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Legislative smoking bans for reducing harms from secondhand smoke exposure, smoking prevalence and tobacco consumption

Feb 4th, 2016
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http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005992.pub3/abstract

Abstract

Background

Smoking bans have been implemented in a variety of settings, as well as being part of policy in many jurisdictions to protect the public and employees from the harmful effects of secondhand smoke (SHS). They also offer the potential to influence social norms and the smoking behaviour of those populations they affect. Since the first version of this review in 2010, more countries have introduced national smoking legislation banning indoor smoking.

Objectives

To assess the effects of legislative smoking bans on (1) morbidity and mortality from exposure to secondhand smoke, and (2) smoking prevalence and tobacco consumption.

Search methods

We searched the Cochrane Tobacco Addiction Group Specialised Register, MEDLINE, EMBASE, PsycINFO, CINAHL and reference lists of included studies. We also checked websites of various organisations. Date of most recent search; February 2015.

Selection criteria

We considered studies that reported legislative smoking bans affecting populations. The minimum standard was having an indoor smoking ban explicitly in the study and a minimum of six months follow-up for measures of smoking behaviour. Our search included a broad range of research designs including: randomized controlled trials, quasi-experimental studies (i.e. non-randomized controlled studies), controlled before-and-after studies, interrupted time series as defined by the Cochrane Effective Practice and Organisation of Care Group, and uncontrolled pre- and post-ban data.

Data collection and analysis

One author extracted characteristics and content of the interventions, participants, outcomes and methods of the included studies and a second author checked the details. We extracted health and smoking behaviour outcomes. We did not attempt a meta-analysis due to the heterogeneity in design and content of the studies included. We evaluated the studies using qualitative narrative synthesis.

Main results

There are 77 studies included in this updated review. We retained 12 studies from the original review and identified 65 new studies. Evidence from 21 countries is provided in this update, an increase of eight countries from the original review. The nature of the intervention precludes randomized controlled trials. Thirty-six studies used an interrupted time series study design, 23 studies use a controlled before-and-after design and 18 studies are before-and-after studies with no control group; six of these studies use a cohort design. Seventy-two studies reported health outcomes, including cardiovascular (44), respiratory (21), and perinatal outcomes (7). Eleven studies reported national mortality rates for smoking-related diseases. A number of the studies report multiple health outcomes. There is consistent evidence of a positive impact of national smoking bans on improving cardiovascular health outcomes, and reducing mortality for associated smoking-related illnesses. Effects on respiratory and perinatal health were less consistent. We found 24 studies evaluating the impact of national smoke-free legislation on smoking behaviour. Evidence of an impact of legislative bans on smoking prevalence and tobacco consumption is inconsistent, with some studies not detecting additional long-term change in existing trends in prevalence.

Authors’ conclusions

Since the first version of this review was published, the current evidence provides more robust support for the previous conclusions that the introduction of a legislative smoking ban does lead to improved health outcomes through reduction in SHS for countries and their populations. The clearest evidence is observed in reduced admissions for acute coronary syndrome. There is evidence of reduced mortality from smoking-related illnesses at a national level. There is inconsistent evidence of an impact on respiratory and perinatal health outcomes, and on smoking prevalence and tobacco consumption.

Plain language summary

Does legislation to ban smoking reduce exposure to secondhand smoke and smoking behaviour?

Since the first national legislation banning indoor smoking in all public places was introduced in 2004, there has been an increase in the number of countries, states and regions adopting similar smoke-free legislation banning smoking in public places and work places since this review was first published. The main reason is to protect nonsmokers from the harmful health effects of exposure to secondhand smoke. Another reason is to provide a supportive environment for people who want to quit smoking.

