This document summarizes evidence from two Cochrane reviews on the impact of smoking bans. The 2010 review found that smoking bans reduced exposure to secondhand smoke in workplaces and public places. There was emerging evidence that bans reduced acute coronary syndrome admissions. The 2016 updated review included more studies and found consistent evidence that smoking bans reduced cardiovascular and respiratory disease admissions and mortality rates. However, the evidence on impacts on active smoking was inconsistent. Overall, the reviews found that smoking bans improved public health outcomes by reducing exposure to secondhand smoke.
This presentation was developed for our CLeaR (local government tobacco control standards) assessment in July 2014. It sets out our vision for tobacco control in Hertfordshire, summarises our strategies and current position and identifies our future work including commitment to harm reduction, getting positive gains from e-cigarettes and driving tobacco related harm down
Presentation delivered by Dr Eibhlin Connolly, Deputy Chief Medical Officer at the Department of Health and Children at the Irish Pharmaceutical Healthcare Association Annual Meeting 2009.
Overview of Tobacco Treatment Provisions at a National Level -- Martin RawGlobal Bridges
Presentation by Martin Raw, UK Centre for Tobacco Control Studies and National Institute of Alcohol and Drug Policies, Brazil, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.
Slides on the current situation with global cigarette consumption and trends, and how new nicotine products could change things.
See blog at: http://www.clivebates.com/?p=2782 for more commentary.
What is wrong (and right) about the Tobacco Products Directive approach to E-...Clive Bates
These are the visual aids for my talk on the truly dreadful European Union Tobacco Products Directive as it applies to e-cigarettes, and why Totally Wicked has a legal case against it.
NYU College of Global Health - E-cigarette seminar - New YorkClive Bates
E-Cigarettes: The Tectonic Shift in Nicotine and Tobacco Consumption: Opportunity or Threat to Saving Lives?
Clive Bates
Friday, October 19, 2018
NYU School of Law, Greenberg Lounge
40 Washington Square South, New York, New York
This presentation was developed for our CLeaR (local government tobacco control standards) assessment in July 2014. It sets out our vision for tobacco control in Hertfordshire, summarises our strategies and current position and identifies our future work including commitment to harm reduction, getting positive gains from e-cigarettes and driving tobacco related harm down
Presentation delivered by Dr Eibhlin Connolly, Deputy Chief Medical Officer at the Department of Health and Children at the Irish Pharmaceutical Healthcare Association Annual Meeting 2009.
Overview of Tobacco Treatment Provisions at a National Level -- Martin RawGlobal Bridges
Presentation by Martin Raw, UK Centre for Tobacco Control Studies and National Institute of Alcohol and Drug Policies, Brazil, at the Global Bridges Preconference at the 15th World Conference on Tobacco OR Health in Singapore.
Slides on the current situation with global cigarette consumption and trends, and how new nicotine products could change things.
See blog at: http://www.clivebates.com/?p=2782 for more commentary.
What is wrong (and right) about the Tobacco Products Directive approach to E-...Clive Bates
These are the visual aids for my talk on the truly dreadful European Union Tobacco Products Directive as it applies to e-cigarettes, and why Totally Wicked has a legal case against it.
NYU College of Global Health - E-cigarette seminar - New YorkClive Bates
E-Cigarettes: The Tectonic Shift in Nicotine and Tobacco Consumption: Opportunity or Threat to Saving Lives?
Clive Bates
Friday, October 19, 2018
NYU School of Law, Greenberg Lounge
40 Washington Square South, New York, New York
12 weeks Switch to Vaping: Science of Vaping Fontem Ventures
A randomised, parallel group clinical study was performed to evaluate the safety profile of an e-vapour
product (EVP; 2.0% nicotine) in smokers of conventional cigarettes (CCs) switching to use the EVP for 12
weeks.
