourke, W Borland
Heart  2009;95:1415-1418   doi:10.1136/hrt.2009.171702
heart.bmj.com/content/95/17/1415.short (STOPIT)

Bar workers' Health and Environmental Tobacco Smoke Exposure (BHETSE): Symptomatic improvement in bar staff following smoke-free legislation in Scotland
 Jon G Ayres, Sean Semple, Laura MacCalman, Scott Dempsey, Shona Hilton, Finton J Hurley, Brian G Miller, Audrey Naji and Mark Petticrew
Occupational and Environmental Medicine doi:10.1136/oem.2008.040311 (published online on 10 February 2009)
http://oem.bmj.com/cgi/content/abstract/oem.2008.040311v1 (BHETSE)

The impact of smokefree legislation in Scotland: results from the Scottish ITC Scotland/UK longitudinal surveys
 Andrew Hyland, Louise M. Hassan, Cheryl Higbee, Christian Boudreau, Geoffrey T. Fong, Ron Borland, K. Michael Cummings, Mi Yan, Mary E. Thompson and Gerard Hastings
The European Journal of Public Health doi:10.1093/eurpub/ckn141 (published online 16 January 2009)
http://eurpub.oxfordjournals.org/cgi/content/abstract/ckn141v1 Link to: ITC Ireland/Scotland Project

Care-home workers' exposure to SHS: a short summary of findings
S Semple, A Naji, S Haw, J G Ayres
Occup Environ Med  2009;66:639-640   doi:10.1136/oem.2009.045864  (published online 16 January 2009)
oem.bmj.com/content/66/9/639.2.extract

Scottish smoke-free legislation and trends in smoking cessation
 Freya J. I. Fowkes, Marlene C. W. Stewart, F. Gerald R. Fowkes, Amanda Amos and Jackie F. Price
Addiction 103(11): 1888 - 1895 doi:10.1111/j.1360-0443.2008.02350.x (published online on 16 October 2008)
http://www3.interscience.wiley.com/journal/121458999/abstract

The impact of the 2006 Scottish smoke-free legislation on sales of nicotine replacement therapy
Sarah A. Lewis,  Sally J. Haw, and Ann McNeill
Nicotine and Tobacco Research 10(12): 1789-92
http://www.ncbi.nlm.nih.gov/pubmed/19023830

Smoke-free Legislation and Hospitalizations for Acute Coronary Syndrome
Jill P. Pell, M.D., Sally Haw, B.Sc., Stuart Cobbe, M.D., David E. Newby, Ph.D., Alastair C.H. Pell, M.D., Colin Fischbacher, M.B., Ch.B., Alex McConnachie, Ph.D., Stuart Pringle, M.D., David Murdoch, M.B., Ch.B., Frank Dunn, M.D., Keith Oldroyd, M.D., Paul MacIntyre, M.D., Brian O'Rourke, M.D., and William Borland, B.Sc.
New England Journal of Medicine 359(5):482-491
http://content.nejm.org/cgi/content/abstract/359/5/482 (STOPIT)
(Note: this research was voted top in the American Heart Association's Top 10 Research Advances of 2008 'In Scotland, after smoke-free legislation covering all enclosed places was implemented, hospital admissions for acute coronary syndrome decreased 17 per cent, compared with only a 4 per cent decrease in England, where there was no such legislation. The decrease in Scotland was highest in never-smokers, but there was also a smaller decrease in former smokers. Smokers had the lowest decrease, but saw a 14 per cent decline. Of the decrease in hospital admissions, 67 per cent were nonsmokers, supporting the argument that protection for these individuals is an important benefit of this legislation, and it should be extended more broadly.')

Observations from behind the bar: changing patrons' behaviours in response to smoke-free legislation in Scotland
 Shona Hilton, Jane Cameron, Alice MacLean  and Mark Petticrew
BMC Public Health 2008(8): 238 doi:10.1186/1471-2458-8-238 (published 14 July 2008)
http://www.biomedcentral.com/1471-2458/8/238 (BHETSE)

Validity of self-reported smoking status: Comparison of patients admitted to hospital with acute coronary syndrome and the general population
Jill P. Pell,  Sally J. Haw,  Stuart M. Cobbe,  David E. Newby,  Alastair C. H. Pell,  Keith G. Oldroyd,  David L. Murdoch,  Stuart D. Pringle, Frank G. Dunn,  Paul D. MacIntyre, Timothy J. Gilbert ,
Colin M. Fischbacher, William Borland
Nicotine & Tobacco Research, Volume 10, Issue 5 May 2008 , pages 861 - 866
www.informaworld.com/smpp/content~content=a793511239~db=all~order=page (STOPIT)

