National evaluation of Scotland's smoke-free legislation

On 11th September 2007, at the conclusion of the international "Towards a smoke-free society" conference, the Scottish Government Minister for Public Health endorsed a 10-point plan for the future of tobacco control in Europe. The 'Edinburgh Statement' will be presented to the European Parliament for consideration for future no-smoking policies across the EU.

Some of the main points in the statement are:

all people should be protected from second-hand smoke and all indoor workplaces and public places should be smoke-free
that all 196 countries who have signed up to the Framework Convention on Tobacco Control are urged to implement comprehensive smoke free legislation within five years
the European Commission is invited to produce a proposal on how legislative safeguards against second hand smoke can be promoted in EU countries that have not introduced smoke-free laws
governments are urged to monitor the activity of the tobacco industry and to consider tighter regulation and control of production
governments are urged to act on their responsibility to protect and discourage children and young people from starting to smoke.

Read the Edinburgh Statement in full

Evaluation of Scotland's smoke-free legislation

On 10th September 2007 the Scottish Government announced that the smoking ban had brought positive results. (Scottish Government press release 10th September 2007)

A study of nine Scottish hospitals has 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 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 secondhand 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.

Papers published to date

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

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

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

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 doi: 10.1080/14622200802443510
http://www.informaworld.com/content=10.1080/14622200802443510

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

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

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

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

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

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

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

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

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

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

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

Useful links:
The Edinburgh Statement
Programme and presentations from "Towards a smoke-free society" conference
Smoke-free success: ASH Scotland presents the Scottish experience
Smoke-free legislation in Scotland
Global Smoke-free Partnership: Briefing on smoke-free and the framework convention