Vaping and tobacco: six things you need to know about harm reductionClive Bates
1. Smoking has not gone away
2. Technologies to obsolete cigarettes
3. Risks and risk (mis)perceptions
4. The public health mechanism and the pleasure principle
5. The youth vaping epidemic – a harder look
6. Policymaking and perverse consequences
Descriptive Epidemiology of Lung Cancer
Description and Classification
Disease Distribution
Disease Frequency in the US Population
Epidemiological Triad
Prevention ==> Primary, Secondary and Tertiary
Summary
Efficacy of Nicotine Replacement Therapy (NRT) to Aid Cigarette Sm.docxtoltonkendal
Efficacy of Nicotine Replacement Therapy (NRT) to Aid Cigarette Smoking Cessation amongst Adults in United Kingdom
Introduction
Tobacco smoking is a major contributor to many serious diseases that eventually lead to death in the United Kingdom (UK). According to Office of National Statistics (ONS) (2017), 7.4 million of United Kingdom’s population are smokers and 19.7 percent of these smokers are adult with age-range of 25 to 34 years. Tobacco cigarettes contain nicotine. Nicotine changes the balance of two chemicals namely noreadrenaline and dopamine which are found in human the brain. The sudden change on the levels of these chemicals after inhalation may result in changes in mood which could result in reduction of stress, anxiety and increase in pleasure (National Health Service (NHS), 2018a). Transmission of nicotine by inhalation of tobacco is the fastest way of distributing nicotine into the bloodstream according to Action on Smoking and Health (ASH) (2019). Therefore, these facts indicate that smoking cigarettes could be profoundly addictive due to the rapid delivery of the desired effects to its users without taking into consideration any adverse effects on the human body and health.
Cigarette smoking harms human health; and stopping has proven hard to do alone. According to Health and Social Care Information Centre (HSCIC) (2017), in 2017 there were 146,234 people who started to try to quit smoking, only 49 percent successfully managed to stay away from using cigarretes and 33 percent of the individuals who successfully managed to stop smoking utilised licensed nicotine containing products. The government came up with tobacco control plan for England to assist its people to stop smoking; the elements of the plan include making tobacco more expensive, restraining tobacco related publicity, efficient control of tobacco products, developing alertness on harm caused by smoking and lowering the instance to be exposed to second-hand smoke (Public Health England, 2015).
Smoking cessation services and interventions are being offered by the NHS. Affirmed by National Institute for Health and Care Excellence (NICE) (2019), there are few evidenced-based interventions for smoking available in the UK for adults which include behavioural support, bupropion, nicotine replacement therapy (NRT), varenicline and very brief advices (VBA). These interventions are available to individuals who seek help through their general practitioner and to those who are being referred to health professionals for assistance; some of the interventions are combined to be able to achieve the desired goal which is to ultimately forgo smoking tobacco.
This paper will discuss the different kinds of NRT available for adults in the United Kingdom. Nicotine replacement therapy (NRT) includes few ways to supplement smoking. It helps to fight the urge to consume or inhale tobacco and also to reduce the effects of withdrawal. In addition, it will help individuals to slowly redu.
A study design proposal for incorporating photos into just-in-time interventions for smoking cessation. The presentation was given for a health communication seminar course in Fall 2016.
Evaluation of Biomarkers of Exposure and Cardiovascular & Pulmonary Function Endpoints in Adult Smokers Following Partial or Complete Substitution of Cigarettes with Electronic Cigarettes
NOTES FOR TWO MORE RESEARCH ARTICLES1The Effe.docxkendalfarrier
NOTES FOR TWO MORE RESEARCH ARTICLES 1
The Effects of Smoking on Lung Cancer Rates among Adults in New York
Pulla Rao Uppatala
MSc in Computer Science, King Graduate School
KG 604: Graduate Research & Critical Analysis
Dr. Aditi Puri
14 Nov 2022
New Research Article 1
Who: The assessment of cost-utility analysis of lung cancer screening and the paybacks on integrating smoking cessation interventions was performed by Villanti et al.
Why: This study aimed to assess whether LDCT screening for lung cancer among commercially insured individuals between 50 and 64 years at high risk for this disorder is turning out to be cost-effective. The authors also strived to quantify the extra payback of integrating smoking cessation solutions within lung cancer screening programs.
When: The authors analyzed their study in 2012 assuming that all existing smokers and half of the prior smoker population aged between 50 and 64 years were eligible for screening, with the minimum being set at least thirty packs –years of smoking.
Where: The researchers used data from National Health Interview Survey on cigarette smoking conditions for individuals between 45 and 64 years who were making 30% of active smokers across the United States at the time. The cancer treatment costs were acquired from New York's taxpayer database, which provided information including physician, hospital, drug and ancillary costs eligible for insurer reimbursement.
