Smoke-free legislation and hospitalizations for childhood asthma

<b>BACKGROUND:</b> Previous studies have shown that after the adoption of comprehensive smoke-free legislation, there is a reduction in respiratory symptoms among workers in bars. However, it is not known whether respiratory disease is also reduced among people who do not have occupational exposure to environmental tobacco smoke. The aim of our study was to determine whether the ban on smoking in public places in Scotland, which was initiated in March 2006, influenced the rate of hospital admissions for childhood asthma.<br></br> <b>METHODS:</b> Routine hospital administrative data were used to identify all hospital admissions for asthma in Scotland from January 2000 through October 2009 among children younger than 15 years of age. A negative binomial regression model was fitted, with adjustment for age group, sex, quintile of socioeconomic status, urban or rural residence, month, and year. Tests for interactions were also performed. <br></br> <b>RESULTS:</b> Before the legislation was implemented, admissions for asthma were increasing at a mean rate of 5.2% per year (95% confidence interval [CI], 3.9 to 6.6). After implementation of the legislation, there was a mean reduction in the rate of admissions of 18.2% per year relative to the rate on March 26, 2006 (95% CI, 14.7 to 21.8; P<0.001). The reduction was apparent among both preschool and school-age children. There were no significant interactions between hospital admissions for asthma and age group, sex, urban or rural residence, region, or quintile of socioeconomic status. <b>CONCLUSIONS:</b> In Scotland, passage of smoke-free legislation in 2006 was associated with a subsequent reduction in the rate of respiratory disease in populations other than those with occupational exposure to environmental tobacco smoke. (Funded by NHS Health Scotland.

Five-minute Apgar score and educational outcomes: retrospective cohort study of 751 369 children

Background: The Apgar score is used worldwide for assessing the clinical condition and short-term prognosis of newborn infants. Evidence for a relationship with long-term educational outcomes is conflicting. We investigated whether Apgar score at 5 min after birth was associated with additional support needs (ASN) and educational attainment. Methods: Data on pregnancy, delivery and later educational outcomes for children attending Scottish schools between 2006 and 2011 were collated by linking individual-level data from national educational and maternity databases. The relationship between Apgar score and overall ASN, type-specific ASN and educational attainment was assessed using binary, multinomial and generalised ordinal logistic regression models, respectively. Missing covariate data were imputed. Results: Of the 751 369 children eligible, 9741 (1.3%) had a low or intermediate Apgar score and 49 962 (6.6%) had ASN. Low Apgar score was independently associated with overall ASN status (adjusted OR for Apgar ≤3, OR 1.52 95% CI 1.35 to 1.70), as well as ASN due to cognitive (OR 1.26, 95% CI 1.09 to 1.47), sensory (OR 2.49 95% CI 1.66 to 3.73) and motor (OR 3.57, 95% CI 2.86 to 4.47) impairments. There was a dose-response relationship between Apgar score and overall ASN status: of those scoring 0–3, 10.1% had ASN, compared with 9.1% of those scoring 4–7 and 6.6% of those scoring 7–10. A low Apgar score was associated with lower educational attainment, but this was not robust to adjustment for confounders. Conclusions: Apgar scores are associated with long-term as well as short-term prognoses, and with educational as well as clinical outcomes at the population level

Impact of Scotland's smoke-free legislation on pregnancy complications: retrospective cohort study

BACKGROUND Both active smoking and environmental tobacco smoke exposure are associated with pregnancy complications. In March 2006, Scotland implemented legislation prohibiting smoking in all wholly or partially enclosed public spaces. The aim of this study was to determine the impact of this legislation on preterm delivery and small for gestational age. METHODS AND FINDINGS We conducted logistic regression analyses using national administrative pregnancy data covering the whole of Scotland. Of the two breakpoints tested, 1 January 2006 produced a better fit than the date when the legislation came into force (26 March 2006), suggesting an anticipatory effect. Among the 716,941 eligible women who conceived between August 1995 and February 2009 and subsequently delivered a live-born, singleton infant between 24 and 44 wk gestation, the prevalence of current smoking fell from 25.4% before legislation to 18.8% after legislation (p<0.001). Three months prior to the legislation, there were significant decreases in small for gestational age (-4.52%, 95% CI -8.28, -0.60, p = 0.024), overall preterm delivery (-11.72%, 95% CI -15.87, -7.35, p<0.001), and spontaneous preterm labour (-11.35%, 95% CI -17.20, -5.09, p = 0.001). In sub-group analyses, significant reductions were observed among both current and never smokers. CONCLUSIONS Reductions were observed in the risk of preterm delivery and small for gestational age 3 mo prior to the introduction of legislation, although the former reversed partially following the legislation. There is growing evidence of the potential for tobacco control legislation to have a positive impact on health

Measuring and stimulating progress on implementing widely recommended food environment policies: the New Zealand case study

