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National (enforced) smoking bans improve health outcomes, Cochrane review shows

National smoking bans do reduce the harms of passive smoking, specifically cardiovascular disease, an updated systematic review from the Cochrane Library has found.1

Since the first version of this review in 2010, more countries have introduced national legislation to ban indoor smoking. The authors said that the updated review provided the most robust evidence yet that smoking bans have led to improved health outcomes.

A team of researchers based in Ireland included 77 studies, representing 21 countries, that investigated the effect of introducing a smoking ban on any measures of health or on smoking behaviour. They retained 12 studies from the original review and identified 65 new studies. Health outcomes were reported in 72 studies, of which 44 specifically assessed cardiovascular disease, 21 assessed respiratory disease, and seven assessed perinatal outcomes.

The review found consistent evidence of a positive effect from national smoking bans on improving cardiovascular health outcomes and reducing mortality from associated smoking related illnesses.

The clearest evidence it found was in reduced admissions for acute coronary syndrome. For example, one study in Ireland found a 12% reduction in admissions for acute coronary syndrome in the first year after the smoking ban, and another Irish study found an 18% reduction.

The greatest reductions in admissions for heart disease after smoking bans were identified in populations of non-smokers, the researchers found. Overall, they said that the evidence was of moderate quality in relation to cardiovascular disease.

But the effects of smoking bans on respiratory and perinatal health were found to be less consistent. Six of the 11 studies reported considerable reductions in admissions for chronic obstructive pulmonary disease, and seven of 12 reported considerable reductions in hospitalisations for asthma. In the seven studies looking at perinatal health the data produced conflicting results, and the study authors said that more research was needed in this area.

The review found 24 studies evaluating the effect of national smoke-free legislation on smoking behaviour. Evidence of an effect from legislative bans on smoking prevalence and tobacco consumption was found to be inconsistent, as some studies did not detect any additional change in existing prevalence trends.

Cecily Kelleher, a review author based at University College Dublin, said, “The current evidence provides more robust support for the previous conclusions that the introduction of national legislative smoking bans does lead to improved health outcomes through a reduction in secondhand smoke exposure for countries and their populations.

“We now need research on the continued longer term impact of smoking bans on the health outcomes of specific sub-groups of the population, such as young children [and] disadvantaged and minority groups.”

BMJ 2016; 352 doi: (Published 04 February 2016) Cite this as: BMJ 2016;352:i701

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