Abstract

Over the past decade, bans on smoking in enclosed public places have been introduced in many states in the US and provinces in Canada, and a growing number of European countries, including Scotland.

Evidence from Scotland and other jurisdictions clearly indicates that when compliance is high, implementation of comprehensive legislation is accompanied by dramatic reductions in worker exposure to secondhand smoke and improvements in respiratory symptoms among both non-smoking and smoking workers alike. Studies have also found population level reductions in secondhand smoke exposure among both adults and children and this has been accompanied by measurable improvements in population health including reductions in hospital admissions for acute myocardial infarction and asthma. The magnitude of the health improvement varies, but a recent meta-analysis of 17 studies found a pooled risk reduction for acute myocardial infarction of 10% (95% CI 6 to 14%) following implementation of smoke-free legislation. While some of the observed risk reduction for heart attack is likely to be associated with behaviour change among smokers (a number of studies report both a reduction in smoking prevalence in the general population and tobacco consumption in those who continue to smoke, post-legislation), a prospective study of admissions for acute coronary syndrome, found that 67% of heart attacks averted were among non-smokers.

In this paper we present an overview of the evidence about the health effects of smoking bans and then go on to consider whether these are simply short-term improvements or are sustained for a number of years after implementation of legislation.