Background: Monitoring the degree of implementation of widely recommended food environment policies by national governments is an important part of stimulating progress towards better population nutritional health. Methods: The Healthy Food Environment Policy Index (Food-EPI) was applied for the second time in New Zealand in 2017 (initially applied in 2014) to measure progress on implementation of widely recommended food environment policies. A national panel of 71 independent (n = 48) and government (n = 23) public health experts rated the extent of implementation of 47 policy and infrastructure support good practice indicators by the Government against international best practice, using an extensive evidence document verified by government officials. Experts proposed and prioritised concrete actions needed to address the critical implementation gaps identified. Results: Inter-rater reliability was good (Gwet\u27s AC2 > 0.8). Approximately half (47%) of the indicators were rated as having \u27low\u27 or \u27very little, if any\u27 implementation compared to international benchmarks, a decrease since 2014 (60%). A lower proportion of infrastructure support (29%) compared to policy (70%) indicators were rated as having \u27low\u27 or \u27very little, if any\u27 implementation. The experts recommended 53 actions, prioritising nine for immediate implementation; three of those prioritised actions were the same as in 2014. The vast majority of experts agreed that the Food-EPI is likely to contribute to beneficial policy change and increased their knowledge about food environments and policies. Conclusion: The Food-EPI has the potential to increase accountability of governments to implement widely recommended food environment policies and reduce the burden of obesity and diet-related diseases

Month of Conception and Learning Disabilities: A Record-Linkage Study of 801,592 Children.

Learning disabilities have profound, long-lasting health sequelae. Affected children born over the course of 1 year in the United States of America generated an estimated lifetime cost of $51.2 billion. Results from some studies have suggested that autistic spectrum disorder may vary by season of birth, but there have been few studies in which investigators examined whether this is also true of other causes of learning disabilities. We undertook Scotland-wide record linkage of education (annual pupil census) and maternity (Scottish Morbidity Record 02) databases for 801,592 singleton children attending Scottish schools in 2006-2011. We modeled monthly rates using principal sine and cosine transformations of the month number and demonstrated cyclicity in the percentage of children with special educational needs. Rates were highest among children conceived in the first quarter of the year (January-March) and lowest among those conceived in the third (July-September) (8.9% vs 7.6%; P < 0.001). Seasonal variations were specific to autistic spectrum disorder, intellectual disabilities, and learning difficulties (e.g., dyslexia) and were absent for sensory or motor/physical impairments and mental, physical, or communication problems. Seasonality accounted for 11.4% (95% confidence interval: 9.0, 13.7) of all cases. Some biologically plausible causes of this variation, such as infection and maternal vitamin D levels, are potentially amendable to intervention.Scottish Collaboration for Public Health Research & PolicyThis is the author accepted manuscript. The final version is available from Oxford University Press via http://dx.doi.org/10.1093/aje/kww09

Modelling the cost differential between healthy and current diets: the New Zealand case study

Background: Evidence on whether healthy diets are more expensive than current diets is mixed due to lack of robust methodology. The aim of this study was to develop a novel methodology to model the cost differential between healthy and current diets and apply it in New Zealand. Methods: Prices of common foods were collected from 15 supermarkets, 15 fruit/vegetable stores and from the Food Price Index. The distribution of the cost of two-weekly healthy and current household diets was modelled using a list of commonly consumed foods, a set of min and max quantity/serves constraints for each, and food group and nutrient intakes based on dietary guidelines (healthy diets) or nutrition survey data (current diets). The cost differential between healthy and current diets was modelled for several diet, prices and policy scenarios. Acceptability of resulting meal plans was validated. Results: The average cost of healthy household diets was 40 and $60 cheaper than current diets due to large energy intakes. Discretionary foods and takeaway meals contributed 30-40% to the average cost of current diets. This cost differential could be reduced if fruits and vegetables became exempt from Goods and Services Tax. Healthy diets were cheaper with an allowance for discretionary foods and more expensive when including takeaway meals. Conclusion: Healthy New Zealand diets were on average more expensive than current diets, but one-quarter of healthy diets were cheaper than the average cost of current diets. The impact of diet composition, types of prices and policies on the cost differential was substantial. The methodology can be used in other countries to monitor the cost differential between healthy and current household diets

Impact of Scotland’s comprehensive, smoke-free legislation on stroke

&lt;p&gt;Background: Previous studies have reported a reduction in acute coronary events following smoke-free legislation. Evidence is lacking on whether stroke is also reduced. The aim was to determine whether the incidence of stroke, overalland by sub-type, fell following introduction of smoke-free legislation across Scotland on 26 March 2006.&lt;/p&gt; &lt;p&gt;Methods and Findings: A negative binomial regression model was used to determine whether the introduction of smokefree legislation resulted in a step and/or slope change in stroke incidence. The model was adjusted for age-group, sex, socioeconomic deprivation quintile, urban/rural residence and month. Interaction tests were also performed. Routine hospital administrative data and death certificates were used to identify all hospital admissions and pre-hospital deaths due to stroke (ICD10 codes I61, I63 and I64) in Scotland between 2000 and 2010 inclusive. Prior to the legislation, rates of all stroke, intracerebral haemorrhage and unspecified stroke were decreasing, whilst cerebral infarction was increasing at 0.97% per annum. Following the legislation, there was a dramatic fall in cerebral infarctions that persisted for around 20 months. No visible effect was observed for other types of stroke. The model confirmed an 8.90% (95% CI 4.85, 12.77, p,0.001) stepwise reduction in cerebral infarction at the time the legislation was implemented, after adjustment for potential cofounders.&lt;/p&gt; &lt;p&gt;Conclusions: Following introduction of national, comprehensive smoke-free legislation there was a selective reduction in cerebral infarction that was not apparent in other types of stroke.&lt;/p&gt