Luke Clancy - Mark Ward Tobacco Free Research Institute TFRI Ireland ICO-WHO Symposium 2012

1. Does the model of comprehensive
smoke-free ban matter?
Mark Ward Luke Clancy
ICO-WHO Tobacco Control Symposium
Barcelona 5 July 2012

2. SESL
Secondhand smoke Exposure and
Smoke-free Legislation

3. What did SESL aim to do?
SESL aimed to provide evidence to support implementation of
comprehensive Smokefree policy across the European Union in
accordance 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. 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 for
any observed reduction in SHS or are other factors important.

5. Overarching Objective
Examine the relationship between the
models of Smokefree legislation
and the
level of exposure to secondhand smoke
in different European countries
to provide the evidence base to enable the legislators to
make Smokefree laws which give maximal protection to
the population

6. Countries included (8)
Ireland – C – April 2004
Italy – C – January 2005
Spain – P – January 2006 – C – January 2011
Scotland – C – March 2006
France – P – January 2007 – C – January 2008
Portugal – P – January 2008
Greece – P – July 2009 – C – January 2010
Turkey – C – July 2009

8. Table 1: SHS data collection
Monitor Duration Conversion Date pre Date post
factor
Aerocet Jan-Dec 2007 Mar-Nov 2008
France Missing
Met One 531 8.2
Sidepak Feb 2006 – Jan April-2010
Greece 30 mins+ 0.32
AM510 2009
Aerocet Oct-2003 Oct-2004
Ireland 3hrs+
Met One 531 None Mar-2004 Mar-2005
x=(y+21.01)/4.01 Nov-Dec 2004 Mar-April 2005
DustTrak
Italy 20 mins x=(y+9.1)/ 2.66 & Nov-Dec
8520
2005
SidePak April 2009 July 2010
Portugal 30 mins 0.51
AM510
SidePak n/a Oct-Dec 2007
Spain Missing 0.51
AM510
April 2009
SidePak
Turkey 30 mins 0.23 (Pre) Sept-2010
AM510
Nov-Dec 2009)
SidePak Jan-March March-May
Scotland 30 mins 0.295
AM510 2007 2007

9. Table 2: Summary of SHS measurements
Overall Range Sig Test R
% % change
change
63% (-)99% - (+)124 z(112)= -8.364, p < 0.001 -0.54
France
40% (-)99% - (+)66% z(14)= -2.291, p < 0.05 -0.43
Greece
82% (-)100% - (-)13 z(42)= -5.648, p < 0.001 -0.62
Ireland
70% n/a U(61) = 267.0, p < 0.01 -0.36
Italy
41% (-)81% - (+)67% z(12)= -2.51, p < 0.05 -0.51
Portugal
35% (-)93% - (+)251% z(12)= -0.941, p = 0.347 n/a
Turkey
92% (-)99% - (-)12% z(53)= -6.334, p < 0.001 -0.61
Scotland

10. Comparison of PM2.5 concentrations before and after implementation of
smoke-free legislation

11. Table 3: Ecological factors
Correlation with p-value r2
change in PM2.5
Female participation .460(n=278) p<0.001 0.21
GDP per capita .432 (n=278) p<0.001 0.19
Minimum hourly wage .404 (n=245) p<0.001 0.16
GINI coefficient -.364(n=278) p<0.001 0.13
Health expenditure as
.358(n=278) p<0.001 0.13
% of GDP
Corruption -.300(n=278) p<0.001 0.09
Trust public institutions .252 (n=278) p<0.001 0.06
Life expectancy – Men .244(n=278) p<0.001 0.06
Men – Smoking -.478 (n=278) p<0.001 0.23
Prevalence
Women – Smoking n/a(n=278) p=0.051 n/a
Prevalence
Overall – Smoking -.171 (n=278) p<0.01 0.03
Prevalence

12. 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=.220
enforcement Adjusted
R2=.214
Smoking -1.56* -.224
prevalence
among men
Intercept = 98.82* *p<.001

13. Key Messages
 Comprehensive Smoke-free laws work.
 Partial smoke-free laws do not work as evidenced by their failure to
reduce SHS significantly in the hospitality sector in Greece, Portugal
and Spain.
 Developments in Greece and Spain have seen stronger smoke-free
laws put in place and these moves represent an important affirmation
of comprehensive laws.
 Any law, regardless of scope must be actively enforced in order to
have the desired impact.
 There is a need to continue surveillance in all countries.
 In particular Greece and Turkey seem to need particular attention .

14. Fully Comprehensive
V
‘Fully’ Comprehensive ?
Ire + Sco
Ita + Fra

15. Acknowledgements
SHS data provided by
Prof Nazmi Bilir (Turkey)
Prof José Alberto Gomes Precioso, Dr Jose Luis Castro, Dr Ana Catarina
Samorinha ,(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)

16. Funding Acknowledgement
SESL was funded by the a Pfizer
Tobacco Control and Policy Micro-Grant project