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The impact of smoke-free legislation on educational differences in birth outcomes
  1. Britt McKinnon1,2,
  2. Nathalie Auger3,4,
  3. Jay S Kaufman1,2
  1. 1Department of Epidemiology, Biostatistics and Occupational Health, McGill University Faculty of Medicine, Montreal, Quebec, Canada
  2. 2Institute for Health and Social Policy, McGill University, Montreal, Quebec, Canada
  3. 3Institut national de santé publique du Québec, Montreal, Quebec, Canada
  4. 4University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
  1. Correspondence to Dr Britt McKinnon, Institute for Health and Social Policy, 1030 Pine Avenue West, Montreal, Quebec, Canada H3A 1A2; britt.mckinnon{at}


Background Smoke-free legislation may have positive effects on birth outcomes. Given that smoking and secondhand smoke during pregnancy vary with socioeconomic position, legislation may have greater effects in some socioeconomic groups. For this study, we evaluated the impact of a 2006 ban on smoking in public places in the Canadian province of Quebec on preterm birth, small-for-gestational-age birth and birth weight, and on educational differences in these birth outcomes.

Methods We analysed data on singleton births in Quebec between 2003 and 2010. Logistic regression was used to model the association of smoke-free legislation with preterm birth (<37 weeks), very preterm birth (<34 weeks), small-for-gestational-age birth (<10th centile for gestational age and sex), low birth weight (<2500 g) and mean birth weight, adjusting for secular trends before and after legislation. Interaction terms were included to assess differential effects by level of maternal education.

Results Smoke-free legislation was associated with average reductions of 3.1 preterm births (95% CI 0.1 to 6.0), 2.3 very preterm births (95% CI 0.9 to 3.7), 5.9 small-for-gestational-age births (95% CI 2.6 to 9.3) and 1.0 low birthweight infants (95% CI 0.4 to 1.6) per 1000 live births, as well as a 17.1 g increase in mean birth weight (95% CI 10.7 to 23.6). Legislation was associated with improved birth outcomes in all categories of maternal education.

Conclusions Smoke-free legislation in Quebec was associated with reductions in preterm and small-for-gestational-age births, and an increase in birth weight. There was no compelling evidence that legislation impacted educational gradients in birth outcomes.

  • Health inequalities

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