1115p4a Hawtintotues
Document Sample
Changes in Exposure of Adult Nonsmokers to Secondhand Smoke After Scotland’s Smokefree Legislation Sally Haw & Laurence Gruer NHS Health Scotland 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. 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 Respondent Profile • • • • • • Total sample Baseline: N=1815 Post-legislation: N=1834 Non-smoker sample Baseline sample: N=1170 (64.4%) Post-legislation sample: N=1190 (64.9%) Samples similar in sex, age, smoking status, provision of sample. Small differences marital status (P<0.05), years in education (P<0.01) and deprivation category (P<0.05). Non-smokers with valid Cotinine Measurement • Sample provided Pre-legislation: 56.0% (N=655) Post-legislation: 51.2% (N=609) • Valid cotinine measurement sample provided Pre-legislation: 53.6% (N=627) Post-legislation: 49.7% (N=592) • 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 (P<.001). Distribution of Salivary Cotinine Concentration 400 Number of samples 300 200 Pre-legislation 100 0 .7 13 07. w lo Be LO 9 0. 10. D* Salivary cotinine concentration (ng/m l) 9 1. 01. 9 2. 02. 9 3. 03. 9 4. 04. 9 5. 05. 9 6. 06. Distribution of Salivary Cotinine Concentration 400 Number of samples 300 Pre-legislation Post-legislation 200 100 0 .7 13 07. w lo Be LO 9 0. 10. D* Salivary cotinine concentration (ng/m l) 9 1. 01. 9 2. 02. 9 3. 03. 9 4. 04. 9 5. 05. 9 6. 06. Impact of Smokefree Legislation • Analysis of covariance (ANCOVA) Independent variables • Smoking ban • Household smoking status Covariates • Sex • Years in education • Carstairs deprivation category Changes in Geometric Mean Cotinine 0.6 Adjusted GM Cotinine (ng/ml) 0.5 0.4 0.3 0.2 0.1 0 Pre-ban Post-ban 0.43 0.26 Adjusted reduction: 39% (95%CI, 29% to 47%; P<0.001) Change in Geometric Mean Cotinine by Household Smoking Status 1.2 Adjusted GM Cotinine (ng/ml) 1 0.8 0.6 0.4 0.2 0 0.92 0.81 Non-smoking households Smoking households 0.35 0.18 Pre-ban Post-ban Non-smoking: adjusted reduction 49% (95%CI, 40% to 56%; P<0.001) Smoking: adjusted reduction 16% (95%CI, -11% to 37% ns) Reported Exposure to Secondhand Smoke in Different Locations 40 % Observing Smoking 30 20 10 0 Own home Others home Car Work Pub/ bar Public trans Pre-legislation Reported Exposure to Secondhand Smoke in Different Locations 40 % Observing Smoking 30 20 10 0 Own home Others home Car Work Pub/ bar Public trans Pre-legislation Post-legislation Smoking Restrictions in Homes 100% 80% 60% % 40% 20% 0% Pre-ban Post-ban Pre-ban Post-ban Non-smoking Hhold Smoking Hhold Unrestricted Partial Ban Complete ban OR=1.49 (95% CI 1.26 to 1.76); P<0.001 Smoking Restrictions in Homes 100% 80% 60% % 40% 20% 0% Pre-ban Post-ban Pre-ban Post-ban Non-smoking Hhold Smoking Hhold Unrestricted Partial Ban Complete ban OR=1.49 (95% CI 1.26 to 1.76); P<0.001 Smoking Restrictions in Homes 100% 80% 60% % 40% 20% 0% Pre-ban Post-ban Pre-ban Post-ban Non-smoking Hhold Smoking Hhold Unrestricted Partial Ban Complete ban OR=1.49 (95% CI 1.26 to 1.76); P<0.001 Smoking Restrictions in Homes 100% 80% 60% % 40% 20% 0% Pre-ban Post-ban Pre-ban Post-ban Non-smoking Hhold Smoking Hhold Unrestricted Partial Ban Complete ban OR=1.49 (95% CI 1.26 to 1.76); P<0.001 Smoking Restrictions in Cars 100% 80% 60% % 40% 20% 0% Pre-ban Post-ban Pre-ban Post-ban Non-smoking Hhold Smoking Hhold Unrestricted Partial Ban Complete ban Smoking Restrictions in Cars 100% 80% 60% % 40% 20% 0% Pre-ban Post-ban Pre-ban Post-ban Non-smoking Hhold Smoking Hhold Unrestricted Partial Ban Complete ban Smoking Restrictions in Cars 100% 80% 60% % 40% 20% 0% Pre-ban Post-ban Pre-ban Post-ban Non-smoking Hhold Smoking Hhold Unrestricted Partial Ban Complete ban Smoking Restrictions in Cars 100% 80% 60% % 40% 20% 0% Pre-ban Post-ban Pre-ban Post-ban Non-smoking Hhold Smoking Hhold Unrestricted Partial Ban Complete ban OR= 0.86 (95% CI 0.65 to 1.13); P>0.05 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 nonsmokers living in non-smoking homes 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.