How: The authors used qualitative research methods to build up on the prior simulation model to determine the utility cost of yearly, recurring LDCT screenings for the last 15 years within an assumed high-risk population of 18 million adults aged between 50 and 64 years. It specifically involved those who have consumed over 30 packs within their smoking history. The authors' findings indicate that the recurring yearly lung cancer screening within the high-risk population has been effective. Providing smoking cessation strategies within the yearly screening program has increased the cost-effectiveness of the disorder by between 40 and 45%.
New Research Article 2
Who: The study on Using a smoking cessation quitline to promote lung cancer screening was performed by Sharma et al.
Why: The goal of their study was to compare two alternatives to dispense information concerning lung cancer screening. This included a quitline, a mailed brochure pinned with in-depth messaging facilitated by a quitline coach. Therefore, the authors focused on assessing the strategy that will be effective and have a significant impact on the participants searching for information about lung cancer screening. The authors thus hypothesized that the individuals who received the brochure would repo.
Using theory to guide policy health promot. int.-1996Samuel Lima
Uma abordagem do conceito de promoção da saúde que vai além das estratégias para mudar comportamentos individuais, incluindo no modo de vida, as condições dos contextos, incluindo as características físicas, sociais e
ambientes econômicos em que saúde e comportamento
são moldadas. O núcleo da estratégia é estimular a ação
contra as causas da falta de saúde nas comunidades.
Editorial: Evidence based policy or policy based evidence? by Michael MarmotJim Bloyd, DrPH, MPH
A simple prescription would be to review the scientific evidence of what would make a difference, formulate policies, and implement them—evidence based policy making. Unfor- tunately this simple prescription, applied to real life, is simplistic. The relation between science and policy is more complicated. Scientific findings do not fall on blank minds that get made up as a result. Science engages with busy minds that have strong views about how things are and ought to be.
Similar to Have smoking bans after WHO Framework Convention on Tobacco Control worked in reducing harms of passive smoking? (20)
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
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Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
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Learning Objectives
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2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
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The hemodynamic and autonomic determinants of elevated blood pressure in obes...
Have smoking bans after WHO Framework Convention on Tobacco Control worked in reducing harms of passive smoking?
1. Have smoking bans after WHO
Framework Convention on Tobacco
Control worked in reducing harms of
passive smoking?
Professor Cecily C Kelleher 1,2, Dr Kate Frazer3
UCD School of Public Health, Physiotherapy and Sports Science 1, Department of
Preventive Medicine & Health Promotion, St Vincent’s University Hospital 2,
UCD School of Nursing, Midwifery and Health Systems 3,
Belfield, Dublin 4, Republic of Ireland
2. In this talk
• Brief background and context
• Findings of Cochrane systematic reviews of 2010 and update
of 2016 on impact of legislative smoking bans
• Total smoke free hospital campus ban: an example from
Dublin, Ireland
• Cochrane systematic review 2016 on impact of institutional
bans
• Commentary and conclusions
3. FRAMEWORK CONVENTION ON TOBACCO
CONTROL (FCTC)
FCTC is the first international treaty negotiated under the auspices of WHO
It is an evidence-based treaty that represents a milestone for the
promotion of public health
Provides new legal dimensions for international health cooperation
Since the treaty entered into force in 2005, it has become one of the most
rapidly and widely embraced treaties in the history of the United Nations.
Dr Margaret Chan, Tobacco Atlas 2015:4
4. FCTC – why it is required……
Eriksen, M., Mackay, J., Schluger, N., Gomeshtapeh, F. and Drope, J.,(2015). The Tobacco
Atlas: revised, expanded, and updated. Atlanta, USA: American Cancer Society.
5. Growth of Support
Eriksen, M., Mackay, J., Schluger, N., Gomeshtapeh, F. and Drope, J.,(2015). The Tobacco Atlas: revised, expanded,
and updated. Atlanta, USA: American Cancer Society.
6. The Tobacco Atlas Eriksen, M., Mackay, J., Schluger, N., Gomeshtapeh, F. and Drope, J., (2015). The
Tobacco Atlas: revised, expanded, and updated. Atlanta, USA: American Cancer Society.
Smoke-free laws
Smoke-free legislation by income level; High, middle,
low income countries, 2012
7. An International smoking ban-how many lives
will be saved?