Study characteristics

We searched for studies that investigated the effect of introducing a ban on any measures of health, or on smoking behaviour (up to February 2015). Since the previous version of this review had shown clear evidence that introducing legislation to ban smoking in public places does reduce exposure to secondhand smoke (SHS) in those places, we did not include studies that only reported exposure to SHS. We included 77 studies from 21 countries in this updated review. Studies of health outcomes typically used data from hospitals to look for changes in rates of admissions, discharges or deaths. Most studies looked at illnesses related to the cardiovascular system (heart or blood vessels), such as heart attacks and strokes. Studies also looked at effects on respiratory health, including chronic obstructive pulmonary disease (e.g. bronchitis), asthma and lung function. Seven studies looked at the health of newborn children. Eleven studies reported death rates. The best-quality studies collected data at multiple time points before and after the introduction of a ban in order to adjust for existing time trends. Some studies could compare events rates in areas with and without bans, or where bans were introduced at different times.

Key results

There is evidence that countries and their populations benefit from improved health after introducing smoking bans, importantly to do with the heart and blood vessels. We found evidence of reduced deaths. The impact of bans on respiratory health, on the health of newborn children, and on reducing the number of smokers and their cigarette use is not as clear, with some studies not detecting any reduction.

Quality of the evidence

Legislative bans have not been evaluated by randomized trials, and the quality of the evidence from the types of studies contributing to this review is lower. Changes in health outcomes could be due to other things, such as change in healthcare practices. However, many of the studies used methods of analysis that could control for underlying trends, and increase our confidence that any changes are caused by the introduction of bans.

Secondhand smoke is bad for pets too, and makes dogs fat, study shows

Dec 30th, 2015
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Cats who live with smokers have it even worse than dogs, perhaps because they groom themselves so much, University of Glasgow research finds

Secondhand smoke is bad for pets as well as people, the University of Glasgow says, citing an ongoing study into the effects of secondhand smoke on dogs and cats.

Research under way at the Scottish institution has found that pets living in a smoky environment have a higher risk of health problems including some animal cancers, cell damage and weight gain.

“Pet owners often do not think about the impact that smoking could have on their pets,” said Clare Knottenbelt, professor of small animal medicine and oncology. “Our findings show that exposure to smoke in the home is having a direct impact on pets.

“It risks ongoing cell damage, increasing weight gain after castration and has previously been shown to increase the risk of certain cancers.”

While dogs can take in significant amounts of smoke, the university study shows cats are “even more affected”.

“This may be due to the extensive self-grooming that cats do, as this would increase the amount of smoke (chemicals) taken in to the body,” said Knottenbelt.

The research so far has found that while outdoor access made little difference for cats, smoking away from them did reduce the amount taken into the body.

It has found that when smokers light up fewer than 10 times a day, nicotine levels dropped significantly, but were nonetheless noticeably higher than in cats from non-smoking homes.

An examination of the testicles of castrated dogs found that a gene, which acts as a marker of cell damage, was higher in dogs living in smoking homes.

Dogs living with a smoker also gained more weight after neutering.

The finished research paper is expected to be published in 2016.
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Source URL: http://www.scmp.com/lifestyle/health-beauty/article/1896500/secondhand-smoke-bad-pets-too-and-makes-dogs-fat-study-shows?cx_tag=recommend_desktop

Workers harmed in Florence restaurants that allow smoking

Nov 1st, 2015
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http://www.fox10tv.com/story/30400202/workers-harmed-in-florence-restaurants-that-allow-smoking

FLORENCE, Ala. (AP) – A new air quality study says workers in a Florence restaurant that allow smoking are exposed to a greater amount harmful air particles than those working in non-smoking environments.

The TimesDaily reports (http://bit.ly/1NI9mZr ) that the study says workers in smoking-allowed restaurants are exposed to a 66 percent higher rate than the opposite. It was released this week by the Partnership for a Tobacco-Free Shoals and Smoke-Free Shoals. The results were performed by Roswell Park Cancer Institute this year.

The air in six smoke-free restaurants and six restaurants that allow smoking was tested.

An official from the Partnership for a Tobacco-Free Shoals says the level of harmful air particles measured in bars and restaurants that allow smoking was higher than the level found in forest fires.

