HAVE SMOKING BANS AFTER WHO FCTC WORKED IN REDUCING HARMS OF PASSIVE SMOKING?
Cecily Kelleher. University College Dublin
The FCTC is the first international treaty negotiated under the auspices of WHO and multi- component tobacco control strategies are much needed to combat the ongoing threat to public health of both active and passive smoking. There is emerging evidence that legislative smoking bans at region and country level are having a health impact. Our group’s first Cochrane review, published in 2010 (Callinan et al, 2010), aimed to assess the extent to which legislative smoking bans reduced passive smoke exposure, helped people who wished to do so, to quit smoking and what health impacts were. Bans are the result of policy action and are rarely evaluated in a formal randomized controlled trial for a variety of logistical reasons, being quasi experimental in form. The data are therefore observational. Of 50 studies identified in the first review, all had measures of second- hand smoke (SHS) exposure and requisite pre and post ban data. There was clear evidence of reduced exposure to SHS in these studies, the effect on active smoking was less consistent, in part from paucity of data. In the 2016 follow-up a much larger literature was found and the updated review concentrated on studies with health impact information; 77 studies were identified with a number of health outcomes, the most consistent evidence was on cardiovascular outcomes.
The Republic of Ireland was the first country to ban smoking outright in 2004 and our university teaching hospital instituted a campus wide ban in 2009. We conducted a further systematic review of institutional smoking bans since 2005, the date from which country-wide bans became more frequent. Of 17 studies identified, 12 were in hospitals, 3 in prisons and 2 in universities. A pooled analysis of 11 of these studies showed a significant impact on active smoking in these settings. Overall the quality of the data in systematic terms remains relatively low however. Settings bans have a key role to play in multi-component strategies and further robust studies with controlled designs and longer follow-up are needed, as well as studies that focus on vulnerable and disadvantaged groups.
Cecily Kelleher (DMed, MD FRCPI, MPH, FFPHMI) is Chair of Public Health Medicine and Epidemiology, Consultant in Preventive Medicine and Principal of the College of Health and Agricultural Sciences at University College Dublin. She has over 500 published papers, reports and abstracts and has research interests in health promotion, health inequalities and in cardiovascular, nutritional and lifecourse epidemiology. She has served on numerous National and International advisory bodies. She was instrumental in implementing an outright campus ban in her teaching hospital, which has won an ENSH gold-level International award and is senior author on three Cochrane systematic reviews on the impact of legislative smoking bans.