Kelleher CC, Frazer K. Curr Atheroscler Rep. 2014 Jun;16(6):418. doi: 10.1007/s11883-014-0418-0. Review. PubMed PMID: 24771033.
• Multi-component tobacco
strategies are crucial to combat the
ongoing global smoking challenge
• In the 21st century, many countries
have signed up to the WHO
Framework Convention on Tobacco
Control (FCTC)
• Several reports have appeared from
different countries showing a
temporal relationship between
smoking bans and reduced hospital
admissions
• This will have a measurable benefit
for public health, saving many lives
8. Legislative Smoking Bans:
Levels of Impact
• Macro: Policy level
intervention
• Meso: Institutional or
settings level intervention
• Micro: Individual or inter-
personal level interventionLegislative
Smoking
Bans
MACRO
MESOMICRO
9. Legislative Smoking Bans
Callinan et al, Cochrane Database Syst Rev. 2010 Apr 14;(4):CD005992.
• Studies reporting legislative
smoking bans affecting
populations
• Minimum standard was a ban
explicitly in the study
• Minimum follow-up of six
months for measures of
smoking behaviour
• RCTs, Quasi-experimental,
Controlled before-after,
interrupted time series (ITS)
designs
10. AIM: Assess the extent to which legislation-
based smoking bans or restrictions:
Callinan et al, Cochrane Database Syst Rev. 2010 Apr 14;(4):CD005992.
Reduce
exposure to
Second-hand
smoke (SHS)
Help people
who smoke to
reduce tobacco
consumption/
prevalence
Affect health
of those in
areas which
have a ban or
restriction in
place
Cochrane Tobacco Addiction Group Specialised
Register, MEDLINE, EMBASE, PsychINFO, CINAHL,
Conference Paper Index, reference lists , bibliographies
– up to 2009
11. Evidence in Review
Callinan et al, Cochrane Database Syst Rev. 2010 Apr 14;(4):CD005992.
50 studies – all
SHS exposure(19
with biomarkers)
12 studies
Cardiac
ACS
12 studies
Respiratory
Health
outcomes
Lung function
5 studies
SHS cars
Tobacco
consumption
Cotinine
15 studies
SHS homes
Tobacco
consumption
Cotinine
23 studies
Active
smoking
Smoking prevalence
Tobacco
consumption
Population-level
13 Quasi
experimental
37 uncontrolled
before and after
12. Evidence 2010
Smoking bans
reduced
exposure to SHS
in workplaces,
restaurants, pubs
and in public
places
Greater
reduction in
exposure to SHS
in hospitality
workers
compared to
general
population
No difference in SHS
exposure in cars
No change in either
the prevalence or
duration of SHS in the
home
No consistent
evidence of a
reduction in
smoking
prevalence
Callinan et al, Cochrane Database Syst
Rev. 2010 Apr 14;(4):CD005992:
Following introduction of legislative
smoking bans:
• Evidence for reduced second hand
smoke exposure clear
• Some emerging evidence for
reduced admissions for acute
coronary syndrome (ACS)
• Limited evidence impact on active
smoking rates
14. Legislative Smoking Bans
Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C.
Cochrane Database Syst Rev. 2016 Feb 4;2:CD005992
PICO
• Population: Smokers and non-
smokers
• Intervention: Comprehensive
or partial smoking bans
implemented by legislation
• Comparison: No bans
• Outcomes: health outcomes
associated with second-hand
smoke exposure. Active
smoking, tobacco
consumption
Eligibility Criteria
• Settings: Country, Region or State
• Minimum standard was having indoor
smoking ban explicitly stated in the
study
• 6 months follow up period
• Measured health outcomes
• Population smoking prevalence rates
15. Evidence
Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C.
Cochrane Database Syst Rev. 2016 Feb 4;2:CD005992
A number of studies provided evidence for multiple outcomes
77 studies
44 studies
Cardiovascular
ACS / AMI
Stroke
21 studies
Respiratory
Asthma
COPD
Lung function
7 studies
Perinatal
LBW
Pre term birth
Maternal
smoking
11 studies
Mortality
Smoking
related deaths
24 studies
Active smoking
Smoking prevalence
Tobacco consumption
Population-level
36 ITS
23 Controlled before
and after
18 uncontrolled
before and after
16. Cardiovascular Evidence
Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C.