National smoke-free law needed: WHO

Oct 20th, 2015
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http://www.ecns.cn/2015/10-20/184913.shtml

Some 740 million people in China, including 182 million children, are exposed to second-hand smoke at least once a day in a week, leading to 100,000 Chinese deaths every year, said the latest report of the World Health Organization (WHO) on Monday.

According to the report released at a press conference in Beijing, more than 1 million people die each year in China from tobacco-related illnesses, and the number is expected to triple by 2050 if the smoking habit continues.

The report, jointly released by the WHO, the International Tobacco Control Policy Evaluation Project and the Chinese Center for Disease Control and Prevention (CDC), was based on a survey conducted between 2006 and 2014 in seven cities, including Beijing, Guangzhou in Guangdong Province and Shanghai. The data were collected from 5,600 adult smokers and 1,400 non-smokers.

Liang Xiaofeng, CDC’s deputy director, said China, the world’s largest tobacco producer and consumer, has over 300 million smokers, some 53 percent of whom are male, news site thepaper.cn reported on Monday.

About 72 percent of non-smokers aged 15 and above have been suffering from second-hand smoke, he said.

A survey conducted between 2013 and 2014 showed that 72.9 percent of junior high students were exposed to second-hand tobacco smoke at home, at indoor and outdoor public spaces, or in public vehicles.

“China has the highest rate of smoking in workplaces and homes, and among the highest rates in restaurants and bars. This puts the health of millions of non-smokers at risk every single day,” Dr Geoffrey T. Fong, principal investigator of the ITC Project, said at the conference.

“China’s addiction to tobacco is taking a dreadful toll on its health, its society, and its economy. A national smoke-free law is the only way to effectively protect all of China’s population from the harms of tobacco smoke – and the report we are releasing today demonstrates the urgent importance of this,” said Dr Bernhard Schwartländer, WHO Representative in China.

Beijing has implemented what WHO called “the strongest smoking ban” from June 1, requiring all indoor public places to be 100 percent smoke-free.

“Beijing’s comprehensive law sets an example for the whole country. Although there have been some smoke-free policies in other Chinese cities, they have been poorly enforced. We need more stringent laws, effective enforcement and mass education campaigns to enlighten people about the dangers of inhaling second-hand smoke,” said Liang.

The report also shows relatively high levels of support for smoke-free policies in China. According to a survey conducted between September 2011 and November 2012 in seven major Chinese cities, including Beijing, over half or close to half of smokers in each city supported a complete ban on smoking indoors.

Heated Tobacco Products Create Side-Stream Emissions: Implications for Regulation

Oct 15th, 2015
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Particulate Matter from Electronic Cigarettes and Conventional Cigarettes

Oct 9th, 2015
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Investigating link between thirdhand smoke and cancer

Sep 28th, 2015
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http://universityofcalifornia.edu/news/5452/investigating-link-between-thirdhand-smoke-and-cancer

Thirdhand smoke is a new frontier, and UC’s Tobacco-Related Disease Research Program has assembled a group of investigators, including at Berkeley Lab and UCSF, to study the health risks caused by the remnants of cigarette smoke.

Lawrence Berkeley National Laboratory researchers have been awarded US$1.3 million for two sets of studies to better understand the health impacts of thirdhand smoke, the noxious residue that clings to virtually all indoor surfaces long after the secondhand smoke from a cigarette has cleared out.

The two three-year grants are from the Tobacco-Related Disease Research Program (TRDRP), which is managed by the University of California and funded by state cigarette taxes. In one set of studies, life science researchers will seek to confirm the link between thirdhand smoke and cancer, identifying the mechanisms and biomarkers. In the second set of studies, environmental chemists will seek to characterize the components of thirdhand smoke, including investigating the differences between atmospheric particulate matter versus that in tobacco smoke.

