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Smoking ban in public places benefits kids’ health

A large new study evaluated the benefits of smoke-free legislation particularly for children before and after birth
A large new study evaluated the benefits of smoke-free legislation particularly for children before and after birth
Robin Wulffson, MD

Although die-hard smokers resent the current smoking restrictions, healthcare professionals and non-smokers applaud them. A large new study evaluated the benefits of smoke-free legislation particularly for children before and after birth. The findings were published online on March 28 in the journal The Lancet by European researchers.

The study authors note that smoke-free legislation has the potential to significantly reduce health problems due to second-hand smoke exposure, particularly in children. Therefore, they conducted a meta-analysis to assess the effect of smoke-free legislation on perinatal (during pregnancy) and child health. A meta-analysis is a compilation of data from a number of studies to clarify a point—in this case, secondhand smoke exposure.

The investigators searched 14 online databases from January 1975 through May 2013. They reviewed published studies in multiple languages; they also reviewed unpublished studies in the World Health Organization (WHO) International Clinical Trials Registry Platform for unpublished studies. They included studies conducted with protocols approved by the Cochrane Effective Practice and Organisation of Care that reported relationships between smoking bans in workplaces, public places, or both. In addition, the selected studies focused on children both before and after birth. The primary outcome measures were preterm birth, low birth weight, and hospital visits for asthma. The data was subjected to statistical analysis.

The researchers included 11 eligible studies, comprising more than 2·5 million births and 247 168 asthma flare-ups. Five studies from North America described local bans and six from Europe described national bans. The possibility of bias was high for one study, moderate for six studies, and low for four studies. They found that smoke-free legislation was related to reductions in preterm birth (four studies, 1,366,862 individuals) and hospital visits for asthma (three studies, 225,753 visits). The investigators did not find a relationship between secondhand smoke exposure and low birth weight.

The authors concluded that smoke-free legislation is associated with significant reductions in preterm births and hospital attendance for asthma. They noted that, together with the health benefits for adults, this study provides strong support for WHO recommendations to produce smoke-free environments.

California's groundbreaking statewide smoke-free law, AB 13, protects millions of Californians from secondhand smoke exposure. In January 1995, many of California's enclosed public places and workplaces went smoke-free, and restaurants and bars went 100% smoke-free in January 1998. Unfortunately, a number of exemptions exist that still allow smoking in some workplaces. Employers with five or fewer employees may allow smoking; however, this does not apply to restaurants and bars. Employers may establish separately ventilated break rooms for smoking under certain stringent conditions. Owner-operated businesses, retail tobacco stores, cigar bars, warehouses of a specific size, hotel lobbies, and other specified workplaces are also exempt.

In 2011, a bill, AB575, was introduced to close many workplace exemptions in California’s smoke-free air law. However, the bill was weakened and is held up in the Senate due to political interference. Previously, in 2007, the California legislature adopted AB1467 to close the loopholes in the smoke-free law; however, unfortunately, then-Governor Schwarzenegger vetoed the bill.

On a positive note, many California communities have adopted local 100% smoke-free laws that are stronger than the state law and close the gaps in indoor coverage, providing workers and the public 100% smoke-free protection in enclosed workplaces and public places. Additionally, many California communities are expanding smoke-free protections to outdoor workplaces and outdoor public places where people gather, such as near building entrances, in service lines, on patio dining areas, and at parks, beaches, community events, and recreation facilities. Starting March 8, 2011 in the City of Los Angeles smoking will be prohibited in outdoor dining areas of restaurants, cafes and food courts and within 10 feet of them. Smoking will also be prohibited within 40 feet of food kiosks, food carts and mobile food trucks. Since March 8, 2011 in Los Angeles, smoking is prohibited in outdoor dining areas of restaurants, cafes, and food courts, as well as within 10 feet of them. Smoking is also prohibited within 40 feet of food kiosks, food carts, and mobile food trucks.