Cochrane Database Syst Rev. 2016 Feb 4;2:CD005992
44 studies
Consistent
evidence
ACS/ AMI
33 studies
Consistent
evidence
Stroke
5 studies
Reductions in
admissions for
smokers and
non smokers
43 studies
Cardiac
38 Cardiac
5 Cardiac &
Stroke
6 studies
Stroke
Multiple methods
ITS, Controlled before and
after studies,
Uncontrolled before and
after studies
17. Evidence in Update
Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C. Cochrane Database Syst Rev. 2016 Feb
4;2:CD005992
Respiratory
21 studies
Reductions in
asthma & COPD
admissions
Lung function
improved
Evidence not
consistent across all
studies for asthma
or COPD
Perinatal
7 studies
Evidence of
reductions in LBW
and pre term birth
Reduction maternal
smoking
Evidence not
consistent
Mortality
11 studies
Reductions in
mortality rates
consistent in 8
studies
Active
Smoking
24 studies
Inconsistent
evidence
18. Features of the Evidence Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K,
Kelleher C. Cochrane Database Syst Rev. 2016 Feb 4;2:CD005992
Bias
Use of data
sets
Unverified
smoking status
Sample sizes
Statistical
modelling
19. Acute Coronary Syndrome/ Acute Myocardial
Infarction outcomes
Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C. Cochrane Database Syst Rev. 2016 Feb 4;2:CD005992
UK and Ireland International evidence
Cronin et al. (2012) Ireland
12% reduction in ACS admissions in 1st year after ban.
ACS admissions reduced from 34% in 2003 to 29% in 2009.
Aguero et al. (2013) Spain
REGICOR study. 11% reduction in AMI rates.
Kent et al. (2012) Ireland
18% reduction in ACS admissions in those aged 50 to 55 years and aged 60 to 69
years
Alsever et al. (2009) USA
19% reduction in AMI admissions post ban. No
change in controls.
Liu et al. (2013) England
Age-adjusted rates for MI admissions fell by 42% (39–45%) overall.
41.6% in men and by 42.6% in women
Barone Adesi et al. (2011) Italy
4% reduction in ACS in aged <70 years
Pell et al.(2008) Scotland
ACS admissions reduced 14% smokers, 19% in ex smokers and 21% in non
smokers.
Di Valentino et al. (2015) Switzerland
Reductions in `STEMI admissions from 123.7/100,000
to 89.6/100,000
Schmucker et al. (2014) Germany
16% reduction in STEMI admissions overall. 26%
reduction in non smokers
Sebrie (2014) Uruguay
17% reduction in AMI admissions
20. UK and Ireland Studies in Review
Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C. Cochrane Database Syst Rev. 2016 Feb 4;2:CD005992
England Scotland Ireland
Lee et al. (2011) Smoking
prevalence
Jones et al. (2015)
Scotland and England
smoking prevalence
Cronin et al. (2012) ACS
admissions
Liu et al. (2013) CHD
admissions
MacKay et al. (2010) Asthma
admissions
Goodman et al. (2007) Lung
function
Millett et al.(2013)
Asthma admissions
MacKay et al. (2011) Smoking
prevalence
Kabir et al. (2009) Maternal
smoking and perinatal
outcomes
Sims et al. (2013)
Asthma admissions
MacKay et al. (2012) Peri
natal outcomes & maternal
smoking
Kabir et al. (2013) Perinatal
outcomes
MacKay et al. (2013) Stroke Kent et al. (2012) ACS
admissions
Pell et al. (2008) ACS
admissions
Stallingsmith (2013)
Mortality rates
Pell et al. (2009) Mortality
rates
21. Stroke Outcomes
Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C. Cochrane Database Syst Rev. 2016 Feb 4;2:CD005992
Stroke outcomes Examples
Mackay 2013 Scotland 8.9% reduction in admissions for
cerebral infarction post ban
Loomis 2012 USA 5.2% reduction in admissions in
Florida
Herman USA 14% reduction in admissions in
counties with ban compared to no ban
22. Implications for practice
•Countries and populations benefit from enacting national
legislative smoking bans
Evidence (Moderate)
Improved health outcomes, specifically cardiovascular disease.
Evidence (Low)
Reduced mortality rates for smoking related illnesses.