“These two grants represent the largest annual total in the history of the TRDRP to Berkeley Lab and affirm that we remain on the cutting edge of research in this area,” said Berkeley Lab chemist Hugo Destaillats. “Working with our collaborators over the years, Berkeley Lab has made many important findings on thirdhand smoke, and now we’re excited to use new approaches to better quantify its harm to human health.”

Warnings date back years

Berkeley Lab scientists first sounded the warning on thirdhand smoke with a pair of studies in 2010 establishing that nicotine in thirdhand smoke can react with common indoor air pollutants to produce dangerous carcinogens.

Since then, TRDRP has funded further studies, including one in 2013 led by Berkeley Lab biochemist Bo Hang that found that thirdhand smoke can cause significant genetic damage in human cells. Genotoxicity is associated with the development of diseases and is a critical mechanism responsible for many types of cancer caused by smoking and secondhand smoke exposure.

This body of work led to a California law banning smoking inside daycare centers due to the lingering effects of thirdhand smoke.

“We have established that components in thirdhand smoke do cause DNA damage,” said Hang. “Now we want to look for more evidence of genomic instability and also confirm the link with cancer by finding the mechanisms and biomarkers.”

Gathering data from two studies

To accomplish this, the researchers from Berkeley Lab’s Life Sciences Division will conduct two studies. First, using next-generation toxicological approaches, such as exome sequencing of the whole genome and bioinformatics for analyzing mutation patterns, Hang hopes to further characterize the cancer risk of cells and tissues exposed to thirdhand smoke.

Second, Berkeley Lab geneticist Jian-Hua Mao will use a genetically diverse population of mice to investigate how components of thirdhand smoke cause genetic damage. “Just like humans, mice can have big variations in how susceptible they are to cancer,” Mao said. “We will investigate the dose-response relationship and threshold of detection in certain cells and tissues, and also see if the results lead us to biomarkers of thirdhand smoke exposure.”

Additionally he will look at four time periods in the mouse lifetime — perinatal, postnatal, puberty and young adult — to determine if there are “windows of susceptibility.” “We always say that thirdhand smoke is especially dangerous for kids and babies, but we don’t have concrete evidence,” Hang said. “This should answer that question.”

The other set of studies, led by Destaillats working with Berkeley Lab scientists Lara Gundel and Jennifer Logue, will look at the particulate matter in thirdhand smoke, or PM2.5, particles smaller than 2.5 micrometers in size. “We know particles may account for as much as 90 percent of the harm,” Destaillats said. “But given the lack of toxicological and epidemiological data on tobacco particles, the health data we currently use comes from studies on outdoor atmospheric particles. This more targeted study will shed light on how thirdhand smoke particles compare with atmospheric particles.”

Destaillats, Gundel, and Logue will also further characterize the composition and chemistry of thirdhand smoke. “We have a pretty good idea what’s emitted by cigarettes and the evolution of the components­ — some react, some are absorbed, some disappear,” Gundel said. “But there are still unidentified components in thirdhand smoke.”

Berkeley Lab is a member of the California Consortium on Thirdhand Smoke, which was established in 2011. Other members include UC San Francisco, UC Riverside, the University of Southern California, and San Diego State University.

Why e-cigarettes have their own toxic dangers

Sep 3rd, 2015
by AdminCTA.
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Formaldehyde Exposures Resulting From Use Of Electronic Cigarette Devices

Sep 2nd, 2015
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Big tobacco should be excluded from the TPPA

Aug 25th, 2015
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http://www.stuff.co.nz/dominion-post/comment/71394377/big-tobacco-should-be-excluded–from-the-tppa

PHILIP PATTEMORE

The TPPA may stop New Zealand become smokefree on schedule.

OPINION: Most of us are familiar with the cost to personal health from smoking tobacco, and from passive exposure of children and others who have no choice to tobacco smoke. Tobacco is the largest preventable cause of mortality worldwide – every year 6 million people (more than the population of New Zealand) die from smoking, and another 600,000 die from passive exposure to tobacco smoke. Globally, 50 per cent of children are exposed (UN estimates).

