Levels of second hand smoke in pubs and bars by deprivation and food-serving status: a cross-sectional study from North West England

BACKGROUND: The UK government proposed introducing partial smokefree legislation for England with exemptions for pubs and bars that do not prepare and serve food. We set out to test the hypothesis that pubs from more deprived areas and non food-serving pubs have higher levels of particulate air pollution. METHODS: We conducted a cross sectional study in four mainly urban areas of the North West of England. We recruited a stratified random sample of 64 pubs divided into four groups based on whether their local population was affluent or deprived (using a UK area based deprivation measure), and whether or not they served food. The timing of air quality monitoring stratified to ensure similar distribution of monitoring by day of the week and time of evening between groups. We used a portable air quality monitor to collect fine particle (PM(2.5)) levels over a minimum of 30 minutes in areas where smoking was allowed,, and calculated mean time-time weighted average PM(2.5 )levels. RESULTS: Mean PM(2.5 )was 285.5 μg/m(3 )(95% CI 212.7 to 358.3). Mean levels in the four groups were: affluent food-serving pubs (n = 16) 188.1 μg/m(3 )(95%CI 128.1 to 248.1); affluent non food-serving (n = 16) 186.8 μg/m(3 )(95%CI 118.9 to 254.3); deprived food-serving (n = 17) 399.4 μg/m(3 )(95%CI 177.7 to 621.2); and deprived non food-serving (n = 15) 365.7 μg/m(3 )(195.6 to 535.7). Levels were higher in pubs in deprived communities: mean 383.6 μg/m(3 )(95% CI 249.2 to 518.0) vs 187.4 μg/m(3 )(144.8 to 229.9); geometric mean 245.2 μg/m(3 )vs 151.2 μg/m(3 )(p = 0.03). There was little difference in particulate levels between food and non food-serving pubs. CONCLUSION: This study adds to the evidence that the UK government’s proposals for partial smokefree legislation in England would offer the least protection to the most heavily exposed group - bar workers and customers in non food-serving pubs in deprived areas. The results suggest these proposals would work against the UK government’s stated aim to reduce health inequalities

An evaluation of the effects of the smoking ban at an acute NHS trust

The purpose of this study was to explore the effects of a complete smoking ban at an NHS Trust focusing on the attitudes, compliance and smoking behaviour of NHS Staff on the smoke-free NHS policy. Questionnaires were distributed to staff 17 months after the Trust implemented its smoking ban and two months before the nationwide smoking ban. Although the study showed that a significant proportion of respondents were in favour of the ban (78.3%), results also suggested that many staff felt that designated areas should be provided for those who smoked. Positive staff attitudes towards the ban did not seem to affect actual behaviour as staff continued to smoke on hospital grounds. This study suggests that more work is needed to enforce the smoke-free policy and increase awareness of workplace smoking cessation interventions in order to change smoking behaviour in this workplace

Passive tobacco exposure may impair symptomatic improvement in patients with chronic angina undergoing enhanced external counterpulsation

<p>Abstract</p> <p>Background</p> <p>The adverse effects of tobacco abuse on cardiovascular outcomes are well-known. However, the impact of passive smoke exposure on angina status and therapeutic response is less well-established. We examined the impact of second-hand smoke (SHS) exposure on symptomatic improvement in patients with chronic ischemic coronary disease undergoing enhanced external counterpulsation (EECP).</p> <p>Methods</p> <p>This observational study included 1,026 non-smokers (108 exposed and 918 not-exposed to SHS) from the Second International EECP Patient Registry. We also assessed angina response in 363 current smokers. Patient demographics, symptomatic improvement and quality of life assessment were determined by self-report prior and after EECP treatment.</p> <p>Results</p> <p>Non-smoking SHS subjects had a lower prevalence of prior revascularization (85% vs 90%), and had an increased prevalence of stroke (13% vs 7%) and prior smoking (72% vs 61%; all p < 0.05) compared to non-smokers without SHS exposure. Despite comparable degrees of coronary disease, baseline angina class, medical regimens and side effects during EECP, fewer SHS non-smokers completed a full 35-hour treatment course (77% vs 85%, p = 0.020) compared to non-smokers without SHS. Compared to non-smokers without SHS, non-smoking SHS subjects had less angina relief after EECP (angina class decreased ≥ 1 class: 68% vs 79%; p = 0.0082), both higher than that achieved in current smokers (66%). By multivariable logistic regression, SHS exposure was an independent predictor of failure to symptomatic improvement after EECP among non-smokers (OR 1.81, 95% confidence intervals 1.16–2.83).</p> <p>Conclusion</p> <p>Non-smokers with SHS exposure had an attenuated improvement in anginal symptoms compared to those without SHS following EECP.</p

Parental and household smoking and the increased risk of bronchitis, bronchiolitis and other lower respiratory infections in infancy: systematic review and meta-analysis

<p>Abstract</p> <p>Background</p> <p>Passive smoke exposure increases the risk of lower respiratory infection (LRI) in infants, but the extensive literature on this association has not been systematically reviewed for nearly ten years. The aim of this paper is to provide an updated systematic review and meta-analysis of studies of the association between passive smoking and LRI, and with diagnostic subcategories including bronchiolitis, in infants aged two years and under.</p> <p>Methods</p> <p>We searched MEDLINE and EMBASE (to November 2010), reference lists from publications and abstracts from major conference proceedings to identify all relevant publications. Random effect pooled odds ratios (OR) with 95% confidence intervals (CI) were estimated.</p> <p>Results</p> <p>We identified 60 studies suitable for inclusion in the meta-analysis. Smoking by either parent or other household members significantly increased the risk of LRI; odds ratios (OR) were 1.22 (95% CI 1.10 to 1.35) for paternal smoking, 1.62 (95% CI 1.38 to 1.89) if both parents smoked, and 1.54 (95% CI 1.40 to 1.69) for any household member smoking. Pre-natal maternal smoking (OR 1.24, 95% CI 1.11 to 1.38) had a weaker effect than post-natal smoking (OR 1.58, 95% CI 1.45 to 1.73). The strongest effect was on bronchiolitis, where the risk of any household smoking was increased by an OR of 2.51 (95% CI 1.96 to 3.21).</p> <p>Conclusions</p> <p>Passive smoking in the family home is a major influence on the risk of LRI in infants, and especially on bronchiolitis. Risk is particularly strong in relation to post-natal maternal smoking. Strategies to prevent passive smoke exposure in young children are an urgent public and child health priority.</p

Quantifying the cost of passive smoking on child health: evidence from children's cotinine samples

We document the main risk factors that determine children's exposure to passive smoke, and we use econometric techniques to provide a new economic quantification of the effect of this exposure on child health. One of our main contributions is the use of a large nationally representative sample of children drawn from the Health Survey for England, for whom we match parental and household smoking and demographic characteristics. We use an objective measure of children's exposure, namely the level of cotinine in their saliva. We find that both parental and child carer smoking behaviour are major risk factors in determining children's exposure to passive smoke. For a child who is exposed to a high number of passive smoking risk factors, the income equivalence of such exposure is £16000 per year. Finally, comprehensively controlling for child passive smoking does not explain the observed gradient between household income and parental-reported child health in England