Evidence (Low)
Improved perinatal and respiratory health outcomes.
Reductions in tobacco consumption.
23. Implications for Research
Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C. Cochrane Database Syst Rev. 2016 Feb 4;2:CD005992
• Additional research with longer term impact on health
outcomes in sub groups of the population
Young children
Disadvantaged and minority groups
• More research on health impact of smoking bans
Respiratory health
Perinatal health
Active smoking
• More systematic indicators to allow for quantifying effects
24. Key Message
Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C. Cochrane Database Syst Rev. 2016 Feb 4;2:CD005992
Introduction of a legislative smoking ban leads to
improved health outcomes through a reduction in
second-hand smoke exposure for countries and their
populations
26. Implementation of a campus-wide Irish hospital smoking ban in
2009: prevalence and attitudinal trends among staff and patients in
lead up.
Fitzpatrick P, Gilroy I, Doherty K, Corradino D, Daly L, Clarke A, Kelleher CC. Health Promot Int. 2009 Sep;24(3):211-22.
• Three separate data sources, 8 staff
and patient surveys between 1997-
2006, 1-week observational survey
in smoke shelters and attitudinal
interviews with patients and staff
• Smoking rates in patients remained
steady but declined in staff
• Those using shelters were mainly
women and staff members
• Early majority tipping point support
for implementing total smoke-free
campus ban
27. Smoke-Free Campus Policy
Fitzpatrick et al, Health Promo Int 2009; 24(3): 211-22
2006
Survey of staff
and patients
2007
Commitment of
Senior
management
Legal advice sought
Meetings with Trade
Unions & other
stakeholder groups
2008
Steering Group:
Senior
Management
Project group:
All stakeholders
Implementation &
Communication plan
2009
1st January 2009
SMOKE FREE
CAMPUS POLICY
INITIATED
2010
One year post-
introduction
evaluation
Survey of staff
and patients
28. Smoke free hospital campus: Strong positive shift in
attitudes post implementation but paradox in nursing
and medical attitudes
Fitzpatrick P, Gilroy, I, Doherty K, Clarke A, Comerford D, Daly L, Kelleher C. Clinical Health Promotion 2012 Apr;2 (1): 12-16
• Significant fall in smoking rates
in staff (17.8% v 10.7%; p=0.02)
but not patients (22.7% v
18%;NS)
• Positive shift in attitude of
patients (58.6%v 84.2%;
p<0.001) and staff (52.4% v
83.3%; p<0.001)
• Nurses more likely than other
groups, including doctors, to
agree they had a role in
implementation
29. National and International Impact: ENSH
Award Fitzpatrick P, Gilroy I, Doherty K, Conlon G, Daly L, Kelleher C. Exempting patients from a smoke-free hospital policy on compassionate grounds.
BMJ. 2014 Jan 21;348:g389
30. New Evidence 2016
Search Strategy 2005 to 2015
• Cochrane Central Register of Controlled
Trials (CENTRAL);
• MEDLINE,
• EMBASE,
• Reference lists of identified studies
31. Institutional Ban Evidence
Frazer K, McHugh J, Callinan JE, Kelleher C. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure.
Cochrane Database Syst Rev. 2016 May 27;(5):CD011856
Complete or partial
smoking bans
National legislative ban
No National legislative ban
Healthcare facilities
Third level education
institutions
Prisons / correctional
facilities
32. Observational level data
Frazer K, McHugh J, Callinan JE, Kelleher C. Impact of institutional smoking bans on reducing harms and secondhand smoke exposure.
Cochrane Database Syst Rev. 2016 May 27;(5):CD011856
17 studies
12 hospitals
Active Smoking Mortality
3 Prisons
Mortality
Active smoking
2 Universities
Active smoking
3 controlled before
and after studies
14 uncontrolled
studies
33. Evidence of institutional policies
Frazer K, McHugh J, Callinan JE, Kelleher C. Cochrane Database Syst Rev. 2016 May 27;(5):CD011856
• No change patient smoking rates
• Reduction in staff smoking rates
• Reduction in SHS exposure
Hospitals
• No evidence reduction in prevalence
• Reduction in mortality rates
• Reduction in SHS exposure
Prisons
• Reduction in smoking rates
• Reduction in SHS exposureUniversity
34. Impact of institutional smoking bans on reducing harms and
secondhand smoke exposure
Frazer K, McHugh J, Callinan JE, Kelleher C. Cochrane Database Syst Rev. 2016 May 27;(5):CD011856
35. Evidence of impact on active smoking rates
Frazer K, McHugh J, Callinan JE, Kelleher C. Cochrane Database Syst Rev. 2016 May 27;(5):CD011856
11
Observational
Studies pooled
data
N=12,485
Heterogeneity
evident
36. Quality of Evidence for institutional smoking
bans
• We found evidence of an effect of
settings-based smoking policies on
reducing smoking rates in hospitals
and universities.
