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Changes in Exposure of Adult Nonsmokers to Secondhand Smoke After Scotlands Smokefree Legislation

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Non-smoking Hhold. OR=1.49 (95% CI 1.26 to 1.76); P 0.001. Smoking Restrictions in Cars ... the legislation seem to be non-smokers living in non-smoking homes ... – PowerPoint PPT presentation

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Title: Changes in Exposure of Adult Nonsmokers to Secondhand Smoke After Scotlands Smokefree Legislation


1
Changes in Exposure of Adult Non-smokers to
Secondhand Smoke After Scotlands Smokefree
Legislation
  • Sally Haw Laurence Gruer
  • NHS Health Scotland

2
Health Education Population Survey (HEPS)
  • Household survey of mainland Scotland conducted
    in most years since 1996
  • To monitor health related attitudes and behaviour
  • Data collected in 2 waves per year to give
    probability sample of 1800 adults (aged 16 to 74
    years).
  • Addresses selected from Royal Mail post code
    address file using multi-stage, cluster random
    sampling strategy.
  • Post code sectors stratified by Carstairs
    deprivation index within each of the 14
    administrative NHS areas.

3
Study of Change in Adult Exposure to Secondhand
Smoke
  • Module of questions added to core HEPS
    questionnaire
  • Estimated length of exposure in public and
    private places in previous 7 days
  • Smoking restrictions in homes and cars
  • Attitudes towards legislation
  • Saliva sample for testing for cotinine
  • Baseline data collection September 05 to March
    06
  • Post legislation sample September 06 to April 07

4
Respondent Profile
  • Total sample
  • Baseline N1815
  • Post-legislation N1834
  • Non-smoker sample
  • Baseline sample N1170 (64.4)
  • Post-legislation sample N1190 (64.9)
  • Samples similar in sex, age, smoking status,
    provision of sample.
  • Small differences marital status (Plt0.05), years
    in education (Plt0.01) and deprivation category
    (Plt0.05).

5
Non-smokers with valid Cotinine Measurement
  • Sample provided
  • Pre-legislation 56.0 (N655)
  • Post-legislation 51.2 (N609)
  • Valid cotinine measurement
  • sample provided Pre-legislation 53.6 (N627)
  • Post-legislation 49.7 (N592)
  • Respondents who provided valid similar in sex,
    age, marital status, years in education and
    smoking status
  • Differences in deprivation category of place of
    residence
  • Post legislation respondents from most deprived
    less likely to provide sample (Plt.001).

6
Distribution of Salivary Cotinine Concentration
7
Distribution of Salivary Cotinine Concentration
8
Impact of Smokefree Legislation
  • Analysis of covariance (ANCOVA)
  • Independent variables
  • Smoking ban
  • Household smoking status
  • Covariates
  • Sex
  • Years in education
  • Carstairs deprivation category

9
Changes in Geometric Mean Cotinine
Adjusted reduction 39 (95CI, 29 to 47
Plt0.001)
10
Change in Geometric Mean Cotinine by Household
Smoking Status
Non-smoking adjusted reduction 49 (95CI, 40
to 56 Plt0.001) Smoking adjusted reduction 16
(95CI, -11 to 37 ns)
11
Reported Exposure to Secondhand Smoke in
Different Locations


12
Reported Exposure to Secondhand Smoke in
Different Locations


13
Smoking Restrictions in Homes
Smoking Hhold
Non-smoking Hhold
OR1.49 (95 CI 1.26 to 1.76) Plt0.001
14
Smoking Restrictions in Homes
Smoking Hhold
Non-smoking Hhold
OR1.49 (95 CI 1.26 to 1.76) Plt0.001
15
Smoking Restrictions in Homes
Smoking Hhold
Non-smoking Hhold
OR1.49 (95 CI 1.26 to 1.76) Plt0.001
16
Smoking Restrictions in Homes
Smoking Hhold
Non-smoking Hhold
OR1.49 (95 CI 1.26 to 1.76) Plt0.001
17
Smoking Restrictions in Cars
Smoking Hhold
Non-smoking Hhold
18
Smoking Restrictions in Cars
Smoking Hhold
Non-smoking Hhold
19
Smoking Restrictions in Cars
Smoking Hhold
Non-smoking Hhold
20
Smoking Restrictions in Cars
Smoking Hhold
Non-smoking Hhold
OR 0.86 (95 CI 0.65 to 1.13) Pgt0.05
21
Conclusions
  • Legislation to prohibit smoking in public places
    resulted in a large reduction in adults
    non-smokers exposure to secondhand smoke across
    a whole population
  • After implementation of the legislation, exposure
    to secondhand smoke was reduced in all public and
    work places but not in the home or private cars
  • The legislation did not result in increased
    exposure to secondhand smoke in the homes of
    non-smokers who lived with other smokers
  • The main beneficiaries of the legislation seem to
    be non-smokers living in non-smoking homes

22
Implications
  • Reductions in exposure may generate health gains
    but without further action on smoking in private
    places these are likely to accrue to non-smokers
    living in non-smoking households.
  • Legislation on smoking in cars may be acceptable.
  • Raise awareness of risks of SHS and even at low
    levels of exposure non-smokers are at heightened
    risk.
  • Promote smoking cessation.
  • Further research to determine most effective way
    of promoting smoke-free homes and cars.
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