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6.4 Infection and environment
O6-4.6 Impact of Scottish smoke-free legislation on use of nicotine replacement therapy and adult smoking prevalence
  1. D Mackay1,
  2. S Haw2,3,
  3. J Pell1
  1. 1Public Health Section, University of Glasgow, Glasgow, UK
  2. 2Scottish Collaboration for Public Health Research & Policy, Edinburgh, UK
  3. 3NHS Health Scotland, Edinburgh, UK

Abstract

Introduction In Scotland, legislation was implemented in March 2006 prohibiting smoking in all wholly or partially enclosed public spaces. We investigated the impact on NHS prescriptions for nicotine replacement therapy (NRT) and smoking prevalence.

Methods We analysed monthly data on the gross ingredient cost of all NRT prescribed in Scotland 2003–2009. The Scottish Household Survey provided quarterly data on self-reported smoking status between January 1999 and March 2010. We developed time series models for both datasets using Box-Jenkins autoregressive integrated moving averages.

Results NRT prescription costs were significantly higher than expected over the 3 months prior to implementation of the legislation. Prescription costs peaked at £1.1 million in March 2006; £231 753 (95% CI £200 800 to £262 707, p<0.001) higher than the monthly norm. Following implementation of the legislation, costs fell exponentially by around 22% per month (95% CI 13% to 32%, p<0.001). Twelve months following implementation, the costs were not significantly different to monthly norms. Smoking prevalence fell by 6.0% overall, from 31.3% in January 1999 to 25.3% in March 2010. In the quarter prior to implementation of the legislation, smoking prevalence fell by 2.4% (95% CI 0.4% to 4.4%, p=0.019) more than expected from the underlying trend.

Conclusions Prescriptions for NRT increased in the 3 months prior to Scotland's smoke-free legislation, resulting in a fall in smoking prevalence but neither were sustained. We argue that the early benefits may have been sustained for longer, if the high profile media awareness and education campaigns that preceded the legislation had continued post-legislation.

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