• In prisons, reduced mortality rates
and reduced exposure to
secondhand smoke were reported.
• However, we rated the evidence
base as low quality using GRADE
criteria, as all studies observational
• We therefore need more robust
studies assessing the evidence for
smoking bans and policies in these
important specialist settings.
Quality of
evidence low
Impact of national bans V
no national bans not
consistent – weak
evidence / heterogeneity
Inconsistent
evidence and
confidence in
effect is limited
37. Implications for Practice and Research
Settings bans components of multifactorial tobacco control
activities
Further robust studies using control groups and longer
follow up
38. References
Callinan JE, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing secondhand smoke exposure,
smoking prevalence and tobacco consumption. Cochrane Database Syst Rev. 2010 Apr 14;(4):CD005992. doi:
10.1002/14651858.CD005992.pub2. Review. Update in: Cochrane Database Syst Rev. 2016;2:CD005992. PubMed
PMID: 20393945.
Eriksen, M., Mackay, J., Schluger, N., Gomeshtapeh, F. and Drope, J.,(2015). The Tobacco Atlas: revised, expanded, and
updated. Atlanta, USA: American Cancer Society.
Fitzpatrick P, Gilroy I, Doherty K, Corradino D, Daly L, Clarke A, Kelleher CC. Implementation of a campus-wide Irish
hospital smoking ban in 2009: prevalence and attitudinal trends among staff and patients in lead up. Health Promot
Int. 2009 Sep;24(3):211-22. doi: 10.1093/heapro/dap020. PubMed PMID: 19531558.
Fitzpatrick P, Gilroy, I, Doherty K, Clarke A, Comerford D, Daly L, Kelleher C. Smoke free hospital campus: Strong
positive shift in attitudes post implementation but paradox in nursing and medical attitudes. Clinical Health
Promotion 2012 Apr;2 (1): 12-16.
Fitzpatrick P, Gilroy I, Doherty K, Conlon G, Daly L, Kelleher C. Exempting patients from a smoke-free hospital policy on
compassionate grounds. BMJ. 2014 Jan 21;348:g389. doi: 10.1136/bmj.g389. PubMed PMID: 24448418.
Frazer K, McHugh J, Callinan JE, Kelleher C. Impact of institutional smoking bans on reducing harms and secondhand
smoke exposure. Cochrane Database Syst Rev. 2016 May 27;(5):CD011856. doi: 10.1002/14651858.CD011856.pub2.
Review. PubMed PMID: 27230795.
Frazer K, Callinan JE, McHugh J, van Baarsel S, Clarke A, Doherty K, Kelleher C. Legislative smoking bans for reducing
harms from secondhand smoke exposure, smoking prevalence and tobacco consumption. Cochrane Database Syst
Rev. 2016 Feb 4;2:CD005992. doi: 10.1002/14651858.CD005992.pub3. Review. PubMed PMID: 26842828.
Kelleher CC, Frazer K. An international smoking ban-how many lives will be saved? Curr Atheroscler Rep. 2014
Jun;16(6):418. doi: 10.1007/s11883-014-0418-0. Review. PubMed PMID: 24771033.
39. Acknowledgements
• Ms Joanne Callinan and Dr Kate Frazer each received Health Research
Board of Ireland 2-year Cochrane Training Fellowships to conduct
these reviews
• Mr Jack McHugh was funded as a SSRA summer student placement
to work on the institutional review
• We thank the University of Oxford Cochrane Tobacco Addiction
Group for their unfailing assistance with these reviews
• All the empirical research presented was approved by either the UCD
Human Research Ethics Committee or SVUH Ethics Committee
• There are no conflicts of interest to declare
Thank you