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Does the model of comprehensive smoke-free ban matter?

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Luke Clancy - Mark Ward
Tobacco Free Research Institute
TFRI Ireland

ICO-WHO Symposium 2012

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Does the model of comprehensive smoke-free ban matter?

  1. 1. Does the model of comprehensive smoke-free ban matter? Mark Ward Luke Clancy ICO-WHO Tobacco Control Symposium Barcelona 5 July 2012
  2. 2. SESLSecondhand smoke Exposure and Smoke-free Legislation
  3. 3. What did SESL aim to do?SESL aimed to provide evidence to support implementation ofcomprehensive Smokefree policy across the European Union inaccordance with Article 8 of the WHO Framework Convention on Tobacco Control The clearest and most rapid support in driving advocacy for Smokefree and Article 8 of the WHO FCTC is to examine the exposure outcome from different models of Smokefree law
  4. 4. Hypothesis (1) Comprehensive laws are the only laws to deliver the full potential of reduction of exposure to second hand smoke. (2) Is the comprehensive nature of the law the only reason forany observed reduction in SHS or are other factors important.
  5. 5. Overarching Objective Examine the relationship between the models of Smokefree legislation and the level of exposure to secondhand smoke in different European countriesto provide the evidence base to enable the legislators to make Smokefree laws which give maximal protection to the population
  6. 6. Countries included (8)Ireland – C – April 2004Italy – C – January 2005Spain – P – January 2006 – C – January 2011Scotland – C – March 2006France – P – January 2007 – C – January 2008Portugal – P – January 2008Greece – P – July 2009 – C – January 2010Turkey – C – July 2009
  7. 7. Table 1: SHS data collection Monitor Duration Conversion Date pre Date post factor Aerocet Jan-Dec 2007 Mar-Nov 2008France Missing Met One 531 8.2 Sidepak Feb 2006 – Jan April-2010Greece 30 mins+ 0.32 AM510 2009 Aerocet Oct-2003 Oct-2004Ireland 3hrs+ Met One 531 None Mar-2004 Mar-2005 x=(y+21.01)/4.01 Nov-Dec 2004 Mar-April 2005 DustTrakItaly 20 mins x=(y+9.1)/ 2.66 & Nov-Dec 8520 2005 SidePak April 2009 July 2010Portugal 30 mins 0.51 AM510 SidePak n/a Oct-Dec 2007Spain Missing 0.51 AM510 April 2009 SidePakTurkey 30 mins 0.23 (Pre) Sept-2010 AM510 Nov-Dec 2009) SidePak Jan-March March-MayScotland 30 mins 0.295 AM510 2007 2007
  8. 8. Table 2: Summary of SHS measurements Overall Range Sig Test R % % change change 63% (-)99% - (+)124 z(112)= -8.364, p < 0.001 -0.54France 40% (-)99% - (+)66% z(14)= -2.291, p < 0.05 -0.43Greece 82% (-)100% - (-)13 z(42)= -5.648, p < 0.001 -0.62Ireland 70% n/a U(61) = 267.0, p < 0.01 -0.36Italy 41% (-)81% - (+)67% z(12)= -2.51, p < 0.05 -0.51Portugal 35% (-)93% - (+)251% z(12)= -0.941, p = 0.347 n/aTurkey 92% (-)99% - (-)12% z(53)= -6.334, p < 0.001 -0.61Scotland
  9. 9. Comparison of PM2.5 concentrations before and after implementation of smoke-free legislation
  10. 10. Table 3: Ecological factors Correlation with p-value r2 change in PM2.5Female participation .460(n=278) p<0.001 0.21GDP per capita .432 (n=278) p<0.001 0.19Minimum hourly wage .404 (n=245) p<0.001 0.16GINI coefficient -.364(n=278) p<0.001 0.13Health expenditure as .358(n=278) p<0.001 0.13% of GDPCorruption -.300(n=278) p<0.001 0.09Trust public institutions .252 (n=278) p<0.001 0.06Life expectancy – Men .244(n=278) p<0.001 0.06Men – Smoking -.478 (n=278) p<0.001 0.23PrevalenceWomen – Smoking n/a(n=278) p=0.051 n/aPrevalenceOverall – Smoking -.171 (n=278) p<0.01 0.03Prevalence
  11. 11. Table 4: Regression analysis of country characteristics, level of legislation and percentage reduction in PM2.5 B β Final R=.469*Level of 28.26* .309 R2=.220enforcement Adjusted R2=.214Smoking -1.56* -.224prevalenceamong men Intercept = 98.82* *p<.001
  12. 12. Key Messages Comprehensive Smoke-free laws work. Partial smoke-free laws do not work as evidenced by their failure toreduce SHS significantly in the hospitality sector in Greece, Portugaland Spain. Developments in Greece and Spain have seen stronger smoke-freelaws put in place and these moves represent an important affirmationof comprehensive laws. Any law, regardless of scope must be actively enforced in order tohave the desired impact. There is a need to continue surveillance in all countries. In particular Greece and Turkey seem to need particular attention .
  13. 13. Fully Comprehensive V ‘Fully’ Comprehensive ?Ire + ScoIta + Fra
  14. 14. Acknowledgements SHS data provided byProf Nazmi Bilir (Turkey)Prof José Alberto Gomes Precioso, Dr Jose Luis Castro, Dr Ana CatarinaSamorinha ,(Portugal)Prof Bertrand Dautzenberg (France)Dr Francesco Forastiere, Dr Pasquale Valente and Dr Giuseppe Gorini(Italy)Professor Pat Goodman and Ms. Marie Mccaffrey (Ireland)Dr Maria José Lopez (Spain)Dr Sean Semple (Scotland)Dr Constantine Vardavas and Prof Panagiotas Behrakis (Greece)
  15. 15. Funding Acknowledgement SESL was funded by the a PfizerTobacco Control and Policy Micro-Grant project

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