After the smoke has cleared-Reflections on Scotland's tobacco control legislation
 P. Donnelly and P. Whittle
Public Health 122(8): 762-766 doi:10.1016/j.puhe.2008.03.003 (published online 15 May 2008)
http://www.ncbi.nlm.nih.gov/pubmed/18485428

A qualitative analysis of compliance with smoke-free legislation in community bars in Scotland: implications for public health
 Douglas Eadie, Derek Heim, Susan MacAskill, Alastair Ross, Gerard Hastings and John Davies
Addiction 103(6): 1019 - 1026 doi :10.1111/j.1360-0443.2008.02217.x (published online on 28 June 2008)
http://www3.interscience.wiley.com/journal/119412011/abstract

Impact of smoking cessation and lifetime exposure on C-reactive protein
Claire E. Hastie, Sally Haw, Jill P. Pell
Nicotine & Tobacco Research, Volume 10, Issue 4 April 2008, pages 637 - 642
www.informaworld.com/smpp/content~content=a792240791~db=all~order=page

Bar workers' exposure to second-hand smoke: the effect of Scottish smoke-free legislation on occupational exposure
 Sean Semple, Laura Maccalman, Audrey Atherton Naji, Scott Dempsey, Shona
Hilton, Brian G. Miller and Jon G. Ayres
Annals of Occupational Hygiene Advance Access (published online on September 10, 2007)
http://annhyg.oxfordjournals.org/cgi/content/abstract/mem044v1 (BHETSE)

Smoking in the home after the smoke-free legislation in Scotland: qualitative study
 Richard Phillips, Amanda Amos, Deborah Ritchie, Sarah Cunningham-Burley,
Claudia Martin
BMJ, doi:10.1136/bmj.39301.497593.55 (published 9 September 2007)
http://www.bmj.com/cgi/content/full/bmj.39301.497593.55v1

Changes in child exposure to environmental tobacco smoke (CHETS) study after implementation of smoke-free legislation in Scotland: national cross sectional survey
 Patricia C Akhtar, Dorothy B Currie, Candace E Currie, Sally J Haw
BMJ, doi:10.1136/bmj.39311.550197.AE (published 9 September 2007)
http://www.bmj.com/cgi/content/full/bmj.39311.550197.AEv1 (CHETS)

Changes in exposure of adult non-smokers to second-hand smoke after implementation of smoke-free legislation in Scotland: national cross sectional survey
Sally J Haw, Laurence Gruer
BMJ, doi:10.1136/bmj.39315.670208.47 (published 9 September 2007)
http://www.bmj.com/cgi/content/full/bmj.39315.670208.47v1 (HEPS)

Impact of socioeconomic deprivation and type of facility on perceptions of the Scottish smoke-free legislation
 Lorna Richmond, Sally Haw and Jill P. Pell
Journal of Public Health 2007 29(4):376-378; doi:10.1093/pubmed/fdm056
http://jpubhealth.oxfordjournals.org/cgi/content/full/29/4/376

Expectations and changing attitudes of bar workers before and after the implementation of smoke-free legislation in Scotland
 Shona Hilton , Sean Semple , Brian G Miller , Laura MacCalman , Mark Petticrew , Scott Dempsey , Audrey Naji  and Jon G Ayres
BMC Public Health 2007, 7:206 doi:10.1186/1471-2458-7-206
http://www.biomedcentral.com/1471-2458/7/206/abstract (BHETSE)

Secondhand smoke levels in Scottish pubs: the effect of smoke-free legislation
 Sean Semple, Karen S Creely, Audrey Naji, Brian G Miller and Jon G Ayres
Tobacco Control 2007;16:127-132; doi:10.1136/tc.2006.018119
http://tobaccocontrol.bmj.com/cgi/content/full/16/2/127 (BHETSE)

Short-run economic effects of the Scottish smoking ban
 Jérôme Adda, Samuel Berlinski and Stephen Machin
International Journal of Epidemiology 2007 36(1):149-154; doi:10.1093/ije/dyl258
http://ije.oxfordjournals.org/cgi/content/full/36/1/149

Respiratory Symptoms, Pulmonary Function, and Markers of Inflammation Among Bar Workers Before and After a Legislative Ban on Smoking in Public Places
Daniel Menzies; Arun Nair; Peter A. Williamson; Stuart Schembri; Mudher Z. H. Al-Khairalla; Martyn Barnes; Tom C. Fardon; Lesley McFarlane; Gareth J. Magee; Brian J. Lipworth
Journal of the American Medical Association 2006;296:1742-1748.
http://jama.ama-assn.org/cgi/content/full/296/14/1742

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