Effect of smoke-free policies in outdoor areas and private places on children's tobacco smoke exposure and respiratory health: a systematic review and meta-analysis

Márta K Radó, Famke J.M. Mölenberg, Lauren E.H. Westenberg, Aziz Sheikh, Christopher Millett, Alex Burdorf, Frank J van Lenthe, Jasper V. Been

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Smoke-free policies in outdoor areas and (semi-)private places (e.g. cars) may lower health harms caused by tobacco smoke exposure (TSE). We aimed to review studies reporting the impact of such policies on children’s TSE and respiratory health.Methods: We conducted a systematic review and meta-analysis and searched 13 electronic databases until January 29, 2021. Eligible for the main analysis were (non)-randomised trials, interrupted time series and controlled before-after studies.
Primary outcomes were: TSE in places covered by the policy, and hospital attendance for wheezing/asthma, and for respiratory tract infections (RTIs) in children aged <17 years. Risk-of-bias was assessed on a 4-point scale ranging from low to critical using ROBINS-I. Random-effects meta-analysis was conducted where appropriate. PROSPERO: CRD42020190563.Findings: Seven of the 11 identified studies fit pre-specified robustness criteria. These assessed smoke-free cars (n=5), schools (n=1), and a comprehensive policy covering multiple areas (n=1). Risk-of-bias was low to moderate in six studies and critical in one. In meta-analysis of ten effect estimates from four studies, smoke-free car policies were associated with an immediate TSE reduction in cars (risk ratio [RR] 0·69, 95% CI: 0·55 to 0·87; n=161,466). One study reported a gradual TSE decrease in cars. Individual studies found TSE reductions in school grounds following a smoke-free school policy and in hospital attendances for RTI following a comprehensive smoke-free policy.Interpretation: Smoke-free car policies are associated with reductions in reported child TSE in cars, which could translate in health benefits. Very few studies assessed policies regulating smoking in outdoor areas and semi-private places.
Original languageEnglish
JournalThe Lancet Public Health
Volume6
Issue number8
Early online date15 Jul 2021
DOIs
Publication statusE-pub ahead of print - 15 Jul 2021

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