That’s why the majority of people, including smokers in this country, want stronger regulation and more taxes. New Zealand doctors and nurses are therefore deeply concerned about the protections and rights given to tobacco corporations by the Trans Pacific Partnership Agreement (TPPA) .

But its not just smokers and their families that are adversely affected by tobacco. Few people are aware of the environmental and human costs of farming and processing tobacco particularly in developing countries. Tobacco plants displace food crops, and cause serious nicotine poisoning in farmers and tobacco workers (often children). Curing the green Virginia tobacco leaf requires huge amounts of firewood, mostly obtained in these countries by cutting down forests, and consequently contributing to landslides, water catchment disruption, flooding and loss of biodiversity.

Two tobacco leaf merchants and four multinational cigarette companies control the international tobacco market, and reap massive profits. The corporations are currently using their financial and legal muscle to challenge tobacco control public health legislation in Uruguay, Australia and other countries. Defending this challenge in Uruguay was so expensive that the government was about to repeal the law before being rescued by the Bloomberg Philanthropic Trust and the Gates Foundation.

Australia believes that they were fully entitled to make tobacco plain packaging laws. However it has already cost the Australian government an estimated 50 million dollars contesting first part of the tobacco company challenge – simply establishing that there is no basis for that challenge.

Given these facts it is greatly concerning but perhaps not surprising that these tobacco corporations, along with other corporations, have had access to the Trans Pacific Partnership Agreement texts that have been denied to New Zealand citizens and health analysts.

Within the United States there have been strong calls from many to “carve” tobacco out of trade agreements. This has been opposed by other politicians protecting the financial interests of their tobacco growing states and the heavyweight US Chamber of Commerce. This lobbying group for large businesses, with its worldwide affiliates, use their influence to challenge tobacco control measures, such as warning labels on cigarette packs. In Ukraine their influence was used to bring a World Trade Organisation dispute against Australia for their plain packaging legislation, even though Ukraine does not export tobacco to Australia. In Nepal the Chamber affiliates have challenged and delayed the implementation of graphic labels for cigarette packages. It is an organisation that seems willing, even determined to make things difficult for health in poor countries.

The TPPA gives giant tobacco corporations and their ethically-challenged supporting offices unprecedented entry into our country’s public health policies.

New Zealand has dragged its feet implementing plain packaging laws for tobacco. Australia took 19 months, Ireland 22 months and the UK 35 months; we’re 38 months and still awaiting a second reading of the bill. The most likely reason is the one given by John Key in 2013 – we need to wait and see what happens to the challenge in Australia. In other words we have suffered a “chill” based on our existing agreements, and Australia’s case, and here we are about to hand over yet more power to the tobacco corporations. How will TPPA nations like Vietnam have the resources to tackle this issue if we don’t?

Globally, there are even bigger risks to health: other investment agreements that will likely cross fertilise with the TPPA. The Regional Comprehensive Economic Partnership and PACER Plus negotiations include some of the poorest nations on the planet. If we let the TPPA lock in the ability of big tobacco companies to sue New Zealand we will risk making our Asian and Pacific neighbors (such as Kiribati, Vanuatu, Myanmar and Cambodia) susceptible to that same toxic and unethical power.

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New Zealand is the first nation to set a date to be smokefree. However, we are not shaping up well to achieve the Government’s own target of a Smokefree Aotearoa by 2025.. Our Government needs to be consistent in its commitment to this goal..

We should have nothing to do with an industry that has such a chilling reputation for making its billions from death, disease and environmental degradation. We need to tell them and their American and Japanese representatives that, just as New Zealand rejoices in being nuclear-free, we are determined to become the world’s first smokefree nation.

Philip Pattemore is an associate professor of paediatrics at Otago University, and wrote this on behalf of Doctors for Healthy Trade.

– The Dominion Post

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